Helpful Article On How To Help Your Claim

[SSGmajik]

I thought this was a decent article. Some things are no brainers, but some of the other info is pretty helpful.

http://www.blogs.va.gov/VAntage/7769/getting-your-claim-processed-favorably-and-quickly-some-helpful-hints/

[carlie]

VAconfusion.pdfVAconfusion.pdf

I can't seem to get this topic off my mind today.

So I have wondered thru out the VA websites to find any written regulations on whether or not

the VA Primary Drs are authorized to fill out the DBQ forms.

VBA is very careful to dance all around this subject.Which only makes me more curious.

They are specific that Private Drs outside of system can use them.

So I deceided to ask this Enquiring Question to OUR all knowing, All Seeing IRIS people.I will attach their email response to me. And people wonder why us Veterans just keep screwing up our own claims. Everything is so simple and easy to understand. And we pay these people $65,000+ bonuses. Geez, I wish I knew about these jobs when I got out. Oh thats right, I had one of those SPN # and was blackballed, sorry different topic. Anyway I sent them a link to their own website (VA.gov) concerning DBQ questionaires. This should be a good learning experience for both of us! LMAO Mike Ps Sorry double posted the email.

It is quite clear in the information that VA has online, that

providers with an active medical licenses (doctors) can fill out

the DBQ's - it does not matter which - it can be either a private practice doctor

or a VA doctor.

I have no idea what would lead you to think that VA is dancing around this

as to me - it appears very clear.

Only Specialty's like Audiology / Vision and Mental Health, have some exceptions.

http://benefits.va.g...N/dbqs/FAQS.asp

Q: What are Disability Benefits Questionnaires (DBQ)?

A: Disability Benefits Questionnaires (DBQs) are downloadable forms created for Veterans’ use in the evaluation process

for disability benefits.

DBQs will help speed the processing of Veterans’ disability compensation and pension claims.

DBQs allow Veterans and Servicemembers to have more control over the disability claims process by giving them the option

of visiting a primary care provider in their community, at their expense, instead of completing an evaluation at a Department of Veterans Affairs (VA) facility. The streamlined forms use check boxes and standardized language so that the disability rating can be made accurately and quickly.

Q: Why were DBQs developed?

A: DBQs were developed to streamline the collection of necessary medical evidence for the purpose of processing Veterans’ claims. DBQs provide Veterans with an improved means to submit medical evidence to support their claims.

Q: Who is authorized to complete a DBQ?

A: Providers with active medical licenses must sign and attest to a medical condition on completed DBQs.

The DBQ can be completed either by:

• Veterans’ private treatment providers, or
  
• Veterans Health Administration (VHA) clinicians.
  
  Q: How many medical conditions are covered by DBQs?
  A: More than 70 DBQs cover a full range of medical conditions. While some DBQs are specific to a single condition (for example: hypertension, arthritis, and prostate cancer), most forms can be used for several related conditions (for example: heart conditions, kidney conditions, endocrine conditions). Please see the extensive list of conditions on the VA website at: http://benefits.va.g...isabilityexams.
  
  Q: Where can you find DBQs?
  A: DBQs can be viewed on the VA website at: http://benefits.va.gov/disabilityexams
  
  Q: What are the benefits of using DBQs?
  A: DBQs simplify the documentation of medical conditions. By completing check-the-box DBQs rather than generating long narrative summaries, it is anticipated that VBA will reduce the time it takes to make a claims decision.
  Also, providers treating Veterans who are familiar with their conditions can speed the process by completing DBQs for their patients.
  
  Q: How do DBQs help with VA’s Fully Developed Claims (FDC) Program?
  A: DBQs are valuable for Fully Developed Claims processing because they provide medical information that is directly relevant to determining a disability rating, which helps ensure the VA’s ratings specialists have precisely the information they need to start processing the claim.
  
  Q: Will VA reimburse providers’ examination costs or travel costs to the Veteran for DBQ-related actions?
  A: No. This information is printed on the DBQ forms and appears on the Internet website where DBQs are publicly available.
  Veterans have the option to take a DBQ to their private provider or Veterans Health Administration (VHA) clinician for completion, but Veteran are responsible for any related co-pay or costs, including costs for travel or testing. (A Veteran is always entitled to an examination and any required testing at no charge for a scheduled compensation appointment that has been requested by VBA.) Asking your primary care provider to complete a DBQ is no different than asking your provider to write a letter or note providing medical evidence of a medical condition in support of a claim. The same co-pay rules apply equally to both situations.
  
  Q: How can you get further answers to DBQ questions?
  A: VA has a national call center available to assist at (800) 827-1000.
  
