00:00:00 Speaker 1
Many veterans walk into C&P exams without a clear understanding of what the appointment is designed to evaluate. Others have pain or limitations that did not become serious until years after service, or they are frustrated when the X-ray does not explain what they are feeling. Today, we are bringing together the VA claims perspective and the medical perspective to make these issues easier to understand.
00:00:36 Speaker 1
Welcome. I'm Kenneth Davis. Today, I'm joined by Dr. Whitney, a private medical provider who serves the veteran community and brings experience in emergency medicine and clinical care. We're going to discuss what veterans should expect at a C&P exam, why symptoms may become more noticeable years later, and why an X-ray may come before an MRI. This conversation provides general education information. It is not individualized medical advice or VA claims advice. Dr. Anthony Whitney
00:01:14 Speaker 2
Thank you for joining us. Thank you for having me today, Mr. Davis. I really appreciate that. As you mentioned, Dr. Anthony Whitney here. I'm a doctorate-prepared nurse practitioner. Been in the medical field in different aspects for about 18 years now. So I've been around medicine a while. Started as an EMT, so I've seen it from the front lines before anybody else sees patients, and all the way up to the emergency room, and now as a clinician inside a practice.
00:01:40 Speaker 1
But I do want to roll over into some CMP examination processes. I know obviously you've been providing examinations ongoingly, and I know also not only have you been providing examinations ongoingly, I'm sure there's a lot of similarities to a regular exam versus a CMP examination. I know obviously they may not be the same, but even though they're not routine, could you break down some of the correlating aspects versus a regular examination that typically goes in for just a routine appointment?
00:02:20 Speaker 2
Most definitely. I feel like a CMP exam. This is a great topic. CMP examples are good because, C B the C N P exam is literally one of the biggest exams in a veteran's life, and I don't really know veterans understand that, especially when you go into the military. For example, Mr. Dave, when you went and did your military service, were you thinking about your C N P exam?
00:02:41 Speaker 1
No way, shape, or form.
00:02:43 Speaker 2
So let's think about it quickly from a civilian's point of view. When you or I get a job, or when I apply for a job, I'm asking about the four hundred one k. I'm asking about the retirement plan. I'm asking about the benefits. For a veteran, the C and P exam is part of the retirement plan. It's a part of something that is going to help provide them funds because they may not be able to do the job they did ten years ago before they got into the service because of some ailments that they may have now from serving for the country. I don't I won't say all veterans, but I'm.
00:03:20 Speaker 2
Sure, there's a large portion of veterans that never even think about the CMP exam, and when they get to their CMP exam, they don't realize how important that exam is. That's a big thing. I just want all the viewers to understand the CMP exam is bigger than a job interview. You need to go into the CAP exam prepared for that exam, and the preparation is different, like you said, from your regular. I go see my doctor visit to go into the CMP exam. One of the big things that makes this different is when you go see your primary care doctor. They're trying to work with you to figure out how can we best take care of this problem you're having. I want to see what specialist I need to get you into, what medication I need to start you on, what have you tried in the past.
00:04:15 Speaker 2
So they're as we call it trying to pull information out of the veteran, right? Because they want to provide them with the best care and get them feeling better. But when you go into your CACP exam, you may see a doctor, you may see a nurse practitioner, you may see a physician assistant, and I won't say that they're against you, but they're not trying to pull information out of you. They're looking at a form, a DBQ, the Disability Questionnaire, with a set list of questions. And they're asking you those set list of questions, and they need you as the veteran to give them the information to be able to check those boxes. So they can't coach you. For example, when I say by coaching, if a patient comes in to me and says, 'I've had back pain, I've had lower back pain for three years,' and that's all they say, as their provider, I'm going to say, 'When did the pain start? Can you tell me what makes the pain better or worse? What have you tried for the pain?'
00:05:12 Speaker 2
When you're at home, what do you do for the pain? On your bad days, how do you take care of the pain? I'm going to ask follow-up questions as your provider to get the most information I can to be able to treat you the best. When you go into your CAP exam, that's not how it goes. They're not listening to everything you say. They're listening to cues or words you say so they can check boxes. For example, you go into your CMP exam. Let's say we keep talking about the lower back. And they say, Mister Davis, what are you? You here for your lower back CMP exam today? And you say, Yes, I am. And they're gonna say, How long have you had back pain? And your response is, I've had back pain for a while. And that's it. So that doesn't give the CMP examiner anything to check a box. So from that one statement, they say, Veteran has had back pain for a while. And that's it. Do you really want to work on?
