Jump to content
VA Disability Claims Community Forums - HadIt.com Veterans
  • veterans-crisis-line.jpg
    The Veterans Crisis Line can help even if you’re not enrolled in VA benefits or health care.

    CHAT NOW

  • question-001.jpeg

    Have Questions? Get Answers.

    Tips on posting on the forums.

    1. Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery instead of ‘I have a question.
       
    2. Knowledgeable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title.
      I don’t read all posts every login and will gravitate towards those I have more info on.
       
    3. Use paragraphs instead of one massive, rambling introduction or story.
       
      Again – You want to make it easy for others to help. If your question is buried in a monster paragraph, there are fewer who will investigate to dig it out.
     
    Leading too:

    exclamation-point.pngPost straightforward questions and then post background information.
     
     
    Examples:
     
    • Question A. I was previously denied for apnea – Should I refile a claim?
      • Adding Background information in your post will help members understand what information you are looking for so they can assist you in finding it.
    Rephrase the question: I was diagnosed with apnea in service and received a CPAP machine, but the claim was denied in 2008. Should I refile?
     
    • Question B. I may have PTSD- how can I be sure?
      • See how the details below give us a better understanding of what you’re claiming.
    Rephrase the question: I was involved in a traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?
     
    This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial of your claim?”
     
    Note:
     
    • Your first posts on the board may be delayed before they appear as they are reviewed. This process does not take long.
    • Your first posts on the board may be delayed before they appear as they are reviewed. The review requirement will usually be removed by the 6th post. However, we reserve the right to keep anyone on moderator preview.
    • This process allows us to remove spam and other junk posts before hitting the board. We want to keep the focus on VA Claims, and this helps us do that.
  • Most Common VA Disabilities Claimed for Compensation:   

    tinnitus-005.pngptsd-005.pnglumbosacral-005.pngscars-005.pnglimitation-flexion-knee-005.pngdiabetes-005.pnglimitation-motion-ankle-005.pngparalysis-005.pngdegenerative-arthitis-spine-005.pngtbi-traumatic-brain-injury-005.png

  • VA Watchdog

  • Can a 100 percent Disabled Veteran Work and Earn an Income?

    employment 2.jpeg

    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

  • 0

Vamc Keeping C & P Examiner Credentials Secret


vaf

Question

I learned something this morning, and thought I'd share it with everyone here.

I checked the State Board of Medical Examiners for the name of the "requesting physician" who recently conducted an orthopaedic C & P for a veteran I'm trying to help file a request for increase. I couldn't find the name there as an M.D., an N.P., a P.A., or anything else. A friend of mine then checked the national AMA website, and "Dr." Evans wasn't found there, either.

I then called the Patient Advocate's office at the VAMC where the C & P took place. The "Advocate" told me the following. No, this individual doesn't hold any medical licensing of any sort in this state. No, she won't tell me what his credentials are without his signed release. No, she won't tell me what state he IS credentialed in without his signed release. But, according to her, it's her job to make sure he is qualified to treat patients and perform C & P exams there, so I'll "just have to take her word for it."

I told her that I know for a fact several resident doctors I checked on were rotating there with expired state medical licenses, something she evidently was NOT aware of. I got this information from checking the state licensing website. I also told her that a veteran has the right to know the credentials of the "requesting physician" performing a C & P, and on anyone treating the veteran. If we knew what state this person was licensed in, we could check the appropraite website, the guy would be listed there and it's public information.

This really galls me. Who the hell is she advocating for, it sure isn't the veteran.

I told her that following this policy will invite challenges to C & P examinations, and that she is preventing access to public information.

Link to comment
Share on other sites

  • Answers 16
  • Created
  • Last Reply

Top Posters For This Question

16 answers to this question

Recommended Posts

Vicki- I had a heck of a time determining a VA doctor's license number but the state med board here found it for me.

I was under the impression that all of these C & P docs have to be doctors with unexpired licenses.

Who knows- many are not listed on the medical web sites-but still could be legit.

One thing I did that might help someone here-

I went to the Healthgrades site.

For a small fee- $7 bucks I think but it could have gone up---in helping a local veteran-we got a complete run down on a C & P doctor who-we found had no expertise whatsoever in the C & P exam field.

We also found he was a moonlighter for Workmen's comp claims.

At the same time (I think I got a break when I ordered 2 reports, I put his private doctor's name into healthgrades (the VA had knocked down his IMO with the moonlighter's opinion)

and found his doctor's credential's were far beyond the VA doctor's.

