63SIERRA

VHA DIRECTIVE 1134 nov 2016 VHA strives to be the provider of choice for all enrolled Veterans and its strategic goal is to deliver personalized, proactive, patient-driven care. Timely completion of forms on behalf of Veterans is an important way for VA health care providers to understand and advocate for Veterans’ concerns. Additionally, completion of medical forms by health care providers based on an examination or knowledge of the Veteran’s conditions, is included under title 38 Code of Federal Regulations (CFR) 17.38(a)(1)(xv) as part of the medical benefits package (with the exception of the completion of examination forms if a third party would customarily pay health care practitioners for the examination, but will not pay VA). NOTE: At present, as a matter of policy, there are no known forms that would fall under this exception. 3. DEFINITIONS a. Assessment of Function (or Functional Assessment). An assessment of function provides data on how an individual relates and adjusts to their environment when performing a specific task. Assessments of function generally will include measures of motion, strength, pain, endurance, flare-ups, safety, and the ability to perform and repeat meaningful tasks (e.g., assessment of daily living, reviews of medical record, etc.). Typically, VA providers can conduct assessments of function within the clinical environment and they can be enhanced by physical therapy, kinesiotherapy, or occupational therapy consultation. NOTE: For example, a form which asks a provider to estimate how long a patient can stand is considered an assessment of function and therefore should be answered to the best of a provider’s ability and clinical expertise based on the evaluation completed, even though the specific activity may not have been directly observed. b. Disability Benefits Questionnaire. A Disability Benefits Questionnaire (DBQ) is a standardized VA documentation tool used to provide pertinent medical information for Veterans in support of the disability compensation process. c. Functional Capacity Evaluation. A functional capacity evaluation (FCE) evaluates an individual's capacity to perform work activities related to his or her participation in employment and compares the individual's health status and functional status to the demands of the job and the work environment. Typically, a FCE is November 28, 2016 VHA DIRECTIVE 1134 2 conducted for the purposes of determining feasibility for employment in a specific job. A well-designed FCE may take hours to perform and consists of a battery of standardized assessments requiring direct observation that offers results in performance-based measures. FCEs should only be performed by qualified rehabilitation professionals that have appropriate training and specialized equipment to include validity and effort measures in the evaluation. Due to the lack of specialized equipment available at most VA medical facilities required to perform FCEs, these evaluations are not routinely conducted by VA providers. NOTE: A FCE is not a type of evaluation that is done for the purposes of VA disability benefits or compensation claims. d. Medical Opinion. A medical opinion is a provider’s statement of findings and views, which may be based on review of the Veteran’s medical records or personal examination of the Veteran, or both. Medical opinions are often concerned with establishing causality between a Veteran’s claimed condition and events in military service or to a previously determined service-connected disability. e. Personal Representative. A personal representative is a person who, under applicable law, has authority to act on behalf of the individual. This may include power of attorney, legal guardianship of an individual, the executor of the estate of a deceased individual, or someone under Federal, state, local or tribal law with such authority (e.g., parent of a minor) (see VHA Handbook 1605.1 on the VHA Publications Web site). f. Provider. Physicians, advanced practice registered nurses, physician assistants, and other health care practitioners who provide primary or specialty care services to patients in accordance with licensure, scope of practice, or functional statement. 4. POLICY Except when specifically prohibited, it is VHA policy that providers, when requested, must assist patients in completion of VA and non-VA medical forms and provide medical statements with respect to the patient’s medical condition and functionality.pt when specifically prohibited, it is VHA policy that providers, when requested, must assist patients in completion of VA and non-VA medical forms and provide medical statements with respect to the patient’s medical condition and functionality.

