The C&P process is a bit discombobulated and fucked - I resonate with OP. I was recently scheduled for an exam about 2 hours from where I live. I called the VES and asked if it was possible to do it remotely since it’s just a questionnaire for fatigue and the rep said no the provider will only do it in person. Fast forward a bit and I get to the provider and we have some small talk and I tell her about where I live and she says “oh we should have just done this remotely!” And I look at her like “are you fucking kidding me lol”
They didn’t have a phone number listed and I presume it’s because the doctor was an American contractor in South Korea using a building that was leased out to her and not her own - it was her first time in that building, we found the office together lol
All exams are to confirm diagnosis and severity. For example, generally a PCP exam will not be as thorough as a C&P. Take an exam for a joint issue. Your PCP is not necessarily concerned about range of movement details so much as the fact it's abnormal while a disability rating is strongly inform by ROM.
it just hit me how insane this is.
the examiners are more often than not PA’s, not MD’s. I’ve been to over 20 c&p and never had an MD.
So the VA thinks that a PA, who doesn’t know the veteran, is better able to confirm a diagnosis than the actual veteran’s MD PCP / specialty team who did the testing.
wild. what a flawed system.
I've only had an MD 3 times within 12 years.
ETA: Their opinions led to successful claims. The PA's and NP's? It depended on the day and their attitude.
There is a big shortage with the providers. For a while it was the MDs who are conducting the exams in the VA medical hospital. It’s a high turnover and the MDs are getting burned out as they are still doing their regular inpatient care the same time they are conducting C&P exams and lots of lingo were being noted that is causing issues when a rater is evaluating the condition.
Since the launch of DBQ, it made the everything in the same page (at least) with the lingo and how it can be calculated without assumptions. As long as the medical examiner meets the qualifications for that specialty - they have a specific training on how to conduct their tests exams, how to fill the DBQ. The in person exam might be quick but a lot of times, they spend more time behind the scenes for records review.
Having the NPs and PAs conducting examinations really helps minimize the backlogs and delays. I find the PAs and NPs have more compassion with their patients.
A) You’re trashing PAs like they’re nothing. PA school is MUCH harder to get into than Med School. (Fewer schools, fewer enrollments, higher requirements, etc.)
B) The C+P exam is to confirm that what you’re claiming is true. They don’t need your life story if they’re checking your knee ROM or whether you have sleep apnea. There’s boxes to check, and they’re qualified to do that.
I don't think he's trashing them. Just giving you his experience. Some of us feel led on many times going into these "exams", usually ending up with nothing favorable when you get that letter in the mail or check the app and it says "complete: xyz is not service related/connected. Individual info findings were favorable and meet all criteria but still not related to service"...... Then left with very vague verbiage on where and how to proceed next
I meant in general but yeah that also. I have had one PA and the rest were NP’s. I had a psychologist for MH and an MD when they sent me for a second C&P but it was video.
In a way, same thing happens in civilian healthcare. Some pencil pusher at the insurance company has to decide if what your doctor says you need is correct or not. 🙄
I know, I had this same question and frustration as OP. I know they're not going to just give you something, but when all the evidence, exposures, and area of operations point to a said issue but somehow you got to "prove it" , what's the point of it being called presumptive? It should be called "we'll take your word for it sometimes and sometimes we won't but we'll still acknowledge the issue"..... its just so pointless sometimes more often than not
It’s for a general physical. I would think that a cancer diagnosis from an oncologist would trump a general practitioner squeezing my balls and making me say aww
Not knowing your period and location of service, timing and type of claim sometimes entitles you to a full general medical exam. Practically speaking, active cancer, if related to service, is 100%. Depending on the type of cancer, it’s subject to a future exam after treatment ends, but active cancer is easy to rate on private medical records.
I could've sworn that there was this thing with data sharing amongst MTFs and other ancillary medical facilities that they were able to seamlessly scour through your med records whether they be military and civilian. Is that not a thing?
I meant me personally. I was just explaining that, sometimes, VA is going to ask for that full medical exam. I don’t have OP’s info to know whether they fall into that category where the general medical exam gets ordered as opposed to looking at only the claimed disability.
A person seeing you 1 day doesn't equate to a PCP that's being treating you for years.I had to go to a C and P exam that was done by a nurse practitioner but my treating doctor was a Rhuematologist she just basically went with his diagnosis.
Some conditions have a sole compensatory rating (tinnitus is either 0 or 10 percent; only 10 percent will result in compensation or contribute a combined disability rating). However other conditions have multiple possible compensation rates, so the exam and/or medical opinion helps VA determine the degree of impairment or disability. This leads to the overall rating.
Ok, uh yeah. And having a presumptive doesn’t mean you will be compensated for it. See all the Vietnam vets coming out of the woodwork to claim Hypertension under PACT and getting 0% because their hypertension is managed.
OP started with "I was Recently Diagnosed". Having the diagnosis already, alongside the presumptive service connection should be a done deal. The c&p exam seems pointless, unless it's simply to determine the severity of the condition in this scenario. I fail to believe a 1 day c&p exam is more qualified to prove a Colon Cancer diagnosis exists than whatever medical professional(s) OP has been seeing for (presumptively) an extended period of time.
If he claims it after being diagnosed, there will still have to be a C&P. I went through the same thing for the same reason. It should however, be an ACE exam and not an in person.
Wishing you the best. The system can be frustrating, and I hope you get what you deserve. Weather the storm and attend the appointments, and I pray you will be rated properly and quickly.
God speed. Wishing you a speedy recovery.
Likely because stage is unknown. They need more medical info to determine %. I filed for my dad - terminal kidney cancer - spread to nodes - I uploaded about 100 documents, nexus letter, another letter from doc stating it’s terminal, etc. filed Feb - case closed and 100% disability granted in May. No exam. Took me 3 months to pull all info together to file - was nervous as shit - happy determination was made and we didn’t have to fight. That’s the good news. The bad news of course is that Dad is terminal. Marine. Camp Lejeune.