We submitted these printouts and also I found online where his private doctor had spoken at a big symposium on the same disability he had.As a headline speaker, we printed that out too -it indicated his expertise which he had not put into his first IMO.

Also his private doctor had prepared an additional IMO as the first one did not conform to what the VA needed. With the second opinion and the healthgrade printouts, it helped a lot and he did win his claim.

http://www.healthgrades.com/consumer/index...57557&SID=1

But this is why I recommend getting an IMO-

Although the VA ignored my first IMO, they got a VA "expert" opinion, that my second IMO knocked down.

Also if I need it I have info on the VA doctor's background that does not compare to my IMO doctor's.

When Dr. Bash prepared my second IMO he certainly pointed out the medical inaccuracies of the VA opinion and that the VA doctor offered no rationale for the opinion nor any background at all to give the VA opinion any credence.

He also highlighted his specific areas of expertise that made his opinion probative.

It sure pays when getting an IMO, to be sure that the IMO doctor-as Dr. Bash does-- fully complies with the criteria that VA wants:

Specific medical rationale for the opinion,

full consideration of all pertinent medical records,

a More than likely, or as likely as not statement ,

and-if it regards the SMRs- a clear statement of how the present disability is associated medically to the SMRs.

Edited by Berta (see edit history)
Link to comment
Share on other sites

I finally reached the veteran's wife. She said the guy is an N.P. So now we have an N.P. of dubious licensure, information of which is being kept secret by the VAMC, performing orthopaedic C & P examinations.

Boy, am I going to have fun with this....

I've already recommended strongly that they consult a board certified orthopaedic physician to blow this guy out of the water.

Think I'll take another look at that VA mission statement...

Link to comment
Share on other sites

GOOD FOR YOU!

I fully believe this is what many claimants HAVE to do-

either get an IMO to combat the quackola stuff or fight the opinion in any way they can!

If I have to do more to knock down the VA opinion I got- which Dr. Bash knocked down as well as me already-I will suggest that-based on the VA "expert's" opinion-if the VA did not kill my husband (documented) in their misdiagnosed malpractice statements in the FTCA award, then this VA C & P expert sure would have killed him- based on the opinion this doc rendered in an SSOC.

Sometimes you have to get tough.

I have gotten in older claims- some of the most bizarre medical crap I have ever seen.

Of course by then I had some medical background and could fight back with medical evidence from the med recs.

But why should a claimant have to study medicine to knock down a VA doctor's opinion?

When a claimant succeeds in knocking down medical crapola from the VA, as I did in my last claims-it seems to me that even though VA kept saying I was not "competent" enough to render medical opinions

(which proved my claims anyhow)

what competence do their doctor's show when they write some of this stuff that is "medically inaccurate" as my IMO doctor stated recently to the VA.

Link to comment
Share on other sites

  • HadIt.com Elder

I was give a nerve conduction test by a German who had not Graduated from College. He told me the VA did not have to use people with valid credentials. The test was supposed to be administrated by MD's bt the VA was short that week.

Link to comment
Share on other sites

Pete, did you challenge the exam? Because that's what we need to do to cost the VAMC the additional time and money to redo a C & P exam to make it valid. That's the only way they will get the message to do it right the first time.

Link to comment
Share on other sites

I learned something this morning, and thought I'd share it with everyone here.

I checked the State Board of Medical Examiners for the name of the "requesting physician" who recently conducted an orthopaedic C & P for a veteran I'm trying to help file a request for increase. I couldn't find the name there as an M.D., an N.P., a P.A., or anything else. A friend of mine then checked the national AMA website, and "Dr." Evans wasn't found there, either.

I then called the Patient Advocate's office at the VAMC where the C & P took place. The "Advocate" told me the following. No, this individual doesn't hold any medical licensing of any sort in this state. No, she won't tell me what his credentials are without his signed release. No, she won't tell me what state he IS credentialed in without his signed release. But, according to her, it's her job to make sure he is qualified to treat patients and perform C & P exams there, so I'll "just have to take her word for it."

I told her that I know for a fact several resident doctors I checked on were rotating there with expired state medical licenses, something she evidently was NOT aware of. I got this information from checking the state licensing website. I also told her that a veteran has the right to know the credentials of the "requesting physician" performing a C & P, and on anyone treating the veteran. If we knew what state this person was licensed in, we could check the appropraite website, the guy would be listed there and it's public information.

This really galls me. Who the hell is she advocating for, it sure isn't the veteran.

