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Really concerned about referral


awgv001
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Question

I knew it may be too good to be true to get a referral back into Neuro so soon...

So I found out today, after short research on who I will be seen by, I'm being sent to a (less than) 2 star Neurology office in TN - with an MD with almost 40 reviews and his personal rating is a 2.8/5...Now I obviously may have a chance at a decent experience as every encounter I have had has been different. I don't expect to get a 5 star anything, but when a majority posts how you spend little time speaking with this individual, and how they scribble out information and attempt a variety of prescriptions...like, I know I gotta let them do their work, whatever that entails, and they should also have access to all my VA medical info for review right? I'm going to bring copies of my evidence, some of which I planned to bring to my hearing whenever that happens.

I honestly don't want any of that except for scans or perhaps something to counteract the double vision if possible...I have had diagnosis since 2016 for TBI from the director of the VA office in Decatur (STILL NOT SC'D, awaiting BVA hearing) and several residuals/secondaries (migraines, tinnitus, double vision, balance disorder), and I'm hoping to just sit with the guy, get paperwork filled out (TBI DBQ), and get an impression on my TBI and its secondaries...I have already dealt with "bad" Neurologists that pick and choose what they want to tackle, or record. What options do I have? I'm thinking about calling TriWest again to see what other options are available...

This scares me. I want IMO's, and a rather extensive DBQ done, not to become a test subject, or a punching bag.

 

Edited by awgv001
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This is the drawback to "free" medical care, the VA mostly picks who you get care from and, as far as C and P exams, they make it clear you dont chose your examiner.  This is the precise reason I opted into Part B for medicare, because we have more choices there.  While I would have to pay deductables and copayments, many, many Vets elect not to go to VA, but instead seek their care outside of VA and, for some very good reasons.  

The biggest one?   Well, both VAMC and private care have "good" and "not so good" docs.  But, in the VA, they have a "magic wand" to make a good doc bad.  How do they do that?

Its easy, really.  They force that doc to be overworked, pushing hundreds of patients in on them in a small period of time.  So, the "good doc" has to do a very hurried job, and that haste lowers the quality of medical care.  

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18 minutes ago, broncovet said:

This is the drawback to "free" medical care, the VA mostly picks who you get care from and, as far as C and P exams, they make it clear you dont chose your examiner.  This is the precise reason I opted into Part B for medicare, because we have more choices there.  While I would have to pay deductables and copayments, many, many Vets elect not to go to VA, but instead seek their care outside of VA and, for some very good reasons.  

The biggest one?   Well, both VAMC and private care have "good" and "not so good" docs.  But, in the VA, they have a "magic wand" to make a good doc bad.  How do they do that?

Its easy, really.  They force that doc to be overworked, pushing hundreds of patients in on them in a small period of time.  So, the "good doc" has to do a very hurried job, and that haste lowers the quality of medical care.  

Thanks for your fast response as always @broncovet - Oh, I forgot to mention this is not a C&P exam! Which is in part why I'm going to push for a full TBI DBQ if possible. It's an evaluation, and perhaps any workups and medical tests as they are opening the door to analyze my issues again.

They had another option, albeit that one was even worse, they called mainly because they couldn't get in touch with the "other office"...guess they didn't want any more business, lol. So I asked them about who else I could go to, so instead of further east in NC (the drive is atrocious) they mentioned the one in TN (all highway nice, straight, and easy for the most part.

This person's clinic seems to be under-worked, as even google shows a review of 1.7 (only 6 reviews) as of today. The feedback is pretty atrocious, so I'm looking to prepare for the worst. 66 reviews with 35 of them being 1 star on the doctor himself...

What kinds of things should I do to further prepare?

I have a folder organized with my notes, evidence, and some prior diagnosis etc. Being a specialist facility, they should afford the time to the patient to address the medical and administrative needs...

Not sure how long the appointments are with this person either, but if I'm going to be driving for 3-4 hours a day to go see this person, it better not be adversarial.

Edited by awgv001
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It sounds like you have reviewed the options, and you are not willing to drive to seek better options.  Oh, I completely get that.  The science of "proxemics" affects our everyday decisions. 

We make choices based on what is available locally, including marriage, food, shelter, and pretty much everything.  Even if you like authentic Mexican Food (I do), its hardly practical for me to travel to Mexico every time I want it.  

If you find the medical care to be sub par and of a concern then try to get it changed.  I would not change it "solely" upon substandard reviews, those can happen for a number of reasons, sometimes unrelated to the quality of care.  One or two reviewers with "anger management" issues, can skew the review ratings negatively, just like "favorable" reviews can often be bought.  

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Wish I could give your comment a "Like" - so I hope that counts for one.

I understand the business warfare, and I will note that "drug seeking" plays a huge role with the negative reviews aspect as well. If it were that consistently bad, you'd think there's an entity out there to do "QA" work and either remediate or shut down a derelict office in such circumstances, aside from general annual or other re-training.

I'm going to give it a shot regardless, and hopefully be granted an honest and fair impression of my circumstances.

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@broncovet

Whelp, if it looks and smells like a stepped-in dog turd...

Had the consult, Doc immediately starts rambling off his common knowledge factoids about Syncope and such, in story-time mode. First, he asked why I was even seeing him in the first place, after having seen other Neuros in the past. Did not review any records, paid little attention to what I had to say, and instead ordered new scans wanting to check out my heart (I had a stress test not all that long ago, exam came up negative for any discrepancies, and have 0 known heart issues. I briefly explained my injury history, and how other similar injuries were incurred as a result of personal assault...(begins staring a hole through my head).