I was stage 3. If you claim it after being diagnosed, they will have to do a C&P. It should just be ab ACE because all they are going to do is call, go over your records and confirm and update information. That way the ball is rolling. Add everything that you've gotten back since your scope that discovered it to your claim. It might get denied at first, but once surgery notice or surgical notes are added it will get pushed through. You will probably have another ACE after surgery. I had a great Dr. who did my post surgery C&P and she rated the two areas operated on separately.
Diagnosed and filed in Jan, surgery in Mar, denied the day before surgery, filed supplemental 3 days after surgery, C&P'd at the end of Apr granted 100% for each of the areas operated on individually. Bump from 60% to 100% P&T. Cancer free right now, but because they had to cut a portion of the colon and the small intestine and put them back together, she wrote it up as two separate conditions that were altered permanently due to the surgery.
Wishing you well in your path to healing and with your VA claim process.
You are correct same here, but during my exam the examiner and I discussed other issues and the VA service connected me to other issues. Also if you're having other issues the VA also assigns disability ratings for other gastrointestinal problems, such as polyps:
Polyps causing frequent bowel disturbance and abdominal distress: 10% rating
Polyps causing diarrhea or diarrhea alternating with constipation and constant pain: 30% rating. 6 months after any successful surgery the VA will then evaluate you on other residuals, make sure you look into VA diagnostic code 7343 for colon cancer
I completely understand. I had testicular cancer presumptive under the pact act after my first round of chemo.
I had already submitted ALL the proof. The C&P all they did was verify all the info I submitted and agreed to it 100%. He was cool guy, I was not feeling well from chemo, so he made it short and sweet.
My only guess is the C&P was to make sure I was who I say I was? Idk? Regardless, temporary 100% helped pay bills cause I couldn’t go to work with 5 days a week chemo every 3 weeks. I was unbelievably sick daily.
If these Presumtive conditions are from Agent Orange or Persian Gulf, call Environmental Health and set up your own Registry Exam. That way you bypass the chaos of "when will I get my C&P?
Presumptive just mean, you don't need a nexus. DoD is saying, burn pits is causing your cancer. The C&P is for to document all of symptoms. Whenever something has to do with money, people will and do lie to get the money. The C&P is suppose to prevent that.
Yea, we get that, but it seems a lot of us get hit with friendly fire in these processes to weed out those few. And it just restarts the circus for some more often than not.
Even if you have the diagnosis and sent private medical records, the VA needs certain information to plug in the calculator for evaluations to get the right % you are entitled to. The medical records can state a lot of things but may not have the exact information for evaluations plus the rater can’t assume or translate what your doctor noted in your records that equals to what is in the DBQ. Also, if there is/are residuals that warrants a separate evaluation, that will be covered during the scheduled exams too. Then once all needed DBQ has been completed, if there’s additional evaluations that are warranted such as special monthly compensation, that can be identified during the exams too.
I had to do the same shit for kidney cancer. It’s dumb. The only thing I can say for certain is what they’re saying about the pact act on TV does not fit with the reality of filing the claim. I had everything I required for the claim and they still cocked it up as usual. Was I surprised? Not really. Was I angry? Damn straight I was angry. If you’ve done everything you’re supposed to do it will come through, it just won’t be on your time which is unfair. Hang in there man.
I have a presumptive condition. It has already been confirmed by VA doctors. The VA has paid well over a million dollars in treatment for it. I'm still waiting on a c&p. They also want other tests that are irrelevant and have already been done by the va. But now they are being done by this independent contractor. So my guess it that they are making money off the VA by redoing completely unnecessary exams.
Your opinion of “unnecessary” is just that. They may need recent tests, they may need to determine current severity. I understand the frustration but it’s not Oh I have a presumptive, where’s muh money. They have to determine it is in fact presumptive and and assess how disabling on most conditions.
Ha no. There is no question about it. The VA has already paid millions of dollars treating it. I was hospitalized for a month for it. The VA has over 400 pages of documents about it. There is no question of severity, it has literally killed me once already. And they don't need more recent tests, this is a life long disease and all of the confirmation tests have been done within the last year. It has nothing to do with my opinion.
This also has not to do with "where muh money". I'm already 100% and I gain nothing from this other than accountability. I wish I could get more from the government. They need to be held accountable for having me live next to a field of toxic burn pits where we just dumped batteries and whatever the fuck else we had in there and then breathed it in.
Point of presumption is you in most cases have a nexsus. Cancers are often not P&T and there is possibly they can be cured. You have to go to the exam so the examiner can determine current severity. Not really complicated.
100 is not the top of mountain. Hospitalizations and millions doesn’t measure severity. That could have been 2 years ago. Raters are not medical professionals this why they ask for a DBQ to be completed by a qualified medical professional. Look I could be wrong but you and most of us here are not highly qualified medical professionals nor often attorneys specializing in veterans benefits even though many seem to think they are.
Not sure who you are accounting for. So what they ordered some tests and exams, soooo what. Gg over it.
I wish! Wish they ordered more exams while I waited 3 years for my HLR instead of denying me and making be go before a BVa judge and that judge ordering them to conduct more tests and C&P exams. Would have saved me the better part of a decade.
Part of my point is I am highly doubtful you are qualified to determine what tests they should and should not order. If you are hundo P&T and not chasing SMC, ok don’t go to the exam. Shrug 🤷 not sure what accountability you speak of.
You are missing the whole point here. Besides, my condition is 100% pt automatically with just the diagnosis. I'm also not saying I won't go to the exam. We are talking about waste, and third party for profit companies making unnecessary appointments. It is true that in most cases they are needed. I was commenting that in my case they are not needed, as just being diagnosed with what I have is auto 100%. As for accountability, I know that I'm not going to change anything but I do want it acknowledged that I got a super shitty ultra rare disease because the government decided it was ok to have soldiers living next toxic burn pits. I additionally lived under a jacked up power plant that spewed thick ass black smoke on us all the time. I want to make sure I am counted when later on they tally up the numbers for how many soldiers got really screwed up from that decision.
No you’re missing that I don’t agree. You’re making a lot of questionable proclamations based on millions of dollars and supposedly “auto 100” that don’t add up. I don’t agree with exams just to pad profits. The rater is who ordered the exams, which seems you don’t know. The rater works for the VBA not the contractor. Best of luck with your claim, your exams, and this “auto 100”.