I told her that following this policy will invite challenges to C & P examinations, and that she is preventing access to public information.

you go girl//bigjim

Link to comment
Share on other sites

  • HadIt.com Elder

I had a nurse practitioner give me a C&P exam that the VARO used to dispite what my VA cardiologist had stated, the VARO does what they want and however they want, once you piss them off you won't get your claim approved until you get it to the BVA is my experience and have a good IMO to dispute their garbage

Link to comment
Share on other sites

It's bad enough that unqualified individuals are conducting C & P exams, but even worse that basic information regarding their lack of credentialing and qualifications is being kept secret by the VAMC.

Unless we challenge these bogus C & P exams and cost the VAMC in time and money to redo them, we'll continue to be subject to flawed exams.

Link to comment
Share on other sites

Right- if a vet is forced into obtaining a costly IMO- the VA can challenge it if the doctor's rationale was not stated well, or VA can question the IMO doctor's credentials as to opining on the specific disability.

We should be able to do that too regarding their doc opinions.

Sometimes I wonder if that former VA nurse, who killed four vets in Massachusetts, ever did C & Ps too.

http://www.findarticles.com/p/articles/mi_...309/ai_n9406341

Here is another VA nurse patient killer:

http://www.usmedicine.com/article.cfm?arti...&issueID=40

Ten counts of murder against him-Columbia, MO VAMC.

and of course Dr. Michael Swango not only commited fraud with VA but killed some vets too.

It just points out that a vet should know who they are getting as a C & P doctor and as a primary care physician too.

Link to comment
Share on other sites

  • HadIt.com Elder

Vicki,

You stated that this is for an increase. I went through the same thing on an increase of a knee problem. The C&P was scheduled with a PA who was not capable of performing a drawer test for laxity. I have had so many knee exams that I know when the test is done properly.

I went to the ortho clinic and told them about the bogus exam and talked them into scheduling an exam with an ortho doctor. A board certified surgeon performed the test for me. I sent his notes to the RO.

If this guy is treated at the VAMC the RO usually just pulls his treatment records to see if the condition degraded since it was last rated. They schedule the C&P exam just to say they did. They do not even need to schedule a C&P. The treatment notes can be sufficient. If he has not been treated at the VA or he has no records to submit from an outside doctor they just do not take the C&P seriously. That is why it is done by a PA. They save the doctors the hassle of working on a claim that they have no evidence of increase before it is time to schedule the exam.

Link to comment
Share on other sites

I understand all that, but more so, it's this cloak of secrecy that concerns me even more. It's an intentional campaign to hide the most basic information from veterans that they are entitled to know before letting anyone at the VAMC touch them for any reason.

I say challenge the exam, cite the fact that the VA challenges credentials when an opinion doesn't concur with theirs, plus the VA's own core values regarding communication.

The VAMC Director never called me back, so that tells me something right there.

Link to comment
Share on other sites

If the doctor does not have a license he may be an intern. Interns are not licensable until they enter into residency. I cannot speak for other professions, but psychologists are not licensed until they finish their post-doctoral residency.

Is the VAMC that is being talked about attached to a medical school?

In any event if the person is not licensed at the time of exam, he does have a medical supervisor who checks and monitors their work. If the conclusions of the C and P are wrong the Supervisor will intervene.

I did C and P for mental health issues for the VA, and as early as 1986 (Ibeleive), an independent practitioner HAS to be licensed in order to practice their profession. Exceptions are those grandfathered in previous to that, interns, or trainess. The latter 3 will be supervised.

Patrick

Link to comment
Share on other sites

  • HadIt.com Elder

Vicki,

What patrick is saying is probably wat happened when I explained to the ortho clinic that the PA did not do a proper drawer test. They did not hesitate to schedule an new exam. Maybe it would be better to talk to the ortho clinic.

I think you should be very focused and expalin specifically what it is about the C&P exam you object to when talking to hospital personel. That is what worked for me on the botched drawer test. I had some exams performed by interns while in treatment that I also objected to te clinic and the objections resulted in the clinic scheduling an exam with the interns supervisor to unravel the interns mistakes. The treatment exams did more to advance my claim and the complaints resulted in development of the corrections very quickly.

Link to comment
Share on other sites

Thank you for the suggestions. One thing I noticed in the C & P was that nothing was discussed regarding range of motion measurements, although the veteran's wife said the examiner had the veteran in pain at one point, and that the examiner wrote things down after each movement. However, none of this is in the C & P.

