to send to the C&P department. I would like some feedback from everyone if I am
handling this situation properly, or suggestions on handling it differently. Thanks
Dear Compensation & Pension Exam Department:
On February 25, 2008, I was scheduled for a 6:15pm C&P Exam at the 3NW Clinic in
the Loma Linda VA Hospital. I received a call from Sam on approximately February 19,
2008, informing me that I had been scheduled for a C&P Exam of my spine at
5:30pm. I arrived at the Clinic at approximately 5:05pm. I was told that there would be
three doctors performing the exams andeverything would go rather quickly. The first
doctor did not arrive until 6:35pm. The second doctor arrived at approximately7:00pm,
and the third around 7:20pm. I was not called until approximately 7:50pm for my exam.
There was no one checking in patients at the front desk like Sam had stated there
would be. All arriving patients were very confused by the lack of organization!
Dr. Lim was the doctor that performed my exam. He very quickly reviewed his paperwork to see what type of exam needed tobe performed. I was then asked when the back condition began, my current pain level, years and branch of service, any flare-ups, any numbness, and a few other questions. I had already obtained the Spine C&P Exam protocols off of the internet and had typed up a report of my Subjective Complaints. I also provided a doctor's note from the VA Primary Physician and some recent MRI reports. Dr. Lim very quickly thumbed through my evidence and then I was asked to stand. I was instructed to try to touch my toes, twist side to side, and lean side to side. He then had me flex my leg while he applied resistance. I was then told to report to X-ray and then go home. I was not in the exam room for more than five minutes. The length of the exam was not so troubling as the quality of the exam. The Spine Examination Worksheet instructs the examiner to utilize a goniometer to measure the degrees of range of motion. Dr. Lim failed to use a goniometer, but instead relied on the subjective eyeball method. I saw that he wrote down that my forward flexion was 0 to 80. I contend that my range of motion is less than 80 degrees. Dr. Lim also failed to have me perform repetitive forward flexions to determine if fatigue would cause reduced range of motion.
After the objective part of the exam was completed, I emphasized that Dr. Lim needed to address what my range of motion would be during a flare-up. He stated that he would not do that. Government Accounting Office Report # GAO-06-46 dated October 2005 concerning: Veterans' Disability Benefits: VA Could Enhance Its Progress in Complying with Court Decision on Disability Criteria. The GAO report concluded that the VA is not currently assessing flare-up conditions when performing A C&P Exams. Further, the Deputy Director of Veteran Affairs, Gordon Mansfield, agreed with the GAO's report and agreed to make internal changes to comply with the Deluca v. Brown decision regarding flare-ups. Additionally, according to U.S. Court of Appeals for Veterans Claims in DeLuca v. Brown, 8 Vet. App. 202 (1995), the court held that when federal regulations define joint and spine impairment severity in terms of limits on range of motion, VA claims adjudicators must consider whether ange of motion is further limited by factors such as pain and fatigue during "flare-ups" or following repetitive use of the impaired joint or spine.
My intentions of this letter of not meant to be disrespectful, but raise concern for the lack of professionalism that I experienced during my last visit. I drove fifty miles each direction to the exam. I was at the Clinic for over three hours by the time my exam was completed. And I walk away with an ineffective exam. I noticed that Dr. Lim's nametag stated that he was a resident. Are residents permitted to perform C&P Exams? I look forward to your response in how the Loma Linda VA is going to address my concerns.