Denial Of Treatment

[catt02189]

This is rather a long story, but hopefully I can keep it brief, but may omit a few important details in the process. I would like some suggestions on how to proceed with this because I am lost at this point.

In 1999, my husband had reconstructive surgery on his left shoulder at the VA hospital. Claim was lost and wasn't pursued at the time. In 2004, he refiled and was given service connection 10%. He is a paramedic. His job is to treat and LIFT patients. His shoulder has acted up since the surgery. In July, he left work early (first time ever) because the pain in his left shoulder became so severe he couldn't do his job. Saw primary at VA. Ortho referral. Saw ortho same week at VA hospital. Note from both unable to work and pain meds prescribed, MRA ordered. First MRA available September 11. Sent paperwork to Regional office with both letters from doctors that couldn't work asking for a temp upgrade. HAH ! MRA switched to fee based and done August 21 - labrum tear. Then we wait. Can't get ahold of primary. VA refuses to pay until day surgery is done. No workman's comp because VA s/c. Finally talks to primary to get release to return to work because falling through cracks. Primary refused to release to work. Loses job, insurance, benefits. Finds new job. Goes back to work. Still no appointment given from VA. Finally, November 12 sees ortho for five minutes to be given a referal to yet another ortho department further away because this VA hospital can't do this surgery. More waiting. Called yesterday to be told by primary that the consult was rejected and that he should be put on anti inflamitories. Now, he has been for 6 months. He has returned to work since the VA can't take care of the mess it created and we have 5 kids. Don't know how much damage he has done to it further his only light at the end of the tunnel was that this surgery would make the pain stop. For six months, I have been watching him live with unbearable pain and popping narcs like they are candy and everyone passing the buck.

We have contacted 2 Senators offices one that is a presidential nominee candidate. Gotten no where. Talked to SO. gotten nowhere. Talked to regional office, patient advocates, head of hospital...nowhere.

This seemed real simple to me. You put someone out of work - you put them at 100%. They need surgery to put them back off of 100% - you do the surgery. You don't keep prescribing them narcs and have them lifting patients an average of 45 or more people a week. My husband loves his job and just wants to be able to do it.

Thank you,

Andrea

[catt02189]

If he has medical insurance go see a private orthopod and get it done right. This BS could go on for months. I would not take my cat to the local VAMC for surgery. I would not even let them give me an injection. You can get workers compensation for the injury because even though the injury was SC the job he does now aggravated it. Do you have an workers compensation lawyer? I would consult with one pronto. It is illegal to fire someone who is injured by direct or aggravation of a pre-existing injury form work duties. I had a service connected injury that was aggravated by work and I got workers compensation. Usually, you must choose one or the other.

It has already gone on for 6 months and they said a year as far as increase in s/c. Job would not take him back without a medical release or him signing a statement he wouldn't claim workman's comp if it got worse. He found a new job. Has no other health insurance because that went out the window with the other job. He is working now and was waiting on the VA to schedule the surgery...that is where we hit the brick wall.

[catt02189]

I was just looking for a suggestion as to what approach to take with this as it stands. Anyone?

[jbasser]

If his Job aggravated his condition it does not matter what workers comp says. Get an attorney. They are not like the VA. The VA can get away with dragging a claim out because you cannot use an attorney ulless you are at the appeal atage. WOrkers comp is nothing but disability insurance hiding behind a government program.

Dont play the games these people play. I dont.

[Speaking Out]

I like the advice of consulting an attorney. You have a couple of issues here. First, this sounds like something that should be covered by workers comp and by your husbands work asking him to sign that he wouldn't file workers comp in the future if the injury is aggravated is a telling thing and second, you might have an EEOC violation here. Disabled Veteran's are not a defined class protected, but a person with a disability is. I am suprised the patient advocates office hasn't been helpful in getting your husband's care under control. How can a consult be rejected? That sounds crazy to me.

[catt02189]

I like the advice of consulting an attorney. You have a couple of issues here. First, this sounds like something that should be covered by workers comp and by your husbands work asking him to sign that he wouldn't file workers comp in the future if the injury is aggravated is a telling thing and second, you might have an EEOC violation here. Disabled Veteran's are not a defined class protected, but a person with a disability is. I am suprised the patient advocates office hasn't been helpful in getting your husband's care under control. How can a consult be rejected? That sounds crazy to me.

I appreciate the thought on the attorney, but like I said, he has a new job and he isn't willing to risk losing it going after the other job. The issue is where to go with the VA. I was suprised that the advocate didn't help worth a damn either, but upon meeting all of them at his last appointment, I will just say I have never met so many people that are completely apathetic to what is going on with another human being. And yes, I know it sounds crazy that it was rejected, but it was by the Indianapolis VA.

[john999]

I think I would try the media if the congressman did not help. If you are going to stick with the VA you just have to make so much noise they can't ignore you. Patient advocates are supposed to help but they are often retards. You have to create a fuss to get help. Just don't slug anyone but make noise. Forget about being reasonable or polite. Be a pain in their ass! It is not so smart to not go after the employer but that is your choice. Go to the VAMC and keep agitating until you get what you want or go to jail. That is about what it takes.