May 2, 2024 • 60 mins
Bethanie Spangenberg from Valor 4 Vet joins Ray and James to discuss C&P exams, stateside Agent Orange exposure claims, and strategies for successful VA disability claims.
• VA tends to order C&P exams more frequently than necessary
• C&P exam formats have evolved from general worksheets to structured Disability Benefits Questionnaires (DBQs)
• James Cripps shares his groundbreaking case as the first veteran to receive compensation for Agent Orange exposure in the continental US
• Chloracne proved to be a critical biomarker that helped establish Agent Orange exposure
• Contract exams have concerning quality issues including inadequate medical reviews and inappropriate exam locations
• Military.com report reveals contract examiners sometimes shred veterans' evidence
• Inadequate reimbursement rates for contract examiners lead to rushed exams and quality concerns
• Veterans should mention all symptoms during C&P exams, even if not specifically asked
• Documentation of treatment in service records significantly strengthens disability claims
• Success stories highlight how proper claims strategies can be life-changing for veterans
Visit valor4vet.com for nexus letters and medical expertise, or vatheredneckway.com for guidance on submitting successful VA claims.
Tune in live every Thursday at 7 PM EST and join the conversation! Click here to listen and chat with us.
Visit J Basser's Exposed Vet Productions (Formerly Exposed Vet Radioshow) YouTube page by clicking here.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ray Cobb (00:01):
Blog Talk Radio.
J Basser (00:05):
It's time for the Exposed Vet Radio Show.
The Exposed Vet Radio Show, wediscuss issues affecting today's
veteran.
Now here's your host, john andRay.
Ray Cobb (00:18):
Hey, good evening everybody.
John's taking the night offtonight.
His son is getting ready tograduate from the University of
Kentucky.
Well, I think about two orthree degrees.
He has some honors.
So John had to go over theretonight and, I think, attend a
banquet.
So congratulations to him andhis son and what they've
accomplished so far, looking fora good future for that young
(00:42):
man, very, very smart, veryintelligent.
My co-host tonight is over inWest Tennessee, a little west of
Nashville, not too far.
It's within Stone's Throw, aswe say down here in the south,
and that's James Cripps.
James, welcome aboard.
James Cripps (00:59):
Well, I appreciate the invite, Ray.
Ray Cobb (01:02):
Yeah, and our special guest tonight, our VIP, is
Stephanie.
Stephanie is in charge of Valorfor Vet.
Am I correct there, stephanie?
Bethanie Spangenberg (01:15):
So, Ray, you always get my name.
Ray Cobb (01:17):
Yeah, bethany, I'm sorry, I'm saying Stephanie,
that's all right.
Bethanie Spangenberg (01:21):
You know.
What's funny, though, is mymother's name is Stephanie, so
I'm used to the Stephanie,bethany or Brittany.
I answer to all of them, ohokay.
It's Bethany Spangenberg, withValor for Vets.
Ray Cobb (01:34):
Okay, and I think tonight you're going to start
off talking a little bit aboutS&P exams, is that right?
No, I'm sorry we're going totalk about my mind just went
blank in.
James Cripps (01:55):
C&P exams.
Bethanie Spangenberg (01:58):
C&P exams from contractor exams, the do's
and the don'ts.
There's a militarycom reportthat came out that we can talk
about.
There's, you know, alldifferent things that we can
cover tonight's show.
Ray Cobb (02:16):
All right, let's get started C&P exams.
When I had my first one, I wasscared to death.
I didn't have any idea what wasgoing to happen.
I was scared to death.
Bethanie Spangenberg (02:24):
I didn't have any idea what was going to
happen.
So that's a familiar feeling,especially because the VA tends
to call veterans for exams whenthey're not necessary.
And you know, someinvestigation reports or
(02:48):
follow-up reports have said,yeah, the VA tends to order
examinations, or the raters atthe regional office tend to
order exams more frequently thanthey should and they're
supposed to be kind of slowingdown on that, trying to be able
to rate the veteran for what isin the file versus having them
come in for another exam.
So typically when you get aletter in the mail, if it's with
the contractor that's doing theexam or if it's with the VA,
(03:10):
you'll get a letter to reportfor the exam.
Some of them even say not toreport to the exam.
So just depends on what, whatcondition they're looking at and
they should disclose that inthe letter that they send to you
.
So that kind of gives you aheads up on what topic will be
discussed.
So now your first comp and pen.
(03:31):
What exam was that for?
What were they evaluating youfor then?
Ray Cobb (03:36):
My first one was diabetes.
Military-connected Agent Orangein the United States,
military-connected Agent Orangein the United States and, of
course, at that time, the onlyperson.
Well, as a matter of fact, whenI went for my C&P exam the
first time, no one had receivedit, and then James became the
(04:04):
first to receive his AgentOrange exposure in the United
States.
And then my CFP.
I had two CFP exams and thesecond one.
They were about a year apart.
I think they sent me for onebefore I went to the board.
They sent me for one at thebeginning, when I first filed
the claim, or shortly thereafter, and then my next CMP was a
(04:24):
little bit before I went beforethe board okay, so we're really
the same.
Bethanie Spangenberg (04:31):
Each like was your experience the same
when you went for those, sinceit was for the same condition?
Ray Cobb (04:39):
and now they it wasn't .
The second one asked more likehow do you know you were exposed
to Agent R's.
And then both the commonquestion that they both asked
did we have any history ofdiabetes in our family?
(05:03):
We have any history of diabetesin our family?
Ah, you know, that's kind ofone thing that they were
reaching out after.
Then the rest of that was whatis my blood sugars doing?
What's my highs, what's my lows?
Have I found anything thatwould cause it to go up?
(05:24):
Or was there?
What could I do to when it wentup?
What could I do to get it down?
Bethanie Spangenberg (05:36):
Questions of that nature.
Ray Cobb (05:39):
Now, about what date or time frame was your first
comp and pen?
Oh, 2006.
And it was until recently allmy.
Bethanie Spangenberg (06:03):
CMPs have been done by VA nurse
practitioners.
Okay, the reason I ask isbecause when so I've been, I was
in-house doing compensation andpension exams from about 2011
to 2013, and it was about thattimeframe that they really
opened up what we now call DBQs.
Prior to that, they referencedthem as worksheets and it wasn't
(06:27):
really targeted for the legalschedule and we just collected
basic history and examinationinformation.
It wasn't something specificregarding how many low blood
sugars or specific questionsabout insulin and how many shots
per day.
We were just to document,almost as if it was a clinic
(06:47):
exam.
And even prior to thoseworksheets.
You look at DBQs historically, alot of the older exams I can
say probably 1980s, early 1990sthey were actually really
thorough from the medicalperspective but again, they
weren't tailored to the ratingschedule.
(07:10):
They were more of acomprehensive examination and
assessment by the physician andI really appreciate reading
those old reports because I'mlike man, that's a really good
assessment of a clinicalcondition and so to see that
(07:32):
transformation of you know theolder exams and what was done
and as they brought in theworksheets and then as they
brought into the DBQs, so yourfirst C&P exam, if that was
2006,.
They didn't have DBQs then.
So a lot of the questions mayhave been broader questions like
just tell me about your bloodsugars or what was your
(07:53):
something not specific to rating?
That's why I asked thatquestion.
It's kind of understanding thehistory behind those changes.
Ray Cobb (08:03):
Yeah, that's a.
James Cripps (08:04):
You know, Bethany .
Ray Cobb (08:06):
Go ahead, James.
James Cripps (08:11):
I submitted my claim and I went four years all
the way to the Board of VeteransAppeals with no C&P exam.
They would not order a C&P exambecause I was claiming exposure
inside the continental UnitedStates and the VA and the DOD
(08:32):
said we never, ever used AgentOrange inside the continental
United States.
So they expected my claim to bejust thrown out at the board.
But the judge recognized, youknow that I had ischemic heart
disease, although that wasbefore ischemic heart disease
(08:53):
was recognized.
I had to claim it as secondaryto diabetes.
But I had the diabetes, I hadthe chloracne, I had the heart
disease, I had the neuropathyand the judge picked up on the
fact.
You know this guy's gotchloracne and that's a bowel
marker.
So those claims were awardedwithout a C&P examination.
(09:19):
The first C&P examination Iever had was years later lost
the use of two feet, even had apsychological claim granted
severe anxiety and depression,without a C&P exam.
So times have changed.
Bethanie Spangenberg (09:42):
They have, they really have.
That's interesting.
You went four years withouteven just talking to any
examiner whatsoever.
James Cripps (09:51):
Right.
Bethanie Spangenberg (09:52):
You know that evidence would have been
valuable to have.
James Cripps (09:57):
I wanted.
I begged for a C&P exam.
It's in my records that I wasjust begging for one and they
just refused to give me one.
They wasn't obligated to giveme one because they said it
wouldn't make any difference inthe claim.
Bethanie Spangenberg (10:14):
Now what time?
Frame was that.
James Cripps (10:17):
That was 2001.
In 2009, I submitted the claimin 2005.
Bethanie Spangenberg (10:22):
I submitted the claim in 2005.
I'm assuming, I guess, as faras from there you went to the
board and what happened fromthere with your claim?
James Cripps (10:42):
It was awarded at the board.
J Basser (10:44):
It was a partial grant .
James Cripps (10:48):
They granted what they could grant and then they
sent it back to the regionaloffice and said pay the man for
what we have granted and sendhim for C&P exams.
On the other issues they sat onit six months and sent it right
back to the AMA without doingC&P exams.
(11:08):
So the AMA headed it off.
They saw what was happening.
It was bias in the claim andthey went ahead and warded the
others without a C&P, without aCNP.
Bethanie Spangenberg (11:33):
But at the Board of.
James Cripps (11:35):
Veterans Appeals.
I had 13 nexus letters.
Bethanie Spangenberg (11:37):
That takes a lot of doctor shopping.
I have no doubt yeah.
James Cripps (11:44):
I've got a friend and he was just notified today
of an upcoming C&P exam.
It said expect a letter andit's either going to be on aid
and attendance or it's going tobe on loss of use of two hands.
(12:07):
Aid and attendance is prettywell straightforward.
It's just making sure he has tohave help with his activities
and daily living.
What can he expect on a loss ofuse of two hands?
That's not going to deal withloss of motion but grip and
(12:28):
strength.
What can he expect out of thatexam?
Bethanie Spangenberg (12:35):
Do you know what the loss of use of
both hands is tied to?
Is it tied to neuropathy?
James Cripps (12:40):
Is it tied to diabetic neuropathy Is it tied
to Diabetic?
Bethanie Spangenberg (12:44):
neuropathy .
Okay, so it's going to be.
To be honest, it should be thestandard diabetes exam, because
the standard diabetes exam asksthe examiner to test the upper
and lower extremities.
So I'll be surprised becausetypically your loss of use with
(13:07):
diabetes will come in your feetfirst and then they go into your
hands.
James Cripps (13:12):
He already has lost use of two feet.
Bethanie Spangenberg (13:16):
Perfect.
So that helps his claim.
