Sarah Greenberg

Hello everyone! My blog post, thanks to all of your help and input, is LIVE! The blog post is back dated to veterans day, but was published a few days ago. Here's the link: http://www.eyecareleaders2020.com/2015/11/10/toolkit-how-ecps-can-help-veterans-who-need-further-treatment/ This post would not have been possible without you. Thank you for answering all of my questions and reading and revising my work! I am truly grateful for this community. I want to write more posts like this to advocate for vets! Here's the link again! http://www.eyecareleaders2020.com/2015/11/10/toolkit-how-ecps-can-help-veterans-who-need-further-treatment/ Thank you again, everyone! Sarah Greenberg

Broncovet, Thank you for reading my post and thank you SO MUCH for your clarifications. I'm revising my article now. I am blown away by all of the feedback I've received in this forum! Thank you again! Sarah

Andyman, Your post is so helpful for me. I want to capture the frustration and hopelessness that accompanies the VA claims process. My grandfather is a vet, and my mom worked with the VA on his behalf to procure him hearing aids at a reduced price. I know that isn't the same process as getting disability compensation, but this process was so convoluted and frustrating. My grandfather, who's 89 years old, would have NEVER been able to figure out everything the way my mom did. Thank you for giving me the vet's perspective! Sarah

Hello everyone! Thank you all for your help. I am so grateful for your expertise. Here is my article so far. What do you think? What you need to know about helping vets who walk through your doors While many physicians want to help veterans get the medical attention and compensation they need, navigating the Veterans Affairs claims process can be a nightmare. In fact, some vets say that way the VA merely placates the men and women who risked their lives for their country partially explains why the suicide rate among vets is so much higher than the national average. As an eye care physician, you can help advocate for your veteran patients to get the compensation they deserve. We want to equip you with the knowledge and tools to do just that. What you need to know first: 1. Veterans need to meet three requirements in order to receive benefits: a. The vet has a documented in-service event, or was on active duty-with at least one day within a period of war. This event in service could include a single incident/event (explosion, gun shot, exposure to chemicals). The physician must rely on the vet’s account of the service event, unless the event is in records available for the physician to review. b. The vet needs a current diagnosis of a physical/mental condition from an Independent Medical Exam (IME). This is where you come in. As a physician, you are qualified to make this diagnosis. c. A “nexus,” or connection between the in-service event and the current diagnosis. The nexus needs to be stated in a formal letter from you, the physician who has conducted the Independent Medical Exam (IME). In the letter, state the symptoms the vet is experiencing, and the extent to which the symptoms affect his/her ability to drive and earn a living. If the vet is homeless or about to become homeless, state that as well. What you need to do next (paperwork): 1. In your nexus letter, the VA requires precise language to demonstrate the connection between the vet’s time in service and his/her current medical condition. Use this jargon when stating the nexus: a. If there is a 50% chance that the vet’s condition was caused/aggravated by his/her time in service, then write, “This condition was as likely as not caused/aggravated by the vet’s in-service event (state the event).” b. If there is a 75% chance, then write, “This condition was more likely than not caused/aggravated by the vet’s in-service event (state the event).” c. If there is a 100% chance, then write, “This condition is due to the vet’s in-service event (state the event).” d. If you’re not certain of the percentage, but the evidence appears plausible, use the 50% chance jargon. 2. During the Independent Medical Exam (IME, the exam you conduct for the vet), you also need to complete a Disabilities Questionnaire (DBQ). Published by the VA, DBQ’s are medical examination forms specific to the disability of the veteran. The VA uses the DBQ when reviewing your IME and nexus letter to assign the appropriate amount of disability compensation to the vet. a. The DBQ’s are categorized by type of condition/disease (i.e. Ophthalmological). Find all DBQ forms here. Find the DBQ for Eye Conditions here. b. Attach your nexus letter and diagnosis to the DBQ. c. Note: The DBQ does not always ask for a nexus, diagnosis, effective dates, or how the condition has affected the vet’s ability to work; these are crucial elements for the vet to get compensation. 3. To ensure that the VA reviews all of your paperwork, not just the DBQ, do the following: a. On the last page of the DBQ, there’s a space for remarks or comments. Write, “See my attached nexus opinion” so the VA has to find it. b. Number every page of the paperwork packet (DBQ, nexus letter, IME paperwork) so that nothing gets lost. c. At the top of the DBQ, write, “This is a VA Exam” so that the VA does not discard it (that has happened). What you need to do last: 1. Make a copy of the DBQ, nexus letter, and IME and give the copy to the vet. YOU keep the originals. Keep the vet’s paperwork for 10-20 years. Some disability claims go on for 13+ years. a. Vets are responsible for submitting their paperwork to one of these Mailing Addresses for Disabilities Claims. b. Some vets should seek legal representation if their claims have been denied several times. Refer them to the Veterans Benefits Manual, the most reliable source of legal information for vets to win their claim. You can also refer vets to the list of lawyers who represent veteran claimants, vetted by the National Organization for Veterans Advocates.