00:06:11 Speaker 2
Paying the pitcher for the examiner because the raider is not going to be the one doing your exam. An examiner can't coach you. They can't ask leading questions like, 'You said you've been having back pain for a while, but do you remember specifically when it started and what you were doing?' Because now that is coaching. See what I'm saying? Makes sense. So that is probably the most important thing.
00:06:38 Speaker 1
That's phenomenal. I think you gave a great explanation there of really describing what the onset and veterans. When we talk about the onset, we want to make sure that we understand. As he mentioned, back pain could have happened during your second deployment or during your first deployment when you were doing a vertical replenishment or when you were doing anything. Hunking rucksacks or being able to move different boxes or different things because we are asked to do so much, even though it isn't documented as your job or specialty.
00:07:17 Speaker 2
One hundred percent. And like you said, that statement, we're being asked to do things even outside of your job, right? That's a thing that happens normally for veterans, right? They just think that's a normal part of the day, right? Carry this, carry that, march here, march there, jump off of this, jump off that. That's just a part of the job. So I really think veterans sometimes downplay some of the things that actually happen during those activities. For example, like you said, we're doing a ruck march, and you're marching. Let's say you're marching, and something happens. You're carrying all your gear. You twist your ankle, right? And your ankle's hurting pretty bad. In the military, I wasn't in the military, but the assumption is they're gonna you're gonna get up and you're gonna keep marching. In the civilians.
00:08:03 Speaker 2
Point of view, right? If I'm working my normal job at a warehouse, and I'm walking up stairs and I twist my ankle and it's that bad, I'm asking to go home for the day because I need to go to the doctor. There are other things that protect civilians. You have OSHA, you have FMLA, and things like that, right? So that ankle sprain that I just went to the doctor for, a veteran is still marching another two or three miles, jumping up and down. So that ankle injury is now being worsened by what you are expected to do.
00:08:35 Speaker 1
Veterans! I hope you guys were listening to that. I hope you guys were really understanding that and unpacking that because that's a huge point. You are expected to continue out the day, continue your job, protect and serve. But with that, you also have to protect and serve yourself as well. And if you don't, there could be ramifications that can lead to chronic issues that can last for the rest of your life, one hundred percent. What I mean by that is that there are many times in many cases where you roll over as a veteran and sometimes civilians as well, because there are strenuous jobs that can lead to chronic ailments.
00:09:22 Speaker 1
Going to be something that you deal with throughout the day, and really, it's a part of your life, and you forget to identify. One hundred percent. What would you say to the veterans who are just getting up and that ankle pain has worsened? What would you say to them to better identify how you know if it's worse or if it's not, or how to even deal with it?
00:09:45 Speaker 2
So when you say chronic, something chronic, just because I have a chronic illness, ailment, doesn't mean that it may hurt ten out of ten every day. That's what I want the veterans to understand. Just because you have some good days, don't downplay your bad days because those are the ones that really affect your life. So we're talking about the ankle. We talk musculoskeletal in general. Let's say you go to your C and P exam and this is a good day for you. My lower back isn't hurting as bad as it normally is.
00:10:19 Speaker 2
Four out of ten pain every single day. Let's say that's my normal. I live in four out of ten pain. So this day on my CMP exam is a four out of ten day. So I go into my exam, and when you go into a CAP exam for something muscular skeletal, they're going to check things that they can document. So like range of motion is the biggest one. Range of motion is key. Flexion, extension. So if we talk about the back, can you bend over and touch your toes? Can you flex your back? Can you lean from side to side? Let's say this is a good day. You're gonna go in there, and the examiner is gonna ask you to bend over and touch your toes. You may be able to get closer now than you are on a normal day. Because let's say you go and work a normal job. By the third day of your workday, let's say you're doing a warehouse job like that. The third day of your workday, my back pain is 10 out of 10. It's 10 out of 10 now. I can barely touch my knees, let alone my toes. So you need to explain that to your examiner.