So what he should expect isthey should do inspection of his
hands.
They're going to see if he hassoft sensation.
So they'll take like a cottonball or tissue and run it
through on his fingertips and uphis arm.
They may even do like a sharpdoll, like they'll have a sharp
(13:37):
object or a doll object thatthey'll press on the hand to see
if he can feel.
They should do a cold, likesomething cold, to see if he can
feel whether it's cold or hot.
They'll do his range of motion.
They will do his strengthtesting.
That is a comprehensive exam.
Some examiners will do the bareminimum, some of them will do
(13:59):
range of motion, strengthtesting and then they try to
grade whether it's mild,moderate or severe neuropathy on
the hands.
So he should be.
If it's done the right way, heshould be in and out in about 45
minutes.
If they cut him short it'll belike 20.
Yeah.
James Cripps (14:22):
I have lost the use of two hands granted and
lost the use of two feet.
I had C&P for loss of use oftwo feet.
I did not have a DBQ or an examfor loss of use of two hands.
Bethanie Spangenberg (14:41):
So for your feet, what did they
determine the severity to be?
James Cripps (14:47):
Severe.
Bethanie Spangenberg (14:50):
And they didn't look at your hands at all
.
James Cripps (14:53):
No.
Bethanie Spangenberg (14:57):
If there's veterans out there and they're
listening and you know that yourneuropathy and your feet are
severe and you're going for yourDBQ, ask them about your hands,
say, well, what about my hands?
I have the same or similarsymptoms in my hands and you can
say they're about the same,maybe they're not as bad.
But you need to bring that totheir attention because the
(15:18):
examiner who is doing anevaluation for diabetes, it is
in their form to look forneuropathy of all four
extremities, not just the lower.
So in that instance, if you areconcerned with neuropathy,
bring it up.
Excuse me, you need to eitherfile for it so that way they
(15:41):
address it, or look at your oldrecords to see if there's
anything documented in the DBQ,because that's concerning.
Ray Cobb (15:57):
That would be something as a representative
that I would want to look at.
In 2014, or 15, excuse me, 2015,I went for my first foot drop
in my right foot and secondaryto diabetic neuropathy, and they
(16:17):
did check my left foot, whichat that time was fine, but they
never checked my hands.
And then, I think a year later,I had to go back for the other
foot and finally got loss of useof both feet about 14 months
apart, but they still never.
My hands are bothering me now,but my rating is so high I don't
(16:38):
even fool with it.
Should they have checked myhands at that time when they
were checking me for foot drop?
Bethanie Spangenberg (16:45):
Yes, they should have.
They should have.
James Cripps (16:52):
You know, that kind of explains my situation,
because I won my lawsuit twofeet at the Board of Veterans'
Appeals.
Then I went back for loss ofuse of two hands.
That was awarded at the courtand they paid me back to the
(17:18):
same date of loss of use of twofeet, which was a 10-year total
back pay.
Bethanie Spangenberg (17:30):
It's good that they finally discussed it,
so I guess what they were sayingthere.
James Cripps (17:35):
Yeah, I guess what they were saying there is.
It should have been inferred atthe same time as loss of use of
two feet been inferred at thesame time as loss of two feet.
Bethanie Spangenberg (17:52):
Yeah, because your hands are going to
be, the blood flow is typicallybetter because they don't have
the resistance that your feet do.
So for your blood to get backfrom your feet back up to your
heart, it's more work, it'sfurther distance for your feet
back up to your heart, it's morework, it's further distance for
your feet.
So that's why diabetics tend toget the neuropathy in their
feet first and then they developit in their hands.
(18:12):
If a diabetic has a mildneuropathy, clinically we're not
going to suspect that there isneuropathy in their hands.
It's not until the neuropathygets progressively worse in the
feet that we get concerned withthe neuropathy in the hands.
But if there's a patient that Iknow has severe neuropathy in
their feet clinically, I'mabsolutely going to look at
(18:33):
their hands and inspect and seewhat changes are going on with
their hands.
James Cripps (18:40):
Actually my hands are clawing.
That's not good.
I had an EMG years ago on myhands.
I went to a hand specialist andhe said Mr Cripps, I don't
think there's anything wrongwith your hands.
He said, but I want you to gosee my specialist.
(19:01):
And he sent me for an EMG onthe hands and the guy did the
EMG, stuck all the needles in meand did his testing and he
didnít say anything.
But he followed me back out tothe desk to make my return
appointment or settle up orwhatever it was.
(19:22):
I had to go back to the desk forand he walked up behind me and
he reached down and with somekind of instrument I never saw
what he had he snagged the palmof my hand and ripped up on it
and I knew he did something.
And I looked at my hand and itwas bleeding and he said I
(19:45):
apologize for that, I had to dothat.
But he said now I can tell you,your hands are not going to get
any worse.
Must have been some kind ofnerve or something that he poked
or prodded or ripped.
I don't know what he did, butit convinced him that that hand
(20:07):
didn't have much feeling in it.
Bethanie Spangenberg (20:10):
That almost sounds like he didn't
believe you, so he had to pokeyou hard enough to make you
bleed.
James Cripps (20:17):
Well you know the doctor that sent me to him.
When I got up off of the tablehe said Mr Cripps, you asked me
for an opinion.
I said, and he said you know Mr.
Cripps, I don't think there's adamn thing wrong with you, but
I want you to go see myspecialist.
Well, he sent me to see threespecialists and I got a letter
(20:40):
from all three of them, soactually he did me a favor.
Bethanie Spangenberg (20:48):
I guess he had to learn the hard way.
I don't know who's the victimhere.
James Cripps (21:01):
I guess he just thought I was a whiner, I don't
know.
Ray Cobb (21:05):
About the time that James was going through that, I
was really chasing him.
I was right behind him just bya few months, going through all
these type of things, and Ithink it was 100% correct that
what was really interesting backduring that time frame is that
(21:26):
they didn't believe us becausethere wasn't.
You know, James was the firstagent orange exposure, Mine was
the second, just a few monthslater and nobody else had had it
so and the others wereassumptions for being in Vietnam
, and the others wereassumptions for being in Vietnam
(21:47):
.
And I think you know I've raninto a lot of doubt where you
know, some folks even just callme a liar.
Bethanie Spangenberg (22:00):
Yeah, you know, I actually I have.
You know I work with a lot ofclinicians in this space and I
have a lot of clinicians thatask me questions about the
disability because they reallydon't understand how the VA
(22:20):
disability works.
Even clinicians inside the VAdon't understand how the
disability claims process works,how the disability claims
process works, and so sometimesit's the conversation of look,
they're not.
These veterans aren't standinghere with their foot to the
ground demanding that it was100% caused by service.
So the clinicians that ifclinicians are trying to
(22:43):
understand from that perspective, saying that there's absolute
proof that Agent Orange causedsomething, they have the wrong
mindset Because regardlesswhether or not they believe
they're a veteran or not, thestandard is not 100%, not 100%.
So what I tell those cliniciansis I say listen to their story,
(23:05):
document their symptoms and letthe compensation and pension
examiners handle their role.
You are their primary caredoctor, you are their orthopedic
specialist.
Document their symptoms.
It is not your place to try to100% prove that this happened.
And I feel like a lot ofveterans when they talk to their
(23:27):
doctor about even you twohaving the stateside exposure
where they don't believe you.
I feel like those cliniciansget wrapped up in like well, we
have to have 100% absolute proofthat this has caused it.
We have to have 100% absoluteproof that this has caused it.
And so they start to make youinto like whiners or like you're
(23:49):
telling tall tales, and I feellike a lot of veterans face that
when they go to the VA or to goto their providers and so if
that's their mentality, you knowthey've got the wrong
perspective and they really justneed to focus on the clinical
care and let the competent takecare of itself.
James Cripps (24:10):
Well, you know, in my case I have chloragny and
the only way you can getchloragny is dioxin exposure.
So it was, you know it dictatedmy exposure.
Actually it was a biomarker.
The environmental cliniciansaid it's a telltale sign.
(24:30):
Without that, I don't know.
I think they would have wrotethe heart disease as to
intercurrent causes and diabetesthe same thing.
But the chloragny and thechloragny is what I had the 13
(24:50):
diagnosis of, because I knewthat was going to be a critical
factor that turned their headsand made them think, hey, this
is not a whiner.
You know, where did he get thischloracne?
How can we explain that away?
They couldn't.
Bethanie Spangenberg (25:11):
And I'm glad that you were able to get
that service connection and whatwe see today.
We don't see a lot of thechloracne in the day-to-day
clinic stuff, lot of the coreacne, and in the day-to-day
clinic stuff there's actually awhole group of people involved
with the VA, the they call itthe risk, the war-related
illness and injury study centerand that is dedicated
(25:35):
specifically to war exposuresand chemical exposures.
So they can take a lot of notonly Agent Orange and these burn
pits but a lot of the otherchemicals that have been exposed
to our military people and theyput out a lot of information to
educate other clinicians.
(25:56):
But day to day that chloracneis not something we're seeing.
But veterans have to fight thatbattle.
The comp and pen examiners haveto make that opinion and I
don't know that all the comp andpen examiners are qualified to
render those opinions.
So I'm glad you're able to getthat.
(26:16):
I think there's.
I bring that up because I wantthe limitations to be known and
I say that so that veteransdon't give up.
I say that just because oneclinician doesn't believe you or
they're not listening to you,that there is other resources
(26:37):
available for you to talk withsomeone or get that opinion from
someone that's listening.
James Cripps (26:45):
Well, the acne was not on my entrance exam, but
it was all over my ETS exam.
Okay, so it happened in service.
No doubt about it.
Bethanie Spangenberg (26:58):
And it was bad.
James Cripps (27:02):
When I was transferred to Germany from Fort
Gordon I couldn't even leanback in a sedan seat, couldn't
stand it.
But I had no idea what wascausing it and to this day I
have pretty bad chloracne andI'm 76 years old.
Bethanie Spangenberg (27:23):
You know, I'd really appreciate seeing
some of those pictures.
Do you have older pictures ofwhat it looked like?
James Cripps (27:30):
I do on my website.
Bethanie Spangenberg (27:33):
Okay, I'll have to look into it.
James Cripps (27:40):
It's pretty revealing.
I'll tell you, I've never seenanother case like it and, as you
know, there are no new cases.
There will never be any newcases, I don't guess, unless it
comes from a chemical factory orsomething like that.
Ray Cobb (27:58):
Yeah, it's not around anymore.
Bethany, I know that when youwere talking about the doctor's
caring, I had no idea that AgentOrange existed and I'd been out
of the service quite a fewyears and I'd gotten back into
(28:18):
the va medical because ofdiabetes and I go in down to
nashville to the clinicalemergency.
My diabetes was over 500 andthey checked it and, uh, it
actually, while I was there, gotup to 700 and something.
And and it actually, while Iwas there, got up to 700 and
something.
And this ER doctor comes in andhe's looking at me and he looks
(28:43):
at my chart.
He says where were you inVietnam?
I says, well, I wasn't inVietnam.
He said you had to be.
