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100% T&p Redused For Not Using Va?

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bassrunnin1

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I don't know if this is the right forum or not but I have always used the VA for Psychiatrist and always used outside Psychologist even before my claim was decided. Although I did have to stay in their psych ward last year, I have ptsd and bipolar. If I only had PtSD I could stick with the VA has med changes don't need to made often after the cocktail is worked out. But with Bipolar I am a rapid cycler and I cycle about every 6-8 weeks. It takes to long to make appointments, and my last leg of going to someone outside for meds was when I had to call the crisis line. So I want continue to see this outside NP for meds since I can see her every 3 weeks as we try to get this cocktail resolved. I am afraid that if I stop going to the VA for Psych meds they will reduce me. They have me as 100% T&P, no future exams required. l do use the VA for PCP 1x year for physical and Sleep center for Apnea and that will remain the same. However if I have a sinus infection or such I go to an outside clinic. I hope this helps...thanks in advance...I just don't want the VA to think I'm scamming them or something...however PTSD can get better for some (not often I'm sure) but Bipolar is a life condition and never goes away and the Bipolar was included in my final rating (PTSD/Bipolar) but shows as PTSD since medical can only have 1 illness listed in the final rating. But I was awarded more because of the Bipolar onset due to PTSD. Hope that helps...

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  • Content Curator/HadIt.com Elder

I don't think the VA will reduce your rating just because you choose to see an outside doc. Because you are both P&T and get SSDI, chances are you are in good shape, in my opinion.

P&T and no future exams offers you some security, but is not a guarantee. One thing I learned about the VA is they sometimes do stupid stuff. They have to follow specific rules. If they intend to try and reduce your rating, they are first supposed to send you a letter stating their intent to reduce along with their fuzzy reasoning. You get a chance to respond and submit evidence showing otherwise.

Also, if you choose to get your meds from an outside doc, they might not be as affordable as the VA (free). If you want, you might consider talking with your VA and non-VA psychiatrists and let them know your intentions and sign the appropriate releases. Your non-VA doc could then consult with your VA doc, and maybe you can still get your meds issued to you through the VA via proxy. Not all providers might do this, but it might be worth a shot.

Good luck!

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I agree with Vync. Remember, F.E.A.R is "False Expectations Appearing Real".

For the VA to reduce you, they have to send you a letter and give at least 60 days notice AND you have a right to a hearing on the reduction.

At the hearing you could provide your private medcial records and it isnt likely you would be reduced UNLESS your condition "actually improved under ordinary conditions of life". This means "working". If you are working, you could get reduced, but if you are not, it would be very difficult to reduce you once you get P and T.

The VA would have to show you have sustained improvement (not just episodic improvement..everyone has good days).

In short, dont worry about it, as it is highly unlikely to happen.

When will you have had your rating 10 years? Their are protections at:

5 years (or P and T) You already get these.

10 years (for service connection)

and

Grandaddy 20...twenty years can not be reduced or SC severed except in case of fraud.

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  • Content Curator/HadIt.com Elder

More good advice from broncovet

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  • HadIt.com Elder

Using VA medical treatment to document conditions can be useful come claim time. At the same time, the VA may provide less effective treatment, such as drugs selected more for lower cost than

an optimum drug. A way to compromise and potentially benefit is to have an outside provider actually treat, and the VA provide the majority or all of the prescriptions.

Usually, a VA PCP will co-operate. When they don't want to, I've had quite a bit of luck when an outside specialist is the treating doctor, by saying

"the drug is on the VA's formulary"(when it is). "In order to change, the specialist must approve."

In the past, I've even had VA pharmacologists try to substitute, claiming that the preferred drug was not available. (They didn't order it, likely due to cost.)

This gets really messy, when the drug is commonly available at local pharmacies, and you ask for the paperwork to buy outside and be reimbursed.

I had this sort of happen a couple of times within the last two years. What the VA Pharmacy did was to substitute pills that had to be split to obtain the proper dosage.

Calling them on this was interesting, because the pharmacy didn't follow regs and guidelines, and had somehow altered the prescription ordering system to automatically supply the incorrect dosage,

unless the VA PCP specifically said not to do so.

At least this was not as bad as a debacle a few years ago (decade?) over the drug Lisinopril. The VA wanted to save money by not supplying it. Unfortunately,

all the alternatives were less effective, and had more common serious side effects. As soon as it became generic the VA did not have a problem. Again, unfortunately, it seems that the generic supplied by the VA may have more side effects than the original.

Edited by Chuck75
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What do you mean about 5, 10 and 20 year exeptions? Could someone explain that a little more? ALso, how do you go about getting your meds through the VA, do you have the civilian doctor tell you what you need and then at the VA appointment say what they suggested and have the VA dr write the scripts to get them through the VA, or are there other options. If you could, could you outline those options for me? I'm new to navigating the VA health Care system, except my C&P exams...which everyone was a great help in that matter.

Edited by bassrunnin1
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What do you mean about 5, 10 and 20 year exeptions? Could someone explain that a little more? ALso, how do you go about getting your meds through the VA, do you have the civilian doctor tell you what you need and then at the VA appointment say what they suggested and have the VA dr write the scripts to get them through the VA, or are there other options. If you could, could you outline those options for me? I'm new to navigating the VA health Care system, except my C&P exams...which everyone was a great help in that matter.

"Also, how do you go about getting your meds through the VA, do you have the civilian doctor tell you what you need and then at the VA appointment say what they suggested and have the VA dr write the scripts to get them through the VA?"

Basically, you take a copy of the prescription written by the outside treating doctor to the VA VA facility (CBOC in my case)

I also have used an actual pill bottle that has the prescription number, the issuing doctor's info, and so forth.

The VA PCP looks at things, then writes an in VA prescription.

If the PCP does not agree, then you can ask why, and ask the PCP to contact the outside physician.

The basic VA law involved is the Veterans Millennium Act (As I remember).

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