This was an orthopaedic C & P. The VAMC is not attached to a medical school, but the local State Hospital has a State Medical School attached. PGY I-VI resident doctors from various disciplines are scheduled for rotations at the VAMC, mostly in Internal Medicine. They don't use the word "intern"anymore at the hospital here, instead referring to these doctors in training as residents. I worked there until recently, and anytime we came across a resident who had let their state license to practice medicine expire, they were to be pulled off rotation and not allowed to work until the license was renewed.

As the veteran's wife finally told me, the guy was not a resident doctor, he said he was an N.P. Of course, all we have to go on is the guy's word for it. So, it appears that this same requirement is not applied to NP's, PA's, or anyone else acting in the role of a physician when they conduct C & P exams if they land a job at the VAMC instead of working at a hospital in this state.

With all due respect, I don't trust a supervisor with an M.D. to correctly oversee anything an N.P. does in orthopaedics. Usually when something goes wrong, it's not the M.D. who signed off on the exam who blows the whistle on it, is it? It's the veteran who normally has to press for a new examination.

One more thing. On the C & P form where it says "Requesting Physician," why is the examiner's name just there, with no credentialing abbreviations after like N.P., P.A. etc.? It makes it look like the examiner is a "physician" when he really isn't.

Link to comment
Share on other sites

I havn't found this for medical C&P's but maybe this will help.

Notice that NP's, Pa's and other's must have "close supervision" and close supervision by the definition supplied below requires the proper licenced professional meet with the veteran.

Department of Veterans Affairs VHA DIRECTIVE 2006-013

Veterans Health Administration

Washington, DC 20420 March 7, 2006

QUALIFICATIONS FOR EXAMINERS PERFORMING COMPENSATION AND

PENSION (C&P) MENTAL DISORDER EXAMINATIONS

1. PURPOSE: This Veterans Health Administration (VHA) Directive establishes policy for VHA clinicians and managers regarding the professional qualifications required to perform Compensation and Pension (C&P) examinations for mental disorders.

2. BACKGROUND

a. On February 9, 2005, the Veterans Benefits Administration (VBA) issued C&P Fast Letter 05-01, Qualifications for Examiners Performing Compensation and Pension (C&P) Mental Disorder Examinations. C&P Fast Letter 06-03 revises those instructions and provides additional guidance. This VHA Directive is issued concomitantly to provide congruent directions to VHA personnel.

b. The objective of a C&P mental disorder examination is to obtain competent, critical, objective, and unbiased results. To ensure that examination providers are competent to provide findings and opinions that are valid and necessary for rating purposes, individuals who conduct C&P mental disorder examinations must have specific qualifications. As discussed in subparagraphs 4a and 4b, only certain individuals are permitted to conduct initial mental disorder examinations. In addition to those individuals, certain other individuals are permitted to conduct review or increase mental disorder examinations as discussed in subparagraph 4c.

c. To maintain the integrity of the patient-provider relationship, it is preferable that a veteran’s treating physician not perform the C&P examination for mental disorder.

3. POLICY: It is VHA policy that each mental health professional who conducts a VHA C&P examination for mental disorder must be appropriately qualified.

4. ACTION: Each facility Director, or designee, is responsible for ensuring that the:

a. Mental Health Professional Conducting C&P Examinations for Mental Disorders is Clinically Privileged. The mental health professional who conducts a C&P examination for a mental disorder must be clinically privileged, as governed by applicable law and the policies established at individual VHA facilities, to perform and/or supervise the performance of the following activities as required for all C&P examinations for mental disorders. The mental health professional must be able to:

(1) Diagnose all mental disorders, including personality disorders, using the nomenclature in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

THIS VHA DIRECTIVE EXPIRES MARCH 31, 2011

VHA DIRECTIVE 2006-013

March 7, 2006

2

(2) Provide an assessment of each veteran using the multi-axial system as set forth in DSM-IV with a narrative explanation of the Axis V determination.

(3) Determine when clinician-administered psychometric testing is necessary and integrate the results of such testing into the examination reports.

(4) Assess the need for, and effectiveness of, pharmacological and non-pharmacological treatment.

(5) Provide a prognosis with respect to each mental disorder or condition.

(6) When necessary, comment on the significance of the veteran’s prior mental health assessments (as reported) with respect to symptoms, occupational history, social history, and global assessment of functioning.