  Q: Are DBQs mandatory?
  A: No. Use of DBQs is not mandatory.
  
  Q: How do you submit completed DBQs to VA?
  A: Veterans and/or their physicians may mail or securely fax completed DBQs to the VA Regional Office handling the Veteran’s claim. To find mailing addresses, visit the VBA website at: www2.va.gov/directory/guide/Allstate_flsh.asp To find fax numbers, visit the VA website at http://benefits.va.g...disabilityexams. Completed DBQs may also be submitted directly to the VA Regional Office.
  
  FOR VETERANS
  
  Q: Will DBQs reduce claims processing time?
  A: Yes. If a provider uses a DBQ to evaluate a medical condition for a disability claim, it has the potential to significantly reduce the processing time.
  
  Q: Will VA make these forms available for additional medical conditions?
  A: There are no more DBQs planned for public release. With few exceptions, the current DBQs cover every condition for which a Veteran can receive compensation. If you have questions or cannot find the appropriate DBQ, please call 1- (800) 827-1000.
  
  Q: Which DBQs are not available for use by private providers?
  A: There are no DBQs for the following medical examinations:
  • Initial Examination for Post-Traumatic Stress Disorder
    
  • Hearing Loss and Tinnitus
    
  • Residuals of Traumatic Brain Injury
    
  • Cold Injury Residuals
    
  • Prisoner of War Examination Protocol
    
  • Gulf War Medical Examination
    
  • General Medical Examination for Compensation Purposes
    
  • General Medical Examination for Pension Purposes
    
    Q: Why are those DBQs not available for public use?
    A: VA has determined that the examinations required to complete those DBQs either require specialized training, specialized equipment, or specialized testing generally not available through private providers or, if these examinations are available, the cost to the Veteran would be so great as to render the DBQ cost-prohibitive. For these reasons, VA has determined that it is in the Veteran’s best interest to still require these examinations to be conducted by a VA clinician.
    
    Q: Where can you find DBQs?
    A: DBQs can be viewed on the VA website at: http://benefits.va.gov/disabilityexams
    
    Q: Are DBQs just for presumptive conditions (conditions presumed to be service connected)?
    A: No, DBQs will be used for almost every condition for which a Veteran can receive compensation.
    
    FOR MEDICAL PROFESSIONALS
    
    Q: Why would a Veteran need a DBQ if VA has most of their medical records?
    A: In some cases, VBA can use information in the Veteran’s health record to adjudicate the claim, if the information is sufficiently complete for rating purposes. However, if the information in the health record is incomplete, VA will require a DBQ to provide the additional medical evidence needed.
    
    Q: How far back can previous medical test results be used as evidence when completing a DBQ?
    A: There are no set rules regarding the age of available test results. If previous tests reflect the current medical condition of the Veteran, the examiner should indicate that those test results reflect the Veteran’s present condition and degree of disability.
    
    Q: What happens if VBA finds a DBQ completed by a private physician or a VHA clinician insufficient?
    A: Incomplete DBQ forms do not contain the information needed to rate the disability and, therefore, are considered insufficient. VA will strive to obtain the needed information during the claims development process. However, if the additional information cannot be obtained, VA may have to schedule the Veteran for a VA examination.
    
    Q: Can DBQs be completed during a regular medical appointment?
    A: Yes. Many of the DBQs can be completed in a short amount of time. The estimated respondent burden for each DBQ varies from 15 minutes to 1 hour depending on the complexity of the form and the conditions covered. The estimated respondent burden is listed on the DBQ form itself.
    
    Q: Should providers discuss the completed DBQ findings with the Veteran?
    A: The providers are the most qualified to discuss the Veteran’s health, but cannot and should not offer any opinions as to the outcome of the disability benefits claim. VBA, not the provider, makes the decision on the Veteran’s disability claim. The provider should remind the Veteran that the examination and DBQ report are only one part of the total evidence reviewed by VBA in making a disability benefit decision.
    
    Q: Will private providers be trained or certified in VA examination requirements, similar to VA clinicians?
    A: No, private providers completing DBQs are providing medical information on a Veteran they are treating. This is no different than letters previously submitted related to a Veteran’s condition. DBQs ensure that primary care providers gather the medical information VA needs to determine the disability rating.
    
    Q: Who can complete a mental health DBQ?
    A: In order to conduct an initial examination for mental disorders, the examiner must meet one of the following criteria:

    • a board-certified or board-eligible psychiatrist;
      
    • a licensed doctorate-level psychologist;
      
    • a doctorate-level mental health provider under the close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist;
      
    • a psychiatry resident under close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist; or
      
    • a clinical or counseling psychologist completing a one-year internship or residency (for purposes of a doctorate-level degree) under close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist.
      

