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mssoup1

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  1. I have not posted in quite some time, but as I read this post, I wanted to reply. I have Champva and while they have been great to me, I am sure not everyone has experienced this. If you need to see your EOB, you can do that online now through the Champva website. In fact, you can also access your Medicare EOB's from their website as well. They are not available though to see until some action is taken on the claim you filed and that still does not mean you may not end up having to make a call to them. But if you know the bill has been paid, then you should be able to access the EOB showing that. Hope this helps someone. mssoup
  2. My husband is on fee basis outside of the VAMC because they no longer have a dermatology department. He was granted the fee basis and told to find a doctor who would accept him on a fee basis from the VAMC, then call them back and let them know who the doctor was. They then wrote a letter to that doctor, with a copy to my husband, stating that the VAMC was approving the outside care and to bill the VAMC. They also stated the terms of the fee basis visits; i.e., 4 visits within the next 6 months, then further approval would be needed for more visits, if needed. The doctor would have to request the additional visits. The doctor also needs to send regularly to the VAMC a copy of your medical notes from each visit with him. If he fails to do this, then that is where you can get into a lot of problems with the fee basis care. I would always, at each visit, take your copy of the approval letter with you to the fee basis doctor. This way, the doctors office can not say they did not receive it. Also, if you get the approval for the fee basis visits, never, never give them your personal insurance cards. We really had to fight this one. We told the doctors office that the VAMC would be paying the bill based on the letter they received, therefore, there was no reason for them to have an personal insurance cards he had, including his Medicare card. Hope this helps. mssoup
  3. Dean, I sent you an e-mail on your posting. mssoup
  4. Just my thoughts a few questions asked. As far as getting unemployability goes, the VA is basically rating you this way because you are stating that you have service connected disabilities which prevent you from working, therefore, you are considered to be unemployable. I have read where some veterans are rated this way, but still work. I am not saying that they should or shouldn't, but with the way the government is trying to reduce various ratings veterans are receiving, I would think twice about working. If you get a questionaire or the VA finds out by any other means that you are working, they could easily call you in for an exam to see if your condition has improved. Based on who does the exam, you could possibly lose some of your benefits. As far as tinnitus is concerned, I filed a claim for my husband and he was approved and rated at 10%. I was in the examination with him and there is no exam for determining whether you have tinnitus or not. The examiner will ask you certain questions, like do you have ringing in your ears and how often do you have this. Based on the answers you give determines whether or not the doctor feels that you have tinnitus. mssoup
  5. Just a followup. I filed a claim for my husband for hypertension. He is currently on medication and for the most part it had been controlled, until, as usual, the VAMC discontinued what he was taking and put him on what they stated was an equivalent to what he was on. While his BP is basically doing okay, it is not doing as well as it was. But to my point, he was service connected for his hypertension, but since it was considered controlled with medication, he was given a 0% rating. Just thought I would add my experience with this type of claim. mssoup
  6. Just thought I would add a few comments based on my experiences I had. The statement "The NP cannot override a Licsened MD" is not always true. A NP gave my husband an exam, but there was the doctor who oversaw her that signed that he agreed with her assessment. This, even though he had not even looked at my husband. We also had an IMO and was written in my husbands favor. The VARO denied the claim, based primarily on the NP's C & P. Also, as far as getting C & P exam results and finding out that they are inadequate. I would get my husbands C & P exam results as soon as they were put into the system and go over every word in it. I found some to be so inadequate, I felt that they must have written my husbands results based on another veteran they had seen the same day. I would immediately write a letter and dispute word for word everything in the C & P results that were not correct. I would then send this to the VARO. I didn't want to waste time on the VARO making a decision based on what I knew to be an inadequate C & P exam. To me, this saved everyone time all the way around. A new C & P exam was then requested based on the previous one being inadequate. Funny how the second time around that the results of a C & P exam could change so much and in my husbands favor. They knew they messed up the first time around. Just thought I would add something to the post on some experiences we had. mssoup
  7. I am sure this has been asked and answered here before, but I could not find it. Can anyone tell me how often a veteran can receive a pair of glasses if he is eligible to receive them. Is it once a year, every two years? What happens if they break or lose their glasses? Thanks mssoup
  8. If I was not allowed in with my husband on his regular visits or C & P exams, I would immediately get up, go to the Patient Advocates office and blow my stack there. I have had to use the Patient Advocates office more than one time and they have been helpful in getting any problems resolved in our favor. The Patient Advocates are there to assist the patient with any problems that they have, regardless of what they are. For us, they have been quick in getting back with us on any resolution to the problem. I know that VAMC's are different, depending on where you live, but it shouldn't be. I have read a lot of postings here where some veterans are having a terrible time with their VAMC in getting medical reports, or help of any kind. Also, the idea of not letting someone go into the examination room with a veteran, if that is the veterans wish, is so far off base. I live in Virginia, and again, as I stated before, we have not had any problems with Release of Information or my going in with my husband on any exam. Also, we use the Patient Advocates office when ever we have a problem and, so far, they have addressed every problem we have had. mssoup