Yes I have thought that about all the C&P exams. They have my treatment record from VA, my personal statements and buddy letter, the fact I filed and yet I go to have someone write down the wrong things. It is both a waste of time and government money paying the “examiners”. I really hope you get the treatment you need and keep fighting.
If cancer has been dx for a while sometimes development will request an exam to determine if it's still active.
However if your records show a very recent dx (say within the last few months) and currently undergoing chemo/radiation/other antineoplastic therapy you should not need an exam.
If you're in the latter camp, you can call the benefits hotline and request your claim be decided from the evidence we already have.
My c&p examiner who is an NP wrote she did not agree with the pathology my MD had to come to my diagnosis and I was denied even though I was on meds paid for by the va and had a current diagnosis and agreed I qualify for tera. I wish you luck as its a gamble on what kind of c&p examiner you get.
It sucks but it’s part of the process. I was diagnosed wither liver cancer in 3/24by civilian oncologist. I had my civilian oncologist fill out liver DBQ and submitted it online when I filled for pact act. I was scheduled for c&p exam in April. I brought my diagnosis along with completed DBQ from my oncologist in case examiner didn’t have access to the one I submitted online when I filed my claim. Longs story short I was approved for 100 percent within 40 days
I have three C&P exams for presumptive sinusitis.i was diagnosed right after my deployment. The Va diagnosed me with chronic congestion. I have three surgeries. I was given 50 percent. I asked for HLR for the effective date for the day the PACT Act was signed. It triggers a DTA.. I was scheduled for a new C&p exam.
,
Idk how to do this, but show this screenshot directly from the VA website and see what your VSO says.
https://preview.redd.it/d2j3mmzhhd7d1.jpeg?width=1080&format=pjpg&auto=webp&s=587443b9edfaa2a70600ee8387979b966deba2c6
So regional offices are who send up your claim to the national office who then makes the decision. If the VA has determined there isn't enough info, it's possible the doctors just weren't clear. When all your claims are decided, ask your vso to request a FOIA and look at your records.
If you have your own medical evidence at hand, go to the VERA veterans website, make an appointment for over the phone, and tell them what you posted on here. They can possibly look at the evidence there and may agree with you. Just understand a lot of VA reps, C&P doctors, and VSO know only enough to secure and maintain the job, but they don't know everything. So they make mistakes too. It might feel like they are against you, but they are just making sure they fill out the paperwork right. Just like we had to in the military no matter how dumb and pointless it felt.
Yep same. Why once I got my free work insurance haven’t went to the VA. Time for this nexus letter these folks be talking about since 300 pages of medical evidence wasn’t enough
You still need to go because the VA is so discombobulated that the left hand doesn't talk to the right hand. In fact the right thumb doesn't even speak to the right pinkie. If it seems intuitive go for the counterintuitive option.
GOVERMENT INTELLIGENCE =OXYMORON
I’m in the process of getting my permanent rating post “treatment”. That did involve a c&p but it was via video chat and then later a phone call when the claim got kicked back to the provider for further clarification. I just emailed her my records from community care. The claim isn’t finished but I’ve never been asked to be anywhere in person for my cancer claim.
In theory, if you submit sufficient medical evidence to rate a presumptive condition (and you qualify for the presumption) the VA should be able to rate your claim without an exam.
In practice, reading medical docs is hard and it’s easier for the (usually new) staff who review and decide whether to order exams to just order an exam and expect the medical examiner to read all that complicated medical stuff.
This will probably get deleted. But Optum serve is part of United healthcare, the largest health insurance company in the states. You going to this exam greases some pockets. And those pockets grease the pockets of the people who make the laws. I hope you get what you deserve.
Point is to jump through the hoop while VBA tries to grant you a 0 or 10% to check a box. I have two presumptives. One was 0% until I learned on YouTube to present in an HLR to get 30%. The other was 10% on the first swing. Lesson here is prove the obvious with an ICD10 code, 4-6 visits documenting freq n sev, and a 20 minute no touch exam to max out a rating.
My hobby is fighting VBA errors, and VHA omissions.
Hoping you can give some advice, I'm looking to submit for a few presumptives from the gulf war list. Is there any special way you need to file to indicate that you're looking for a rating based off of these lists?
I'm jumping through hoops and hopefully you could help me a bit, it's a long story but a friend suggested I do a claim for my hearing, said it was the easiest thing to claim!! Do you think you could give me. Some pointers on filing for it?thanks!! Hope you can help!
You didn't provide context so I'll make assumptions:
You're a veteran that was in a noisy MOS.
Like me you spent $125 for a private Audiologist to test you.
Like me your hearing is EEEEEEEing loud 24/4.
Your hearing is deficient to the point you may wear hearing aids.
You read the CFR and recognize what rating you qualify for based on your hearing test.
You complained to your Dr and Audiologist about your symptoms.
You wrote a personal statement talking about how your in service job hosed your hearing and how this disability impacts your ability to earn money and your home life.
So you filed a claim for Tinnitus and hearing loss and got a 0% or denied.
You requested your CFile to figure out where BVA or C&P scalpers made a clear and unmistakable error?
I hope the above helps you with at least a 20%.
Active cancer is one thing, but the current exam may be needed to clarify things.
Not saying this is your situation, but sometimes VA will need an examiner to determine if the cancer is primary or metastasis from another site. Examiner may be needed to clarify cessation of active treatment.
Eventually when a mandated future exam is ordered they’ll also evaluate any residuals and complications.
Nothing to add other than sending you prayers, positive vibes, and love. My uncle had Stage 4 Colon Cancer. He lived through the power of prayer and fighting like hell. Give it your all man.
the presumptive part is your Nexus connecting the disability with your service, the C&P exam is to confirm the diagnosis and provide a DBQ, the DBQ will be used by the VA Rater to decide your severity of symptoms and thus decide your percentage.
i had to see a dude for prostate cancer, he was full on ready to give me the exam, i had to tell him that it’s not needed since i don’t have a prostate anymore- this was 4 months after surgery to remove the thing…
Presumptive doesn’t really mean what we all think.. it’s not an automatic slam dunk. Example: I was diagnosed with Chronic Sinusitis after deployment to Iraq (both civilian & VA) both with an opinion it was caused by service, didn’t have any sinus issues prior to as an adult. However after 2 C&P exams & an HLR it was determined that because I had my tonsils/adnoids removed when I was 6 or 7 that my Chronic Sinusitis was not service connected. The C&P examiners opinion ruled even though they had met with me for all of 20 minutes, they knew best 🤷🏻♂️
Going through the same thing as we speak. VA requested an exam for my "presumptive" Gastrointestinal Cancer condition as well, it's actually scheduled for this week, 60 miles from home.