And I said, no, sir, I wasn'tin Vietnam.
And he looked at my chart andflipped it two or three pages.
He says well then, where wereyou exposed to Agent Orange?
So doctors had been putting itin my notes and at that time we
(29:05):
didn't have VAgov, we couldn'tgo look at our medical notes
unless we went and got them, youknow.
And so I said, oh, that's easy.
I was at Fort McKellips,alabama chemical headquarters,
and he said have you put in forit?
And I said no, he said well,when you leave here today, you
go down to Building 8 and youturn in a claim for Agent Orange
(29:27):
exposure.
And I did, and that was thebeginning of it.
Wow.
But he took the time to lookover my records and I think all
he had was paper records becausehe had papers there in front of
him.
He wasn't looking on a computer, he had papers in his hands
(29:48):
flipping the pages.
So that was a while back.
Thank goodness we do have thecomputers nowadays.
But he didn, they paid attention.
James Cripps (30:02):
I was unaware of my exposure, even though I
actually sprayed it every dayfor a year and a half.
I was just killing weeds.
Agent Orange was the furthestthing from my mind and in 2004,
I saw the word for the firsttime, chloracne, and that
(30:26):
intrigued me.
The acne part of it, because Ihad acne so bad for so many
years.
So I looked it up, I did alittle research on chloracne and
what convinced me that Iactually had chloracne is the
(30:47):
butterfly formation on the face.
Chloracne never involves thenose and I never had a pimple on
my nose.
I get to thinking.
So I went to see a skinspecialist and he said, yeah, no
doubt my Agent Orange exam bythe clinician.
(31:12):
He recognized what it was, butI used that four years that they
refused to give me a C&P examto get those 13 opinions.
I had to nail it, I had toprove it and I knew I was going
to have to prove it or lose it.
(31:33):
But the chloracne, I think, iswhat actually won the case.
Ray Cobb (31:48):
Bethany.
Another question I knownowadays our C&P exams are done
by contract.
What do you see in that area?
Do you see that as animprovement or a disadvantage.
Bethanie Spangenberg (32:05):
So there's a couple of things.
I'm kind of sitting the fencefor some of the contract exams.
I'm concerned with a recentarticle that came out.
So my thoughts originally whenthey started moving to the
contract exams was that Ipreferred them to be contract
(32:26):
only because inside the VA thecompensation and pension
examiner they can do a very poorjob and they're still getting a
full-time paycheck withbenefits, and so the quality of
their work doesn't necessarilymean that they're going to move
(32:47):
positions.
They're not going to take themfrom comp to pen and put them
into primary care and thosecompensation and pension
examiners.
Production isn't necessarilypriority for them.
And I say that because when Iwas there I took over for
(33:07):
someone and I reduced their timein half and I would look at a
case and I would say, well, Ican determine this without doing
an exam.
I could write an opinion, I canreview the report and I don't
ever have to talk to the veteranor do the case and it makes my
numbers look good and thosenumbers reflected directly on
the chief of staff.
(33:28):
So my production was good andit made the chief of staff happy
.
They had some quality measuresin there.
They had some quality measuresin there, but the quality
(34:05):
measures weren't necessarilyclinicians reviewing other
clinicians' work.
It to me was more prevalent inthe contract side of things.
I know that they brought thecontract examinations on to meet
the need.
With COVID it kind of shut alot of it down, but with the
PACT Act they've more thandoubled the need for contract
exams and our company wasactually approached to be a
(34:27):
subcontractor to do these examsand so I found out what their
expectations were, you know whatkind of reimbursement they were
giving, what the requirementswere, and so it kind of opened
my eyes up to what is happening,actually happening on the
(34:49):
outside.
So there's other companies.
So we didn't end up doing itbecause we would have to shut
down the access to our veteransdirectly.
So we decided, you know we'renot going to go that route, we
are going to stay with whatwe're doing and find a different
means of getting exams.
So did you, ray or James?
(35:13):
Did you guys read the articlerecently from military?
It was put out like a week agofrom militarycom.
No, I didn't.
James Cripps (35:22):
About what.
Bethanie Spangenberg (35:24):
About comp and pen exams.
Ray Cobb (35:27):
No.
Bethanie Spangenberg (35:29):
So there was a report and so Senator
Elizabeth Warren pushed foranswers by May 14th from the VA.
And so in the article it'stalking about how the contract
examiners are not reviewingservice treatment records.
They are shredding evidencebecause they don't have a means
(35:53):
of getting it to the VA.
So veterans are walkingpaperwork into their exam and
rather than getting it to the VA, they're shredding it, and I've
heard about that for a while.
It talks about the qualityconcerns regarding the
examinations being done at likemedical spas or in hotels or
(36:15):
like co-working spaces andnon-medical facilities.
So those are concerns, and so Iwas interested in hearing that
information and I kind of wrotesome of my frustrations out and
I was going to even put a blogpost out about this article
(36:37):
because, being on our side andunderstanding trying to provide
an exam for a veteran, the costwas our concern.
If we're providing a productdirectly to the veteran, we need
to try to fit what the veterancan afford.
Veteran can afford, andunfortunately that cost was
(37:00):
astronomical, especially afterCOVID.
So I could not find an examinerto spend six hours and pay them
$1,000 to do exams, and if youbreak that down hourly that's.
I mean I'm talking about anurse practitioner or a PA
spending a day doing six hours,that's six exams, and so the
(37:23):
cost has gone up astronomically.
And then I see this cost thatthe VA is putting out to these
contract examiners and the costthat the government is
reimbursing the contractexaminers is not going to cover
(37:44):
the cost of doing an exam in amedical facility.
So the quality I would say isreflective of the money that's
being reimbursed to theexaminers, because the money is
not significant for me to gointo a medical facility and rent
a space to do these exams.
The other caveat is if I'm in aclinic and I'm like, okay, I
(38:07):
want to open up my clinic to dothese disability exams, well, it
takes me one hour to do a backDBQ.
So the back DBQ I see one examfor an hour where, if I'm in the
clinic, I can see four patientsin an hour for a follow-up
(38:29):
visit and the insurance willreimburse me significantly
higher than the VA would.
So why am I going to lower mymedical practice revenue by
filling that space with a compand pen exam when I can make
four times as much money byseeing my patients in the clinic
?
So it's not ideal for thepractice and then for the
(38:55):
individual clinicians it's andthen for the individual
clinicians it's how can weoptimize our reimbursement, and
still get the job done Does thatmake sense.
Ray Cobb (39:09):
Yeah, yes, hold on.
James Cripps (39:10):
You know the VA, the last C&P exam that I had and
I guess the last one I'll everhave.
The VA wanted a retrospectiveopinion of when I would have
been due are one paid inattendance.
(39:31):
They sent me to achiropractor's assistant to do
the exam.
I had my scooter but I couldn'tget into the building because
there were steps to go up to getinto the building.
I managed to get into thebuilding and the meeting was
(39:54):
held in a closet.
It couldn't have been no morethan six by eight, if even that
big.
My wife answered most of thequestions and the examiner said
that my wife wasn't present.
He did note that I ambulatedinto the building.
(40:23):
I had no other choice.
But he was also sharing thiscloset with a State Farm agent.
Bethanie Spangenberg (40:30):
Oh my gosh , I couldn't believe it yeah.
I mean, but that's the perfectexample.
So the examiner is trying tooptimize their availability, the
space that they have availableto them.
The cost for me to rent even aan exam room from a chiropractor
(40:54):
cannot be.
There's no value at the end ofthe day, when I've done my exams
and then I've paid out what itcosts to rent the medical
facility.
James Cripps (41:09):
This guy could make money at 50 bucks a pop
doing C&P exams.
Didn't take him 10 minutes.
Bethanie Spangenberg (41:18):
Oh, then that's a quality concern.
Ray Cobb (41:25):
Bethany, have you heard anything about these
contract people being sent thewrong C&P forms to fill out?
I know that happened to me onmy last one.
Bethanie Spangenberg (41:41):
I haven't heard that.
I wonder if that's because ofthe request that came down from
the regional office.
That's what that sounds like.
James Cripps (41:56):
Yeah, I think the writer defines the DBQ, don't
they?
Bethanie Spangenberg (42:03):
Yeah, the writer's supposed to say that's
not your choice.
James Cripps (42:06):
The writer chooses the DBQ.
Ray Cobb (42:08):
Right, yes, yeah, I know that the lady that did my
C&P.
She said it happened all thetime.
I had to go back to her for asecond one and that one lasted
an hour and a half and wasreally in-depth and that was for
my R2.
So, Bethany, you mentioned aminute ago about a back.
(42:33):
You're sorry about doing a backC&P.
I think we have a caller.
Let me see if I can get him tojoin us.
He's from over there wherejames is, I believe, in that
area.
See if we can get him to comeup for you there.
Caller, are you callingconcerning your back and
neuropathy in your feet?
James Cripps (42:55):
uh, yes, just that would be me.
Ray Cobb (42:57):
Okay, that's good, got the right one there.
Yeah, we have Bethany on.
James Cripps (43:06):
Tell Bethany what's going on and what you'd
like to know.
Well, I was diagnosed with dropfood and I've had back issues
all the way through.
It's noted in my militaryrecord not diagnosed.
And it's noted in my militaryrecord not diagnosed, but just
the fact that they just give meDarvon and muscle relaxers for
about six years or so of mymilitary time and nothing was
(43:32):
ever done.
So I ended up with drop foot.
So I'm looking to find a way toget the connection for my
injuries that were just workinginjuries, not necessarily a
falling off of something orsomething like that.
So the fact that it's noted inmy record is that any way that
(43:58):
could be taken as connection.
Bethanie Spangenberg (44:01):
So I love to hear that you were treated
for your back and prescribedmedications for your back in
service.
So that is very valuable.
When I look at these, from thecompensation and pension trying
to form a nexus there's a fewother questions I want to know
and understand and pensiontrying to form a nexus there's a
few other questions.
James Cripps (44:21):
I want to know and understand what was your
specialty in the military?
I was in engineering.
I was an engine man on boardship.
I overhauled, repaired andworked on extremely large diesel
engines, as well as the pumpand rigging and winches and
stuff that go along with asalvage ship.
I was on a sea tug Ocean goingtug.
Yes, go ahead.
Bethanie Spangenberg (44:45):
How often did you?
James Cripps (44:46):
lift anything over 50 pounds.
Bethanie Spangenberg (44:49):
Daily Okay .
James Cripps (44:49):
Every day yeah.
Bethanie Spangenberg (44:54):
Pretty much every day.
You said you had no particularor specific injuries to your
back.
James Cripps (45:02):
But what did you do when you got out of the
military?
Bethanie Spangenberg (45:08):
I got out of the military and went into
heating and air conditioning.
Okay, and how often did youhave to lift anything over 50
pounds when you've done theheating and air more or less
than you did in the military?
James Cripps (45:21):
A lot less.
Yes, very much less Okay.
Bethanie Spangenberg (45:26):
And when you got out of the military.
James Cripps (45:28):
I'm sorry.