  9. My husband has had a number of C & P exams done in the past and I have been with him on all of them. I didn't ask if I could be in there with him, I just walked in and sat down. I don't know of any regulation or rule that states that you cannot have someone with you during a C & P exam. Even if the examiner states that the spouse or whoever cannot stay with the veteran during the exam, the veteran should be able to state that they want that person there with them. When my husband first starting seeing the psychiatrist he sees now, she never really stated I could not go in with my husband, but she gave me that impression. Well, I figured that since these were his initial routine treatment exams that maybe she just wanted to talk to him alone for a few visits to try and get him to talk to her. But, after a while, I then started going in with him because I felt he wasn't telling her everything. She looked at me funny when I started to walk with my husband to her office, but she never said anything. Now, I go in with him at various times to just keep abreast of how things are really going with her treatments. Of all the different doctors and C & P's that my husband has been to, I have always been allowed in the room with him. I just cannot imagine any doctor not allowing someone to be in the examining room with the veteran if he has no problem with it. mssoup
  10. I personally have this and have to stay away from a lot of foods, especially those which I tend to love but can't have. While foods can cause the problem to be worse, so can smoking, alcohol and most of all, NERVES. As to what causes it, I don't really know. I know in our family it apparently is partly due to being hereditary. I have 7 siblings and most of them have some sort of GI problems, including IBS and Chrohns. My mother had colon cancer and now everyone in my family is tested every couple of years by having a colonoscopy done. I have had two stomach surgeries done in the past and now only have about 28% of my stomach left. After the first surgery, I had what they call "dumping syndrome" bad, bad, bad. The nausea and diarhea were horrible. I would no sooner eat something until both of these would happen almost immediately. Makes it rough to go out somewhere to eat or take a long distance trip. I would also get stomach cramping that would be so painful that it was almost unbearable. Well, I had the second surgery because the doctor felt that by rerouting some of my piping, that he could eliminate some of the problems I was having. Well, whatever he did, it really helped. While I do occasionally have bouts with this, it is not near like it was. In fact, if I have a few drinks of alcohol at night, I know I will then pay dearly the next day. Also, if I get really upset over something, which I do a lot, then it makes the problem much worse. I personally know what this is like through myself and my family and I can honestly say it is something horrible to have to live with and I truly sympathize with anyone who has it. If you have not been to see a doctor yet for your symptoms, I would definitely make that appointment with the GI physician and go. There are meds out there that can help some people. But, until the physician does some testing, they will not know what they are dealing with. You could have some other problem besides IBS. mssoup1
  11. If you have Medicare and a secondary insurance, then the VA cannot bill either one. They cannot bill Medicare since this is not allowed. And since they cannot bill Medicare for the service, your secondary insurance will not pay anything. If you only have a private insurance and not Medicare, then, yes, the VA can bill them. But, it is my understanding that the VA accepts whatever the private insurance approves and pays. You should not be billed for anything. If this is not correct, then I am sure someone will come along later who knows more about this and respond to your question. mssoup1
  12. While my husband had a BVA traveling board hearing instead of having to go to DC, I think that the hearings are all the same, regardless of how or where they are held. I posted the experience that we had earlier and have copied that posting below. Hope this might be of some help to you. Just my 2 cents worth since I have been before two BVA hearings before. These were in person at the VARO office.Try to be as calm as possible. Getting nervous or upset will only cause you to forget important things you want to make sure you get communicated to them. Just remember, they put their pants on the same way you do, so don't feel like you are the little person that someone is looking down on. In fact, we had a female law judge on one hearing and after about a minute, she made us feel like she was there to help us and she made us very comfortable.Take any of your most important evidence with you. If you have certain areas within the document that pertains to what you want them to see, highlight that area so it stands out and the whole document does not have to be read. If they act as though they have not heard of the evidence you may bring up, show your copy to them. This does go a long way. I had to do it several times and did help our claim in the end. Make a time frame sheet as to when things have happened and dates you turned in evidence or additional information to the VARO. If they want to know something specific, you don't want to have to dig through a lot of paperwork to find the answer or say "I don't know" unless you have to. You are alloted a specific amount of time for your appeal hearing, so you want to make sure you get the most for the buck. Make a list of anything that you want to make sure you get conveyed to the law judge. Doesn't have to be detailed, just to jog your memory while you are there so you don't forget anything. Remember, this is your one chance to appeal to the BVA in person and you want to make sure that you have all of your ducks in a row.When speaking to them, make them feel as though you are very knowledgeable about the VA regs, codes and processes. If you have more than one claim on appeal to the BVA that will be heard at this time, take each claim separately and stay with it until you have finished what you have to convey to them. Don't try to talk about more than one claim at the same time. This will only confuse them. Stay with one, finish it, then move on to the next one. I not only took relevant evidence, letters, etc. with me, but I wrote up a letter based on what I wanted to convey to the law judge. In the letter, I even had regs and codes quoted. My words in the letter I kept in black. Any regs or codes that I had