I Just Discovered A Form To Use To Get A Medical Opinion

[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.

[allan]

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:_________________________________________________

[nanaeris]

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?

[Pete53]

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

[Rockhound]

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

[c&p man]

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

[carlie]

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