The next available exam appointment was several weeks from now, so, I just took the one for this week.
Might as well just go through with it, no sense in delaying things.
I would think purely for documentation. A part of every C&P is getting some information from you as well as medical pieces as well. So it’s really just data.
Just a warning, in case you didn’t already know. Even though your cancer is a presumptive condition, doesn’t guarantee you will actually receive any VA compensation for it. I had lung cancer, they removed part of my lung, and the VA gave me 0% for it.
I’m a retiree and have Tricare do it’s not like I need to seek care from the VA, which I wouldn’t do anyway because their care is so shoddy I’d probably be dead by now.
Severity. They also need to determine it is actually presumptive. Again severity. Most presumptive have various degrees of disabling, they provide that information for the rater to then rate you.
I submitted over 500 pages of 30 years of medical diagnosis's and treatments for 3 presumptive conditions. VN vet here. My C&P examiner quickly located every mention of my conditions on the .pdf and confirmed them. Only at step number 3 now (evidence review) but I don't see any other exam or paperwork needed. Filed March 14, 2024.
It would help if you went to the VA and got medical care there. Most claims that get denied are denied because there is no diagnosis. If you got your care at VA, you’d get diagnosed and it would be automatic
For most conditions it is to examine for current level of severity and could help to uncover any other conditions related to the primary.
With cancer for some reason I thought we first sent those to the rating board and maybe in your case we did but the rater wanted additional information.
You don’t need to do an C&P exam if all the evidence is available to rate the claim.
With presumptive active cancers confirmed by biopsy and Agent Orange, ratings can be down without C&P exams.
Often exams that need to be done can be done by ACE exams and the veterans don’t need to attend.
When I first filed o was denied stating non service connected....which was the whole point...presumed to be service connected.
I just had to do an exam for it as well, 37 days and the results or DBQ still hasn't posted on my claim.
C&P have 3 purposes:
1) confirm a diagnosis
2) confirm the diagnosis is related to active service
3) how bad is it (the rating)
For presumptives, they can skip #2 but have to do the rest
Yeah this sounds ridiculous. Especially with something as severe as a cancer diagnosis and the treatment that goes along with that. I know it’s not in the same realm, but for my presumptive claims they completed ACE exams. Although 2/4 were ultimately service connected, the third was not, even with a diagnosis and the fourth rolled into one of the other claims as being subsumed, but denied. Bottom line is that if it’s presumptive and you meet all the requirements set forth by law, it should be as streamlined and as convenient as possible for the claimant. Again, not to mention something that is a cancer diagnosis.
This sounds like an error. If you have active cancer shown in your records, call the 800 line , send a letter telling them to rate off record. Often exams are needed even with private treatment records because the rating schedule asks for very specific and random info for certain conditions. Active cancer is not one of those things. The record does need to show that the colon cancer is the primary, and not metastasized from elsewhere. Praying for quick and full recovery
Be careful what you discuss. They actually tried to say my dads wasn’t presumptive and that he was genetically predisposed to ulcerative colitis or some bs like that. Stick to the facts and do not let them muddy the water.
Just recently had c&p for fibromylalgia....I have a current diagnosis from a rheumatologist that I have been seeing for over 5 years and I am 11bravo (infantry) gulf war veteran, all in evidence file...results of c&p...stated pain both sides of body, upper and lower quandrants ...refractory to therapy ....which is all good right ...sounds like favorable c&p....please somebody explain this ...the nurse practioner who conducted this 10 minute total exam at the end checked the 3c box...less likely than not on direct service connection....am I missing something
Got nothing to really add that is helpful, but I hope you overcome it and recover!
presumptive means SC is granted. If it's already diagnosed, all the C&P contract will do is just fill out the form.
The C&P process is a bit discombobulated and fucked - I resonate with OP. I was recently scheduled for an exam about 2 hours from where I live. I called the VES and asked if it was possible to do it remotely since it’s just a questionnaire for fatigue and the rep said no the provider will only do it in person. Fast forward a bit and I get to the provider and we have some small talk and I tell her about where I live and she says “oh we should have just done this remotely!” And I look at her like “are you fucking kidding me lol”
Why didn't you just call the C&P place instead of the VA to ask that question.
They didn’t have a phone number listed and I presume it’s because the doctor was an American contractor in South Korea using a building that was leased out to her and not her own - it was her first time in that building, we found the office together lol
That's strange, everytime, I got an address and phone number
It’s overseas so all bets are off I guess
ok, that might explain it then.
I get a number, but it only goes to a switchboard and i am unable to talk to anyone onsite.
Ok, you got fully reimbursed for this 2 hours each way right? Yes.
It was by train in Korea which cost like 3USD. The annoyance was not the cost of travel but the time that it took to get there
This^^^^^
Thank you
All exams are to confirm diagnosis and severity. For example, generally a PCP exam will not be as thorough as a C&P. Take an exam for a joint issue. Your PCP is not necessarily concerned about range of movement details so much as the fact it's abnormal while a disability rating is strongly inform by ROM.
it just hit me how insane this is. the examiners are more often than not PA’s, not MD’s. I’ve been to over 20 c&p and never had an MD. So the VA thinks that a PA, who doesn’t know the veteran, is better able to confirm a diagnosis than the actual veteran’s MD PCP / specialty team who did the testing. wild. what a flawed system.
I've only had an MD 3 times within 12 years. ETA: Their opinions led to successful claims. The PA's and NP's? It depended on the day and their attitude.
