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From: Craig N. Bash, M.D., Neuro-Radiologist
Orthopedic Joint disease
The VA is using Nurse Practitioners (NPs) and Physician Assistants (PA) to do C&P exams for joint problems... these people are not as well trained as physician.
In the orthopedic medical world, the physical exam only documents a small portion of total joint problems. Surgical planning is done from the radiologic images and due to the importance of these images they are all displayed during surgery in the operating room.
Due to the lack of knowledge of the "physician extender" examiners they often miss important aspects to the rating. The old adage applies; You see what you look for and you look for what you know. Less training means less knowledge means less known items to look for.
Radiology imaging is important to the rating as these studies often document bony arthritis, documenting soft tissue injuries such as rotator cuff injuries and hip cartilage damage.
More recently, the VA only images joints when absolutely necessary and they only allow certain radiologists to read these “VA claims studies” in dark room isolation. This is a situation ripe for bias as these studies are never re-reviewed.
As a board certified radiologist I often re-read any and all imaging studies that I feel need to be re-read.
In my experience, the VA imaging read outs are often watered down interpretations of early joint disease, which of course then leads to under-ratings.
* Veterans should seek MD experts who are able to do Independent DBQs for arthritis.
* Veterans should seek MD experts who can redo exams by Nurses and PAs.
* Veterans should seek MD experts who can order and re-read all imaging studies.
Each MD medical opinion should evaluate and agree or disagree with any other DBQ/IME in the record and discuss any secondary complications and/or potential CUE issues.
Please remember that All claims should be placed on the correct forms as VA has adopted a draconian rule in 2015 of “No form No benefits”
/s/ Craig N. Bash M.D., Associate Professor
<email@example.com> cell 240-506-1556
From: Craig N. Bash, M.D., Neuro-Radiologist
I have listed below some of my experiences with the VA, which involves veteran medical opinions:
1. Over 5000 patient independent veteran medical opinions-IMOs/IMEs.
2. Over 500 Board of Veterans Appeals (BVA) cases processed with veteran medical opinions.
3. Over 1000 name mentions in Court of Veterans Appeal (CVA) with veteran medical opinions.
4. Over 50 Personal expert witness testimonies/veteran medical opinions for veterans at regional office
rater/ DRO and Board of Appeals levels.
5. Over 50 site visits to 30 of the largest VA tertiary care hospitals with veteran medical opinions on
quality of care for hospitalized spinal injured veteran in and outpatients.
6. Over 20 VA nursing home visit with associated veteran medical opinions on quality of care.
7. Over 10 VA clinic visits with associated veteran medical opinions on quality of care.
8. Over 3 years as a medical director for Paralyzed Veterans of America. (PVA).
9. Over 7 veteran service organizations have used my veteran medical opinion reports.
10. Over 40 lectures to large groups of veteran service officers.
11. Over 50 VA advocacy lawyers have used my Veteran Medical opinions.
12. Over 3 years as a resident in radiology at the Washington DC VA hospital.
13. Over 6 years as a member of Paralyzed Veterans of America (PVA) Spinal cord research committee.
14. Over 10 years as research director of Shapiro spinal cord research foundation for vets/non-veterans.
15. Over 3 years studying spinal cord CSF flow in veterans and non-veteran patients at the NIH.
16. Over 15 years studying Multiple Sclerosis in vets/non-veterans with research MRI scans at the NIH.
17. Over 25 years teaching Uniformed Services medical students medical issues common in Veterans.
18. Over 32 “Bash Bulletins” concerning veteran medical opinions on my web site.
19. Over 30 years as an over 100% service connected for my own spinal cord medical issues.
20. Over 5 months as an inpatient in Boston West Roxbury VA hospital.
21. One year as Neuro-radiology Fellow at University of Maryland/Shock Trauma/Baltimore VAMC.
22. Helped formulate VA formulary, VA clinical practice guidelines for spinal cord and Multiple
23. Advised VA committee on benefit/care guidelines for VA offspring with Spina Bifida.
24. SES level committee chairman for CDC injury prevention (veteran and non-veteran) sub-committee.
25. Two TV public service announcements (7 on your side) and over 10 SVR radio shows.
**** All the above integrate to support my 90% success rate in VA claims due to my experience and
Craig N. Bash M.D., M.B.A. -- Associate professor-- Cell 240-506- 1556—firstname.lastname@example.org
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