No, go ahead, I'll let youfinish.
In the heating and airconditioning.
You always had someone to helpyou.
You had someone else to liftthe other part of it, so you
didn't have to lift over 50pounds very often.
Bethanie Spangenberg (45:49):
Okay, and just for understanding of like I
follow medical history and howthings were treated like over
time what dates of service like?
When did you get out?
James Cripps (46:00):
I got out in 73, went in in 65.
Bethanie Spangenberg (46:04):
Okay.
James Cripps (46:06):
Almost eight years Okay.
Bethanie Spangenberg (46:09):
And then, when did you first seek
treatment for your back afteryou got out of service?
James Cripps (46:18):
It was just off and on, wasn't right away.
Bethanie Spangenberg (46:26):
I guess I'm trying to get an
understanding of like okay, whenI hit 40, I had to go see my
primary care doctor and theygave me more muscle relaxers or
something along those lines ofyour history about how things
had continued.
James Cripps (46:45):
Well, I didn't see many doctors.
I didn't go to the VA.
I didn't think I had a right togo to the VA after they said
that you had to haveservice-connected disability or
injury and it just didn't stackup for me to understand that
(47:05):
part of it.
But I went pretty often, but Ididn't once twice a year.
It was a much easier job thanwhat I was doing in service Okay
and which came first Mucheasier job than what I was doing
in the service Okay, and whichcame first the drop foot or the
(47:30):
discovery of you havingarthritis in your back?
Knowledge of it drop foot camefirst, but I've always had a
back injury or back problem.
Bethanie Spangenberg (47:38):
Okay, so I would appreciate looking at
your medical records because, oreven if you don't do something
like us, I still encourage youto apply From an occupational
standpoint.
If you're lifting something morethan 50 pounds on a regular
basis without assistance foreight years and then you
(47:58):
transition to a job that let meback up and you were treated for
back issues in service that isvery prominent in your history
and then you take the fact thatyou transition to something
that's less labor intensive andthat you have assistance with.
If there's something that youknow is going to give you
(48:19):
troubles with lifting ormaneuvering, that toll on your
body is much greater from themilitary service than it ever
would be in your occupationpost-service.
So you take that time inservice, your duties in service,
your symptoms in service andyears later you now have drop
(48:40):
foot and back issues.
I would encourage you to applyfor a service connection for
your back and your neuropathy oryour drop foot.
So I think you've got a.
You know I can't always say agood chance, but I like your
(49:00):
chances.
So they're more likely than notgoing to be service-connected,
just based on your history andwhat I know from my practice in
both medicine and occupationalhealth and competent.
So I would absolutely encourageyou to go 100 miles an hour and
fight for that claim.
Ray Cobb (49:21):
Yeah, and.
James is there and he can helpyou go right through it.
He can take you right down thepath.
James Cripps (49:28):
Yeah, he needs an access letter, can he?
Bethanie Spangenberg (49:33):
get denied first on this one, because I
like that he's got it documentedin service.
Ray Cobb (49:40):
In other words, get denied.
James Cripps (49:42):
He's not filed for it.
Bethanie Spangenberg (49:44):
Yeah, I'm not filed for it.
Filing if you get denied willhelp you out, because the fact
that you have it documented inservice and when you go to write
your statement, you put inthere that you were lifting more
than 50 pounds, 50 pounds plusevery day and what you were
doing you need to make surethat's very clear.
James Cripps (50:03):
Yes, okay.
Ray Cobb (50:06):
Great Thanks for the call.
Appreciate it, Bethany.
We've got another thing.
Thank you, Bethany.
This is what James does in hisarea down there, and he's
extremely good at it.
And, james, I think you've gota great story to tell us tonight
.
A phone call you got thismorning, didn't you?
James Cripps (50:28):
Well, it actually was about 2 or 3 o'clock this
evening.
A lady called.
She was crying.
My wife actually answered thephone.
She wanted to know if this wasthe phone number of the guy that
won the first Agent Orangeclaim at Fort Gordon.
(50:48):
She got on the phone and shesaid her husband had won his
Agent Orange claim at FortGordon after a seven-year battle
and she said it was your storyand your inspiration that
spurred us on to fight thisthing and not quit.
Bethanie Spangenberg (51:11):
That's awesome.
James Cripps (51:15):
It's a warm feeling really to be able to
change somebody's life.
We like to hear those stories,we like to know what we're doing
.
She had just found my websiteand she listened to the Exposed
(51:37):
Vet broadcast two or threebroadcasts ago when we were
talking about Fort Gordon aftermy last WRDW broadcast down
there.
But anyway, she said I'm goingback to your website.
That's a huge website and it is.
(51:57):
There's a lot of informationthere.
But yeah, we're always glad tohear that we're not just wasting
our time, that somebody'sactually benefiting from what
we're doing.
Bethanie Spangenberg (52:10):
That's exciting.
You know, I'd like to take aminute to share a story, if you
don't mind.
Ray Cobb (52:17):
No, go ahead please.
Bethanie Spangenberg (52:20):
I think in any profession, you know, you
really need to be humble andappreciate what you know and
what you don't know.
And if you don't know, you know, be able to, you know, tell the
person you're working with hey,you know, I'm not sure, but let
me find a resource.
Or, you know, I encourage youto seek other resources.
(52:40):
So back several years ago, Ithought I wanted to do the
representation thing we'retalking gosh six or seven years
ago, right when I first becameaccredited, and then, when I got
into it, they started doing thechanges to the AMA.
First it was RAMP and then theymessed up RAMP and then they
(53:01):
turned it to the AMA and that'sbeen a hot mess.
So I decided you know what, I'mnot going to do this and I
turned my veterans over to anattorney that I have known for a
long time.
You know I can't help you atthis point because I don't feel
(53:22):
like they're going to listen tome.
I for your claim, and this isone particular woman I said I
know this, I know you have thisclaim, I believe your story, I
believe in what the evidence isshowing, but I need to give you
to somebody else and I found outthis week that she was finally
granted and she wasretroactively paid for that
(53:45):
whole time period.
And even though she's no longerwith me as me being her
representative, she was stillable to get that service
connection, and so that's stilla win.
That's still a win for me,because I knew she had the
disability, I knew it wasrelated to service and she
(54:11):
didn't get there with anythingthat I did from the medical
standpoint.
The legal evidence was therefor her, and so I was not able
to carry her to the finish line,but I knew somebody who did,
and six years later she'scrossed the finish line and she
got a retroactive pay.
So that's so exciting to sharein that good news and that
life-changing event.
So I just wanted to share that,oh appreciate you doing that.
James Cripps (54:34):
Every time they win, we win again.
Ray Cobb (54:36):
Yep every time.
And I don't know of anythingthat makes me feel any better
than when a person says do yourealize how you've changed our
life?
I had a gentleman just a fewweeks ago.
Same thing.
He was at 40 percent and I toldhim one simple little thing.
(54:59):
When he told me he had beenfired because he couldn't get
along with others, I said willyour employer write you a letter
to that effect?
And he said well, I guess hewill.
He turned it in and withinthree weeks he had gone from 40%
to 100% on his PTSD because hecould not work with others.
(55:20):
And you know, I mean he workedfor the state of Tennessee and
he took care of the grounds atthe state park.
You know he drove a tractor andmowed the grass and things.
So it wasn't exactly a recordhigh-paying job.
And now he's making more thanhe did when he worked for the
(55:41):
state and he had been with thestate long enough to be able to
take an early retirement.
So a great change in his lifeand a change for his wife as
well.
That's awesome.
That's what it's all about.
We're down to less than fourminutes left in the program.
Tell us a little bit, bethany,about your webpage and exactly
(56:06):
what all you do and how peoplecan reach out and get in touch
with you.
Bethanie Spangenberg (56:12):
So my company is Valor for Vets.
We are a team of medicalexperts that provide nexus
letters and we've been doing itas a team since 2015.
Next year will be our 10 years.
We really focus onunderstanding the requirements
of the VA and really trying toput the quality factor above the
(56:33):
VA's expectations.
So we also provide a few of theDBQs that can be conducted by
ACE and we work with veterans,vsos and attorneys that are
accredited agents.
So if you want to visit ourwebsite, there's a wealth of
information on our websiteregarding medical conditions as
well.
(56:53):
Our website is VALOR V-A-L-O-R,the number four vet V-E-T dot
com.
Ray Cobb (57:02):
And I like one thing on your web page that I enjoyed
but this is just a personal whenyou I looked on your web page
and I saw where you could findout about your company and he
actually got a video whereyou're talking and you're
telling how you developed yourcompany and how you found it.
And that's really strong guys.
If you're you know, a lot oftimes we hear names and doctor's
(57:26):
names or whatever, but itdoesn't tell you how they got it
.
If they have a degree, itdoesn't even tell you where it
came from.
But in her webpage it takes youstep by step and it's a
beautiful webpage and easy tofind things and easy to get
through.
Bethany, and I appreciate thatbeing there, and I have
recommended to several veteranshere in the Middle Tennessee
(57:48):
area to look into it and to seewhat's going on and get in touch
with you if they think that youcan help and guys, it doesn't
hurt to reach out and if shecan't help, I'm sure she'll tell
you so or, like she saidearlier, direct you in the right
direction and that's what it'sall about.
Bethanie Spangenberg (58:08):
And we actually just added recently an
option to ask a medical expert aquestion.
So if there's something youknow and that's at no cost, so
if you have, just like thecaller came on tonight if he
wants to explain his story, youknow, night, if he wants to
explain his story, you know, Ican kind of give what little bit
feedback I did and encourageyou or guide you in the next
step or in the right directionso you can go on our website and
(58:30):
fill that out.
Ray Cobb (58:32):
Yeah, great, james, tell us about.
I love the name of your webpageVA, the Redneck Way.
I mean that, just that suitsyou perfect.
I'm telling you.
James Cripps (58:42):
I mean that suits you perfect.
I'm telling you, tell them howto reach you.
Yeah, you can communicate withme or get a hold of me, or read
a whole lot.
There's a lot of informationthere on how to win your claim,
how to submit your claim.
(59:04):
It's kind of inspiring.
And that's VATheredneckwaycom.
Ray Cobb (59:09):
Spell it just like it sounds, vatheredneckwaycom and
folks, I have a local radiostation that I do every Tuesday
morning, 9 o'clock Central Time.
You can go on the Internet andgo to WZYX Radio and click on
the live and you can hear itlive, or you can look down and
find where it says recorded andyou'd be able to listen to the
(59:30):
previous recorded shows for theprevious four weeks.
With that guys, we're out oftime.
Bethany, a special thanks toyou for coming on tonight.
I thoroughly enjoyed it.
It's a topic that's alwaysinterested me.
On tonight, I thoroughlyenjoyed it.
It's a topic that's alwaysinterested me.
And with that we will beshutting down on behalf of John
James and Bethany.
This is Ray Cobb sayinggoodnight and have a great
(59:52):
evening.
J Basser (59:55):
You have been listening to the Exposed that
Podcast.