Ok after getting passed around the the phone system for half an hour, I came right back where I started, the chief of staffs office. They could not or would not tell me if it is, or isnt in the doctors job description to write DBQs for veterans. I was told to research VHA DIRECTIVE 1134 DATED NOV 2016.

they are trying to circumvent me making a formal complaint.. they are investigating.. stay tuned. we, ll be right back Folks!!

spell

you know the DBQ debacle seems like another program of illusion created by the VA. They say,, ohh, we help the veterans get compensation, we even have a standard form in our system that the veterans docs at the VA can fill out for them, to assist them, yes were here to help..see, look at the form... but this is a lie, they arent making the doctors fill them out. I can just picture in my mind, someone at the regional office having a veterans claim all wrapped up in pretty paper with a brilliantly devised plan to deny them, all of the creative writing has come to fruition and everyone in the office has given them cudos for thier ingenious little creation, then here comes the veteran with favorable evidence from the VA, that changes the outcome of the claim, and they have to go shake to piggy bank to pay the veteran. Do you think that the "offending" doctor might get a call of admonishment from the regional office? Me tinks so. Most veterans dont realize that the doctors at the VA and comp and pension folks at thier regional offices communicate regularly. sometimes the snake that bites you is sitting right in front of you.

a change of doctors, a formal written complaint, CCd to uncle donald and the sec of VA , whoever that is this week, and booger on thier desk may be in order. we cant force the doctors to do thier jobs, but we sure can wreak hell and havok on them. if nobody raises hell and makes waves, then they keep doing bad things to good people. In case they havent noticed, folks are losing jobs at the VA for being cockroaches. Doctors, to janitors.

we actually went talk to the patient advocate " directors gatekeeper" and he told us to go upstairs to C&P office on 6th floor and ask somebody. so we asked and the clerk said somebody would call us. later that day we a call from a super in the C&P office and were told to call the regional office and ask for a Dav Or VFW service officer.. I almost hit the floor laughing.. At this point we really dont want a DBQ from a doctor that doesnt want to do one, but it would be nice to disgrace someone who is supposed to be " honored to serve this nations best and bravest". I will continue to do research for regulations regarding this situation, and if the DRs are indeed supposed to write DBQs for veterans, I will post the DRs name, so future patientsw will know they are being seen by a dr who is there just for a paycheck, and to send funds back to pakistan to take care of thier grandpas yak.

There are MANY diagnostic test that the VA uses that are old and antiquated that should have stopped being used in the 60s, but the ones that are quite effective in screwing the veteran out of compensation die hard, they know that spinal injuries is one of the top compensable injuries that veterans tend to have, so they dont look very hard into the root problems, because spinal issues rarely improve, and are expensive to treat. Knowing the full extent of your back problems can open a very expensive can o worms on the VA. Also there are so many causes that can be linked to service such as wearing a 8 pound kevlar helmet for 6 months, sleeping on a rifle in a cot for months, hopping out of trucks with heavy weight in a rucksack, running in combat boots. jumping out of planes, ect. the list could go on infinitely. Now when you finally do get that elusive MRI, the very first thing the va will claim is DDD.. Degenerative disc disease.. the reason being, it is a natural progessive disease associated with aging. so once you can prove you do have actual spinal injuries thru an MRI, that will be the second issue you must deal with when seeking compensation.

range of motion test is a BIG scam. people with neck and back pains range of motion fluctuates greatly from day to day, and even hourly. muscle spasm, medication, nerves being pinched, arthritis, ect, all have fluctuating variances of severity. even weather changes can affect pain levels. Get an MRI, and see a neurologist for a opinion and submit the evidence to the VA. The VA doesnt like to send vets for MRI because its conclusive, hard evidence. They play the x ray, and bend until your ass hurts game then say your good to go. its almost comical when you think abt it. you go to the CP, they tell you to bend over, and call it done... they should stand behind you with a jar of vaseline before asking you to bend, because they are going to give you the shaft with this scam exam. Think abt it, have you ever gone to a doctor abt your back pain and been asked to see how far you can bend over? Ive been seen many pain management doctors and have not once been asked to bend over as a diagnostic tool. just ridiculous. really.