00:11:18 Speaker 2
I have a chronic back pain. On my normal days, I'm always a four out of ten, but after a couple days of work, my back pain is ten out of ten. It's so bad that I'm waking up in the middle of the night because I need to take more ibuprofen. It's so bad that I had to call out of work the next day because my back pain is so bad. This helps examiners document chronicity. How chronic is this problem, and how does it affect your job and everyday life? And I don't think that's what a lot of veterans understand. Just because you're having a good day, don't forget about the bad days where you couldn't go to work, you missed the kids' baseball game or football game. You couldn't go out to dinner with your partner because your back was hurting. Those are the things that I think the veteran needs to make sure that they explain to the examiner.
00:12:08 Speaker 1
Wow. That's so much insight that is phenomenal and veterans, just from a previous Raider's perspective. Doctor Whitney is talking about the functional impact, the functional limitations. Those functional limitations affect employment, they affect times with family, and they actually affect your ability during your daily living activities. With that being said, you have to really understand that these chronic issues, just because it is not ten out of ten on a regular basis, what we are saying, it does not mean that it is going away. It is abnormal, and it is not a part of your life as a regular human or regular civilian as you are now.
00:13:05 Speaker 1
A veteran first, but you're also human and a civilian now, so we must understand that. These are the parameters or benefits offered because you served in the military. Now you need to be able to take advantage of that. It's awesome. Being able to provide this information here, you guys are understanding why it was so detrimental. Also, why was it so important that you are speaking truth to power about your injuries and limitations?
00:13:40 Speaker 2
That's great. And just to pick up on a little point you said there about you have to remember now. Now you're in civilian life, right? Now you're civilian. You're not in the military. You may be a veteran first, but when you go to that exam, you can't have the same mindset as I'm in the military. Meaning, when an examiner asks you, Mr. Davis, can you bend over and touch your toes? And you push through the pain, and you touch your toes, and you are almost in tears to do that. What the examiner writes down is, veteran has full range of motion. Wow! And you just had to dig as deep as you could to touch your toes, and that's going to affect your rating, right? Because in the military, you've been taught push through that pain, touch those toes, march a little farther, run a little faster.
00:14:29 Speaker 2
So if you take that same mindset into your CAP exam, when you get your rating back, you just shot yourself in the foot, because when you done, this is far as I can go before I start having pain documented. Veteran can only bend 30 degrees.
00:14:47 Speaker 1
There we go. Wow. So I guess when we answer, I want to be very clear now.
00:14:56 Speaker 1
If a veteran is going into any type of examination, and we're going to just stick with musculoskeletal, just for sake of an example, so if at any point in time when any type of pain or any type of discomfort is happening, is that something that the veteran should report?
00:15:16 Speaker 2
That's you should report that to your examiner, because then the examiner can document that. Examiner has to be able to document, and that's why. They measure range of motion, so now I can put numbers to your ailment. That's the expectation of physical therapy. I want to see how what we've been doing the last two weeks has gotten any better. Can you go a little farther? Can you bend a little more? That's not what your C&P exam is for. Your C&P exam isn't to go in there and show I can do all of this. It may hurt, but I can push through it. That's not the point of this exam.
00:15:51 Speaker 2
This point is examined to see what your functional limitations are and what mobility reductions you have that you didn't have before you went in.
00:15:59 Speaker 1
Military. That's a very, very powerful, very, very powerful. I ask, if there is an examiner stating, I think you can go more. What does a veteran put in that position?
00:16:17 Speaker 2
Examiner shouldn't be asking you to go more. But there is a time where examiners may, based on their opinion, think that you're faking. That's a big thing or malingering, that you're not going as far, and you just tell them this is as far as I can go. What makes this an easier thing for a veteran is coming to that C M P exam prepared. I brought in all of my paperwork from my doctor's appointments from my physical therapy.
00:16:49 Speaker 2
Statements from my loved ones who see me every day. The power of having a statement from a, let's say for a wife, who can say, 'I see my husband every day in pain. He can't bend over and tie his shoes. I have to help him do it for him.' Things that you may not even think of as a veteran, because now this is just a normal part of your life. You don't even think about whether you can tie your own shoes. You just know your wife is there to help you. So when a C and P examiner asks you, I think you go a little farther. I cannot. If I go farther, I'm in excruciating pain, and I might not be able to get back up. If I go farther than this tomorrow, I might not be able to go back to work because the pain is going to flare up. So that's what you tell them because now we can start talking about flare-ups. That's a big thing: flare-ups. Just because I have a good day today may not be good tomorrow because I'm having a flare-up. So that is one thing.
