{ "version": "1.0.0", "segments": [ { "speaker": "Leah B", "startTime": "6.48", "endTime": "44.085", "body": "If you're a veteran who recently received a negative C and P exam, this video is definitely for you. Because one of the biggest mistakes that I see veterans make after a bad C and P exam is immediately assuming that their case is over or immediately reacting emotionally without first understanding what went on, what actually happened, medically within the exam itself. Now before I jump in, I wanna make sure that we make something really clear. Not every negative C and P exam is wrong. Sometimes the examiner's conclusions are medically sound or medically accurate based on the available evidence." }, { "speaker": "Leah B", "startTime": "44.085003", "endTime": "70.53", "body": "But there are also situations in which the examiner may have overlooked something, the medical evidence was not, reviewed properly or understood, risk factors may not have been fully addressed or the rationale was just incomplete. And what veterans do next can have a major impact on their claim, the strength of their claim moving forward, or kinda what happens. Does the claim die? Does it continue? Are you just defeated?" }, { "speaker": "Leah B", "startTime": "71.225", "endTime": "119.82", "body": "I hope not. So from the medical side of things, the biggest mistake I see is veterans not actually reviewing the contents of the exam correctly or reading the rating decision letter. So we've done some videos on this in the past, and we've talked about, you know, information that you can gather from the rating decision letter that tells you specifically, what were the favorable findings, what were the, you know, some of the the negative rationale if there was a negative opinion, and it kinda outlines some of those things. And then furthermore, you can get into that C and P exam or that compensation and pension exam and read specifically what did the examiner state, what evidence was reviewed, what was the medical opinion, what were the findings, you know, did did they see you for migraines? And they said that, you only had one a month, but really you have you told them you have 10 a month." }, { "speaker": "Leah B", "startTime": "119.82", "endTime": "148.03", "body": "Was there a mismatch in that data? Right? So many veterans receive a denial or hear that they had a negative opinion and immediately go online looking for someone to fight to fight that exam for them. But before doing anything else, maybe it's extremely important in some cases to understand the medical reasoning behind the opinion. Always checking with your VSO or an accredited legal professional can be super important because they can help guide you if if you aren't sure where to look." }, { "speaker": "Leah B", "startTime": "148.03", "endTime": "167.83", "body": "But that rating decision letter that's uploaded on va.gov is going to show you, a lot of these details and a lot of these puzzle pieces. So was the examiner saying that there was no diagnosis? Were they saying that there was no evidence of chronicity? Were they saying there was no medical connection? Things like that." }, { "speaker": "Leah B", "startTime": "167.83", "endTime": "194.26999", "body": "Did they identify other nonservice related risk factors? You know, do you have COPD and you've smoked, you know, a pack of cigarettes a day for twenty years, and they're saying that's the reason versus maybe a combat deployment, you know, exposure? Did they state that records were silent for complaints or treatments? Did they say, you know, maybe you claimed your back and you said that you were seen in service for your back, but they're saying there it was silent. Right?" }, { "speaker": "Leah B", "startTime": "194.26999", "endTime": "209.845", "body": "Is there a mismatch in that information? There are all very different these are all very different medical issues that can come into play. Right? So understanding the actual deficiency can be critical because different problems require different types of evidence or different tools. Right?" }, { "speaker": "Leah B", "startTime": "209.92499", "endTime": "235.965", "body": "So let me give you another hypothetical example. Okay? So let's say a veteran files a claim for migraines, alright, secondary to their service connected tinnitus or tinnitus, right, and receives a negative CMP opinion. A lot of veterans might just immediately think, oh, I just need another Nexus letter or I need to get a Nexus letter. But when you actually review the exam and the records carefully, the issue may not be that simple." }, { "speaker": "Leah B", "startTime": "236.525", "endTime": "269.23502", "body": "Maybe the examiner stated something like there was no documented chronic migraine condition or migraine diagnosis in the records. In that situation, the