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Q6: I was evaluated by both a private doctor and a VA orthopedist, both saying that I needed knee replacement surgery and that both knees were acutely unstable. I applied for an increase and a PA in Comp & Pen evaluated my knees and within 5 minutes had completed his evaluation and rated my knees at 10%. I find it odd that both my doctors who are prestigious in their own right get outweighed by a PHYSICIAN ASSISTANT. How can this be? 

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A1:  That is because the VA would take the lesser since it is in their best interest and cost them less and you would have to fight even harder to get anywhere with it. See a VSO and write to your congressman for a specialist should always outweigh a PA so see an outside orthopedist to verify your condition and that combined with the VA orthopedist should then outweigh the PA. The VA put me in for an P & C exam two weeks after I had labs for stopped my Metformin and my kidney functions improved. They sent me to a chiropractor for the exam instead of a Diabetic specialist. I am waiting for them to reduce my disability and they can explain to a court why the chiropractor is better suited for making that decision and just kept asking me if I can work and at 68 and retired and lucky I did at 54 for all my conditions within two years got a lot worse. The VA will take any means they can to reduce and save money but imagine they give out bigger bonus checks to the higher ups to offset it. Worked for the Post Office as a clerk for 30 plus years and saw how the system works and the VA is no different and lies are what keeps them going. Best of Luck.  (JRM)  2/13/18


A2:   I had a "pretend doctor" [nurse practitioner], tell me to stop using my fast acting insulin at meal times as a treatment for diabetes then lied about it in patient notes. The VA denied my request to change primary provider. A letter to my Congressman has them reconsidering their decision. It is time for Veterans to start fighting back against "pretend doctors", who do not have what it takes to get a license of their own, Personally, with the experience I have had with NP, PA over the last few years leads me to the decision I would rather have a Combat Medic treat me than one of those "pretend doctors". The VA is using way too many of them in lieu of real Doctors. We are entitled to the best medical care that can be provided. This practice is the same as telling a plane full of passengers heading overseas that we have a commercial Pilot, not an ATP, flying the plane who has never flown this type yet. But don't worry about it, there is an ATP with thousands if hours in type in Denver the pilot can call if there is a problem. That is, of course, if that Senior Pilot has his cell phone on.  (JB)  2/13/18











A3:  The private doctor is not a specialist, so his opinion may not outweigh the PA for this reason.  As for the orthopedic doctor, the regulation stipulates that he must state that he has reviewed all the available evidence, including STR's. If he has not and this is usually the case, then the PA will outweigh since he has access to ALL the veteran's records.  (AP)  2/13/18


A4:  Unfortunately the VA does put a lot of faith in a PA's decision, normally because they are working under a MD who must sign off on it. However, a PA's decision is easily appealed, all you will need it either a DBQ or a letter of opinion from a medical professional that has higher credentials than the PA. (preferably one that specializes in the specific condition being rated!).  (LC)  2/14/18


A5:   If you have replacement you probably could get a higher rating.  (LM)  2/18/18


A6:  I would file a NOD/appeal to BVA and challenge the NP/PA's opinion & qualifications. Have your doctor attached his/her CV or qualifications, i.e. training, education, experience, expertise, ect..when rendering an expert opinion regarding your condition. The VA generally uses NPs & PAs to do C&P due to shortage of real doctors and if veterans don't challenge their opinions, then the VA wins. I believed most of these NP's & PA's are operating outside their areas of expertise and are way over their heads in terms of training, experience, educations to offer an expert opinion on complex medical issues. Don't be afraid to challenge the VA and fight for your rights. I would hair an attorney that has experience in this area of VA proceedings to assist you. Stay focus and keep your eye on the price (increase or service connection) for your condition. Don't get upset with the VA because they're DO what they have to do to pay less money. Don't take it personal, educate yourself on how to fight the VA on an even playing field. Get a copy of your C&P and a copy of your C-File so you can fine out what the VA have on you. WHATEVER YOU DECIDE TO DO "DO NOT ASK THE VA FOR RECONSIDERATION OF YOUR CLAIM BECAUSE THERE IS NO SUCH THING IN VA PROCEEDINGS. IT'S JUST A FEEL GOOD WAY PHRASE THAT PEOPLE THROW AROUND THINKING THE VA IS SERIOUS ABOUT LOOKING AT YOUR CLAIM. BY LAW, THE VA HAS NOOOO OBLICATION TO RECONSIDER YOUR CLAIM ONCE THEY DENIED IT, THEY'LL SIT ON IT UNTIL YOUR APPEAL TIME RUNS OUT THAN THEY'LL SEND YOU A LETTER INFORMING YOU THAT YOUR APPEAL TIME HAS EXPIRED, TRY AGAIN WITH NEXT TIME AND MAKE SURE YOU HAVE NEW AND MATERIAL EVIDNCE IF YOU WANT TO REOPEN YOUR CLAIM, 2-YEARS LATER OR IF YOU'RE STILL KICKING. You can email me if you need more info. Good luck.  (SS)  4/11/18


A7:  Because you're dealing with a "US Government Agency" and they can do anything they want. Furthermore, those people in St. Louis who "Rate-You" haven't been in the Military or a war, and have "NO" medical background. Figure that one out. That information came from a "Veteran SO" who has been there decades.  (CS)  11/29/20