00:17:46 Speaker 2
They do, even if they do. Actually, that can segue into you telling the examiner, "If I do go any further tomorrow, I'm not going to be able to get out of my bed." And even more than that, functional limitations matter, right? Because they need to know the functional limitation impact this has on your everyday life. You got to go through 365 days, right? You got it. I want to know what it's like all the time. And just because today may be a good day for my CEP exam. After this exam, I might have a bad day tomorrow because I had to bend over ten times.
00:18:21 Speaker 1
Musculoskeletal conditions; it may not be something that you have a flare up every day, but one thing we do know: it is a chronic issue that you dealt with on going through service. And guess what? It's not going anywhere. You're going to deal with it on going through life. Those things don't change. Also, you can know that even receiving under regulation four point five nine CFR four point five nine, you are going to receive a minimal compensable rating based upon, again, that surgical connection under a musculoskeletal condition. So please make sure that you are in these CEP exams, providing the injury that you have actually dealt with.
00:19:07 Speaker 1
Understandably, it's very understandable why symptoms wax and wane. We think we talked about it earlier, but I think a lot of times symptomatology and symptoms may present during the most opportune time. I guess. Can I ask why symptoms from old injuries or repeated military service or strain, or any type of physical duties, or not even physical duties, just some duties that arise later, or some things that arise later, actually become noticeable years later.
00:19:48 Speaker 2
I feel like the biggest thing, and this is a good topic because this can happen. You can be in the military service ten, twenty years, and let's say you never once went to sick bay or sick call. Then you get out of the military service, and you start noticing things are hurting. I feel like one of the biggest things that masks why you're in the military is the mindset of the military. Push through it. You're in the military, you're a veteran. You can push through this. We need you. Your squad needs you. Your mate, your teammates need you, and you do that every day. So you don't really pay attention to it because you realize there's another person that is depending on you in that line or on that squad. But then let's say once you get out of the service.
00:20:34 Speaker 2
You're not marching every single day. You're not jumping out of the back of Humvees or out of planes or into the water every single day. So now the things you used to do every day, which kept the joints a little lubricated, as we want to say, that's not happening every day. So now that back pain that was nagging you, but you push through it after it warmed up, it's not warming up anymore. So now, when you wake up in the morning, you notice that back pain. It's kind of if I could put into something easier to understand. If you get into a car accident, you have a lot of adrenaline going. You get into a car accident, airbags go off. You may be able to get out the car, walk around, make sure things are okay. You may not feel anything that day. What's going to happen tomorrow when I wake up? My neck. Oh man, I can't turn. My back.
00:21:27 Speaker 2
I can't bend over, right? And that's just because you're now taken out of that situation that masks that pain, and now you have to deal with it. So a lot of things that were there before become more noticeable a year after service, two years after service, because you may still do a little something physical after service, but as you stop and get more into civilian life, you start recognizing things a lot more.
00:21:52 Speaker 1
And I can attest to that. First and foremost, because again, as you said, some things you just don't activate that you did when you were in service. You aren't getting up at five in the morning, getting on a run. That's just not happening anymore. You're not doing the things that could potentially put you in the most physical, mental, body, and spiritual shape at that moment. You are not doing what service tells you to do. So now you have to make sure that those physical elements
00:22:26 Speaker 1
Physical joints are always in operation, but now one big thing that's been really touted and kind of one of the most disruptive conditions toward military service these days has been mental health. PTSD, anxiety, depression, bipolar disorderā€”just so many different mental issues. And we understand that these things that come up, and they may come up, and I want to be very, very understanding to any veteran who is dealing with this. If it does trigger you in any type of way, please, we're here to be able to make sure that we provide service, support, and service to you. But we are going to go ahead and make sure that we lead into this with care, sensitivity, and understanding that these mental ailments are something very serious.
00:23:24 Speaker 1
Now we talk about some injuries that are seen, and these are some that are not. What is the baseline of this, and why does this actually happen?