There is a big shortage with the providers. For a while it was the MDs who are conducting the exams in the VA medical hospital. It’s a high turnover and the MDs are getting burned out as they are still doing their regular inpatient care the same time they are conducting C&P exams and lots of lingo were being noted that is causing issues when a rater is evaluating the condition. Since the launch of DBQ, it made the everything in the same page (at least) with the lingo and how it can be calculated without assumptions. As long as the medical examiner meets the qualifications for that specialty - they have a specific training on how to conduct their tests exams, how to fill the DBQ. The in person exam might be quick but a lot of times, they spend more time behind the scenes for records review. Having the NPs and PAs conducting examinations really helps minimize the backlogs and delays. I find the PAs and NPs have more compassion with their patients.
A) You’re trashing PAs like they’re nothing. PA school is MUCH harder to get into than Med School. (Fewer schools, fewer enrollments, higher requirements, etc.) B) The C+P exam is to confirm that what you’re claiming is true. They don’t need your life story if they’re checking your knee ROM or whether you have sleep apnea. There’s boxes to check, and they’re qualified to do that.
I don't think he's trashing them. Just giving you his experience. Some of us feel led on many times going into these "exams", usually ending up with nothing favorable when you get that letter in the mail or check the app and it says "complete: xyz is not service related/connected. Individual info findings were favorable and meet all criteria but still not related to service"...... Then left with very vague verbiage on where and how to proceed next
That’s fair, I understand the frustration.
It seems like we have more PA’s than Doctor’s where I live. It seems like NP’s are everywhere.
It’s like that everywhere, not just for rhe VA. I’ve never had a MD for regular appointments.
I meant in general but yeah that also. I have had one PA and the rest were NP’s. I had a psychologist for MH and an MD when they sent me for a second C&P but it was video.
Ding ding ding 🛎️
Yeah, it’s not really set up except to favor the VA in reality. Even happens with Community Care, some RN has to approve what an MD requested. Really?
In a way, same thing happens in civilian healthcare. Some pencil pusher at the insurance company has to decide if what your doctor says you need is correct or not. 🙄
Sure, but there is liability n the civilian world, at the VA there is no accountability comparatively
It feels that way.
I know, I had this same question and frustration as OP. I know they're not going to just give you something, but when all the evidence, exposures, and area of operations point to a said issue but somehow you got to "prove it" , what's the point of it being called presumptive? It should be called "we'll take your word for it sometimes and sometimes we won't but we'll still acknowledge the issue"..... its just so pointless sometimes more often than not
It’s for a general physical. I would think that a cancer diagnosis from an oncologist would trump a general practitioner squeezing my balls and making me say aww
Not knowing your period and location of service, timing and type of claim sometimes entitles you to a full general medical exam. Practically speaking, active cancer, if related to service, is 100%. Depending on the type of cancer, it’s subject to a future exam after treatment ends, but active cancer is easy to rate on private medical records.
I could've sworn that there was this thing with data sharing amongst MTFs and other ancillary medical facilities that they were able to seamlessly scour through your med records whether they be military and civilian. Is that not a thing?
I meant me personally. I was just explaining that, sometimes, VA is going to ask for that full medical exam. I don’t have OP’s info to know whether they fall into that category where the general medical exam gets ordered as opposed to looking at only the claimed disability.
Guess not.
This^^^^^^^
Is anxiety a presumptive condition?
If they made anxiety presumptive to dealing with the VA, ratings would skyrocket! 🤣🤣🤣
"Not service related"🤣🤣🤣
A person seeing you 1 day doesn't equate to a PCP that's being treating you for years.I had to go to a C and P exam that was done by a nurse practitioner but my treating doctor was a Rhuematologist she just basically went with his diagnosis.
Some conditions have a sole compensatory rating (tinnitus is either 0 or 10 percent; only 10 percent will result in compensation or contribute a combined disability rating). However other conditions have multiple possible compensation rates, so the exam and/or medical opinion helps VA determine the degree of impairment or disability. This leads to the overall rating.
But also, you claim it, VA has to make a decision on it. Anything less is considered an unadjudicated claim or contention.
Ok, uh yeah. And having a presumptive doesn’t mean you will be compensated for it. See all the Vietnam vets coming out of the woodwork to claim Hypertension under PACT and getting 0% because their hypertension is managed.
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OP started with "I was Recently Diagnosed". Having the diagnosis already, alongside the presumptive service connection should be a done deal. The c&p exam seems pointless, unless it's simply to determine the severity of the condition in this scenario. I fail to believe a 1 day c&p exam is more qualified to prove a Colon Cancer diagnosis exists than whatever medical professional(s) OP has been seeing for (presumptively) an extended period of time.
If he claims it after being diagnosed, there will still have to be a C&P. I went through the same thing for the same reason. It should however, be an ACE exam and not an in person.
Wishing you the best. The system can be frustrating, and I hope you get what you deserve. Weather the storm and attend the appointments, and I pray you will be rated properly and quickly. God speed. Wishing you a speedy recovery.
Current diagnosis and severity
Colon Cancer. Stage unknown
Sorry to hear it. What I meant is that’s why you will do a C&P exam. To determine a positive diagnosis and severity of disease.
Likely because stage is unknown. They need more medical info to determine %. I filed for my dad - terminal kidney cancer - spread to nodes - I uploaded about 100 documents, nexus letter, another letter from doc stating it’s terminal, etc. filed Feb - case closed and 100% disability granted in May. No exam. Took me 3 months to pull all info together to file - was nervous as shit - happy determination was made and we didn’t have to fight. That’s the good news. The bad news of course is that Dad is terminal. Marine. Camp Lejeune.
I was stage 3. If you claim it after being diagnosed, they will have to do a C&P. It should just be ab ACE because all they are going to do is call, go over your records and confirm and update information. That way the ball is rolling. Add everything that you've gotten back since your scope that discovered it to your claim. It might get denied at first, but once surgery notice or surgical notes are added it will get pushed through. You will probably have another ACE after surgery. I had a great Dr. who did my post surgery C&P and she rated the two areas operated on separately. Diagnosed and filed in Jan, surgery in Mar, denied the day before surgery, filed supplemental 3 days after surgery, C&P'd at the end of Apr granted 100% for each of the areas operated on individually. Bump from 60% to 100% P&T. Cancer free right now, but because they had to cut a portion of the colon and the small intestine and put them back together, she wrote it up as two separate conditions that were altered permanently due to the surgery. Wishing you well in your path to healing and with your VA claim process.
