Patient Advocate Story

[Capt.]

Hello All,

I wanted to share a Patient Advocate story and let some of you know that the PA is there for the Vet and did come to my aid recently. First to let you know that the VA PCP doctors can get information from the Veterans Benefits Administration. On my last appointment I brought in a new medical notebook, that I carefully put together, which had my Civilian doctors IMO's , test and opinions, treatment records. I also had the Service Medical Records and the VA Progress reports. I asked him why he did not put in the record that he did not want me to have a spa for my Peripheral Neuropathy, even though the Nuerologist and Podiatrist did and made prescriptions for it. I also asked him why my VA Dr. diagnosis , opthamology report on antherosclorsis was not there in the Progress Report. I also asked why a VA doctor wanted me to be checked out by a Rheumatologist for immune system problems but no appointment. Ok so I followed up and got the Progress Reports 3 days laterafter my appointment and it was unbelievable. Somehow he wrote in the notes that I brought in a 3 inch thick booklet of records , tests and that I believed all of my diseases were service related. He went on to add that I had a lawyer in such and such city and had been denied once and that I was going to use all of the evidence in my folder for an appeal. Huhhh!!!. He also added that he did not want me to use the spa even though it plainly says by the other VA doctor to continue with my hydrotherapy. OK , so now I have one doctor says I need it and another one says I don't.The progress note also had left out the VA doctor diagnosis of antherosclorsis. Ok ....so I picked up the phone and called the Patient Advocate in another city ,who also had access to the console notes and progress reports. His first words were . "what do these comments about your attorney and denial and an appeal have anything to do with treating you? I said I that I was glad he noticed that too. He said this is against protocol and that the doctor knew better and was not suppose to write this in the progress reports. He also asked where the report was for the antherosclorosis and I said I have the report. He said to fax it to him and he would have it put into the console reports. He also said he was going to talk to his boss and call me back. In about 4 hours I get a phone call from the patient advocate and he said his boss was also concerned by the doctors notes and said they would send me a form to sign and ask what I wanted to strike from the record concerning his report. I got the report and filled it out and have sent it to them. I will give a followup to him next week to see what the console Progress reports read and to what the Doctor said as they were going to caution him about what he can say in the reports and to tell him that I had called the PA on him. I also asked him if it was proper to let the doctor review the past records and including private doctors and he said absoulutely. He then suggested that I get a new doctor....hahahhah. but I have already fired one about 3 yrs ago to get this one and since it is just a small clinic, that I was running out of doctors.

Has anyone else had this type of treatement from a V A doctor and has anyone used the Patient Advocate like I did. I will say that the people could not have been nicer and were in agreement that the doctor has overstepped his duties and the way he is to treat me.I will give an update to this as it continues. God Bless, Happy New Year. NEVER GIVE UP. C.C.

[broncovet]

Captain

Wow..this sounds like a "catch 22" if I have ever heard of one. The Veteran needs a Nexus statement from his doctor, but the doc is not required to give any such statement.

I may be missing something but this sounds like an easy way for the VA to get out of paying. Even tho the Vet got hurt in the military, the doctor does not have to say that..he just has to say the Vet is suffering from...condition, and he cant attest to where the Vet got his medical condition.

Fortunately, I got a "pro Vet" doc who gave me a nexus statement, that was favorable, and I ultimately won my claim, even tho it took 7 years.

I happen to know a little something about workmens comp, tho I will NOT reveal my source. Typically lawyers get to know the "claimant favorable" doctors..and they direct their clients to see THIS OR THAT doc. The lawyers do not want the claimant to really tell anyone that the lawyer suggested they see Dr. X. The lawyers know that evidence wins claims, and the some docs will offer more client favorable evidence than other doctors.

In a nutshell, if you want a favorable outcome on your claim, then it is best to go to a doctor who tends to write things in the medical report that are favorable to the Veteran. Dr. Bash, for example, is well known to write favorable reports for Vetrans..(IMO's and IME's). I dont know what you would have to do to make this happen. Perhaps you would need to move to another VA, if you ran out of docs, that is, there are no docs at your VA that are "Veteran friendly". Perhaps u need to go to a nearby town for medical care, or even pay for an IMO or IME. Or, maybe u need to go "doctor shopping". I do not recommend anyone lie or commit any sort of fraud..ever. However, there is nothing wrong with going to a doctor who is "pro Veteran". I think all docs should be Pro Veteran, but I know that is not the case.

There arent ANY experienced VA lawyers in my town, and it is a fairly large city with probably several dozen social security disability lawyers.

[Hoppy]

Captn

If I knew how to speed things up I would pass it along. Maybe somebody else might be able to help. I'm at a loss.

I'm currently helping a veteran who was diagnosed under the DSM II with a metal condition. The DSM II was abandoned and replaced by the DSM III. The DSM III and DSM-IV use entirely different diagnostic system than the DSM II. The DSM II was considered unreliable and speculative.

The VA determined the recent claim the veteran submitted was in attempt to reopen a previously denied claim. In order for a claim to be considered sufficiently similar to a previously denied claim the factual basis of both claims must be the same. I find it absurd that the VA raters think that they can understand the factual basis of a mental health claim when the original diagnosis was made under the DSM II. I am of the opinion that prior to weighing any evidence in this type of claim a contemporaneous opinion from a qualified clinician should be obtained. This is due to the fact that diagnostic terminology, criteria and methodology has changed significantly.

The veteran's claim has been thrown into the appeal process and he was forced to obtain a medical opinion as to the nature of the disability that onset while in the military.