00:23:36 Speaker 2
This is something good to talk about because mental health is becoming talked about more recently than it was before, and I think a lot of veterans are still stuck in their old ways. So they don't openly talk about mental health. But something as simple as a back injury. If I say I hurt my back, you wouldn't think about mental health. But the way this could impact your mental health, let's say I injured my back while I was in the service. I got out of the service. Me and my family are now doing civilian life, so I'm at home with the kids. Sometimes I normally have been deployed, so I'm at home with the wife and the kids. I got a job now.
00:24:19 Speaker 2
Working, which is good, but this job is a little more demanding. I'm doing physical labor, not anything close to the military. The military, you're expected to carry 100 pounds around, and this is just your normal day. So now I'm at my normal job, and I had a rough week, but this weekend my daughter's got a big recital, but I just had to work because I got to provide for my family still. My daughter got a big recital, or my son, or any of you got something big going on. The family's been looking forward to it. Friday comes around, rough day at work. Somebody called out. You had to do a little more. Saturday, time of the recital. You wake up Saturday morning, back is locked up. You can't get out of the bed. So what happens? You miss that big family event you've been waiting for all week. Now that may that one incident may not cause any issues, right ma'am?
00:25:16 Speaker 2
You apologize to the family; they understand because your families are understanding. They understand, right? But for you, it may weigh on you, but just a little. Let's say it happens three or four times a year, and now I'm getting depressed because I can't go and support my family as something they want me there for. So now I'm feeling less of a person, and this is when depression sinks in. Now you're thinking about how did I get here, and I start thinking about past things that happened to you during your military service. It starts bringing up those intrusive thoughts that you haven't thought about in a couple of years, but now those same things are affecting your family. All of this happened from a little back injury, and now it's affecting my mental health. I would like veterans to really understand that just because you may not have experienced combat, so you may not experience people dying or anything like that, a musculoskeletal injury can lead into mental health issues.
00:26:15 Speaker 1
And veterans, I wanted to preface this as making sure that we are leaning into this with sensitivity and understanding. With that, that example is so prevalent to everyday life for many veterans, and these things are beyond frustrating. It could take you down a pathway that you never really thought and really understood, and I think it's something that because every veteran wants to serve selflessly, a lot of times
00:26:44 Speaker 2
One hundred percent. 100, and that's what I really want the veterans to understand. Just because you may not have experienced something traumatic during your service, doesn't mean it's not going to affect you. You won't be affected in some type of mental health way later on. Because you want to serve, you want to commit, you want to be there for your family, but sometimes you can't, and that is the point. That is where mental health really starts to come into play. Where you really want to be there for your family, but you just physically cannot, and that will weigh on anybody. That'll weigh on anybody.
00:27:23 Speaker 1
And just to understand, traumatic incidences are subjective. One hundred percent. Traumatic incidences are subjective. The amount of stress tolerance is subjective. One hundred percent. But with that, I did want to talk a little bit more about maybe PTSD. How does that typically arise? What are some of the symptoms to be on the lookout for, and possibly what do you see most common?
00:27:57 Speaker 2
So PTSD again, also subjective, right? Every situation, every person will handle a situation differently, and it'll affect them differently. The big thing veterans have to realize is you're not in the military anymore. You don't have to be the tough guy or the tough woman. It's okay to open up. It's okay to discuss these things. Because that's the only way you're going to get help. It's never a good thing to suffer in silence. That's never something that you want to do.
00:28:36 Speaker 2
And PTSD, anything can trigger PTSD. Going to the grocery store can trigger PTSD. People, civilians, right? We, some of them can only think about like Fourth of July. That's a big one, right? The Fourth of July is a big one, right? Because that's all that civilians kind of put two and two together with. But as the veteran experiencing the PTSD, the Fourth of July may be the least of your worries. I have to go to the grocery store, and it may be too many people in that grocery store, and I don't know what's going to happen. And now, what am I thinking about? I'm thinking about back when I was in service. I may have to go to a football game or a recital, and it's 150 people, 200 people in this room, and now I just feel uncomfortable being around all these people, not knowing what's going to happen.