I have always felt that the range of motion standard of testing was a sad joke. heres why. as a back pain and neck pain sufferer myself, there are days when I cannot even tie my shoes due to muscle spasms tiying my leg and back muscles in knots. As nerves get pinched in your spine, they signal the muscles surrounding them to contract. to 'PROTECT'.. After hours of this going on, the back of your legs and buttock will feel like a rubber and that has been twisted and would super tight, to the point they cannot stretch. There are other times though, when the pinching of the nerves isnt so profound, and the muscle tightness isnt so bad. So lets say you go to a CP exam, after a week of rest, using your Tens unit, and things arent as bad as they usually are, and you can bend to touch your toes. even though this is a rare occasion, the VA will say your range of motion is normal.. The VA really need to dithc the range of motion scam, and look at tangible evidence such as MRIs, radiology reports, and neurology reports. also medications. if the veteran is on strong muscle relaxers, or strong pain medication, then they may be able to do the range of motion tests more easily , but this is not a true indicator of disability, because pain levels are supposed to be rated pre medicated state. I think the range of motion scam is a rabbit hole the VA uses to deny veterans. They like to use it as a indicator instead of sending you for an MRI, because 1, the MRI is quite definitive, and 2, they dont want to pay for an MRI. I would get an MRI, and a neurologists statement, pain management records, and use that to fight for your claim. The old how far can you bend and does it hurt in your ass or your leg scam is old hat.

you are entitled to an accurate exam, you could request a new exam due to the one you had being in error. I myself had 3 exams, over one scar, due to " errors".... lies, malicious deception, fabricated negative evidence, ect. I read all CP exams results in a detailed, forensic manner. theres more merit put on an in person exam than a remote exam. be suspiscious abt everything they do. if its not correct, insist they correct it.

recently my spousie asked her psyc dr at the VAMC in temple tx, if she would write a DBQ for her, regarding her long time depression illness, the Dr informed her that she writes DBQs for nobody. I would like to know if it is part of a Doctors job description to write DBQs for the veterans they care for. We have received letters from the VA that seem to indicate that it should be no problem getting a DBQ . Why the Dr doesnt want to write one is interesting, maybe she doesnt want to get involved in the claims process. The primary care doc that my wife sees wrote a wonderful letter for her, but she is not a psychiatrist and that is mandatory for a mental illness claim.

""""" Since VA says they "own " the farmed out C & P exams and pay some non VA medical entity for the exam, The VA will not release QTC or any other farmed out exams until they make a decision. ''' ONE HELL OF A CONFLICT OF INTEREST wouldnt ya think. ? They play it both ways for example my wife got a VERY FAVORABLE letter from her primary doctor whom she has been seeing for years, regarding a claim that is ongoing. the VA refuses to send her for a C$P exam, because they would first have to try and contradict thier own VA doctors opinion. that in iself would look really bad on them, if they try to send her outside the system to get an opposing opinion. . The RSVR also disregarded buddy statements from officer level troops she served with. The raters want to pick and choose what evidence they use and dont use, in order to get the desired outcome, which is usually denial. We did a formal hearing request and told them when we got there what we wanted, yet they still kept turning the mike off, and were trying to refuse evidence we were submitting. I bet that MANY of the senior raters and rsvrs with some longevity , are going back and trying to "correct " the sins of thier past, inserting information that they previously omitted, and many other shinanigans. I would urge veterans to review your claims files and look for things that have been added or omitted. YOUR FIRED isnt just a tv show anymore, its reality for ALOT of miscreants that have been running wild at the VA for years. And its about damned time.!!! Good men and woman have died by neglect, suicide, and suffered needlessly because of the dirty deeds being commited at VAMCs and ROs. I dont feel sorry for those who get fired at all.

