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Examiner Insight

Today we will be taking a look into the goings on of a VA contract examiner. Our examiner Arthur has been in the biz for decades and knows their way around broken Vets. But what Arthur does not know… is that we bugged their office!

Day Before the Exam

Exam requests and records review

Finally, those maintenance guys are gone… But now the lights in my office are very dim for some reason… Always fixing one thing and breaking something else I swear.

I sit down into my well worn green leather office chair and access the portal to see what exam requests await me. The monitor’s harsh brightness cutting through the darkness of the room. Illuminating the diplomas from medical school; which have seen better times, the paper and ink faded as they have given way to the ravages of time.

Examiners get exam requests which detail what issue(s) and DBQs the VA wants done. Included with this request is a copy of the Veteran’s Claim file (c-file), this file contains everything the VA has ever gotten from the Veteran, DoD, etc. The size of the c-file determines how many individual folders I get. Generally speaking each folder contains 3,000 pages (with the file merging various documents into a single running document). I’ve gotten files as small as 25 pages to as large as files with over 40,000 pages! While there is a search function built into the program it is far from perfect.

Also... seriously, some micro-phish records are very out of focus or if they are in-focus look like they’ve been run through the the drier with a bunch of permanent markers. So sometimes it is just impossible to make tops or bottoms out of what a record says; which isn’t even to mention the ‘hand writing’!

In a perfect world, the VA will have ‘bookmarked’ things in the file to help speed my review along… but it is NOT uncommon for the VA to not bookmark things or to bookmark things that are not relevant to the claimed conditions. So yeah… I don’t trust the g-men one bit!

Day of the Exam

Gathering evidence. The purpose of an examination is to help fill in gaps in the medical record and to evaluate a condition's current Severity.

It was yet another rainy day when I first saw trouble from my slightly drawn blinds; Long slender legs sprouting from a pair of ruby red high heels, gray overcoat, and short blonde hair with a lit cigarette in her hand as she ran to cover to get out of the rain.

The VAs exam request was for direct medical opinion and examination for asthma. My record review showed that she was diagnosed and treated for acute bronchitis once during her military service over 20 years ago and her VA medical records showed a diagnosis of asthma from 2 years ago.

Prepared having finished my coffee, I let my staff know I was ready to see her. Or well… perhaps I was not prepared after all.

When I turned to face her, my gaze was left wanting; seemingly the woman I had seen only moments before had vanished! As she rolled herself into my office, my face must have double-crossed me as she asked me if something was wrong.

“Oh nothing Ms.” I replied.

I then started asking her questions about the history of her breathing issues and other questions on the respiratory DBQ.

She tells me about how she did not have any issues before the military and that she started having troubles after entering service. Her brown eyes grew dim as she spoke about always struggling to catch her breath when she ran. I then asked her how long she has been smoking; with a sudden smile and perk she told me she had NEVER smoked before!

Clearly… poker was not my game as she asked me what was wrong. Now I was almost sure… I was not wearing clown make up; as it was a Friday and my circus activities only happen every third Sunday. Taking a look at the wall behind me, further confirmed that I did not have a degree from clown college. But then again, in their current state perhaps she thought I had.

“Oh nothing Ms.” I again replied. But it was becoming clear to me that this dame thought I was a clown in her circus!

I then explained to her how we would conduct her respiratory function test. Again and again she put out as much effort as one trying to whisper next to a candle to not put it out.

I eventually let her know we were done and that she could leave.

But she asked if I was going to evaluate her claim for increase of her right leg nerve condition and loss of use of her legs. I told her that I was not going to do so. In a fury she stood up and got into my face, the smell of smoke enveloping me as she yelled with the force of wild tasmanian devil.

Eventually I was able to explain to her that the VA had not ordered examinations for those claims and that today’s exam was only for asthma.

In a huff she stormed out of my office; on those capable long slender legs.

I called after her to come back and get her wheelchair, but it was too late as she already gone. As quickly as she came into my life she was gone, leaving me with more questions than answers; my wheelchair Cinderella.

After the Exam

Finalizing DBQs and medical opinions

The day done I sit alone in my still dimmed office. No matter how hard I tried, I couldn’t get her out of my mind… or her wheelchair out of my office… she said her boyfriend would be coming by to pick it up tomorrow.