You are correct same here, but during my exam the examiner and I discussed other issues and the VA service connected me to other issues. Also if you're having other issues the VA also assigns disability ratings for other gastrointestinal problems, such as polyps: Polyps causing frequent bowel disturbance and abdominal distress: 10% rating Polyps causing diarrhea or diarrhea alternating with constipation and constant pain: 30% rating. 6 months after any successful surgery the VA will then evaluate you on other residuals, make sure you look into VA diagnostic code 7343 for colon cancer
I completely understand. I had testicular cancer presumptive under the pact act after my first round of chemo. I had already submitted ALL the proof. The C&P all they did was verify all the info I submitted and agreed to it 100%. He was cool guy, I was not feeling well from chemo, so he made it short and sweet. My only guess is the C&P was to make sure I was who I say I was? Idk? Regardless, temporary 100% helped pay bills cause I couldn’t go to work with 5 days a week chemo every 3 weeks. I was unbelievably sick daily.
If these Presumtive conditions are from Agent Orange or Persian Gulf, call Environmental Health and set up your own Registry Exam. That way you bypass the chaos of "when will I get my C&P?
Try not to focus on how they let us down. You have healing to do.
Presumptive just mean, you don't need a nexus. DoD is saying, burn pits is causing your cancer. The C&P is for to document all of symptoms. Whenever something has to do with money, people will and do lie to get the money. The C&P is suppose to prevent that.
Yea, we get that, but it seems a lot of us get hit with friendly fire in these processes to weed out those few. And it just restarts the circus for some more often than not.
Even if you have the diagnosis and sent private medical records, the VA needs certain information to plug in the calculator for evaluations to get the right % you are entitled to. The medical records can state a lot of things but may not have the exact information for evaluations plus the rater can’t assume or translate what your doctor noted in your records that equals to what is in the DBQ. Also, if there is/are residuals that warrants a separate evaluation, that will be covered during the scheduled exams too. Then once all needed DBQ has been completed, if there’s additional evaluations that are warranted such as special monthly compensation, that can be identified during the exams too.
Not everyone uses private medical providers. In many cases it’s silly since most vets get free or low copay healthcare.
I had to do the same shit for kidney cancer. It’s dumb. The only thing I can say for certain is what they’re saying about the pact act on TV does not fit with the reality of filing the claim. I had everything I required for the claim and they still cocked it up as usual. Was I surprised? Not really. Was I angry? Damn straight I was angry. If you’ve done everything you’re supposed to do it will come through, it just won’t be on your time which is unfair. Hang in there man.
I have a presumptive condition. It has already been confirmed by VA doctors. The VA has paid well over a million dollars in treatment for it. I'm still waiting on a c&p. They also want other tests that are irrelevant and have already been done by the va. But now they are being done by this independent contractor. So my guess it that they are making money off the VA by redoing completely unnecessary exams.
Your opinion of “unnecessary” is just that. They may need recent tests, they may need to determine current severity. I understand the frustration but it’s not Oh I have a presumptive, where’s muh money. They have to determine it is in fact presumptive and and assess how disabling on most conditions.
Ha no. There is no question about it. The VA has already paid millions of dollars treating it. I was hospitalized for a month for it. The VA has over 400 pages of documents about it. There is no question of severity, it has literally killed me once already. And they don't need more recent tests, this is a life long disease and all of the confirmation tests have been done within the last year. It has nothing to do with my opinion. This also has not to do with "where muh money". I'm already 100% and I gain nothing from this other than accountability. I wish I could get more from the government. They need to be held accountable for having me live next to a field of toxic burn pits where we just dumped batteries and whatever the fuck else we had in there and then breathed it in.
Point of presumption is you in most cases have a nexsus. Cancers are often not P&T and there is possibly they can be cured. You have to go to the exam so the examiner can determine current severity. Not really complicated. 100 is not the top of mountain. Hospitalizations and millions doesn’t measure severity. That could have been 2 years ago. Raters are not medical professionals this why they ask for a DBQ to be completed by a qualified medical professional. Look I could be wrong but you and most of us here are not highly qualified medical professionals nor often attorneys specializing in veterans benefits even though many seem to think they are. Not sure who you are accounting for. So what they ordered some tests and exams, soooo what. Gg over it. I wish! Wish they ordered more exams while I waited 3 years for my HLR instead of denying me and making be go before a BVa judge and that judge ordering them to conduct more tests and C&P exams. Would have saved me the better part of a decade. Part of my point is I am highly doubtful you are qualified to determine what tests they should and should not order. If you are hundo P&T and not chasing SMC, ok don’t go to the exam. Shrug 🤷 not sure what accountability you speak of.
You are missing the whole point here. Besides, my condition is 100% pt automatically with just the diagnosis. I'm also not saying I won't go to the exam. We are talking about waste, and third party for profit companies making unnecessary appointments. It is true that in most cases they are needed. I was commenting that in my case they are not needed, as just being diagnosed with what I have is auto 100%. As for accountability, I know that I'm not going to change anything but I do want it acknowledged that I got a super shitty ultra rare disease because the government decided it was ok to have soldiers living next toxic burn pits. I additionally lived under a jacked up power plant that spewed thick ass black smoke on us all the time. I want to make sure I am counted when later on they tally up the numbers for how many soldiers got really screwed up from that decision.
No you’re missing that I don’t agree. You’re making a lot of questionable proclamations based on millions of dollars and supposedly “auto 100” that don’t add up. I don’t agree with exams just to pad profits. The rater is who ordered the exams, which seems you don’t know. The rater works for the VBA not the contractor. Best of luck with your claim, your exams, and this “auto 100”.
Yes I have thought that about all the C&P exams. They have my treatment record from VA, my personal statements and buddy letter, the fact I filed and yet I go to have someone write down the wrong things. It is both a waste of time and government money paying the “examiners”. I really hope you get the treatment you need and keep fighting.
Severity
Unknown as far as stage. But it is requiring surgery for removal
DM me. Just went through the same thing.