Any opinions expressed on theshow are the opinions of the
guest speakers and notnecessarily the opinions of
Exposed that, Exposed Thatcom orBlog Talk Radio.
Tune in next week for anotherepisode of the Exposed that
Podcast.
Thanks for listening.
Ray Cobb (01:00:18):
I'm sorry just a second.
I'm sorry, I'm sorry, I'm sorry, I'm sorry, I'm sorry, I'm
sorry, I'm sorry, I'm sorry, I'msorry, I'm sorry, I'm sorry,
I'm sorry, I'm sorry, I'm sorry,I'm sorry, I'm sorry, I'm sorry
, I'm sorry, I'm sorry.
Bethanie Spangenberg (01:00:30):
I'm sorry.
Blog Talk Radio.
J Basser (00:05):
It's time for the Exposed Vet Radio Show.
The Exposed Vet Radio Show, wediscuss issues affecting today's
veteran.
Now here's your host, john andRay.
Ray Cobb (00:18):
Hey, good evening everybody.
John's taking the night offtonight.
His son is getting ready tograduate from the University of
Kentucky.
Well, I think about two orthree degrees.
He has some honors.
So John had to go over theretonight and, I think, attend a
banquet.
So congratulations to him andhis son and what they've
accomplished so far, looking fora good future for that young
(00:42):
man, very, very smart, veryintelligent.
My co-host tonight is over inWest Tennessee, a little west of
Nashville, not too far.
It's within Stone's Throw, aswe say down here in the south,
and that's James Cripps.
James, welcome aboard.
James Cripps (00:59):
Well, I appreciate the invite, Ray.
Ray Cobb (01:02):
Yeah, and our special guest tonight, our VIP, is
Stephanie.
Stephanie is in charge of Valorfor Vet.
Am I correct there, stephanie?
Bethanie Spangenberg (01:15):
So, Ray, you always get my name.
Ray Cobb (01:17):
Yeah, bethany, I'm sorry, I'm saying Stephanie,
that's all right.
Bethanie Spangenberg (01:21):
You know.
What's funny, though, is mymother's name is Stephanie, so
I'm used to the Stephanie,bethany or Brittany.
I answer to all of them, ohokay.
It's Bethany Spangenberg, withValor for Vets.
Ray Cobb (01:34):
Okay, and I think tonight you're going to start
off talking a little bit aboutS&P exams, is that right?
No, I'm sorry we're going totalk about my mind just went
blank in.
James Cripps (01:55):
C&P exams.
Bethanie Spangenberg (01:58):
C&P exams from contractor exams, the do's
and the don'ts.
There's a militarycom reportthat came out that we can talk
about.
There's, you know, alldifferent things that we can
cover tonight's show.
Ray Cobb (02:16):
All right, let's get started C&P exams.
When I had my first one, I wasscared to death.
I didn't have any idea what wasgoing to happen.
I was scared to death.
Bethanie Spangenberg (02:24):
I didn't have any idea what was going to
happen.
So that's a familiar feeling,especially because the VA tends
to call veterans for exams whenthey're not necessary.
And you know, someinvestigation reports or
(02:48):
follow-up reports have said,yeah, the VA tends to order
examinations, or the raters atthe regional office tend to
order exams more frequently thanthey should and they're
supposed to be kind of slowingdown on that, trying to be able
to rate the veteran for what isin the file versus having them
come in for another exam.
So typically when you get aletter in the mail, if it's with
the contractor that's doing theexam or if it's with the VA,
(03:10):
you'll get a letter to reportfor the exam.
Some of them even say not toreport to the exam.
So just depends on what, whatcondition they're looking at and
they should disclose that inthe letter that they send to you
.
So that kind of gives you aheads up on what topic will be
discussed.
So now your first comp and pen.
(03:31):
What exam was that for?
What were they evaluating youfor then?
Ray Cobb (03:36):
My first one was diabetes.
Military-connected Agent Orangein the United States,
military-connected Agent Orangein the United States and, of
course, at that time, the onlyperson.
Well, as a matter of fact, whenI went for my C&P exam the
first time, no one had receivedit, and then James became the
(04:04):
first to receive his AgentOrange exposure in the United
States.
And then my CFP.
I had two CFP exams and thesecond one.
They were about a year apart.
I think they sent me for onebefore I went to the board.
They sent me for one at thebeginning, when I first filed
the claim, or shortly thereafter, and then my next CMP was a
(04:24):
little bit before I went beforethe board okay, so we're really
the same.
Bethanie Spangenberg (04:31):
Each like was your experience the same
when you went for those, sinceit was for the same condition?
Ray Cobb (04:39):
and now they it wasn't .
The second one asked more likehow do you know you were exposed
to Agent R's.
And then both the commonquestion that they both asked
did we have any history ofdiabetes in our family?
(05:03):
We have any history of diabetesin our family?
Ah, you know, that's kind ofone thing that they were
reaching out after.
Then the rest of that was whatis my blood sugars doing?
What's my highs, what's my lows?
Have I found anything thatwould cause it to go up?
(05:24):
Or was there?
What could I do to when it wentup?
What could I do to get it down?
Bethanie Spangenberg (05:36):
Questions of that nature.
Ray Cobb (05:39):
Now, about what date or time frame was your first
comp and pen?
Oh, 2006.
And it was until recently allmy.
Bethanie Spangenberg (06:03):
CMPs have been done by VA nurse
practitioners.
Okay, the reason I ask isbecause when so I've been, I was
in-house doing compensation andpension exams from about 2011
to 2013, and it was about thattimeframe that they really
opened up what we now call DBQs.
Prior to that, they referencedthem as worksheets and it wasn't
(06:27):
really targeted for the legalschedule and we just collected
basic history and examinationinformation.
It wasn't something specificregarding how many low blood
sugars or specific questionsabout insulin and how many shots
per day.
We were just to document,almost as if it was a clinic
(06:47):
exam.
And even prior to thoseworksheets.
You look at DBQs historically, alot of the older exams I can
say probably 1980s, early 1990sthey were actually really
thorough from the medicalperspective but again, they
weren't tailored to the ratingschedule.
(07:10):
They were more of acomprehensive examination and
assessment by the physician andI really appreciate reading
those old reports because I'mlike man, that's a really good
assessment of a clinicalcondition and so to see that
(07:32):
transformation of you know theolder exams and what was done
and as they brought in theworksheets and then as they
brought into the DBQs, so yourfirst C&P exam, if that was
2006,.
They didn't have DBQs then.
So a lot of the questions mayhave been broader questions like
just tell me about your bloodsugars or what was your
(07:53):
something not specific to rating?
That's why I asked thatquestion.
It's kind of understanding thehistory behind those changes.
Ray Cobb (08:03):
Yeah, that's a.
James Cripps (08:04):
You know, Bethany .
Ray Cobb (08:06):
Go ahead, James.
James Cripps (08:11):
I submitted my claim and I went four years all
the way to the Board of VeteransAppeals with no C&P exam.
They would not order a C&P exambecause I was claiming exposure
inside the continental UnitedStates and the VA and the DOD
(08:32):
said we never, ever used AgentOrange inside the continental
United States.
So they expected my claim to bejust thrown out at the board.
But the judge recognized, youknow that I had ischemic heart
disease, although that wasbefore ischemic heart disease
(08:53):
was recognized.
I had to claim it as secondaryto diabetes.
But I had the diabetes, I hadthe chloracne, I had the heart
disease, I had the neuropathyand the judge picked up on the
fact.
You know this guy's gotchloracne and that's a bowel
marker.
So those claims were awardedwithout a C&P examination.
(09:19):
The first C&P examination Iever had was years later lost
the use of two feet, even had apsychological claim granted
severe anxiety and depression,without a C&P exam.
So times have changed.
Bethanie Spangenberg (09:42):
They have, they really have.
That's interesting.
You went four years withouteven just talking to any
examiner whatsoever.
James Cripps (09:51):
Right.
Bethanie Spangenberg (09:52):
You know that evidence would have been
valuable to have.
James Cripps (09:57):
I wanted.
I begged for a C&P exam.
It's in my records that I wasjust begging for one and they
just refused to give me one.
They wasn't obligated to giveme one because they said it
wouldn't make any difference inthe claim.
Bethanie Spangenberg (10:14):
Now what time?
Frame was that.
James Cripps (10:17):
That was 2001.
In 2009, I submitted the claimin 2005.
Bethanie Spangenberg (10:22):
I submitted the claim in 2005.
I'm assuming, I guess, as faras from there you went to the
board and what happened fromthere with your claim?
James Cripps (10:42):
It was awarded at the board.
J Basser (10:44):
It was a partial grant .
James Cripps (10:48):
They granted what they could grant and then they
sent it back to the regionaloffice and said pay the man for
what we have granted and sendhim for C&P exams.
On the other issues they sat onit six months and sent it right
back to the AMA without doingC&P exams.
(11:08):
So the AMA headed it off.
They saw what was happening.
It was bias in the claim andthey went ahead and warded the
others without a C&P, without aCNP.
Bethanie Spangenberg (11:33):
But at the Board of.
James Cripps (11:35):
Veterans Appeals.
I had 13 nexus letters.
Bethanie Spangenberg (11:37):
That takes a lot of doctor shopping.
I have no doubt yeah.
James Cripps (11:44):
I've got a friend and he was just notified today
of an upcoming C&P exam.
It said expect a letter andit's either going to be on aid
and attendance or it's going tobe on loss of use of two hands.
(12:07):
Aid and attendance is prettywell straightforward.
It's just making sure he has tohave help with his activities
and daily living.
What can he expect on a loss ofuse of two hands?
That's not going to deal withloss of motion but grip and
(12:28):
strength.
What can he expect out of thatexam?
Bethanie Spangenberg (12:35):
Do you know what the loss of use of
both hands is tied to?
Is it tied to neuropathy?
James Cripps (12:40):
Is it tied to diabetic neuropathy Is it tied
to Diabetic?
Bethanie Spangenberg (12:44):
neuropathy .
Okay, so it's going to be.
To be honest, it should be thestandard diabetes exam, because
the standard diabetes exam asksthe examiner to test the upper
and lower extremities.
So I'll be surprised becausetypically your loss of use with
(13:07):
diabetes will come in your feetfirst and then they go into your
hands.
James Cripps (13:12):
He already has lost use of two feet.
Bethanie Spangenberg (13:16):
Perfect.
So that helps his claim.
So what he should expect isthey should do inspection of his
hands.
They're going to see if he hassoft sensation.
So they'll take like a cottonball or tissue and run it
through on his fingertips and uphis arm.
They may even do like a sharpdoll, like they'll have a sharp
(13:37):
object or a doll object thatthey'll press on the hand to see
if he can feel.
They should do a cold, likesomething cold, to see if he can
feel whether it's cold or hot.
They'll do his range of motion.
They will do his strengthtesting.
That is a comprehensive exam.
Some examiners will do the bareminimum, some of them will do
(13:59):
range of motion, strengthtesting and then they try to
grade whether it's mild,moderate or severe neuropathy on
the hands.
So he should be.