more important issue might be ongoing treatment or having a diagnosis in general. So having a nexus letter might not be super beneficial because it's not the nexus that the is the issue. It's it's that there's not an exam a diagnosis. So, you know, getting another causation opinion might not be the helpful, you know, tool there." }, { "speaker": "Leah B", "startTime": "269.315", "endTime": "318.635", "body": "Or maybe the examiner acknowledges that the diagnosis is there, but they failed to discuss aggravation at all, if your case is an aggravation case. That might be a situation where a targeted medical opinion addressing aggravation could potentially be helpful. Or maybe on the other hand, the file already contains a favorable medical opinion, and medical evidence, but VA properly, did not they failed to properly weigh it or they failed to apply the correct legal standards, and and maybe it becomes more of a legal issue that an accredited attorney or representative should be involved in. And that's why veterans should should avoid assuming every negative exam requires the exact same response. As medical professionals, our role is to evaluate and explain, the medical portion." }, { "speaker": "Leah B", "startTime": "318.715", "endTime": "348.57498", "body": "We are not determining legal strategy, arguing case law, or telling veterans how to appeal their claims. That is the role of an accredited legal professional and, or representative like a BSO, who who is an accredited person. Right? So I think understanding that that distinction can be incredibly important. The medical side focuses on things like diagnosis, causation, aggravation, symptoms, functional impact, and then the medical rationale, of course." }, { "speaker": "Leah B", "startTime": "348.895", "endTime": "388.04", "body": "The legal side of things focus focuses on things like, statutes, regulations, appeal strategy, procedural errors, evidentiary standards, and how VA, applied the law to your specific set of evidence. Another major mistake that I see is veterans focusing only on the conclusion while ignoring the rationale. So a lot of people can become fixated on whether the examiner checked a positive or negative box, But the rationale is usually far more important. So a strong medical opinion should explain why the condition is or is not related. Okay?" }, { "speaker": "Leah B", "startTime": "388.44", "endTime": "416.19", "body": "Even in a negative opinion, it should have a strong, analysis. How the records support the conclusion, whether medical literature supports the rationale, whether other risk factors were considered, whether the timeline is, medically consistent. A conclusion without reasoning is generally not very persuasive. K? So whether it is favorable or unfavorable, you know, a a well thought out opinion is with rationale is important." }, { "speaker": "Leah B", "startTime": "416.19", "endTime": "428.445", "body": "So another mistake veterans make is submitting emotional arguments instead of targeted medical evidence. Right? So I completely understand the frustration. I'm a veteran too. I understand that frustration that veterans feel after a negative exam." }, { "speaker": "Leah B", "startTime": "428.445", "endTime": "457.525", "body": "But from an evidentiary standpoint, strong claims are usually built on organized documentation and medically relevant evidence, not anger or other emotions. A strong medical response is not that this examiner hates veterans. This exam was unfair. This examiner only spent five minutes with me. Those things might be true, and there might be some quality control issues going on, but a strong, medical response identifies things that are specific, like medical deficiencies." }, { "speaker": "Leah B", "startTime": "457.925", "endTime": "474.66", "body": "Like, the examiner overlooked documented complaints. The examiner, misstated the timeline. The rationale failed to address relevant literature. The the opinion did not discuss aggravation. The examiner relied on inaccurate factual assumptions or just flatly put wrong information." }, { "speaker": "Leah B", "startTime": "474.66", "endTime": "498.39", "body": "Right, guys? So that is the type of medical analysis that tends to carry more weight. Another thing I think veterans should understand is that negative CMP exams does not automatically mean additional medical evidence is necessary in every case. Right? Sometimes the issue may actually be a procedural or legal, concern rather than medical." }, { "speaker": "Leah B", "startTime": "498.39", "endTime": "533.83", "body": "Right? So for example, there may already be favorable evidence in the file that was not properly weighed. The these issues might, there might be legal issues involving presumptive service connection, duty to assist errors, effective dates, or how