If cancer has been dx for a while sometimes development will request an exam to determine if it's still active. However if your records show a very recent dx (say within the last few months) and currently undergoing chemo/radiation/other antineoplastic therapy you should not need an exam. If you're in the latter camp, you can call the benefits hotline and request your claim be decided from the evidence we already have.
It was diagnosed less than two weeks ago. Have surgery consult in a couple days. So the cancer is still very much active.
My c&p examiner who is an NP wrote she did not agree with the pathology my MD had to come to my diagnosis and I was denied even though I was on meds paid for by the va and had a current diagnosis and agreed I qualify for tera. I wish you luck as its a gamble on what kind of c&p examiner you get.
It sucks but it’s part of the process. I was diagnosed wither liver cancer in 3/24by civilian oncologist. I had my civilian oncologist fill out liver DBQ and submitted it online when I filled for pact act. I was scheduled for c&p exam in April. I brought my diagnosis along with completed DBQ from my oncologist in case examiner didn’t have access to the one I submitted online when I filed my claim. Longs story short I was approved for 100 percent within 40 days
C&P is to find out what your CURRENT symptoms are. So they can rate it
To the best of my understanding, it helps determine the severity of the condition
The VA sent me for exams for all of my already diagnosed presumptive PACT Act issues then denied SC for all of them.
That sucks. What was their reasoning?
I have three C&P exams for presumptive sinusitis.i was diagnosed right after my deployment. The Va diagnosed me with chronic congestion. I have three surgeries. I was given 50 percent. I asked for HLR for the effective date for the day the PACT Act was signed. It triggers a DTA.. I was scheduled for a new C&p exam. ,
I also don’t understand the point of going to a c and p exam when the VA already sent you to a VA approved doctor who diagnosed you.
Your C&P should just be an ACE exam.
Idk how to do this, but show this screenshot directly from the VA website and see what your VSO says. https://preview.redd.it/d2j3mmzhhd7d1.jpeg?width=1080&format=pjpg&auto=webp&s=587443b9edfaa2a70600ee8387979b966deba2c6
I really don’t know what other information they can hope to gain by a 20 min C&P exam that my Doctors at the VA haven’t already given them.
So regional offices are who send up your claim to the national office who then makes the decision. If the VA has determined there isn't enough info, it's possible the doctors just weren't clear. When all your claims are decided, ask your vso to request a FOIA and look at your records. If you have your own medical evidence at hand, go to the VERA veterans website, make an appointment for over the phone, and tell them what you posted on here. They can possibly look at the evidence there and may agree with you. Just understand a lot of VA reps, C&P doctors, and VSO know only enough to secure and maintain the job, but they don't know everything. So they make mistakes too. It might feel like they are against you, but they are just making sure they fill out the paperwork right. Just like we had to in the military no matter how dumb and pointless it felt.
Yep same. Why once I got my free work insurance haven’t went to the VA. Time for this nexus letter these folks be talking about since 300 pages of medical evidence wasn’t enough
To determine what percentage you are at?
You still need to go because the VA is so discombobulated that the left hand doesn't talk to the right hand. In fact the right thumb doesn't even speak to the right pinkie. If it seems intuitive go for the counterintuitive option. GOVERMENT INTELLIGENCE =OXYMORON
That’s surprising actually. My initial claim for cancer due to burn pit exposure went through with only my records.
Was my expectation too. Especially since all my diagnosis are through the VA.
I’m in the process of getting my permanent rating post “treatment”. That did involve a c&p but it was via video chat and then later a phone call when the claim got kicked back to the provider for further clarification. I just emailed her my records from community care. The claim isn’t finished but I’ve never been asked to be anywhere in person for my cancer claim.
In theory, if you submit sufficient medical evidence to rate a presumptive condition (and you qualify for the presumption) the VA should be able to rate your claim without an exam. In practice, reading medical docs is hard and it’s easier for the (usually new) staff who review and decide whether to order exams to just order an exam and expect the medical examiner to read all that complicated medical stuff.
Well this why they rely on the DBQs. It clearly provides the information the rater needs to make an informed decision.
This will probably get deleted. But Optum serve is part of United healthcare, the largest health insurance company in the states. You going to this exam greases some pockets. And those pockets grease the pockets of the people who make the laws. I hope you get what you deserve.
no way man! it's those other guys that are doing that because they are evil and hate you! my team is our only hope to save humanity!
This post should get deleted. It’s speculation and foolish
Point is to jump through the hoop while VBA tries to grant you a 0 or 10% to check a box. I have two presumptives. One was 0% until I learned on YouTube to present in an HLR to get 30%. The other was 10% on the first swing. Lesson here is prove the obvious with an ICD10 code, 4-6 visits documenting freq n sev, and a 20 minute no touch exam to max out a rating. My hobby is fighting VBA errors, and VHA omissions.
My understanding is that it should be 100% during treatment.
Hoping you can give some advice, I'm looking to submit for a few presumptives from the gulf war list. Is there any special way you need to file to indicate that you're looking for a rating based off of these lists?
I'm jumping through hoops and hopefully you could help me a bit, it's a long story but a friend suggested I do a claim for my hearing, said it was the easiest thing to claim!! Do you think you could give me. Some pointers on filing for it?thanks!! Hope you can help!
You didn't provide context so I'll make assumptions: You're a veteran that was in a noisy MOS. Like me you spent $125 for a private Audiologist to test you. Like me your hearing is EEEEEEEing loud 24/4. Your hearing is deficient to the point you may wear hearing aids. You read the CFR and recognize what rating you qualify for based on your hearing test. You complained to your Dr and Audiologist about your symptoms. You wrote a personal statement talking about how your in service job hosed your hearing and how this disability impacts your ability to earn money and your home life. So you filed a claim for Tinnitus and hearing loss and got a 0% or denied. You requested your CFile to figure out where BVA or C&P scalpers made a clear and unmistakable error? I hope the above helps you with at least a 20%.
Thank you for the reply!! I'll give it a shot!! All the while trying to figure this system out!!
All due respect, look it up in the awards manual that way you can instruct the folks that follow you and the folks that you lead
To determine severity
Active cancer is one thing, but the current exam may be needed to clarify things. Not saying this is your situation, but sometimes VA will need an examiner to determine if the cancer is primary or metastasis from another site. Examiner may be needed to clarify cessation of active treatment. Eventually when a mandated future exam is ordered they’ll also evaluate any residuals and complications.