    In order to conduct a review examination for mental disorders, the examiner must meet one of the following criteria:

    [*]any criteria from above; or

    [*]be a licensed clinical social worker (LCSW), a nurse practitioner, a clinical nurse specialist, or a physician assistant, under close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist

    Q: Will VA use DBQs for Post-Traumatic Stress Disorder (PTSD)?

    A: Yes.: However there are two separate DBQs for PTSD depending on whether the Veteran has already been told by VA that he or she is “service connected” for PTSD. If the Veteran has already been told by VA that he or she is “service connected” for PTSD, then a private mental health provider may complete a Review PTSD DBQ (VA Form 21-0960P3). However, if a Veteran has not already been told by VA that he or she is “service connected,” then a DBQ for the initial diagnosis of PTSD (VA Form 21-0960P4) must be completed by a VA mental health provider. The Initial PTSD DBQ cannot be completed by a private mental health provider.

    Q: Will VA use DBQs for any other mental disorders?

    A: Yes. DBQs concerning all other mental health conditions (other than the initial diagnosis of PTSD) can be completed by any private mental health provider meeting the criteria described above.

[Hoppy]

The information below was taken from VHA directive 2008-71. This directive is used by VA clinicians to not make nexus statements. They can make a statement that MAY be used for rating purposes. Unless the DBQ form states specifically that a nexus opinion is required and requests supporting logic the 2008-71 directive is probably what most VA primary doctors will go by. If the DBQ form does not specifically state it replaces VHA directive 2008-71, there might even be a situation with contradictory instructions. Also, consider that I have had a primary care doctor write a nexus opinion and the RO denied the claim saying that they needed an opinion from a specialist. They did not even consider the primary doctors opinion as sufficient for meeting the requirements to cause them to schedule a C&P exam. VHA is Veterans Health Administration not to be confused with VBA, Veterans Benefits Administration

d. Medical Statements to Support VA Benefits Claims. When honoring requests for medical statements by veterans for VA claims adjudication, care must be taken to avoid conflict of interest or ambiguity.

(1) Determination of causality and disability ratings for VA benefits is exclusively a function of the Veterans Benefits Administration (VBA). VHA providers often do not have access to military medical records, and may not be familiar with all the health issues specific to military service, such as environmental exposure. As a result, they may not feel comfortable in stating causality of a current condition. However, this does not preclude VHA providers from recording any observations on the current medical status of the veteran found in the medical record, including their current functional status.

Edited August 8, 2012 by Hoppy

[Bigred122]

Why then does all my hospital Primary Care and Surgeon say that Administration says they are not allowed to fill them out for the Veteran? I thought it was funny when Iris emailed back to me and didn't know what they were. The system should be simple 1) Primary states whether Veteran has a Service Connected Disabilty 2)C&P exam Drs should only be used to determine percentage of Disability and if more tests are needed to determine percentage, then order them. Not used to find reasons to deny claim. 3) Claim moved to Processing Division where Financial Dept handles that part,Medical or Mental therapies are ordered according to Veterans Disabilities, Medical Equipment Dept to handle and order specialized equipment Veteran needs for everyday existance, Education Dept handles that area if Veteran so chooses and last but not least Any Job Assistance or trainning if Veteran is capable of that as well. They would like any other disability agency would have a Fraud division for the small amout of those needing attention. They would save money in labor by needing less reworking. The right people would be doing the diagnosing and the clerks would be doing the processing of tasks necessary. It could be so simple. Hoppy is right when he says that the way they are doing it now is making it adverserial when they want one VA Dr to disprove another VA Drs opinion. C&P Drs should be used Only to determine % of disability.

For some unknown reason or another I kept thinking when they wrote VHA Drs I was thinking that was the C&P Drs only. My mistake. So I made a copy of that page and going to show it to my Primary Care Dr and going to take a copy to Admin and find out why giving out the wrong info to their Drs. And if they have a directive that supports what they are telling their Drs I want a copy of it!! I need to have this cleared up once and for all.lol Mike

[Notorious Kelly]

Good stuff, SSmajik!

[USNDW]

Sounds good, but after reading through it and knowing that I have done what the writer says will make it easier for the VA to process your claim, and it certainly has not made it any easier.

Claims with supportive medical records including service medical records and recent records showing the current condition and all that.

Still hasn't helped.

I know the writer has good intentions of giving us advice, but in reality we could do what they write and more, it really comes down to each different VARO, and some just suck!