VA interpreted that evidence. Those are situations, where veterans should strongly consider accredited attorneys, accredited claims agents, VSOs to help them, because those issues move beyond purely medical analysis. Now, of course, you can represent yourself if if that's something you feel confident doing." }, { "speaker": "Leah B", "startTime": "534.245", "endTime": "550.64996", "body": "Another major mistake I see is veterans rushing to obtain opinions without first identifying the actual evidentiary gap. Not every case needs that Nexus letter. Not every case needs a DBQ. Not every case needs, some kind of additional addendum. Right?" }, { "speaker": "Leah B", "startTime": "550.64996", "endTime": "574.70496", "body": "The evidence should be targeted towards the actual matter at hand or the actual issue, within your specific claim. Sometimes the most important step is obtaining medical treatment like we discussed earlier. Some it's gathering records. Sometimes it's clarifying inconsistencies. So, sometimes it's that legal counsel, and sometimes a strong medical opinion truly is appropriate." }, { "speaker": "Leah B", "startTime": "575.79", "endTime": "601.05505", "body": "So another misconception that I see, all the time is veterans assuming providers can just connect anything. Okay? That's that's just not possible. So, if that was possible, then, you know, there would just be no VA process, really. If you could just get any doctor to say something and then it got connected, that's you know, medical opinions are can be very helpful and can be important, but they're not gonna be the deciding factor." }, { "speaker": "Leah B", "startTime": "601.29504", "endTime": "616.97", "body": "K? If that was the case, anyone could simply just say something and it would just get approved, and that would not be ethical medicine. Right? A credible medical opinion should be objective and evidence based. Sometimes the records support a claim, and sometimes they don't." }, { "speaker": "Leah B", "startTime": "617.295", "endTime": "644.87", "body": "Unfortunately, sometimes I'm not able to support opinions when I'm asked to write them if the if the facts don't align. Sometimes the evidence supports aggravation rather than direct causation, and sometimes records simply just are not medically sufficient to support the relationship at all. And that's just the way it is. So credibility matters, tremendously, both medically and legally. And finally, probably the most important thing veterans should remember after, a bad C and P exam is this." }, { "speaker": "Leah B", "startTime": "645.335", "endTime": "669.93", "body": "So don't panic. Alright? A negative exam is just one piece of the puzzle. It is not automatically the end of the road for you. The key is understanding, what the actual issue is medically and legally and then determining what type of evidence or professional support or guidance, may be appropriate moving forward for you and for your individual circumstances." }, { "speaker": "Leah B", "startTime": "670.25", "endTime": "687.465", "body": "Because strong claims are usually built through organized records, credible evidence, thoughtful medical analysis, and appropriate legal guidance when necessary. So not hype. Okay? Not, fear, not social media panic. I know that goes around a lot." }, { "speaker": "Leah B", "startTime": "687.465", "endTime": "697.91", "body": "There's a lot of people out here. You know? I I do YouTube stuff. I get it. But there's a lot of people out here that, you know, have a lot of clickbait going on, and they try to strike fear in you guys." }, { "speaker": "Leah B", "startTime": "697.91", "endTime": "707.52496", "body": "And I see it a lot because people will come through and say, well, I saw this on this YouTube channel. I saw this on this YouTube channel. You know? And a lot of these guys are just full of, you know what. Right?" }, { "speaker": "Leah B", "startTime": "707.52496", "endTime": "723.26", "body": "So, I I mean, that's all I have to say about it. So, you know, evidence, you know, evident just evidence and strategy apply appropriately to the facts of the case. That's the most important thing. Right? So I hope this was helpful." }, { "speaker": "Leah B", "startTime": "723.66003", "endTime": "736.625", "body": "Please like and subscribe. Remember, I am a medical professional. I'm a US Army PA, physician assistant, retired physician assistant from the military. I'm still a physician PA now. I often help veterans with medical opinions." }, { "speaker": "Leah B", "startTime": "736.625", "endTime": "749.265", "body": "But if you're needing that legal guidance or that legal scope, please check out va.gov. They have a great search tool to find accredited representation all across The US. K? So thanks for watching, and I'll see you guys next time." } ] }