I couldn’t help but think she was being less than truthful about things.

The credibility of a Veteran is very important, more so when the medical evidence of record is lacking. If I ask you about your medical history do NOT lie! Veterans will sometimes lie about mundane things that genuinely will not hurt their claim. But some Veterans think that saying they ever smoked/smoke will put them in a rough spot and make me give them a negative medical opinion. While sure, if you smoked like a chimney for 30 years after service… it probably will be more likely to have caused your asthma. But if I can clearly see a contradiction in your records find you are a shyster well… then it is not going to end well.

That aside, if you meet the criteria for Presumptive service-connection for asthma or another condition and I can diagnose you; I am not going to be a private dick and try and look for ways to get you denied service-connection - even if the VA asks for a medical opinion!

When it comes to medical opinions:

Over the years I have collected intel on medical research and articles showing causation of certain conditions due to military service as well as other conditions. This is important because when I give a medical opinion I must give appropriate medical rationale; I cannot concoct a tale to fit my professional belief that something is at least as likely as not related to your service or a service-connected condition. Opinions MUST have a leg based on medical proofs AND the medical evidence of record!

When a Veteran provides their own research I will look it over, but know that I still must consider your particular medical history and severity of your conditions, etc!

Looking over her records again I could not help but conclude that this dame’s asthma was less likely than not related to her military service; with her in-service respiratory issues being acute and that her current asthma diagnosis was more likely linked to post-service activities.

The case closed, I finalize everything in the portal.

Requests for Clarification/Insufficient Examination

Sometimes the VA will find issues with a DBQ that an examiner completes. Now sometimes the VA messes up and sends these to examiners by mistake… If I had a nickle for every time I had the VA say I missed something and I had to tell them to READ the remarks section of the DBQ I sent them… I would have 4 nickles; which isn’t a lot but hey it is enough for me to buy lunch!

Requests for Clarification

Sometimes the VA will find things do not add up after looking over a DBQ.

Common needs for clarification are:

  1. Examiner overlooked evidence or did not mention it in their opinion or examination.

    • Most commonly when an examiner states ‘STRs are silent’ for the claimed issue and the STRs do show complaints/treatment.

  2. Information contradicts itself within the same DBQ or set of DBQs done by the examiner.

    • DBQ states there is a diagnosis but then later in the DBQ it states there is no diagnosis.

  3. Exam for increase was done and a new or changed diagnosis was provided but a statement about progression was not provided.

Insufficient Examination

These are considered a quality issue and are held against an examiner.

Common reasons that examinations are found insufficient:

  1. Not all DBQs were completed that were requested by the VA.

  2. A DBQ expressly mentions to do additional DBQs to fully consider a condition/symptom and the examiner fails to do it.

  3. Not all required questions were answered on the DBQ.

  4. Medical opinion provided is not supported by the evidence of record or the rationale is not valid.

  5. DBQ not signed.

Frequently Asked Questions

    • LISTEN TO ME when I am asking you questions! Just answer what I asked and try NOT to volunteer information because YOU think it might help you! I have had many a Veteran talk their way out of a favorable medical opinion.

    • Look at the damn Rating schedule! If you are already at the max do NOT file for an increase for that condition! At best it does nothing for you and at worst can result in the VA reducing you!

    • Don’t lie! Seriously and certainly do not lie about stuff I can clearly tell is a lie. You don’t ride a motorcycle? Guess it was a fashion choice to wear leathers and hold a biker helmet under your arm?

    • Do NOT give me medical records the day of your exam! While sure, you can point things out in them to check I did not miss something. However, I CANNOT base my opinions on evidence that is NOT in the hands of the VA. Because if I do, they will kick my opinion back as it will not be supported by the evidence of record (the VA has).

    • Be on time. I get it, life happens but I generally cannot start things late because it causes a domino effect and can mess up the day’s schedule.

      • If you are running late/going to miss your exam you should make 2 calls. One to whomever is running the exam and the other to the VBA. This way, you can hopefully get re-scheduled.

    • Do NOT give the VA the same evidence twice.

      • Remember when I mentioned the TENS of THOUSANDS of pages of evidence? Yup a lot of it was duplicates… But I still need to review EVERYTHING to be sure I do not miss something.

    • Please just complete the survey you get in the mail. Examiners CANNOT accept gifts.

References