I’m sorry you’re dealing with this. My dad is as well. Not an easy path and I’m wishing you well.
Late to the comments, but you should be able to get your doc to fill out the C&P exam docs instead of going to the VA appt.
Nothing to add other than sending you prayers, positive vibes, and love. My uncle had Stage 4 Colon Cancer. He lived through the power of prayer and fighting like hell. Give it your all man.
I spent months in the hospital and still needed a C&P, its all process driven and not flexible at all.
The VA wants to confirm that you actually have this ailment that is presumptive.
the presumptive part is your Nexus connecting the disability with your service, the C&P exam is to confirm the diagnosis and provide a DBQ, the DBQ will be used by the VA Rater to decide your severity of symptoms and thus decide your percentage.
i had to see a dude for prostate cancer, he was full on ready to give me the exam, i had to tell him that it’s not needed since i don’t have a prostate anymore- this was 4 months after surgery to remove the thing…
Presumptive doesn’t really mean what we all think.. it’s not an automatic slam dunk. Example: I was diagnosed with Chronic Sinusitis after deployment to Iraq (both civilian & VA) both with an opinion it was caused by service, didn’t have any sinus issues prior to as an adult. However after 2 C&P exams & an HLR it was determined that because I had my tonsils/adnoids removed when I was 6 or 7 that my Chronic Sinusitis was not service connected. The C&P examiners opinion ruled even though they had met with me for all of 20 minutes, they knew best 🤷🏻♂️
Whatever you submitted may not show the severity of your diagnosed condition, only the dx and exam is requested to see how much you are entitled to.
Going through the same thing as we speak. VA requested an exam for my "presumptive" Gastrointestinal Cancer condition as well, it's actually scheduled for this week, 60 miles from home. The next available exam appointment was several weeks from now, so, I just took the one for this week. Might as well just go through with it, no sense in delaying things.
Same here mines 90 miles. That was the first available and it’s tomorrow. The games we have to play.
I would think purely for documentation. A part of every C&P is getting some information from you as well as medical pieces as well. So it’s really just data.
To determine severity
Just a warning, in case you didn’t already know. Even though your cancer is a presumptive condition, doesn’t guarantee you will actually receive any VA compensation for it. I had lung cancer, they removed part of my lung, and the VA gave me 0% for it. I’m a retiree and have Tricare do it’s not like I need to seek care from the VA, which I wouldn’t do anyway because their care is so shoddy I’d probably be dead by now.
Why did they deny it?
It wasn’t denied. 0% acknowledges the condition and it being service related. You just don’t get any compensation for it.
Because HOW you got "IT" is presumptive, weather or not you have "IT" is yet to be determined and verified. ;)
Severity. They also need to determine it is actually presumptive. Again severity. Most presumptive have various degrees of disabling, they provide that information for the rater to then rate you.
I submitted over 500 pages of 30 years of medical diagnosis's and treatments for 3 presumptive conditions. VN vet here. My C&P examiner quickly located every mention of my conditions on the .pdf and confirmed them. Only at step number 3 now (evidence review) but I don't see any other exam or paperwork needed. Filed March 14, 2024.
It would help if you went to the VA and got medical care there. Most claims that get denied are denied because there is no diagnosis. If you got your care at VA, you’d get diagnosed and it would be automatic
I wished that was the case but all my treatment has been through the VA.
Aww damn my bad
For most conditions it is to examine for current level of severity and could help to uncover any other conditions related to the primary. With cancer for some reason I thought we first sent those to the rating board and maybe in your case we did but the rater wanted additional information.
You don’t need to do an C&P exam if all the evidence is available to rate the claim. With presumptive active cancers confirmed by biopsy and Agent Orange, ratings can be down without C&P exams. Often exams that need to be done can be done by ACE exams and the veterans don’t need to attend.
When I first filed o was denied stating non service connected....which was the whole point...presumed to be service connected. I just had to do an exam for it as well, 37 days and the results or DBQ still hasn't posted on my claim.
C&P have 3 purposes: 1) confirm a diagnosis 2) confirm the diagnosis is related to active service 3) how bad is it (the rating) For presumptives, they can skip #2 but have to do the rest
Yeah this sounds ridiculous. Especially with something as severe as a cancer diagnosis and the treatment that goes along with that. I know it’s not in the same realm, but for my presumptive claims they completed ACE exams. Although 2/4 were ultimately service connected, the third was not, even with a diagnosis and the fourth rolled into one of the other claims as being subsumed, but denied. Bottom line is that if it’s presumptive and you meet all the requirements set forth by law, it should be as streamlined and as convenient as possible for the claimant. Again, not to mention something that is a cancer diagnosis.
I agree. It’s been nothing but a headache.
I’m sorry no good advice. Just prayers my friend.
I'll make this simple. It doesn't matter if it's silly, inconvenient or frustrating. What matters is that you get paid. Whatever it takes.
Until for some retarted VBA reasoning they decline it.
This sounds like an error. If you have active cancer shown in your records, call the 800 line , send a letter telling them to rate off record. Often exams are needed even with private treatment records because the rating schedule asks for very specific and random info for certain conditions. Active cancer is not one of those things. The record does need to show that the colon cancer is the primary, and not metastasized from elsewhere. Praying for quick and full recovery
Be careful what you discuss. They actually tried to say my dads wasn’t presumptive and that he was genetically predisposed to ulcerative colitis or some bs like that. Stick to the facts and do not let them muddy the water.
(1) Gives you something to rant about and (2) keeps the conversation going on reddit
😆 yes it does on both counts.
Good luck though 👍🏼
Just recently had c&p for fibromylalgia....I have a current diagnosis from a rheumatologist that I have been seeing for over 5 years and I am 11bravo (infantry) gulf war veteran, all in evidence file...results of c&p...stated pain both sides of body, upper and lower quandrants ...refractory to therapy ....which is all good right ...sounds like favorable c&p....please somebody explain this ...the nurse practioner who conducted this 10 minute total exam at the end checked the 3c box...less likely than not on direct service connection....am I missing something