The veteran has been rediagnosed with a service connectable condition that has no cure. The new report states that his condition onset while in the military and became chronic prior to discharge. It absolutely amazes me that the VA would deny a claim without a C&P exam for an uncurable condition that was chronic in the military as the result of raters using the diagnosis generated under a diagnostic system that has been considered unreliable and obsolete for 30 years.

I have developed propose changes in the way mental health claims are adjudicated with the assistance of a PhD who is a VA clinician. I use this case as an example as to why the changes should be made. In the near future these changes will be brought to the attention of the director of the RO and to the Congress. I'm hoping that as a result the claim will be expedited or at least there will be no more unnecessary delays in processing the claim for the veteran I am assisting.

[Hoppy]

Broncovet,

you can say you heard it from me. Over the years I have made many posts comparing the VA to workers compensation. I went to PI school and was specifically trained to assist workers comp lawyers in developing evidence for their claims. It's no secret that workers comp lawyers work with specific doctors. In fact it would be incompetent for a workers compensation attorney to allow a case to go to court without an opinion from a Dr. that he chose. If the attorney doesn't choose the Dr. then there were only two other options. One option is that the claimant choose a Dr. which is equated to choosing a Dr. random. The other option is to rely solely on the opinion of the employers Dr.

I think there might be a crossover in that workers compensation doctors might show an interest in assisting veterans. However, the Dr. would need to work closely with a service officer make sure the evidence is put into the right format.

The VA relies heavily on the decision of raters and medical reports from compensation and pension doctors. The system is not designed in a manner that makes it easy to get outside of their little monopoly. It is a good old-fashioned boys club. The frontline decision-makers in the service organizations and the RO are no way closely competent as the type of representation you obtain in the workers compensation system. Under workers compensation I always dealt with an attorney for every hearing and every office visit to discuss my case. The doctor who my attorney chose to write the reports for my industrial injury was an M.D./ J.D. Under the VA system I was represented by service officers who openly mocked my disability and threw me out of their office. They told me there was no way I could win my claim. Even though service officers are there to represent veterans I am of the opinion that due to the fact that most of them are ex-military rather than ex law students leaves them susceptible to many biases that fog their ability to see the issues in a claim. The fact that service officers do not have a pool of prescreened doctors from which they can seek reports favorable to the veteran counts for two more strikes against a system that already have a strike against it.

In workers compensation is pretty much assumed that employers Dr. would have a bias in favor of the employer and a claimant's Dr. would have a bias in favor claimant. In this state if the Dr. for the employer Dr. for the claimant write reports are contradictory and the lawyers can figure out a resolution then both parties attorneys agree on one agreed medical examiner whose name is on a list and this examiner will write a final report that is given to the judge when the case goes to court. Workers compensation cases go much faster.

[Capt.]

Hello Hoppy and Bronco,,,,,,I normally am in bed asleep but am having alittle setback tonight with this infection. I am tired and in some pain so will try and say something.

I do have at least 4 doctors IMOs all showing the many diseases and diagnosis and nexus. Clinical Phycologist, Neurologists, Neuroradiologist, 2 IMOs from an MD, a statement of cause from a Certified Environmental Scientist that is also an expert witness for the state, and even a VA Podiatrist Nexus.

It is these reports and test and opinions that I hope to propel for someone to acknowledge and to try and help to effectively treat me and also Service Connection and rated accordingly.

I have not pursed the EED and Immunesystme problems and some other that are secondary. I do not want to have the claim pulled and moved off track until we can get a DRO statement or decision.

As Hoppy is saying for his vet , many times the evidence keeps on building because the VA never really seems to get caught up with the case , claim to properly render a deicision before it has already climbed to higher ground , making the VA decisions late and in most cases of noneffect.Then the case is stalemate while the case or claim continues to grow with more test, more doctors , more reports etc. And you know what that means ,,,,,,,BVA and remands for failure to see the obvious.

I will try and keep everyone posted as this old horse is turning hard into the left rail on the track....... God Bless, and thanks a lot folks..NEVER GIVE UP. C.C.

[broncovet]

Captain..

If time is the issue, then you can try 2 things:

1. If it is applicable, ask for an advance on the docket due to hardship, such as if you have very poor health, or if your finances were a wreck. I asked for an advance on the docket due to a pending foreclosure and the VA shredded my request. (Yes, I am still upset about it, but I have learned to forgive, thanks to the good Lord) I am smarter now, and I know better and keep copies of everything, and follow up with IRIS emails and ask things like, "What is going on with my advance on the docket"? Of course, if they say "what advance on the docket", then I accuse them of shredding because I sent it certified return receipt requested.

2. Consider a Writ of Mandamus especially if it has been a VERY long time. I think you know these are almost never granted, but I did have some success with them because they lit a fire under the RO, letting them know that I wont put up with their Bull. In the response to my Writ, the RO made some bad mistakes and showed me their hand. Once I found out they had a pair of Two's, I knew my 3 fours would beat their hand, and I ultimately won my benefits. I use what the RO says against them. Beleive me, they use everything I say against me, so I dissect what they say, and re arrange it in a way that favors me. They cant dispute ONE word of what they say, but they dispute everything I say, so I often use their words against them.

Edited January 3, 2010 by broncovet

[broncovet]

Cap..

If the "old horse" needs to stay on the track, and needs help to file a writ, or whatever, just because their is "snow on my roof", that does not mean there is no "fire" in my fireplace and I will do my best to help ya, cuz I filed one and learned a little from the experience.