(7) Identify veterans presenting with complex diagnostic questions or other issues that are beyond the examiner’s expertise, and refer those veterans identified to a board-certified, or board-eligible, psychiatrist or a licensed doctorate-level psychologist who has the expertise necessary to complete the C&P mental disorder examination.

b. Examiner Qualification Requirements for Initial Mental Disorder Examinations Are Met. Mental health professionals with the following credentials are qualified to perform initial C&P examinations for mental disorders. They are:

(1) Board-eligible psychiatrists (those who have completed a psychiatry residency and who are appropriately credentialed and privileged) and board-certified psychiatrists.

(2) Licensed doctorate-level psychologists.

(3) Doctorate-level mental health providers under close supervision by a board-certified, or board-eligible, psychiatrist or a licensed doctorate-level psychologist.

(4) Psychiatry residents under close supervision by a board-certified, or board-eligible, psychiatrist or a licensed doctorate-level psychologist.

(5) Clinical or counseling psychologists completing a one-year internship or residency under close supervision by a board-certified, or board-eligible, psychiatrist or a licensed doctorate-level psychologist. NOTE: Close supervision means that the supervising psychiatrist or psychologist met with the veteran and conferred with the examining mental health professional in providing the diagnosis and the final assessment. The supervising psychiatrist or psychologist must co-sign the examination report.

c. Examiner Qualifications Requirements for Review or Increase C&P Mental Disorder Examinations Are Met. Mental health professionals with the following credentials are qualified to perform review or increase C&P mental disorder examinations. They are:

VHA DIRECTIVE 2006-013

March 7, 2006

3

(1) Mental health professionals qualified to perform initial C&P mental disorder examinations (see preceding subpar. 4b).

(2) Other mental health professionals, such as licensed clinical social workers, nurse practitioners, clinical nurse specialists, and physician assistants, any of whom must be under close supervision by a board-certified, or board-eligible, psychiatrist or licensed doctorate-level psychologist. NOTE: Close supervision means that the supervising psychiatrist or psychologist met with the veteran and conferred with the examining mental health professional in providing the diagnosis and the final assessment. The supervising psychiatrist or psychologist must co-sign the examination report.

d. Documentation of Qualified Examiners is Completed. As required in the C&P examination worksheets, examining mental health professionals must sign the reports and, if applicable, obtain the signature of the supervising psychiatrist or psychologist. All signatures must include the individual’s professional credentials (i.e., MD, PhD). NOTE: These signatures denote compliance with the requirements of this Directive.

e. Examinations are Returned as Inadequate for Rating Purposes, if Necessary. A C&P examination for mental health disorder may be returned to VHA by VBA as inadequate for rating purposes, when the exam:

(1) Does not include the examiner’s credentials and signature,

(2) Does not include the signature of a board-certified or board-eligible psychiatrist or a licensed doctorate-level psychologist.

5. REFERENCES: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision), American Psychiatric Association, June 2000.

6. FOLLOW-UP RESPONSIBILITY: The Office of Patient Care Services is responsible for the contents of this Directive. Questions may be directed to (202) 273-8434.

7. RESCISSIONS: None. This VHA Directive expires March 31, 2011.

S/Jonathan B. Perlin, MD, PhD, MSHA, FACP

Under Secretary for Health

DISTRIBUTION:

CO:

E-mailed 3/8/2006

FLD:

VISN, MA, DO, OC, OCRO, and 200 – E-mailed 3/8/2006

-----------------------------------------------------------------------------------------------

Time

Link to comment
Share on other sites

  • HadIt.com Elder

Time,

Good find, this is exactly the type of problem I had with an exam. I am starting to have delusions of grandure again. Serveral years ago I thought the legislators were reading my posts on hadit and changing the laws accordingly (big delusion). Many of the problems addressed by the Veterans assistance act of 2000 and VA directives in 1999 were for problems I complained about on hadit. Sometime in 2002 I put up posts that I had been given a diagnosis by a intern in a clinical psychology internship. The diagnosis and consult was signed by a PHD I had never seen. I went to the head of the psych department at the VAMC and told him I did not think it was professional to give me a diagnosis and have it signed by a PHD who never talked to me. I am sure I wrote posts about this on hadit in 2002 or 2003.

They should have put a requirement that all interns and hospital staff be required to read the directives. It would not suprise me if we here on hadit are the only people who know about this directive. Another problem I had is that I did ask complex diagnostic questions involving the resolution of diagnosis made by social security doctors and they were not addressed by the intern. Additionally he did not involve the PHD.

Link to comment
Share on other sites

Guest
This topic is now closed to further replies.
×
×
  • Create New...

Important Information

{terms] and Guidelines