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Va Clinicians Guidelines


free_spirit_etc

Question

This sure seems different than having a doctor state their opinion and give medical sound reasoning for that opinion. It appears that the VA directs clinicians to NOT state opinions - but just discuss objective findings - which leaves the VA free to decide what the VA examiner's actual opinion was. Then, if the VA exam was in your favor - they can deny claims because the examiner's opinion was only implied, or weak.

C&P Service Clinician’s Guide

"1.15 Should opinions of merit or percentage of disability be given by the examiner?

The examining clinician must avoid expressing an opinion regarding the merits of any claim or the percentage evaluation that should be assigned for a disability. An opinion should not be given to the claimant regarding insurability, degree of disability, incurrence or aggravation by military service, or the character and sufficiency of treatment during military service or subsequently thereto. When asked about employability, the examiner should not state that an individual veteran is or is not individually unemployable, but should describe in full the effects of the conditions being examined on functioning, and how that relates to employment.

1.16 How do I give an opinion for nexus (relationship to a military incident?

When asked to give an opinion as to whether a condition is related to a specific incident during military service, the opinion should be expressed as follows:

1. “is due to” (100% sure)

2. “more likely than not” (greater than 50%)

3. “at least as likely as not” (equal to or greater than 50%)

4. “not at least as likely as not” (less than 50%)

5. “is not due to” (0%)"

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free_spirt.

Although this Directive was to expire in 2005, I believe it has been continued and is still in force. Maybe someone else can shed some light on it. I will do some checking around myself to fine out.

Patrick

VHA directive 2000-029

PROVISION OF MEDICAL OPINIONS BY VA HEALTH CARE PRACTITIONERS

Department of Veterans Affairs VAH DIRECTIVE 2000-029

Veterans Health Administration

Washington, DC 20420

PROVISION OF MEDICAL OPINIONS BY VA HEALTH CARE PRACTITIONERS

PURPOSE: This Veterans Health Administration (VHA) Directive establishes nationwide policy requiring VHA health care providers, when requested, and under certain limited circumstances, to provide descriptive statements and opinions for Department of Veterans Affairs (VA) patients with respect to the patients’ medical condition, employability, and degree of disability.

2. BACKGROUND: This policy rescinds all restrictions on VA physicians and other medical practitioners, defined in M-1, Part 1, Chapter 9, section 9.50. Restrictions on the ability of VA health care providers to provide statements and opinions for VA patients are inconsistent with the goal of VHA to provide comprehensive care and place a serious burden on veterans who depend on VHA for their care. This policy must, however, be implemented in a way that avoids inappropriate VHA participation in the claims adjudication process that determines eligibility for VA disability benefits. It is anticipated that this policy area will be the subject of future notice and comment rulemaking.

3. POLICY: It is VHA policy to remove restrictions on the ability of VA health care providers to provide statements and opinions for VA patients.

4. ACTION: Medical facility Directors are to implement this directive immediately. Use the following guidelines:

a. Support by Treating VA Practitioners of VA Benefits Claims

(1) Veteran patients may request descriptive statements regarding their medical conditions and/or opinions concerning the “possible cause(s)” of an existing medical condition for VA disability claims purposes. VHA health care providers shall provide a statement or opinion describing a patient’s medical condition. If the health care provider is the veteran’s treating physician, and is unable, or deems it inappropriate, to provide an opinion of statement, such physician shall refer the veteran’s request to another health care provider for the opinion or statement.

NOTE: For purpose of this policy, a note in the consolidated health record containing a statement such as, “in my medical opinion the currently existing medical condition is ‘related to,’ ‘possibly related, to.’ or ‘at least as likely as not related to’ and injury, disease, or

THIS VA DIRECTIVE EXPIRES SEPTEMBER 31, 2005

VHA DIRECTIVE 2000-029

September 22, 2000

Event occurring during the veteran’s military service” constitutes a sufficient supportive statement. The injury, disease or event can be something described by the veteran or shown in other records, but should be identified as such by the health care practitioner in the health care practitioner’s statement. A statement to the effect of, “I am unable to determine whether a relationship exists” between the present disability and a described injury, disease or, event occurring during the military service”, is also acceptable.

(2) When providing medical statements and opinions, the veteran patient must be informed that decisions concerning VA compensation and/or pension benefits are:

(a) Decided by VA regional office adjudication officials based upon the law, regulations, and the totality of medical evidence pertaining to the disability claimed, and

(:rolleyes: Not controlled by the physician providing the veteran’s care or the medical facility furnishing treatment.

b. Medical of Non-VA Purposes. Veterans may also ask VA health care professionals for medical opinions to assist them in filing claims with other agencies, e.g., the Social Security Administration (SSA). These opinions may be provided in the same manner and under the same restrictions as opinions furnished for Veterans Benefits Administration (VBA) claims processing purposes. NOTE: This does not include completion of Social Security Administration (SSA) forms for examinations where SSA would pay a private practitioner, but is prohibited from paying other Federal agencies such as VA (see Title 38 Code of Federal Regulations (CFR) 17.38(a)(1(xiv)).