If it's done the right way, heshould be in and out in about 45
minutes.
If they cut him short it'll belike 20.
Yeah.
James Cripps (14:22):
I have lost the use of two hands granted and
lost the use of two feet.
I had C&P for loss of use oftwo feet.
I did not have a DBQ or an examfor loss of use of two hands.
Bethanie Spangenberg (14:41):
So for your feet, what did they
determine the severity to be?
James Cripps (14:47):
Severe.
Bethanie Spangenberg (14:50):
And they didn't look at your hands at all
.
James Cripps (14:53):
No.
Bethanie Spangenberg (14:57):
If there's veterans out there and they're
listening and you know that yourneuropathy and your feet are
severe and you're going for yourDBQ, ask them about your hands,
say, well, what about my hands?
I have the same or similarsymptoms in my hands and you can
say they're about the same,maybe they're not as bad.
But you need to bring that totheir attention because the
(15:18):
examiner who is doing anevaluation for diabetes, it is
in their form to look forneuropathy of all four
extremities, not just the lower.
So in that instance, if you areconcerned with neuropathy,
bring it up.
Excuse me, you need to eitherfile for it so that way they
(15:41):
address it, or look at your oldrecords to see if there's
anything documented in the DBQ,because that's concerning.
Ray Cobb (15:57):
That would be something as a representative
that I would want to look at.
In 2014, or 15, excuse me, 2015,I went for my first foot drop
in my right foot and secondaryto diabetic neuropathy, and they
(16:17):
did check my left foot, whichat that time was fine, but they
never checked my hands.
And then, I think a year later,I had to go back for the other
foot and finally got loss of useof both feet about 14 months
apart, but they still never.
My hands are bothering me now,but my rating is so high I don't
(16:38):
even fool with it.
Should they have checked myhands at that time when they
were checking me for foot drop?
Bethanie Spangenberg (16:45):
Yes, they should have.
They should have.
James Cripps (16:52):
You know, that kind of explains my situation,
because I won my lawsuit twofeet at the Board of Veterans'
Appeals.
Then I went back for loss ofuse of two hands.
That was awarded at the courtand they paid me back to the
(17:18):
same date of loss of use of twofeet, which was a 10-year total
back pay.
Bethanie Spangenberg (17:30):
It's good that they finally discussed it,
so I guess what they were sayingthere.
James Cripps (17:35):
Yeah, I guess what they were saying there is.
It should have been inferred atthe same time as loss of use of
two feet been inferred at thesame time as loss of two feet.
Bethanie Spangenberg (17:52):
Yeah, because your hands are going to
be, the blood flow is typicallybetter because they don't have
the resistance that your feet do.
So for your blood to get backfrom your feet back up to your
heart, it's more work, it'sfurther distance for your feet
back up to your heart, it's morework, it's further distance for
your feet.
So that's why diabetics tend toget the neuropathy in their
feet first and then they developit in their hands.
(18:12):
If a diabetic has a mildneuropathy, clinically we're not
going to suspect that there isneuropathy in their hands.
It's not until the neuropathygets progressively worse in the
feet that we get concerned withthe neuropathy in the hands.
But if there's a patient that Iknow has severe neuropathy in
their feet clinically, I'mabsolutely going to look at
(18:33):
their hands and inspect and seewhat changes are going on with
their hands.
James Cripps (18:40):
Actually my hands are clawing.
That's not good.
I had an EMG years ago on myhands.
I went to a hand specialist andhe said Mr Cripps, I don't
think there's anything wrongwith your hands.
He said, but I want you to gosee my specialist.
(19:01):
And he sent me for an EMG onthe hands and the guy did the
EMG, stuck all the needles in meand did his testing and he
didnít say anything.
But he followed me back out tothe desk to make my return
appointment or settle up orwhatever it was.
(19:22):
I had to go back to the desk forand he walked up behind me and
he reached down and with somekind of instrument I never saw
what he had he snagged the palmof my hand and ripped up on it
and I knew he did something.
And I looked at my hand and itwas bleeding and he said I
(19:45):
apologize for that, I had to dothat.
But he said now I can tell you,your hands are not going to get
any worse.
Must have been some kind ofnerve or something that he poked
or prodded or ripped.
I don't know what he did, butit convinced him that that hand
(20:07):
didn't have much feeling in it.
Bethanie Spangenberg (20:10):
That almost sounds like he didn't
believe you, so he had to pokeyou hard enough to make you
bleed.
James Cripps (20:17):
Well you know the doctor that sent me to him.
When I got up off of the tablehe said Mr Cripps, you asked me
for an opinion.
I said, and he said you know Mr.
Cripps, I don't think there's adamn thing wrong with you, but
I want you to go see myspecialist.
Well, he sent me to see threespecialists and I got a letter
(20:40):
from all three of them, soactually he did me a favor.
Bethanie Spangenberg (20:48):
I guess he had to learn the hard way.
I don't know who's the victimhere.
James Cripps (21:01):
I guess he just thought I was a whiner, I don't
know.
Ray Cobb (21:05):
About the time that James was going through that, I
was really chasing him.
I was right behind him just bya few months, going through all
these type of things, and Ithink it was 100% correct that
what was really interesting backduring that time frame is that
(21:26):
they didn't believe us becausethere wasn't.
You know, James was the firstagent orange exposure, Mine was
the second, just a few monthslater and nobody else had had it
so and the others wereassumptions for being in Vietnam
, and the others wereassumptions for being in Vietnam
(21:47):
.
And I think you know I've raninto a lot of doubt where you
know, some folks even just callme a liar.
Bethanie Spangenberg (22:00):
Yeah, you know, I actually I have.
You know I work with a lot ofclinicians in this space and I
have a lot of clinicians thatask me questions about the
disability because they reallydon't understand how the VA
(22:20):
disability works.
Even clinicians inside the VAdon't understand how the
disability claims process works,how the disability claims
process works, and so sometimesit's the conversation of look,
they're not.
These veterans aren't standinghere with their foot to the
ground demanding that it was100% caused by service.
So the clinicians that ifclinicians are trying to
(22:43):
understand from that perspective, saying that there's absolute
proof that Agent Orange causedsomething, they have the wrong
mindset Because regardlesswhether or not they believe
they're a veteran or not, thestandard is not 100%, not 100%.
So what I tell those cliniciansis I say listen to their story,
(23:05):
document their symptoms and letthe compensation and pension
examiners handle their role.
You are their primary caredoctor, you are their orthopedic
specialist.
Document their symptoms.
It is not your place to try to100% prove that this happened.
And I feel like a lot ofveterans when they talk to their
(23:27):
doctor about even you twohaving the stateside exposure
where they don't believe you.
I feel like those cliniciansget wrapped up in like well, we
have to have 100% absolute proofthat this has caused it.
We have to have 100% absoluteproof that this has caused it.
And so they start to make youinto like whiners or like you're
(23:49):
telling tall tales, and I feellike a lot of veterans face that
when they go to the VA or to goto their providers and so if
that's their mentality, you knowthey've got the wrong
perspective and they really justneed to focus on the clinical
care and let the competent takecare of itself.
James Cripps (24:10):
Well, you know, in my case I have chloragny and
the only way you can getchloragny is dioxin exposure.
So it was, you know it dictatedmy exposure.
Actually it was a biomarker.
The environmental cliniciansaid it's a telltale sign.
(24:30):
Without that, I don't know.
I think they would have wrotethe heart disease as to
intercurrent causes and diabetesthe same thing.
But the chloragny and thechloragny is what I had the 13
(24:50):
diagnosis of, because I knewthat was going to be a critical
factor that turned their headsand made them think, hey, this
is not a whiner.
You know, where did he get thischloracne?
How can we explain that away?
They couldn't.
Bethanie Spangenberg (25:11):
And I'm glad that you were able to get
that service connection and whatwe see today.
We don't see a lot of thechloracne in the day-to-day
clinic stuff, lot of the coreacne, and in the day-to-day
clinic stuff there's actually awhole group of people involved
with the VA, the they call itthe risk, the war-related
illness and injury study centerand that is dedicated
(25:35):
specifically to war exposuresand chemical exposures.
So they can take a lot of notonly Agent Orange and these burn
pits but a lot of the otherchemicals that have been exposed
to our military people and theyput out a lot of information to
educate other clinicians.
(25:56):
But day to day that chloracneis not something we're seeing.
But veterans have to fight thatbattle.
The comp and pen examiners haveto make that opinion and I
don't know that all the comp andpen examiners are qualified to
render those opinions.
So I'm glad you're able to getthat.
(26:16):
I think there's.
I bring that up because I wantthe limitations to be known and
I say that so that veteransdon't give up.
I say that just because oneclinician doesn't believe you or
they're not listening to you,that there is other resources
(26:37):
available for you to talk withsomeone or get that opinion from
someone that's listening.
James Cripps (26:45):
Well, the acne was not on my entrance exam, but
it was all over my ETS exam.
Okay, so it happened in service.
No doubt about it.
Bethanie Spangenberg (26:58):
And it was bad.
James Cripps (27:02):
When I was transferred to Germany from Fort
Gordon I couldn't even leanback in a sedan seat, couldn't
stand it.
But I had no idea what wascausing it and to this day I
have pretty bad chloracne andI'm 76 years old.
Bethanie Spangenberg (27:23):
You know, I'd really appreciate seeing
some of those pictures.
Do you have older pictures ofwhat it looked like?
James Cripps (27:30):
I do on my website.
Bethanie Spangenberg (27:33):
Okay, I'll have to look into it.
James Cripps (27:40):
It's pretty revealing.
I'll tell you, I've never seenanother case like it and, as you
know, there are no new cases.
There will never be any newcases, I don't guess, unless it
comes from a chemical factory orsomething like that.
Ray Cobb (27:58):
Yeah, it's not around anymore.
Bethany, I know that when youwere talking about the doctor's
caring, I had no idea that AgentOrange existed and I'd been out
of the service quite a fewyears and I'd gotten back into
(28:18):
the va medical because ofdiabetes and I go in down to
nashville to the clinicalemergency.
My diabetes was over 500 andthey checked it and, uh, it
actually, while I was there, gotup to 700 and something.
And and it actually, while Iwas there, got up to 700 and
something.
And this ER doctor comes in andhe's looking at me and he looks
(28:43):
at my chart.
He says where were you inVietnam?
I says, well, I wasn't inVietnam.
He said you had to be.
And I said, no, sir, I wasn'tin Vietnam.
And he looked at my chart andflipped it two or three pages.
He says well then, where wereyou exposed to Agent Orange?
So doctors had been putting itin my notes and at that time we
(29:05):
didn't have VAgov, we couldn'tgo look at our medical notes
unless we went and got them, youknow.
And so I said, oh, that's easy.
I was at Fort McKellips,alabama chemical headquarters,
and he said have you put in forit?
And I said no, he said well,when you leave here today, you
go down to Building 8 and youturn in a claim for Agent Orange
(29:27):
exposure.
And I did, and that was thebeginning of it.
Wow.
But he took the time to lookover my records and I think all
he had was paper records becausehe had papers there in front of
him.