00:29:23 Speaker 1
It's so tough. It's tough because you don't know your triggers. You don't know what you don't know. But being able to convey that to a civilian examiner appropriately is very hard. I think veterans get a lot of slack and stigma put onto them just due to the fact of veterans and how veterans are portrayed in the news and so on. It becomes more of a hairpin trigger attitude.
00:29:58 Speaker 1
And that's just not true. It's just not true.
00:30:01 Speaker 2
And that's one thing about the military. There's no OSHA, right? There's us civilians. We get protected, right? We got OSHA. We got things that protect us from those type of things, right? And the military, you don't have those things. And like you said, even if you don't watch the news, you could be in a room with somebody just talking about it. And now that is what triggered you. You could be having a great day. You just happen to be in a room with other people you don't know, and they start talking about it out loud, or they're playing it on their phone. The media is so easily accessible right now; it's hard to get away from at times. So even if you're like, I'm gonna step away for a little bit. I don't want to be here. I'm gonna go for a walk. And you're on a walking past. Somebody's walking past you, and they're talking about it, or they're walking in front of you, and they're talking about it, and that could be the trigger. So no matter how hard you try.
00:30:57 Speaker 2
To not, because maybe you know your triggers and you try to get away from them. Sometimes they will find you.
00:31:03 Speaker 1
And social media makes it very, very easy for them to find you. Again, veterans, if you know your triggers, really, really tap into them so you can protect yourself at times. But beyond that, get the medical care and medical assistance that you need. Talk to somebody, please, because your healthcare provider is here for you. They want to be able to provide you the care that you need. But I'll tell you right now, mental health is something that is a very unorthodox topic that we like to talk about. The quicker you are able to talk to someone, the quicker you'll be able to get to a normalized life of your new normal. Please make sure that you're focused on.
00:31:56 Speaker 1
Serving yourself, but also serving others, and how you do so is get the help that you need. We really discussed so much, right? I think we really gave the veterans a lot of value here. But beyond value, now just more or less understanding, right? Because we talked a lot about musculoskeletal issues and how they could cause other issues and so on and so forth. But now, the process, right? It's already a daunting process, the VA process in general. But now, if you have a daunting process with the VA process, but then you have an uncomfortable process with your private medical provider, or the VA in general, getting an X-ray or getting MRIs and all this other stuff. Why does that even happen? Could you start from the beginning? Understand that?
00:32:49 Speaker 2
So I can definitely speak from the private medical insurance over the VA. I don't really know how the VA handles it, and you can interject and let me know since you may know a little more about that part. But from our point of view, I want to say the way imaging is ordered, it's not your provider's fault. When you come in to me as let's say it's your first visit to my practice, and you're coming in talking about your back pain. I'm going to ask you the questions: When did the back pain start? You say it started during your military service. You've had this pain for over ten years. And you, but this is your first time using your private medical insurance. I know as a provider, if you haven't injured yourself in some traumatic way in the last few days, an X ray is not going to show me much. X ray is looking at broken bones, may show you a little fluid, may show you the joint space.
00:33:46 Speaker 2
And we know that, but if I'm like, what you really need is an MRI, and I order that MRI immediately, the insurance company is going to deny that. The reason they denied it is because there's no leading evidence to show that you need this MRI. Meaning, you haven't had an X-ray, you haven't gone to physical therapy, you haven't gone to see an orthopedic specialist. There are things that insurance companies want you to do before they pay whatever thousands of dollars they have to pay for an MRI, which is a crazy thing to think about, right? I need this test, but you have it behind this wall of other unnecessary steps I have to do. For one, hoping that maybe I'm going to be like, all right, I'm tired of going to the doctor, which happens. I'm tired. I went to the doctor again. I've been going to physical therapy for three weeks, and I still haven't got this MRI. And then you just stop going to the doctor. What did you just do? You saved your insurance money.
00:34:44 Speaker 2
Because what physical therapy does now is just like in the C and P exam, physical therapy is going to give me numbers to put to this back pain. Because now I have something more objective and not subjective. I can look at these numbers from physical therapy and say, "Veteran can only bend over or flex forward twenty percent. Veteran can only do lumbar extension ten percent. The normal is thirty for. Extension flexion the normal is ninety. Those are big numbers from what's normal twenty and ten. That's big numbers. So now insurance company is going to say, okay, veteran has got his X-rays, he's done physical therapy. When this provider puts in the MRI, we'll approve it because the MRI is going to be a more detailed exam. Now I'm going to look at the joint space. I'm going to look at the nerve roots. I'm going to get a bigger picture. So that is the reason why.