c. Requirements for Disclaimer. In all instances involving VA determinations, the veteran patient must be asked to sign a statement indicating the veteran’s understanding that the opinions of the VA physician do not constitute an official VA determination of service connection, degree of disability, or eligibility for VA benefits. The disclaimer documented below is being added to VA Form 10-5345, Request for and Consent to Release of Medical Records Protected by Title 38 United States Code of (U.S.C.) 7332, to facilitate its use. In the meantime, for releases of information covered by this directive, incorporate a statement like the following, signed by the veterans, in the Consolidated Health Record:

“I understand that the VA health care practitioner’s opinions

and statements are not official VA decisions regarding whether

I will receive VA benefits or, if I receive

VA benefits, their amount. They may, however, be considered

with other evidence when these decision are made at a VA

VHA DIRECTIVE 2000-029

September 22, 2000

Regional Office that specializes in benefits decisions.”

5. REFERENCE: None.

FOLLOW-UP RESPONSIBILITY: The Office of Patient Care Services, Forensic Medicine Strategic Healthcare Group (11F) is responsible for the contents of this directive.

RECEISSIONS: M-1, Part 1, Chapter 9, section 9.50 and VHA Directive 98-052 are rescinded. This VHA Directive expires September 31, 2005.

*** NOTE *** This directive HAS BEEN REISSUED AND STILL STANDS. S/Frances Murphy, M.D. for

Thomas L. Garthwaite, M.D.

Under Secretary for Health

Patrick

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Oh good. Maybe it is just the C&P examiners (whose opinions they DO read) that they bar from giving opinions... :rolleyes:

I'm not sure on the directive....I saw it awhile back and didn't seem like it applied to my husband. Then when I got the bright idea maybe we could use it to get him an opinion - I couldn't find it - and when I did - I couldn't find whether it is still in force.

Hope somebody can tell us! B)

Free

free_spirt.

Although this Directive was to expire in 2005, I believe it has been continued and is still in force. Maybe someone else can shed some light on it. I will do some checking around myself to fine out.

Patrick

VHA directive 2000-029

PROVISION OF MEDICAL OPINIONS BY VA HEALTH CARE PRACTITIONERS

Department of Veterans Affairs VAH DIRECTIVE 2000-029

Veterans Health Administration

Washington, DC 20420

PROVISION OF MEDICAL OPINIONS BY VA HEALTH CARE PRACTITIONERS

PURPOSE: This Veterans Health Administration (VHA) Directive establishes nationwide policy requiring VHA health care providers, when requested, and under certain limited circumstances, to provide descriptive statements and opinions for Department of Veterans Affairs (VA) patients with respect to the patients’ medical condition, employability, and degree of disability.

2. BACKGROUND: This policy rescinds all restrictions on VA physicians and other medical practitioners, defined in M-1, Part 1, Chapter 9, section 9.50. Restrictions on the ability of VA health care providers to provide statements and opinions for VA patients are inconsistent with the goal of VHA to provide comprehensive care and place a serious burden on veterans who depend on VHA for their care. This policy must, however, be implemented in a way that avoids inappropriate VHA participation in the claims adjudication process that determines eligibility for VA disability benefits. It is anticipated that this policy area will be the subject of future notice and comment rulemaking.

3. POLICY: It is VHA policy to remove restrictions on the ability of VA health care providers to provide statements and opinions for VA patients.

4. ACTION: Medical facility Directors are to implement this directive immediately. Use the following guidelines:

a. Support by Treating VA Practitioners of VA Benefits Claims

(1) Veteran patients may request descriptive statements regarding their medical conditions and/or opinions concerning the “possible cause(s)” of an existing medical condition for VA disability claims purposes. VHA health care providers shall provide a statement or opinion describing a patient’s medical condition. If the health care provider is the veteran’s treating physician, and is unable, or deems it inappropriate, to provide an opinion of statement, such physician shall refer the veteran’s request to another health care provider for the opinion or statement.

NOTE: For purpose of this policy, a note in the consolidated health record containing a statement such as, “in my medical opinion the currently existing medical condition is ‘related to,’ ‘possibly related, to.’ or ‘at least as likely as not related to’ and injury, disease, or

THIS VA DIRECTIVE EXPIRES SEPTEMBER 31, 2005

VHA DIRECTIVE 2000-029

September 22, 2000

Event occurring during the veteran’s military service” constitutes a sufficient supportive statement. The injury, disease or event can be something described by the veteran or shown in other records, but should be identified as such by the health care practitioner in the health care practitioner’s statement. A statement to the effect of, “I am unable to determine whether a relationship exists” between the present disability and a described injury, disease or, event occurring during the military service”, is also acceptable.

