Jump to content


  • veteranscrisisline-badge-chat-1.gif

  • Donation Box

    Please donate to support the community.
    We appreciate all donations!
  • Advertisemnt

  • 14 Questions about VA Disability Compensation Benefits Claims

    questions-001@3x.png

    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
    Continue Reading
     
  • 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

  • Advertisemnt

  • VA Watchdog

  • Advertisemnt

  • Ads

  • 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

Does anyone have experience with "clinical appeals"?


Recommended Posts

I have been told about the existence of a "Clinical Appeal" process.  Was just on hold for 35 minutes to the number given at the local Portland hospital before being disconnected.  Does anyone have knowledge of this process or what the chances of success are or how it works?  I am asking to get an FDA approved urine test that will be sent out to another lab.  Results will be substitute for a scope procedure that has been cancelled due to pandemic.  My assigned specialist retired because of it, I do not have a new one assigned at this point.  I asked a clinic facilitator about the test a month ago and have received no answer.   I already called the company that does the test and they said that the VA hospital here is one of their clients, so there is no new relationship that has to be established.  Cost is $100 or less but requires a doctors order. 

Link to post
Share on other sites
  • Replies 8
  • Created
  • Last Reply

Top Posters In This Topic

Top Posters In This Topic

Popular Posts

Well, Im not sure how many hoops I would jump through to get VA to pay for a test that costs 100.00..the obvious answer here is to go to a private doc and get the test done, if you think its all that

Try a search for "VA clinical appeal form". I found an interesting document from 2016.

Link to post
Share on other sites
  • Moderator

slangpdx I'd do three things. First I would use secure messaging on ebenefits and request authorization for the alternative test. You want to get it in writing. Put the company info in there as well. The second is I would put in a IRIS request on va.gov (under the "contact us" button.) Ask for a email response. Lastly, I would call the VAMC medical director after waiting 4-5 days for #1. Sqeeky wheel works (sometimes.)

Link to post
Share on other sites
  • Moderator

Clinical Dispute.

A clinical dispute is an impasse that occurs between a patient, or the patient’s representative, and a VHA medical facility over the provision or denial of clinical care that potentially could result in a different and/or improved clinical outcome for the Veteran. Clinical disputes generally arise when a patient and a provider disagree with medical determinations of the need for and appropriateness of specific types of medical care and treatment for an individual. Typical examples of these issues are whether a particular drug should be prescribed, whether a specific type of physiotherapy should be ordered, and similar judgmental treatment decisions with which an attending physician may be faced.

Link to post
Share on other sites
  • Moderator
Posted (edited)

Well, Im not sure how many hoops I would jump through to get VA to pay for a test that costs 100.00..the obvious answer here is to go to a private doc and get the test done, if you think its all that necessary.  

However, I have had some good luck changing physicians in the VA if unhappy with a particular doctor, so you can try that first.  

At my VAMC I simply fill out a paper that requests to change doc.  

In my case the doc called me and asked me why I wanted to change.  I explained that I did not think she was thorough, and she pretty much pleaded with me not to change.  I have a strong suspicion she was a foreign doc, in USA with some sort of visa she can only get while working here...and she would be deported if she lost her job.  

Anyway, I constented to keep this doc, pretty much letting her know that I could change again.  After that, I got anything I wanted.  She got it for me right away.  I didnt take advantage but I could have.  

Of course, this wont work all the time.  

However, if unhappy with your doc, just request another one if this is important to you.  

Edited by broncovet
  • Like 1
Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

  • Ads

  • Ads

  • Ads

  • Our picks

    • Post in New BVA Grants
      While the BVA has some discretion here, often they "chop up claims".  For example, BVA will order SERVICE CONNECTION, and leave it up to the VARO the disability percent and effective date.  

      I hate that its that way.  The board should "render a decision", to include service connection, disability percentage AND effective date, so we dont have to appeal "each" of those issues over then next 15 years on a hamster wheel.  
    • Finally heard back that I received my 100% Overall rating and a 100% PTSD rating Following my long appeal process!

      My question is this, given the fact that my appeal was on the advanced docket and is an “Expedited” appeal, what happens now and how long(ish) is the process from here on out with retro and so forth? I’ve read a million things but nothing with an expedited appeal status.

      Anyone deal with this situation before? My jump is from 50 to 100 over the course of 2 years if that helps some. I only am asking because as happy as I am, I would be much happier to pay some of these bills off!
        • Like
      • 13 replies
    • I told reviewer that I had a bad C&P, and that all I wanted was a fair shake, and she even said, that was what she was all ready viewed for herself. The first C&P don't even  reflect my Treatment in the VA PTSD clinic. In my new C&P I was only asked about symptoms, seeing shit, rituals, nightmares, paying bills and about childhood, but didn't ask about details of it. Just about twenty question, and  nothing about stressor,
    • This is the latest Compensation & Pension (C&P) Clinicians Guide dated 20180719. The only other one I've seen is dated 2002, including the one on this website and the VA website. I got this from my claims agent, who got it from the VA.

      VA Compensation & Pension (C&P) Clinicians Guide 2 Final Corrected 20180719.pdf
        • Thanks
        • Like
      • 12 replies
    • I don’t say thank you enough to all of you...
      You, yes you, are the reason HadIt.com has remained a resource-rich resource. Thousands come each month to read, ask questions, or to feel a sense of community.

      Last month June 2020, we over 50k visitors they viewed over 160k pages. Veterans and their advocates, spouses, children, and friends of veterans come looking for answers. Because we have posts dating back 15 years and articles on the home page, they usually can find an answer or at least get pointed in the right direction.

      You all made that possible. Thank you.
        • Like
      • 8 replies
  • Ads

  • Popular Contributors

  • Ad

  • Latest News
×
×
  • Create New...

Important Information

{terms] and Guidelines