Playing Matchmaker with MUSC and PN DBQs
Can SC radiculopathy be diagnosed if there is no objective evidence on exam?
Yesssir! Service connected radiculopathy conditions do not need objective evidence on exam to support the diagnosis.
If surgery is noted in Surgical Procedure, there is no Scar DBQ in the DT/DBQ/IMO tab, and the DBQ is "No" for scars, what options does the examiner have to accurately complete the DBQ?
1. Select "Yes" for scars and add the Scar DBQ
2. Provide an explanation in Remarks/Extra Remarks to explain (i.e. No visible scars on exam).
Name the contention: “A duty to assist error has been identified during the higher-level review for spondylosis”
Spondylosis
Which DBQ(s) should an eating disorder be diagnosed on?
Eating Disorders DBQ always and/or PTSD or Mental Disorders
If any of the Audiological Evaluation test results show CNT/DNT, what information must the examiner add to the DBQ and where?
Examiner should add an Explanation and it should be included in the Comments box.
Which DBQ does SC radiculopathy get addressed on if the VA requested the PN DBQ in the ESR and the Neck DBQ is shown on the DT/DBQ/IMO tab?
The PN because its the one the VA requested it on! (And it is SC, of course)
Should there be a corresponding diagnosis if only 3C (RUOT)) and/or 3D (Flare-Ups) have abnormal findings?
Aht Aht! That is a Nooooo for ALL RUOT and Flare-Up sections on the MUSC DBQs. 3C and 3D are Subjective Findings: Meaning abnormal findings indicated in 3C and/or 3D would not warrant a diagnosis if this was the only abnormal finding in Section III.
When should resolved, newly claimed conditions be diagnosed on exam?
If that particular DBQ allows current and past diagnoses to be rendered. (Same is true for SC conditions).
Which document is a resource that a QA can use to find over 10 examples of markers that can substantiate an MST stressor?
Military Sexual Trauma Job Aid
What is the expected value for the peak pressure, if the tympanogram type is B on the Audiological evaluation?
Nothing! It should be blank.
These DBQs need to be cross-referenced for Muscle Strength Testing:
MS, CNS, Back, Neck, PN/DPN, and Hand
When is a diagnosis of instability warranted?
Only when there is objective evidence on exam to support the diagnosis. (Can't just be yes to veteran reports instability)
Name 5 things that should NOT be mentioned/discussed for a functional impact statement (excluding Audios):
Current occupation status (employed/unemployed/quit)
Workplace name
Title of position
Dates of Employment
If the Veteran has to call out of work or leave work early due to condition.
Besides Adjustment Disorder, which other type of diagnosed disorder(s) require specifiers?
Substance use disorders (including Alcohol use disorder)
Name the hearing loss criteria (3 different ones) that the VA considers to be a disability (or ratable).
(1) the pure-tone auditory air conduction threshold in any of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels (dB) or greater; OR
(2) when the pure-tone auditory air conduction thresholds for at least three of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; OR
(3) when word recognition scores using the Maryland CNC Test are less than 94 percent
**When the Veteran meets at least one of the above criteria, hearing loss must be appropriately diagnosed for the corresponding ear (or both).
**Note: 6000Hz and 8000Hz is not considered for ratable hearing loss.
If the veteran is diagnosed with IVDS, cubital tunnel syndrome, and lle radiculopathy for a new claim, how must the PN DBQ and the Back DBQ be completed by the examiner.
PN DBQ is completed for cubital tunnel syndrome. Back DBQ is completed for IVDS and lle radiculopathy.
Align all overlapping findings with both DBQs-including matching nerves affected. Delineate symptoms and findings in Remarks/Extra Remarks. If delineation is not possible, state so.
This is how to figure out if a surgical procedure is required to be diagnosed:
Check the DBQ guide!
(ALL others not listed specifically on the DBQ guide are diagnosed based on the examiner's discretion)
What must examiners do if the veteran brings in hard copy records to their appointment?
Examiner should thoroughly review the document(s).
In the Evidence Review section, summarize the information from the record under Other .