anyone know why there is a new line of info on disabilities that says.. 'ENVIORMENTAL HAZZARD OF GULF WAR. Example.. disability - fibromyalgia.. service connected- no 'ENVIORMENTAL HAZZARD OF GULF WAR. disability-chronic fatigue syndrome- service connected- no 'ENVIORMENTAL HAZZARD OF GULF WAR. Its just fascinating me how the VA is tapdancing around the Gulf War issues. Ive never seen an entity that could say YES YES YES you are affected,, but NO, NO NO we will never compensate you for it. But just look at how damned hard were trying. And the fine job were doing!!! One day, once your mostly all dead and gone, we shall make it right though, and pay a dozen or 2 widows and surviving veterans, therefore we can forever say.. WE PAID THEM... Just as they did the vietnam vets with agent orange. They tell the gulf war vets that thier conditions are presumptive yet they still deny them as service connected.. Only the sharpest of the demons can construct slide of hand and smoke and mirrors of such effective deception. Lies and trickery at its finest. If fibromyalgia is a presumptive and im a gulf war vet, than how can I NOT be service connected for it? same with chronic fatigue,?

the facts are that most VAMCs dont have specialists inside the VA system, and they dont want to send veterans outside the system for fee based care, so many times, your PCP will downplay your problem, or ignore it and not follow up with it. You may be prescribed something that doesnt work, and you tell them this, and they take no action. Heres an example. friend of mine is service connected for exema.. has terrible outbreaks and is embarresed to wear shorts in this burning texas heat. friend was RX some bullshit cream, that did nothing. Friend told primary that it wasnt working, and primary took NO action or follow up. Friend kept bugging primary for follow up, then primary calls her in and they tale a photo of the outbreak and send it upstairs to dermatology. NO action is taken. Finally friend goes outside the system and sees a real dermatologist. a ointment was RX ed and friends exema is almost completely healed. MOST primary care doctors are internal medicine docs. They are general doctors and usually dont have the expertise to diagnose many things that come to them. Further more, many doctors that work at the VA that come from middle eastern countrys do not have an actual MD. \They go to various millitary style training facilities for abt 8 weeks,and get issued a certfication. The VA accepts these certifications as a reciprocity in lieu of a real MD sheep skin.. So what do you get? a questionable medical entity from a different country who likely cant care less about an american veteran. a foriegn entity who isnt required to carry insurance. a foriegn entity who cannot be sued, because he works for the government. A foriegn entity who is likely not to be fired, because there is a shortage of doctors inside the VAMCs. Ever wonder why there arent many american doctors inside the VAMCS, you would think the VAMCs would be full of american doctors just knocking down the doors to get in and help thier american brothers of nobility, Well the reason there arent alot of american docs in the VAMCS in my opinion is that american docs just cant stomach screwing veterans over. Ive seen several occasions where docs were hired at the VA and quit the next day or less than 2 weeks later. now why would they quit so fast.. I think its because when they are told what to do and not do for veterans, they quickly decide that they want no part of the activity.

if you are being lied to, denied care, mistreated, misled, delayed care, denied medications , ect at VA facilities, report it and there will likely be consequences for the offender if you can get it high enough up the food chain. The new law is now in place, and no Doctor, lawyer or Indian Chief is safe from diciplinary actions anymore. ALWAYS know who you speak with in person or on the phones if they will say, because documentation is always king!!! Documentation is evidences sword... https://www.va.gov/accountability/Adverse_Actions_Report.pdf

