HadIt.com Elder LarryJ Posted January 21, 2008 HadIt.com Elder Share Posted January 21, 2008 Ya'll may know about this form, but I didn't. It's a form that you give your VA health care provider for them to fill out in support of your claim. I had to scan it, so it might not come out very clear. "It is cold and we have no blankets. The little children are freezing to death. My people, some of them, have run away to the hills, and have no blankets, no food; no one knows where they are-perhaps freezing to death. I want to have time to look for my children and see how many of them I can find. Maybe I shall find them among the dead. Hear me, my chiefs! I am tired; my heart is sick and sad. From where the sun now stands, I will fight no more forever." Chief Joseph Link to comment Share on other sites More sharing options...
HadIt.com Elder allan Posted May 21, 2009 HadIt.com Elder Share Posted May 21, 2009 Here's one I saved. You should be able to alter it to fit your issues. *********************************************************************** PHYSICIAN’S QUESTIONNAIRE (Chronic Acquired Psychiatric Disorder Veteran’s Name: C/CSS# 1. How long have you treated the veteran for his psychiatric condition? Year(s)____ Month(s)______ 2. Are you considered his primary care provider for the psychiatric condition? Yes_______ No______ 3. Are you able to review the veterans service medical records and current treatment records? Yes_____ No_____ 4. In your opinion what is the diagnosis of the veteran’s psychiatric condition?____________________________________ 5. In your opinion is the veteran’s current psychiatric disorder, diagnosed above at least as likely as not related to the in-service acute schizophrenic episode in 1973 that led to his discharge from the military? Yes____ No _____ 6. In your opinion was the ……………………….at least as likely as not the initial manifestation of the current psychiatric disorder diagnosed above? Yes ______ No _________ If yes, please provide a brief explanation:_______________ __________________________________________________________ Additional comments:______________________________________ Physician’s Name:_____________Specialty_______________License#_________ Physician’s Signature:_________________________________________________ Link to comment Share on other sites More sharing options...
nanaeris Posted May 26, 2009 Share Posted May 26, 2009 Here's one I saved. You should be able to alter it to fit your issues. *********************************************************************** PHYSICIAN'S QUESTIONNAIRE (Chronic Acquired Psychiatric Disorder Veteran's Name: C/CSS# 1. How long have you treated the veteran for his psychiatric condition? Year(s)____ Month(s)______ 2. Are you considered his primary care provider for the psychiatric condition? Yes_______ No______ 3. Are you able to review the veterans service medical records and current treatment records? Yes_____ No_____ 4. In your opinion what is the diagnosis of the veteran's psychiatric condition?____________________________________ 5. In your opinion is the veteran's current psychiatric disorder, diagnosed above at least as likely as not related to the in-service acute schizophrenic episode in 1973 that led to his discharge from the military? Yes____ No _____ 6. In your opinion was the ……………………….at least as likely as not the initial manifestation of the current psychiatric disorder diagnosed above? Yes ______ No _________ If yes, please provide a brief explanation:_______________ __________________________________________________________ Additional comments:______________________________________ Physician's Name:_____________Specialty_______________License#_________ Physician's Signature:_________________________________________________ Do it has to be a doctor or could it be a licensed mental health provider? Link to comment Share on other sites More sharing options...
HadIt.com Elder Pete53 Posted May 26, 2009 HadIt.com Elder Share Posted May 26, 2009 First choice should be a Medical Doctor who practices or has expertice in the area you are trying to connect. Next any Licensed MD or yourVA MD's After that the chances drop exponentially Good Luck Veterans deserve real choice for their health care. Link to comment Share on other sites More sharing options...
Rockhound Posted May 27, 2009 Share Posted May 27, 2009 I haven't used the information as of yet, but I asked my treating psychiatrist to make a note in my progress notes that delt with her opinion as to whether or not I had a personality disorder. To help support her opinion, I provided her with my Navy physical evaluation summery report of my psychotic episode, along with the C&P examination summery report that opinioned that I had a personality disorder and anthing else that was a part of my C-File and some that wasn't. She then documented this information and her examination of me and opinioned that I didn't meet any known personality, based on the standards of the DSM IV. My belief is that you should provide any and all information that is not available on what you are claiming in the hospitals computors or IMO's files, so the VA can not come back and say they didn't have access to your full medical records, without it, they can ignore the opinion as having little or no weight in their decision. You should list all the information provided the Dr. so the VA can not say it wasn't before the Dr. when they gave their opinion. I can't say it enough times. This will also give weight to any nexus statement they may provide as well. The more you provide, the less it is likely the VA can ignore the opinion. Rockhound Rider :D Are you a paranoid schizophrenic if the ones you think are out to get you, really are? Link to comment Share on other sites More sharing options...
c&p man Posted June 8, 2009 Share Posted June 8, 2009 OKAY.........Let's try this again.Medical_Opinion_of_VA_Practitioner_for_Nexus.doc I dont knoe i this form is still downloadable ,but i couldnt download it. I was trying to get a letter for a nexus statement. thanks larryj for our time and effort Link to comment Share on other sites More sharing options...
carlie Posted June 8, 2009 Share Posted June 8, 2009 (edited) In my medical opinion, the currently existing medical condition is __________ Related to __________Possibly related to __________At least as likely as not related to an injury, disease, or event occurring during the veteran's military service. Present Diagnosis: ________________________________________________________ Injury or event occurring during service (as described by veteran or found in other records provided by veteran): ________________________________________________________________________ ________________________________________________________________________ Signed: Physician/PA/FNP Date I understand that the VA health care practitioner's opinions and statements are not official VA decisions regarding whether I will receive other VA benefits or, if I receive VA benefits, their amount. They may, however, be considered with other evidence when these decisions are made at a VA Regional Office that specializes in benefit decisions. Signature of veteran Date Signature and Title of Practitioner Date MEDICAL RECORD Supplement to Progress Note for Specialized Disciplines – Vertical Medical Opinions by VA Providers for VARO Claims MRC 136-01-908 Edited June 8, 2009 by carlie Carlie passed away in November 2015 she is missed. Link to comment Share on other sites More sharing options...
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LarryJ
Ya'll may know about this form, but I didn't. It's a form that you give your VA health care provider for them to fill out in support of your claim.
I had to scan it, so it might not come out very clear.
"It is cold and we have no blankets.
The little children are freezing to death.
My people, some of them, have run away to the hills, and have no blankets, no food; no one knows where they are-perhaps freezing to death.
I want to have time to look for my children and see how many of them I can find.
Maybe I shall find them among the dead.
Hear me, my chiefs! I am tired; my heart is sick and sad.
From where the sun now stands, I will fight no more forever."
Chief Joseph
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