I made sure to hand the DBQ across his desk, trying to steer the conversation to something productive, to which he commented "This is not typical that a Veteran makes a request for these, as it's usually something assigned from VA." Glances briefly at the first page, refuses, ...then hands it back to me.

Now, I firmly believe I won't get anything accomplished with this individual.

Complete waste of a trip in my opinion.

I guess my only option is to call the my care team, describe what happened and if I should be taken out of this referral and the extra tests he wanted ordered.

If I can get back to the VA Neuro Dr. in Atlanta I saw before I think that would be the key. He know my history, and most likely would assist as I still believe he did a terrific job treating, explaining, and recording. Only issue was I didn't request the dbq right then and there, but I hadn't found out about this DBQ until after I had already ran out of time with him. I walked out of his office originally without a DBQ back in 2016...(The VA website does not distribute a TBI DBQ). Instead, I am using a copy of the DBQ found here --- https://www.ncbi.nlm.nih.gov/books/NBK542603/

I'm hoping that by getting this done it will save me from a remand. It's already been 8 years...

Edited by awgv001
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Do medical workups have to be done every time a Vet wants to have a DBQ filled out?

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Yes, the doctor is testifying that they have examined you and your records in the DBQ.  I guess it could be done as a forensic review but I have not myself personally had one or known one other than Berta's.

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Awgv001.  I understand that you are in the process of a remand right now.  A little good news, if you disagree with the remand you can write a statement and appeal to the BVA again.  You keep your first date and jump to the front of the line at the BVA since your case is a remand and carries the original date.  

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1 hour ago, vetquest said:

Awgv001.  I understand that you are in the process of a remand right now.  A little good news, if you disagree with the remand you can write a statement and appeal to the BVA again.  You keep your first date and jump to the front of the line at the BVA since your case is a remand and carries the original date.  

Actually, this is me possibly jumping the gun. I haven't had a BVA hearing, or a remand, yet. I am seeking to get the DBQ done before having the hearing which is awaiting on the docket to save myself from the possibility of a remand and further delay.

Edited by awgv001
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OK, I misunderstood.  Have you found a doctor to do a DBQ?  It is a good thing to have at the Board, when you have one doctor that says you do and another doctor that says you are not SC the tie goes to the veteran.

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19 minutes ago, vetquest said:

OK, I misunderstood.  Have you found a doctor to do a DBQ?  It is a good thing to have at the Board, when you have one doctor that says you do and another doctor that says you are not SC the tie goes to the veteran.

To clarify, I have never had a doctor say that I "didn't" have TBI, the previous rating decisions wouldn't take my word for it on my 21-whatever aoout the assaults and falls that occurred, so I fought to get back in touch with some fellows I served with. They were able to recall the events pretty well (better than I, after all I was unconscious.)

In the decision from 2018, the (DRO) RATER opined, deciding that TBI was less likely than not related to service.

Here's the thing, the first Neuro recorded Syncope, but no falls or trauma to the head, it was reflected as positive evidence in past denials. There was a Neuro I saw back in 2016, but I never had him do a DBQ so I asked my care team if I could drop the referral Neuro, and go back to the guy I saw before, who already knows my medical history, even if it means more workups and diagnostics. (He already diagnosed me with TBI, same year, and so on so forth).

I feel like the DBQ is best suited for handling the question of "If any secondaries, which ones? How severe are they?" That's why I'm pushing for it.

Edited by awgv001
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OK.  I hope that you can get to this doctor and have him write up a DBQ.  Since he knows your history and has seen you have you contacted his office to see if he can do a DBQ from his records without seeing you.  I now understand your other question better now.  Since he has seen you and treated you he should feel confident doing a DBQ without you there.  If he is not than that is a pickle.  If he is not willing to do a sight unseen DBQ can you afford to see him?  I know that taking a thousand or more dollars and travel is a pain but it would be worth it if it brings you to 100%.  I had to spend $2500 getting my two IMO's from a doctor but got a little over $100K back in benefits using the IMO.

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Just now, vetquest said:

OK.  I hope that you can get to this doctor and have him write up a DBQ.  Since he knows your history and has seen you have you contacted his office to see if he can do a DBQ from his records without seeing you.  I now understand your other question better now.  Since he has seen you and treated you he should feel confident doing a DBQ without you there.  If he is not than that is a pickle.  If he is not willing to do a sight unseen DBQ can you afford to see him?  I know that taking a thousand or more dollars and travel is a pain but it would be worth it if it brings you to 100%.  I had to spend $2500 getting my two IMO's from a doctor but got a little over $100K back in benefits using the IMO.

He's a VA Neuro, so it's no issue for me to go and see him other than the travel into Atlanta. The nurse I spoke to let me know that it may require a new workup since it's been a few years, but I won't know if I don't ask 😉

The thing is, with a TBI DBQ it expands into several other questionnaires for the possible secondaries...for which I have printed off 6 of them...Tbi first, expands into Thoracolumbar Spine, Headaches (including Migraine), Male reproductive organ, eye conditions, and ear conditions - though the last one is mainly in regard to tinnitus. I didn't have that before the TBI.

I most likely will have to see him for ROM tests at least.

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