Examiner needs to add a statement to the remarks explaining that the veteran brought in a hard copy record, that it was reviewed, AND that they advised that the evidence be sent to the VA so it can be uploaded to their records.
If both a Mental Disorders DBQ and an associated pending TBI exam are part of the claim and the Mental Disorders DBQ has been appropriately completed with a Remark delineating symptoms based on a previous TBI exam found in records, should the Mental Disorders DBQ be sent to FCR?
Hold Up! Waaaaait...We should NOT be sending Psych DBQs to FCR if there is still a pending upcoming TBI DBQ exam appointment. Examiners must delineate using the most recent TBI exam.
Why? The examiner will need to compare the TBI DBQ exam differentiation of symptoms/social and occupational impairments attributable to the Psych diagnosis and the TBI diagnosis. This can only be done after the TBI DBQ has been completed.
Please reject any Psych DBQ back to the examiner if it does not align with the TBI DBQ being completed in conjunction.
The veteran was appropriately diagnosed with bilateral hearing loss that meets the VA's criteria for hearing loss.
The ESR is a new claim for the left ear in which the VA asked for a "Direct service connection (Audio Opinion based on MOS-Related Hazardous Noise Exposure)" for the left ear.
Should the examiner give a positive rationale if there is objective evidence of military noise exposure for both ears to fully address the findings on exam?
No! Say Whaaaaa???
If hearing loss for either ear was not claimed up front; meaning it was not listed as a contention in the ESR, then no etiology (opinion) can be indicated in section 4. In this case 4A (right ear) should be No with "Not requested by the VA" selected. 4B (left ear) should be Yes. 4C (right ear) should be blank. 4D (right ear) should be blank. 4E(left ear) should be Yes with rationale included. 4F(left ear) should be No.
ESR shows a claim for radiculopathy on a Neck DBQ. The veteran's symptomology aligns with diabetic neuropathy only. Which DBQ should be completed by the examiner and sent to the VA?
DPN. The nerve!
*If an Examiner determines the actual condition is different than the claim, but clinically in the same realm of the symptoms described, Examiner must evaluated the actual condition. DBQ substitutions are permitted if applicable and comments justifying the change should be provided in Remarks. (True for most all DBQs-See Attachment K).
Should a claim be for radiculopathy (with either a spinal DBQ or a PN DBQ requested), but Veteran truly has a neuropathy (peripheral or diabetic), then Examiner can utilize the more appropriate DBQ (PN or Diabetic PN) (in lieu of the requested one, if applicable) to evaluate level of severity if remarks are provided.
QA follows nb/ns for the Neck DBQ in this case.
What should the examiner do if instability isn’t diagnosable but the Veteran reported instability during the exam?
Acknowledge the Veteran reported instability by selecting "Yes" in the Medical History for the veteran reported instability.
What is the workflow for Asymptomatic Diagnoses for SC diagnosis(es)?
QA Workflow:
Confirm there are no findings on exam related to the asymptomatic diagnosis.
Make sure there is an explanation in remarks or extra remarks as required.
Rationale: Should explain that the *asymptomatic (diagnosis name)* is quiescent on exam due to medication management or some other explanation.
What steps should the QA take if the examiner adds a PTSD DBQ in lieu of the Mental Disorders DBQ?
If the veteran has a diagnosis of clinical hearing loss in the left ear for a new claim, how should Section 1A, Section IV, and the Remarks be completed by the examiner for the left ear?
For 1A Selections:
“Veteran does not have hearing loss that meets VA disability criteria” checkbox SHOULD BE selected for the ear that DOES NOT meet VA disability criteria.
Examiner should also select the appropriate clinical diagnosis in 1A for the ear with clinical hearing loss. (*Note: The “Hearing Loss for VA purposes indicated by a Maryland CNC word recognition score of less than 94%” checkbox should NEVER be selected since this would indicate the Veteran does meet criteria for VA disability.)
Etiology Opinion: Should not be provided in Section IV for clinical hearing loss only.
Explanation is required in Remarks/Extra Remarks Section: Should explain as to why a diagnosis based on VA disability criteria is not warranted.