in the letter, I put in red. This way I could tell the difference between the two. I myself was a little nervous to start with. I have panic attacks, so I thought this was really going to be rough for me. I asked if I could read from my letter and if they had any questions, they could stop me and we could discuss it. They said it was no problem. When I read the letter, I took my time and tried to speak as plain as I could because all of this was being recorded and I wanted to make sure there was no miscommunication in the tape being transcribed. I even sometimes spelled out things which I though might be misrepresented when someone tried to type up the transcript from the tape.You know why you have appealed your claim. Now, be ready to sit there and explain to them the very best you can why you feel your claim should not be denied. Be ready to show them the evidence you have which you feel contradicts the denial from the VARO.While they do have your C-file there with them, if you can readily access your files for any information which they may seem to be concerned with, it would be better for you to say "I have it right here for you" vs. the law judge trying to flip through your c-file to try and find it themselves. If they need a copy of anything you have, they will get someone to make a copy for them.Again, try and be as well prepared for the hearing as possible in order to be able to get your points across to the law judge. Don't ramble on about things. Get the important facts on the table and move on to something else. Don't get them bored right off and then not want to listen to anything else you have to say. Try to keep their attention as much as possible.These are some of the things I did and every claim that was before the BVA was approved, so I must have done something right or it was my lucky day.Good luck and I wish you the best of luck. Just spend some time on getting yourself prepared and try to stay as calm as possible. I am sure things will work our positive for you. mssoup1
  13. You stated that your shrink was willing to write something up for your husband and you wanted to know if he could do that since he was your doctor. If he is a psychiatrist, would be willing to look at your husbands medical records , test him, talk to him and then render an opinion, then I do not see why the VA could deny the report and not use it. Just because he is your psychiatrist doesn't mean that he cannot treat your husband as well. Most psychiatrist don't like to do this, due to a conflict of interest, but there are some that do. There may be others, though, who know more on this subject than I do. Also, I agree with your husband going to the Vet Center for counseling, either one on one, group or both. I know that the local Vet Center that we have has great people who work there and treat the veteran and their spouse/family with the upmost respect. They are also willing to help the veteran in any way that they can. But, even though they can write up a letter in support of your claim, I think you will still need a psychiatrist to diagnose your condition and give their opinion. mssoup1
  14. Kenny, I agree with Josephine in that your C & P reports should have already been completed and available to the RO to look at. It is also my understanding that the RO has a time limit on when they expect to be able to retrieve the report after the C & P exam has been completed. But, then again, I am not sure that this is being followed. In my husbands case, it wasn't. If I had not thrown such a fit about his report not being available after a period of time that I felt it should have been, no report would have ever been available as the doctor went on vacation after my husbands exam and apparently forgot about doing it. Out of all of the C & P exams that my husband has had, with the exception of those couple I have spoken about, the reports are usually available within a day or two. The C & P examiners have too many exams and reports to do each day to hold up on the reports for very long. If they did, they would never get caught up. Sounds to me like maybe someone forgot to write up the reports. Especially since they were all done by the same doctor. This is only my opinion on what I have read here. I also agree with Josephine that you contact the VAMC Release of Information Office in Zebulon and check with them to find out why the reports are not available. You have every right to get a copy. Also, you can call the VAMC in Zebulon and ask for the C & P Department. Tell them about your problem and that you would like to know when the reports are going to be available. This is where I initially found out about my husbands reports not being done. If they state that they don't have them in the system as being completed, contact the Patient Advocate at the Zebulon VAMC, tell her about the problem, and get her involved. I generally have had good luck in getting our Patient Advocate resolve any problems we have. Not sure if any of this applies to you or will even help, but I would try every thing I could to get those reports. mssoup1
  15. My husband had big time problems with one C & P that he had. I got a copy of the C & P and wrote a letter to the RO explaining all of the errors in the report and I requested that he be given another C & P exam due to the one he had being inadequate for use in making a decision. In the past, if we stated a C & P was inadequate, he was given another one. But, on this particular claim, after writing the letter requesting another C & P exam, we heard nothing on the claim. It seemed it just kinda died. He was never scheduled for another C & P exam and as far as I know, unless our POA signed off on dropping it, the claim would essentially still be active. With all of the other claims he had getting approved, which gave him a 100% rating IU P & T, we didn't bring this issue up because it was a SMK claim and would not have actually affected his rating pay other than to give him an extra amount each month. I didn't want to do anything that could have possibly reopened his file now that he had the full rating. I guess that since he was given his 100% rating IU P & T, then the RO felt this claim was moot and just dropped it. I don't have a problem with my husband being given C & P exams. But, if he is, the least the examiner could do is read the medical evidence available to him/her and render a sound decision based on the facts. There is no reason to have a C & P exam report filled with so many errors when this report is such a big factor used in either approving or denying your claim. I guess I am dumb on this, but what is Sensitive 6? Wishing you much luck. mssoup1
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