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Jonah1

No Va Doctor Qualified to Evaluate Me

Question

I received a 10% rating for TMJ. Come to find out I have a condition that is much more serious than TMJ. I actually have maxillary hyperplasia and unilateral mandibular condylar hyperplasia. My top jaw grew shorter than my bottom and my left joint that connects my bottom jaw to my skull, along with the bone the connects the same to my chin, grew bigger and longer than the right, respectively. This has caused my face to become asymmetric and deformed. It has also caused functional problems such as pain, problems chewing and speaking.

Although I am 100% I have been denied a diagnosis and much-needed surgery to correct these conditions. The VA doctors, in order to cover their neglect and abandonment, have gone as far as to lie to my congressman and even to the representative at the new White House line opened up by President Trump. I fear that my only recourse is to claim this condition. The only problem is, I have been informed by the director of oral surgery at the VA that there is absolutely no doctor qualified to diagnose me in the VA or perform the surgery that I need. I don't know how to file this claim to get the care that I so desperately need. Please advise.

 

Thank you.

 

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The obvious answer is you would ask your prime care doc to be seen for this condition, and, if no VA doc can do this, to ask VA to pay for the evaluation from a private doc, through Veterans choice.  Ask your prime care doc, not a congress critter, IMHO.  

 If you are at 100 percent currently, the only way you can get an increase in disability comp is SMC.  

If you are seeking medical care for the condition, then be sure to do what I mentioned in the above.  If you are seeking additional disabilty compensation, in the form of SMC, then you will need to meet the criteria for SMC.  

This is a great example of asking the right person in VA.  

If your prime care doc wont do this, then, if you decide the potential SMC is worth it, then go for a IMO/IME.  

The VA does not have docs in every specialty in all areas.  So you have no choice but to seek private care, which VA SOMETIMES pays for.  That is, if they havent squandered all the money for Veterans choice on cost over rides for hospital construction or other VA wasted tax dollars.  

Edited by broncovet

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On 7/21/2017 at 7:46 AM, broncovet said:

The obvious answer is you would ask your prime care doc to be seen for this condition, and, if no VA doc can do this, to ask VA to pay for the evaluation from a private doc, through Veterans choice.  Ask your prime care doc, not a congress critter, IMHO.  

 If you are at 100 percent currently, the only way you can get an increase in disability comp is SMC.  

If you are seeking medical care for the condition, then be sure to do what I mentioned in the above.  If you are seeking additional disabilty compensation, in the form of SMC, then you will need to meet the criteria for SMC.  

This is a great example of asking the right person in VA.  

If your prime care doc wont do this, then, if you decide the potential SMC is worth it, then go for a IMO/IME.  

The VA does not have docs in every specialty in all areas.  So you have no choice but to seek private care, which VA SOMETIMES pays for.  That is, if they havent squandered all the money for Veterans choice on cost over rides for hospital construction or other VA wasted tax dollars.  

Hi. Thanks for your reply. I've gone the obvious route from the Boston VA to two New York VAs. I went straight to the oral surgeons. The Boston VA surgeon, in 2015, requested funding for me to go to a private surgeon, to obtain imaging and a full evaluation. The funding never came. Eventually, I moved back to NY, paid for my own imaging and received several fully, detailed diagnoses as to what was causing my jaw and face to deform. I provided this to both NY VAs. Even with this in hand, as well as the head of the oral surgery department in Manhattan, vehemently declaring that no VA oral surgeon was qualified to perform the surgery that I need, both the Manhattan and Northport oral surgeons refuse to put that there are no oral surgeons in the VA, who can surgically correct this disease. Their admittance on paper is the only thing standing between myself and outside care. They have been giving and continue to give me the run-around. I say all this to explain that complaining to Congress and the Trump hotline were last resorts. 

I'm TDIU. Can you tell me what SMC and IMO/IME are?

Thanks again.

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SMC   Special monthly compensation.   Its "over and above 100%" if you meet applicable criteria, such as a missing leg or foot, blind, housebound (SMC S), need Aid and Attendance (SMC L)   Rate tables are here, I have no idea if you qualify for SMC, however, Howell suggests you should get SMC S.  Its an extra 347 per month for SMC S.  https://asknod.org/2014/08/25/cavc-howell-v-nicholson-what-smc-s-really-says/

SMC rate tables:  

http://www.benefits.va.gov/compensation/resources_comp02.asp

SMC eligiblity:

http://www.vetsfirst.org/special-monthly-compensation-ratings-are-you-eligible/

 

IMO  Independent medical opinion.  This is a doctors opinion you pay for, if VA docs dont provide an adequate opinion.  

IME  Independent medical exam.  The same as IMO, except the doc actually examines you.  

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