He wasn't looking on a computer, he had papers in his hands
(29:48):
flipping the pages.
So that was a while back.
Thank goodness we do have thecomputers nowadays.
But he didn, they paid attention.
James Cripps (30:02):
I was unaware of my exposure, even though I
actually sprayed it every dayfor a year and a half.
I was just killing weeds.
Agent Orange was the furthestthing from my mind and in 2004,
I saw the word for the firsttime, chloracne, and that
(30:26):
intrigued me.
The acne part of it, because Ihad acne so bad for so many
years.
So I looked it up, I did alittle research on chloracne and
what convinced me that Iactually had chloracne is the
(30:47):
butterfly formation on the face.
Chloracne never involves thenose and I never had a pimple on
my nose.
I get to thinking.
So I went to see a skinspecialist and he said, yeah, no
doubt my Agent Orange exam bythe clinician.
(31:12):
He recognized what it was, butI used that four years that they
refused to give me a C&P examto get those 13 opinions.
I had to nail it, I had toprove it and I knew I was going
to have to prove it or lose it.
(31:33):
But the chloracne, I think, iswhat actually won the case.
Ray Cobb (31:48):
Bethany.
Another question I knownowadays our C&P exams are done
by contract.
What do you see in that area?
Do you see that as animprovement or a disadvantage.
Bethanie Spangenberg (32:05):
So there's a couple of things.
I'm kind of sitting the fencefor some of the contract exams.
I'm concerned with a recentarticle that came out.
So my thoughts originally whenthey started moving to the
contract exams was that Ipreferred them to be contract
(32:26):
only because inside the VA thecompensation and pension
examiner they can do a very poorjob and they're still getting a
full-time paycheck withbenefits, and so the quality of
their work doesn't necessarilymean that they're going to move
(32:47):
positions.
They're not going to take themfrom comp to pen and put them
into primary care and thosecompensation and pension
examiners.
Production isn't necessarilypriority for them.
And I say that because when Iwas there I took over for
(33:07):
someone and I reduced their timein half and I would look at a
case and I would say, well, Ican determine this without doing
an exam.
I could write an opinion, I canreview the report and I don't
ever have to talk to the veteranor do the case and it makes my
numbers look good and thosenumbers reflected directly on
the chief of staff.
(33:28):
So my production was good andit made the chief of staff happy
.
They had some quality measuresin there.
They had some quality measuresin there, but the quality
(34:05):
measures weren't necessarilyclinicians reviewing other
clinicians' work.
It to me was more prevalent inthe contract side of things.
I know that they brought thecontract examinations on to meet
the need.
With COVID it kind of shut alot of it down, but with the
PACT Act they've more thandoubled the need for contract
exams and our company wasactually approached to be a
(34:27):
subcontractor to do these examsand so I found out what their
expectations were, you know whatkind of reimbursement they were
giving, what the requirementswere, and so it kind of opened
my eyes up to what is happening,actually happening on the
(34:49):
outside.
So there's other companies.
So we didn't end up doing itbecause we would have to shut
down the access to our veteransdirectly.
So we decided, you know we'renot going to go that route, we
are going to stay with whatwe're doing and find a different
means of getting exams.
So did you, ray or James?
(35:13):
Did you guys read the articlerecently from military?
It was put out like a week agofrom militarycom.
No, I didn't.
James Cripps (35:22):
About what.
Bethanie Spangenberg (35:24):
About comp and pen exams.
Ray Cobb (35:27):
No.
Bethanie Spangenberg (35:29):
So there was a report and so Senator
Elizabeth Warren pushed foranswers by May 14th from the VA.
And so in the article it'stalking about how the contract
examiners are not reviewingservice treatment records.
They are shredding evidencebecause they don't have a means
(35:53):
of getting it to the VA.
So veterans are walkingpaperwork into their exam and
rather than getting it to the VA, they're shredding it, and I've
heard about that for a while.
It talks about the qualityconcerns regarding the
examinations being done at likemedical spas or in hotels or
(36:15):
like co-working spaces andnon-medical facilities.
So those are concerns, and so Iwas interested in hearing that
information and I kind of wrotesome of my frustrations out and
I was going to even put a blogpost out about this article
(36:37):
because, being on our side andunderstanding trying to provide
an exam for a veteran, the costwas our concern.
If we're providing a productdirectly to the veteran, we need
to try to fit what the veterancan afford.
Veteran can afford, andunfortunately that cost was
(37:00):
astronomical, especially afterCOVID.
So I could not find an examinerto spend six hours and pay them
$1,000 to do exams, and if youbreak that down hourly that's.
I mean I'm talking about anurse practitioner or a PA
spending a day doing six hours,that's six exams, and so the
(37:23):
cost has gone up astronomically.
And then I see this cost thatthe VA is putting out to these
contract examiners and the costthat the government is
reimbursing the contractexaminers is not going to cover
(37:44):
the cost of doing an exam in amedical facility.
So the quality I would say isreflective of the money that's
being reimbursed to theexaminers, because the money is
not significant for me to gointo a medical facility and rent
a space to do these exams.
The other caveat is if I'm in aclinic and I'm like, okay, I
(38:07):
want to open up my clinic to dothese disability exams, well, it
takes me one hour to do a backDBQ.
So the back DBQ I see one examfor an hour where, if I'm in the
clinic, I can see four patientsin an hour for a follow-up
(38:29):
visit and the insurance willreimburse me significantly
higher than the VA would.
So why am I going to lower mymedical practice revenue by
filling that space with a compand pen exam when I can make
four times as much money byseeing my patients in the clinic
?
So it's not ideal for thepractice and then for the
(38:55):
individual clinicians it's andthen for the individual
clinicians it's how can weoptimize our reimbursement, and
still get the job done Does thatmake sense.
Ray Cobb (39:09):
Yeah, yes, hold on.
James Cripps (39:10):
You know the VA, the last C&P exam that I had and
I guess the last one I'll everhave.
The VA wanted a retrospectiveopinion of when I would have
been due are one paid inattendance.
(39:31):
They sent me to achiropractor's assistant to do
the exam.
I had my scooter but I couldn'tget into the building because
there were steps to go up to getinto the building.
I managed to get into thebuilding and the meeting was
(39:54):
held in a closet.
It couldn't have been no morethan six by eight, if even that
big.
My wife answered most of thequestions and the examiner said
that my wife wasn't present.
He did note that I ambulatedinto the building.
(40:23):
I had no other choice.
But he was also sharing thiscloset with a State Farm agent.
Bethanie Spangenberg (40:30):
Oh my gosh , I couldn't believe it yeah.
I mean, but that's the perfectexample.
So the examiner is trying tooptimize their availability, the
space that they have availableto them.
The cost for me to rent even aan exam room from a chiropractor
(40:54):
cannot be.
There's no value at the end ofthe day, when I've done my exams
and then I've paid out what itcosts to rent the medical
facility.
James Cripps (41:09):
This guy could make money at 50 bucks a pop
doing C&P exams.
Didn't take him 10 minutes.
Bethanie Spangenberg (41:18):
Oh, then that's a quality concern.
Ray Cobb (41:25):
Bethany, have you heard anything about these
contract people being sent thewrong C&P forms to fill out?
I know that happened to me onmy last one.
Bethanie Spangenberg (41:41):
I haven't heard that.
I wonder if that's because ofthe request that came down from
the regional office.
That's what that sounds like.
James Cripps (41:56):
Yeah, I think the writer defines the DBQ, don't
they?
Bethanie Spangenberg (42:03):
Yeah, the writer's supposed to say that's
not your choice.
James Cripps (42:06):
The writer chooses the DBQ.
Ray Cobb (42:08):
Right, yes, yeah, I know that the lady that did my
C&P.
She said it happened all thetime.
I had to go back to her for asecond one and that one lasted
an hour and a half and wasreally in-depth and that was for
my R2.
So, Bethany, you mentioned aminute ago about a back.
(42:33):
You're sorry about doing a backC&P.
I think we have a caller.
Let me see if I can get him tojoin us.
He's from over there wherejames is, I believe, in that
area.
See if we can get him to comeup for you there.
Caller, are you callingconcerning your back and
neuropathy in your feet?
James Cripps (42:55):
uh, yes, just that would be me.
Ray Cobb (42:57):
Okay, that's good, got the right one there.
Yeah, we have Bethany on.
James Cripps (43:06):
Tell Bethany what's going on and what you'd
like to know.
Well, I was diagnosed with dropfood and I've had back issues
all the way through.
It's noted in my militaryrecord not diagnosed.
And it's noted in my militaryrecord not diagnosed, but just
the fact that they just give meDarvon and muscle relaxers for
about six years or so of mymilitary time and nothing was
(43:32):
ever done.
So I ended up with drop foot.
So I'm looking to find a way toget the connection for my
injuries that were just workinginjuries, not necessarily a
falling off of something orsomething like that.
So the fact that it's noted inmy record is that any way that
(43:58):
could be taken as connection.
Bethanie Spangenberg (44:01):
So I love to hear that you were treated
for your back and prescribedmedications for your back in
service.
So that is very valuable.
When I look at these, from thecompensation and pension trying
to form a nexus there's a fewother questions I want to know
and understand and pensiontrying to form a nexus there's a
few other questions.
James Cripps (44:21):
I want to know and understand what was your
specialty in the military?
I was in engineering.
I was an engine man on boardship.
I overhauled, repaired andworked on extremely large diesel
engines, as well as the pumpand rigging and winches and
stuff that go along with asalvage ship.
I was on a sea tug Ocean goingtug.
Yes, go ahead.
Bethanie Spangenberg (44:45):
How often did you?
James Cripps (44:46):
lift anything over 50 pounds.
Bethanie Spangenberg (44:49):
Daily Okay .
James Cripps (44:49):
Every day yeah.
Bethanie Spangenberg (44:54):
Pretty much every day.
You said you had no particularor specific injuries to your
back.
James Cripps (45:02):
But what did you do when you got out of the
military?
Bethanie Spangenberg (45:08):
I got out of the military and went into
heating and air conditioning.
Okay, and how often did youhave to lift anything over 50
pounds when you've done theheating and air more or less
than you did in the military?
James Cripps (45:21):
A lot less.
Yes, very much less Okay.
Bethanie Spangenberg (45:26):
And when you got out of the military.
James Cripps (45:28):
I'm sorry.
No, go ahead, I'll let youfinish.
In the heating and airconditioning.
You always had someone to helpyou.
You had someone else to liftthe other part of it, so you
didn't have to lift over 50pounds very often.
Bethanie Spangenberg (45:49):
Okay, and just for understanding of like I
follow medical history and howthings were treated like over
time what dates of service like?
When did you get out?
James Cripps (46:00):
I got out in 73, went in in 65.
Bethanie Spangenberg (46:04):
Okay.
James Cripps (46:06):
Almost eight years Okay.
Bethanie Spangenberg (46:09):
And then, when did you first seek
treatment for your back afteryou got out of service?
James Cripps (46:18):
It was just off and on, wasn't right away.