00:35:38 Speaker 2
It seems like we, the provider, are the roadblock, but it's really not we, the provider. It's just how the insurance company manages care. But one thing I just want to make sure the veterans know, and even the non-veterans that may be watching with their veteran, going to the ER is not going to get you an MRI quicker. Because ER providers have their own way that they order imaging. You are very rare to go into an ER with chronic knee pain and get an MRI. You're going to get an X-ray, and they're going to tell you to follow up with your primary care doctor, because again, MRI is for emergent services that they feel they need in the ER. So I don't want veterans to waste time in the ER thinking they're going to get an MRI faster because they went to the ER.
00:36:27 Speaker 1
Gotcha. So it's just circling back, just understanding MRI. It's definitely not going to be the first choice that your provider is going to lean you towards for the most part. However, again, making sure that you're going through the process of getting your X-rays, getting your treatment plan, and actually then going to get an MRI really helps out because you really need to understand the full ramifications of the injury.
00:37:03 Speaker 2
I would tell the veterans not to let, let's say your CMP exam is before you got that MRI. Don't let that affect your CMP exam. Still go to that exam. But what's good to have is evidence showing I've been to my VA doctor, I've been to my primary care doctor, I've had X rays done, I'm going to physical therapy three times a week. And bring that information in with you. I have an MRI scheduled. It's just not until a month from now.
00:37:35 Speaker 2
Bring that information in because now, if the examiner doesn't have that information readily available, they can look at what you have and it will show. He's been going to physical therapy three times a month for the last two years, and physical therapy is a big thing. I think we underutilize it because a lot of people feel it's not beneficial. Let's say if we take away the beneficial for a functional thing, like I don't feel like my back's getting better. I still can't bend over as much as I want. It's very beneficial for a C and P exam because most jobs in a civilian sector, it's hard to get three days off if you have to do physical therapy three days a week.
00:38:17 Speaker 1
Yeah,
00:38:18 Speaker 2
This segues into functional limitations. This is affecting my job because I have to take off and use my PTO that I can't use to go do something with my family. I have to use it to go to physical therapy.
00:38:32 Speaker 1
And also from a Raiders' point of view, we're looking at it in a sense. We want to get you rated, but we don't have the full course of information in its totality. I'm going to send you a request for individual unemployability because I see that you're not working in your file and now you're looking to get unemployability. They have used the duty to assist to provide you, but you're not completely unemployable, so now you're denied that and now we go through this circle in the situation.
00:39:05 Speaker 2
It's a vicious cycle. And if veterans don't take anything away from this segment here today, don't downplay the little things that impact your life. There's a lot of little things that impact your life. I think we take it for granted, and this is something that veterans go through every day.
00:39:28 Speaker 1
Every day. Veterans, imaging is important. Treatment is important. Continuity is important. Not only that, your well being and your health is most important. Let's make sure that we're utilizing the medical evidence, the X rays, the MRIs, and kind of making sure that we're navigating this in its totality. But you have to know what you are directly requesting when we go into these appointments, when we go into these CME exams, knowing your rights, advocating for yourself, and putting yourself in the best position of success. The veteran community is really, really thankful for you, Dr. Whitney, because without providers like yourself.
00:40:20 Speaker 1
That have the medical experience, that have the understanding of the first responders, the veteran community, and just the community in general. It is something that we honor, we enjoy, and that we really are standing beside you. But now, for veterans watching, please make sure that you understand what goes into the C&P examinations. This is just the first of many. And with that being said, this discussion was only for educational purposes, and it wasn't for claim advisement. I want you to understand: we are here to provide you information, but not preparation for medical concerns. That is not what we're here to do. But with that, Dr. Anthony Whitney, I really appreciate the time. I know you have a busy schedule. I know you have patients to see and veterans to serve.
00:41:18 Speaker 1
But it's been an honor to have you here, and it's been a pleasure. Thank you so much. I got it. With that, you guys have a wonderful day, and again, prepare to compete.