Hi Bronvovet, Thank you again for taking the time to answer my questions and clarify the VA claims process for me. I just listened to one of the Had It podcasts and Dr. Bash also mentioned the "traps" of DBQ's and how to get around them. For example, Dr. Bash said that a physician needs knowledge of the rating schedule, as there are only 70 DBQ's, but 2,000 rating schedules. Is my understanding of the rating schedule correct? I found the rating schedule here. The rating schedule is the document that the VA uses to determine the severity of the disability and the extent to which the disability affects the vet's ability to work, so that the vet receives appropriate compensation. The rating schedule breaks down disabilities into categories based on the part of the body impacted. Each category contains a group of medical issues, which are further broken down into a list of diagnoses that have a specific diagnostic code. Each code specifies symptoms that are required for various ratings of disability. The ratings are percentages and depend on whether the diagnosis is severe, moderately severe, moderate, or mild. For a severe diagnosis and rating, the vet must experience/exhibit the symptoms listed under that rating. Eyecare physicians would use The Organs of Special Sense section of the rating schedule. Whew, is that correct? Where are the symptoms listed in the rating schedule? Thank you so much! Sarah

Vync, Thank you for your help! I really appreciate your additional content and clarifications. Whew, this process is very complex for me. I do have some more questions: 1. Is the presumptive list the same as the DBQ? If not, what is the connection between the presumptive list and the DBQ? 2. After the physician completes IME and DBQ (or gives the DBQ to the vet to complete), does the vet submit the paperwork to the VA regional office? Or does the physican submit the paperwork on his/her behalf? 3. Does all paperwork go to the vet's VA regional office? How does the vet find his/her regional office? 4. Does the physician need to have special paperwork to complete a vet's IME? I know they need the DBQ, but do they need other documents to complete the IME? Can they access that paperwork online? Thank you so much!

Hi Andyman and Vync, Working on this article has been my pleasure. I'm so excited to share everything I've learned from you and this website with our readers. Thank you both for your service, for making this country safe so that I can even do the work that I want to do. My grandfather's a vet-89 years old!-and I'm going to thank him again for serving our country so that his family could be safe. I am so impressed by this website and grateful for the quick, thorough responses on this forum. I'm learning so much and can't wait to show you my article! Thank you both! Sarah

Wow, broncovet and pwrslm, THANK YOU! Thank you for responding so quickly. Broncovet, let me make sure I understand what you told me. I've added a little more content based on my own research and the Had It Podcast (so helpful): 1. The most important question an eyecare physician should ask a veteran is, "Are you seeking disability compensation for the visit today?" If so, the veteran needs to meet three requirements in order to receive benefits: Documented event in service, whenever the vet was on active duty-with at least one day within a period of war? This event in service could include a single incident/event (explosion, gun shot, exposure to chemicals). The vet needs a current diagnosis of physical/mental disease or disability, which a non-VA physician can complete, but the physician must be a specialist, correct? A link between the two, or a nexus, a connection between the current diagnosis and the event. The nexus needs to be proved by medical documentation detailing the continued treatment of the disease/illness/injury since the vet discharged from service. The nexus also needs to be on the list of presumptive diseases, diseases/conditions granted an automatic service connection. Is this list the DBQ? The nexus also needs to be proved by a letter from a medical specialist who has conducted an Independent Medical Exam. In the letter, the doctor should focus on symptoms and give a likely date when symptoms began. The doctor should also show how this affects the vet’s ability to earn a living, drive, find a home, etc. The letter must state that the vet’s condition was caused/aggravated more likely than not by active duty service. A few more questions: 1. After completing the IME and DBQ, does the physician submit the paperwork, meaning the letter and the DBQ to the VA? Or does the vet submit the paperwork? 2. After completing the paperwork, should the physician then have the vet work with an attorney or VSO. What is a VSO? Should all vets seek legal help? Can the eyecare physician help the vet get in contact with legal help? 3. Should eyecare practices have print-outs of DBQ’s so that they can fill them out when treating a vet? Thank you so much for your help!

I'm Sarah Greenberg, a writer for a website called Eye Care Leaders 20/20, which distills the latest medical and business information for eyecare physicians to help them run their practice. We really want to dedicate some of our website content to helping physicians advocate for veterans. As you know, the VA can be disorganized and physicians have been challenged to serve the swelling populations of veterans coming to them. Would anyone consider speaking with me for 10 minutes one day this week? I would like to ask you the following:If a veteran walks into a physician's office for the first time, what are 3-4 crucial questions that the physician should ask the veteran?What does a veteran medical evaluation entail? Can all physicians perform them?What is the most important piece of advice you can give physicians who want to advocate for their veteran patients with the VA?How can physicians learn more about how to advocate for their patients who are veterans?Would anyone consider speaking with me about these questions? Or possibly doing an email exhange with your responses? Thank you! Sarah Greenberg