Bethanie Spangenberg (46:26):
I guess I'm trying to get an
understanding of like okay, whenI hit 40, I had to go see my
primary care doctor and theygave me more muscle relaxers or
something along those lines ofyour history about how things
had continued.
James Cripps (46:45):
Well, I didn't see many doctors.
I didn't go to the VA.
I didn't think I had a right togo to the VA after they said
that you had to haveservice-connected disability or
injury and it just didn't stackup for me to understand that
(47:05):
part of it.
But I went pretty often, but Ididn't once twice a year.
It was a much easier job thanwhat I was doing in service Okay
and which came first Mucheasier job than what I was doing
in the service Okay, and whichcame first the drop foot or the
(47:30):
discovery of you havingarthritis in your back?
Knowledge of it drop foot camefirst, but I've always had a
back injury or back problem.
Bethanie Spangenberg (47:38):
Okay, so I would appreciate looking at
your medical records because, oreven if you don't do something
like us, I still encourage youto apply From an occupational
standpoint.
If you're lifting something morethan 50 pounds on a regular
basis without assistance foreight years and then you
(47:58):
transition to a job that let meback up and you were treated for
back issues in service that isvery prominent in your history
and then you take the fact thatyou transition to something
that's less labor intensive andthat you have assistance with.
If there's something that youknow is going to give you
(48:19):
troubles with lifting ormaneuvering, that toll on your
body is much greater from themilitary service than it ever
would be in your occupationpost-service.
So you take that time inservice, your duties in service,
your symptoms in service andyears later you now have drop
(48:40):
foot and back issues.
I would encourage you to applyfor a service connection for
your back and your neuropathy oryour drop foot.
So I think you've got a.
You know I can't always say agood chance, but I like your
(49:00):
chances.
So they're more likely than notgoing to be service-connected,
just based on your history andwhat I know from my practice in
both medicine and occupationalhealth and competent.
So I would absolutely encourageyou to go 100 miles an hour and
fight for that claim.
Ray Cobb (49:21):
Yeah, and.
James is there and he can helpyou go right through it.
He can take you right down thepath.
James Cripps (49:28):
Yeah, he needs an access letter, can he?
Bethanie Spangenberg (49:33):
get denied first on this one, because I
like that he's got it documentedin service.
Ray Cobb (49:40):
In other words, get denied.
James Cripps (49:42):
He's not filed for it.
Bethanie Spangenberg (49:44):
Yeah, I'm not filed for it.
Filing if you get denied willhelp you out, because the fact
that you have it documented inservice and when you go to write
your statement, you put inthere that you were lifting more
than 50 pounds, 50 pounds plusevery day and what you were
doing you need to make surethat's very clear.
James Cripps (50:03):
Yes, okay.
Ray Cobb (50:06):
Great Thanks for the call.
Appreciate it, Bethany.
We've got another thing.
Thank you, Bethany.
This is what James does in hisarea down there, and he's
extremely good at it.
And, james, I think you've gota great story to tell us tonight
.
A phone call you got thismorning, didn't you?
James Cripps (50:28):
Well, it actually was about 2 or 3 o'clock this
evening.
A lady called.
She was crying.
My wife actually answered thephone.
She wanted to know if this wasthe phone number of the guy that
won the first Agent Orangeclaim at Fort Gordon.
(50:48):
She got on the phone and shesaid her husband had won his
Agent Orange claim at FortGordon after a seven-year battle
and she said it was your storyand your inspiration that
spurred us on to fight thisthing and not quit.
Bethanie Spangenberg (51:11):
That's awesome.
James Cripps (51:15):
It's a warm feeling really to be able to
change somebody's life.
We like to hear those stories,we like to know what we're doing
.
She had just found my websiteand she listened to the Exposed
(51:37):
Vet broadcast two or threebroadcasts ago when we were
talking about Fort Gordon aftermy last WRDW broadcast down
there.
But anyway, she said I'm goingback to your website.
That's a huge website and it is.
(51:57):
There's a lot of informationthere.
But yeah, we're always glad tohear that we're not just wasting
our time, that somebody'sactually benefiting from what
we're doing.
Bethanie Spangenberg (52:10):
That's exciting.
You know, I'd like to take aminute to share a story, if you
don't mind.
Ray Cobb (52:17):
No, go ahead please.
Bethanie Spangenberg (52:20):
I think in any profession, you know, you
really need to be humble andappreciate what you know and
what you don't know.
And if you don't know, you know, be able to, you know, tell the
person you're working with hey,you know, I'm not sure, but let
me find a resource.
Or, you know, I encourage youto seek other resources.
(52:40):
So back several years ago, Ithought I wanted to do the
representation thing we'retalking gosh six or seven years
ago, right when I first becameaccredited, and then, when I got
into it, they started doing thechanges to the AMA.
First it was RAMP and then theymessed up RAMP and then they
(53:01):
turned it to the AMA and that'sbeen a hot mess.
So I decided you know what, I'mnot going to do this and I
turned my veterans over to anattorney that I have known for a
long time.
You know I can't help you atthis point because I don't feel
(53:22):
like they're going to listen tome.
I for your claim, and this isone particular woman I said I
know this, I know you have thisclaim, I believe your story, I
believe in what the evidence isshowing, but I need to give you
to somebody else and I found outthis week that she was finally
granted and she wasretroactively paid for that
(53:45):
whole time period.
And even though she's no longerwith me as me being her
representative, she was stillable to get that service
connection, and so that's stilla win.
That's still a win for me,because I knew she had the
disability, I knew it wasrelated to service and she
(54:11):
didn't get there with anythingthat I did from the medical
standpoint.
The legal evidence was therefor her, and so I was not able
to carry her to the finish line,but I knew somebody who did,
and six years later she'scrossed the finish line and she
got a retroactive pay.
So that's so exciting to sharein that good news and that
life-changing event.
So I just wanted to share that,oh appreciate you doing that.
James Cripps (54:34):
Every time they win, we win again.
Ray Cobb (54:36):
Yep every time.
And I don't know of anythingthat makes me feel any better
than when a person says do yourealize how you've changed our
life?
I had a gentleman just a fewweeks ago.
Same thing.
He was at 40 percent and I toldhim one simple little thing.
(54:59):
When he told me he had beenfired because he couldn't get
along with others, I said willyour employer write you a letter
to that effect?
And he said well, I guess hewill.
He turned it in and withinthree weeks he had gone from 40%
to 100% on his PTSD because hecould not work with others.
(55:20):
And you know, I mean he workedfor the state of Tennessee and
he took care of the grounds atthe state park.
You know he drove a tractor andmowed the grass and things.
So it wasn't exactly a recordhigh-paying job.
And now he's making more thanhe did when he worked for the
(55:41):
state and he had been with thestate long enough to be able to
take an early retirement.
So a great change in his lifeand a change for his wife as
well.
That's awesome.
That's what it's all about.
We're down to less than fourminutes left in the program.
Tell us a little bit, bethany,about your webpage and exactly
(56:06):
what all you do and how peoplecan reach out and get in touch
with you.
Bethanie Spangenberg (56:12):
So my company is Valor for Vets.
We are a team of medicalexperts that provide nexus
letters and we've been doing itas a team since 2015.
Next year will be our 10 years.
We really focus onunderstanding the requirements
of the VA and really trying toput the quality factor above the
(56:33):
VA's expectations.
So we also provide a few of theDBQs that can be conducted by
ACE and we work with veterans,vsos and attorneys that are
accredited agents.
So if you want to visit ourwebsite, there's a wealth of
information on our websiteregarding medical conditions as
well.
(56:53):
Our website is VALOR V-A-L-O-R,the number four vet V-E-T dot
com.
Ray Cobb (57:02):
And I like one thing on your web page that I enjoyed
but this is just a personal whenyou I looked on your web page
and I saw where you could findout about your company and he
actually got a video whereyou're talking and you're
telling how you developed yourcompany and how you found it.
And that's really strong guys.
If you're you know, a lot oftimes we hear names and doctor's
(57:26):
names or whatever, but itdoesn't tell you how they got it
.
If they have a degree, itdoesn't even tell you where it
came from.
But in her webpage it takes youstep by step and it's a
beautiful webpage and easy tofind things and easy to get
through.
Bethany, and I appreciate thatbeing there, and I have
recommended to several veteranshere in the Middle Tennessee
(57:48):
area to look into it and to seewhat's going on and get in touch
with you if they think that youcan help and guys, it doesn't
hurt to reach out and if shecan't help, I'm sure she'll tell
you so or, like she saidearlier, direct you in the right
direction and that's what it'sall about.
Bethanie Spangenberg (58:08):
And we actually just added recently an
option to ask a medical expert aquestion.
So if there's something youknow and that's at no cost, so
if you have, just like thecaller came on tonight if he
wants to explain his story, youknow, night, if he wants to
explain his story, you know, Ican kind of give what little bit
feedback I did and encourageyou or guide you in the next
step or in the right directionso you can go on our website and
(58:30):
fill that out.
Ray Cobb (58:32):
Yeah, great, james, tell us about.
I love the name of your webpageVA, the Redneck Way.
I mean that, just that suitsyou perfect.
I'm telling you.
James Cripps (58:42):
I mean that suits you perfect.
I'm telling you, tell them howto reach you.
Yeah, you can communicate withme or get a hold of me, or read
a whole lot.
There's a lot of informationthere on how to win your claim,
how to submit your claim.
(59:04):
It's kind of inspiring.
And that's VATheredneckwaycom.
Ray Cobb (59:09):
Spell it just like it sounds, vatheredneckwaycom and
folks, I have a local radiostation that I do every Tuesday
morning, 9 o'clock Central Time.
You can go on the Internet andgo to WZYX Radio and click on
the live and you can hear itlive, or you can look down and
find where it says recorded andyou'd be able to listen to the
(59:30):
previous recorded shows for theprevious four weeks.
With that guys, we're out oftime.
Bethany, a special thanks toyou for coming on tonight.
I thoroughly enjoyed it.
It's a topic that's alwaysinterested me.
On tonight, I thoroughlyenjoyed it.
It's a topic that's alwaysinterested me.
And with that we will beshutting down on behalf of John
James and Bethany.
This is Ray Cobb sayinggoodnight and have a great
(59:52):
evening.
J Basser (59:55):
You have been listening to the Exposed that
Podcast.
Any opinions expressed on theshow are the opinions of the
guest speakers and notnecessarily the opinions of
Exposed that, Exposed Thatcom orBlog Talk Radio.
Tune in next week for anotherepisode of the Exposed that
Podcast.
Thanks for listening.
Ray Cobb (01:00:18):
I'm sorry just a second.
I'm sorry, I'm sorry, I'm sorry, I'm sorry, I'm sorry, I'm
sorry, I'm sorry, I'm sorry, I'msorry, I'm sorry, I'm sorry,
I'm sorry, I'm sorry, I'm sorry,I'm sorry, I'm sorry, I'm sorry
, I'm sorry, I'm sorry.
Bethanie Spangenberg (01:00:30):
I'm sorry.
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