(2) When providing medical statements and opinions, the veteran patient must be informed that decisions concerning VA compensation and/or pension benefits are:

(a) Decided by VA regional office adjudication officials based upon the law, regulations, and the totality of medical evidence pertaining to the disability claimed, and

(;) Not controlled by the physician providing the veteran’s care or the medical facility furnishing treatment.

b. Medical of Non-VA Purposes. Veterans may also ask VA health care professionals for medical opinions to assist them in filing claims with other agencies, e.g., the Social Security Administration (SSA). These opinions may be provided in the same manner and under the same restrictions as opinions furnished for Veterans Benefits Administration (VBA) claims processing purposes. NOTE: This does not include completion of Social Security Administration (SSA) forms for examinations where SSA would pay a private practitioner, but is prohibited from paying other Federal agencies such as VA (see Title 38 Code of Federal Regulations (CFR) 17.38(a)(1(xiv)).

c. Requirements for Disclaimer. In all instances involving VA determinations, the veteran patient must be asked to sign a statement indicating the veteran’s understanding that the opinions of the VA physician do not constitute an official VA determination of service connection, degree of disability, or eligibility for VA benefits. The disclaimer documented below is being added to VA Form 10-5345, Request for and Consent to Release of Medical Records Protected by Title 38 United States Code of (U.S.C.) 7332, to facilitate its use. In the meantime, for releases of information covered by this directive, incorporate a statement like the following, signed by the veterans, in the Consolidated Health Record:

“I understand that the VA health care practitioner’s opinions

and statements are not official VA decisions regarding whether

I will receive VA benefits or, if I receive

VA benefits, their amount. They may, however, be considered

with other evidence when these decision are made at a VA

VHA DIRECTIVE 2000-029

September 22, 2000

Regional Office that specializes in benefits decisions.”

5. REFERENCE: None.

FOLLOW-UP RESPONSIBILITY: The Office of Patient Care Services, Forensic Medicine Strategic Healthcare Group (11F) is responsible for the contents of this directive.

RECEISSIONS: M-1, Part 1, Chapter 9, section 9.50 and VHA Directive 98-052 are rescinded. This VHA Directive expires September 31, 2005.

*** NOTE *** This directive HAS BEEN REISSUED AND STILL STANDS. S/Frances Murphy, M.D. for

Thomas L. Garthwaite, M.D.

Under Secretary for Health

Patrick

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  • HadIt.com Elder

My experience with VA is that they will not help directly but they can behind the scenes. For example when I had my big C&P with three Shrinks at Dallas VA there was no way in hell they would cross the shrink who I saw cause he was one that got all the research money.

Sometimes just getting the diagnosis and background in your patient notes is as good as any letter that a VA Shrink would write.

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Didn't find the case yet - but found this: and it looks good! :o

http://www.wvajustice.com/index.php?pr=Veterans_news

In order to get a medical opinion that a veteran’s disability is related to exposure, injury or illness veterans should remember that the law now requires treating VA doctors to provide opinions whether the disability is likely related to what happened in service. In fact, one of the judges of the Veteran’s Court recently reminded the VA that Va doctors are not free to refuse to assist veterans, see Crutcher v. Nicholson, decided January 24,2006.

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1968-

You might not even NEED an IMO-

Based on your combat awards on your DD 214- I think they will award 30 or 50% SC for PTSD ---you are still working right?

They could make a schedular much higher rating----but I sure bet they wont-

In the decision you anticipate-

If they low ball you- that might be when to get the IMO- and have the IMO doctor combat their rationale for the 30 or 50- if you are symptomatic of a higher rating---

You can certainly get it and submit it now- but my point- and this was point I made to someone else here this AM-

A good IMO should generate an award-

but what if they get some quackola opinion after you send them the IMO- you might have to pay more money for an additional IMO regarding what they came up with-

1968- I sure appreciate your method and claims modus operanda-

I think the same way----

where are the land mines-

I did extensive medical research , even with 2 IMOs, to close any potential loopholes in my claim.

I sent the VA an autopied heart picture, consistented with my husband's heart autopsy and related it to DMII

by virtue of ECHO, ECG etc and known medical standards as to DMII heart damage.

I did the same thing with a brain diagrahm of both hemishperes and correlated the clinical record of the veteran with this trauma he had and know medical facts as to DMII and brain ischemia-

They never read my IMOS and my submissions-

My inital assessment in the 2003 claim, they had knocked down because I am a layperson and I had no IMO then. I reminded them that I initially assesed the veteran's heart disease, brain trauma and inappropriate meds-

which the VA agreed was correct- in my wrongful death FTCA claim award information which I got under FTCA and sent to them.

I just sent Dr, Bash $2,000 more bucks for an opinion ,based on additional medical evidence I found in the veteran's med recs, that not only expands his first IMO but is not redundant nor accumulative as it regards-

other facets of Rod's DMII that the VA fail to address.

I also have been fighting with the Medical EXaminer for two years- to get a proper death certificate.

You see- I think like you do- BUT

I am willing to pay for whatever it takes to get my husband Peace with Honor-

The VA can fight over the retro-I dont care-

My point is- if this IMO is costing you money- I think maybe you should hold off for the decision first----

just my opinion-

then again- if you get my DRO- she cannot read- never read a single thing in my c file-

NADA-not even my IMOs.

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  • HadIt.com Elder

1968

If there is anyway you could get a disability retirment after you get the initial PTSD rating that would help with the TDIU. Since you have had stable employment for 25 years it is going to be hard to wrangle a high rating out of the VA for PTSD. Any service connected rating opens the door for IU down the road.

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