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fiasco2g

VA primary care will not refer to Rheumatologist or MRI

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Hello. I am new to this site and need a little info. I am trying to get my va primary care doctor to refer me for an MRI for my back and a Rheumatologist for the pain in my knees, hands, back, etc. He said he does not know why I am hurting but will not send me to a specialist. This was messaging response below:

I have reviewed your lumbar spine films and you have a mild L5-S1 disc disease.  Without radiculopathy, an MRI is not warranted. I understand that you are applying for benefits, but it is not the VA providers responsibility to order all tests and exams that you want done.
  I have to justify all consults and exams.  Your lab work is within normal limits so Rheumatology will not be consulted as they have rules as to who can be seen.  You do not meet the criteria for Rheumatology consult. 

Well I did not want every test in the world just something to diagnosis the problem. I sent him a reply asking what the next step for treatment and diagnosis is then since he told me that he does not know what is wrong with me. I thought 30% of the time

blood work will not tell you anything for Rheumatoid arthritis, fibromylagia, gulf war syndrom, etc. I just need help. I paid for an MRI myself on one knee and it is expensive.

I am not service connect yet but filed an intent to file in January 2016. So I need to get the ball rolling on diagnosis and will go the civilian route if required. But is the VA responsible for at least attempting to diagnosis the problem or just continuing to push me six months down

the road to the next appointment. Thank you for you help.

Edited by fiasco2g

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1 hour ago, fiasco2g said:

Hello. I am new to this site and need a little info. I am trying to get my va primary care doctor to refer me for an MRI for my back and a Rheumatologist for the pain in my knees, hands, back, etc. He said he does not know why I am hurting but will not send me to a specialist. This was messaging response below:


I have reviewed your lumbar spine films and you have a mild L5-S1 disc disease.  Without radiculopathy, an MRI is not warranted. I understand that you are applying for benefits, but it is not the VA providers responsibility to order all tests and exams that you want done.
  I have to justify all consults and exams.  Your lab work is within normal limits so Rheumatology will not be consulted as they have rules as to who can be seen.  You do not meet the criteria for Rheumatology consult. 

Well I did not want every test in the world just something to diagnosis the problem. I sent him a reply asking what the next step for treatment and diagnosis is then since he told me that he does not know what is wrong with me. I thought 30% of the time

blood work will not tell you anything for Rheumatoid arthritis, fibromylagia, gulf war syndrom, etc. I just need help. I paid for an MRI myself on one knee and it is expensive.

I am not service connect yet but filed an intent to file in January 2016. So I need to get the ball rolling on diagnosis and will go the civilian route if required. But is the VA responsible for at least attempting to diagnosis the problem or just continuing to push me six months down

the road to the next appointment. Thank you for you help.

Your problem is not an infrequent one. Even insurance companies are trying to get out of paying for such things as MRI's.

Personally, I do not trust VA PCP's to make decisions based upon the best interest and outcomes for individual veterans. Instead, the "party line" often seems to be as or more important. While I use the VA for no cost prescriptions, the majority of those are originated by non VA doctors. In the not so distant past, I had examples of the VA supplying prescriptions using generics that were not intended for the US market.

In short, if I were you, I'd get an opinion and evidence from outside VA, then proceed.

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I just visited a family friend who is a military doc, and we discussed this issue.  

Docs dont like that they are forced to give us substandard care.  The VA wont hire more doctors, cuz it costs em too much.  I had another friend (psychiatrist) who applied at VA about 5 years ago.  He was qualified, and VA kept giving him the run around until he gave up.  All this stuff that VA wants to hire docs is pure hogwash.  They dont want to pay em.  

VA docs have an enormous patient load, so much so, that they have to herd people in there like cattle.  

When I do get to see  a doc, I get maybe 2 minutes with him/her.  I better not have multiple issues, as he will only deal with one, and gets mad when we say, "Oh, ok for my knees, now what about this maybe cancerous mole?"  

The second issue will largely be unaddressed.  They have 4 more patients waiting, and VA requires they see them on time or close, regardless if the doc has an emergency and has chest pain. The billions of dollars congress gave VA was largely squandered on cost over runs for the hospital, so it was useless.  When will congress learn "throwing money" at VA just means that more will be squandered.  

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I would request a different PCP  ASAP

VA Dr's work for the veteran not the VA.

IF THERE WERE NO VETERANS THE Dr would not have a Job at the VA...period.

Something I learned over the past 30 years or so is never mention a claim or your benefits in a VA Dr's Presents..instead act like you never heard of such thing  but you would like to get the right treatment for your injury/disability,.

now that we have access in our own home  to see what they said about our disability's that will be in MyHealthyVet after 3 days hold  we can get that information & make copies and put them in order to help and submit as evidence during our claim process without the Dr's even knowing it.

But when  DR will not send a veteran for C/S /MRI''s to look for conditions/diseases such as arthritis /Rheumatoid arthritis or any other condition because he thinks you don't meet the criteria..I'd report his Ass in a New York Minute

Absolutely no call for that type of treatment.

and file tort claim of mal-practice.

It would be hard to prove no doubt about that  but it sure would make that A-H Dr do some squirming.

 

.........jmo

..................................Buck

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Thanks. I will work with outside doctors and request a new PCP. Is there an official way to do this or just call them up and request one? I tried to report the doctor to the VA IG but that is probably going nowhere. I thought he actually would help four years ago when I started seeing him he just keeps pushing me six months down the road though.

Edited by fiasco2g

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