If you have ever wondered why you were not offered certain medication by your VA provider, there may be several reasons. The VA uses something called the national pharmalary list.. check it out here. but first read the rest of this post. http://www.pbm.va.gov/apps/VANationalFormulary/ what I have found personally is that due to costs of certain medications, even though they are on the national pharmalary list, these medications will not be offered to you by your care provider. heres an example. many pain sufferers who have tried various medications such as opiate based,and other meds such as gapapentin, tramadal , ect have not gotten much relief. There is another medication used to treat pain called pregablin ( LYRICA).. If you ask your primary care dr abt this medication, you will likely be either told that it is not on the pharmalary list, or that you do not meet the criteria.. If you go to the link I posted, it tells you what the criteria is, which many times is that you have tried other medications without success. In my experience, the best thing you can do if you want to try a medication, is look on the pharmalary list yourself, before asking your doctor to prescribe it.. YOU LET THEM KNOW THAT IT IS INDEED ON THE PHARMALARY LIST.. Ok heres what they may do.. they may try and tell you that the particular VAMC that you go to doesnt prescribe it.. That would be a lie. so dont buy it. they may try to prescribe something that you already tried that didnt work.. do not go for it. there are MANY MEDICATIONS THAT ARE AVAILABLE TO VETERANS THAT THE VAMCs try to not prescribe, due to cost. Take Lyrica for example. its 400.00 for one month rx. ok lets due some math, thats 4800 a year. in 10 years thats 48000 dollars.!!!!!. CAPICHE? Have I earned that medicine? YOUR DAMNED RIGHT i HAVE!!!! Many veterans who were cut off of opiate based prescriptions the last few years after opiate gate went down and there was a big push to stop prescribing, were offered Gabapentin, or tramadol. Tramadol is killing people right and left, it is a very dangerous drug, and Gabapentin has plenty of side effects as well. often times, once those 2 meds are prescribed for pain, and found to be ineffective, that is the end of it. like bugs bunny said at the end of the cartoon., thats all folks.. well now you know that there may be other options. if the meds you are on arent cutting the mustard, do some research. most of the new, effective, but higher priced meds are on the tv commercials . thats how I found out abt Lyrica. its beed a Godsend. its great for diabetic nerve pain, spinal injury related pain, ect. Do tourself a favor.. if your suffering in pain, have ben invoulantarily or voulentarily been taken off of opiate based meds, have tried Gabapenten, Tramadol, ect, with no relief, plz try LYRICA. IT sure helps me.. the best way I can describe it, is it doesnt let the pain consume my focus. the pain is there, but its like I dont care its there.. weird but I like it.

ya think that might be why nobody calls me back from the VAMC ? I guess nobody wants to talk abt 250 million dollar scams anymore.. .

seminole maybe print that article and bring it with you to your next appointment., maybe print a few dozen and go drop them around the lab area... haha put a stack by the sign in kiosk..

they are stealing from us, the veterans. 256 MILLION.. That is equivilant to the entire yearly budget for the central texas VAMC. Companies can steal millions from veterans, and when they get caught, they just have to pay it back.., like a game.

THE CORRUPTION ALWAYS LEADS TO THE MONEY!!! Now you know why your piss is so valuable.

CRIMINAL INVESTIGATIONS * Millennium Laboratories Agrees to Pay $256 Million The Department of Justice (DOJ) announced t hat Millennium Laboratories, a global urinary drug testing lab, has agreed to pay the United States $256 million to resolve allegations that Millennium filed false claims in viol ation of the Public Law 97-258, False Claims Act . The agreement was the result of a VA OIG, Federal Bureau of Investigation (FBI), Defense Criminal Investigative Serv ice (DCIS), and Health and Human Services OIG investigation that alleged that Millenni um submitted false claims to Federal healthcare programs for excessive urinar y drug testing and pharmacogenetics testing, which were also deemed to be medically unnec essary. VA’s portion of the total civil damages is $723,880.

read this ... http://www.va.gov/oig/pubs/highlights/VAOIG-highlights-201607.pdf

Maybe they will give you an answer if you call and ask them, but they never would call me back, every time I followed up with a call they bullshitted me around and said they were checking on it, blah, blah, blah, its been 5 months, and still no answer. Someone , somewhere is pushing the UA tests, for a specific reason. Same with the FLU shots. You cant hardly get in the door at the VA without someone trying to stick a flu shot in your arm., everywhere you go,m in the entrace, , in the lobby, by the coffee shop, theres nurses with little kiosks set up, trying to give a shot. I would imagine theres a contract, that the VA buys, and they are trying to use the shots any way possible, so that next year, they can pay some drug company a small fortune, to provide the wrong strain of virus again. With the Veterans bill of rights, you as a patient, have the right to take part in your healthcare decisions. If yearly Drug testing is required at VAMCs.and regulation, I will gladly comply, but if its as I suspect, a fleecing of the budget, im not going for it.