Doctor Must Give His Opinion If You Ask Him

[betrayed]

question: If a patient ask me to fill a form out for him in order to obtain a drivers license, or obtain SSN or VA benefits am I required to do this.

Answer: If you are asked to fill out a form to assit a patient in obtaining disability or pension benefits, you are required to provide a descriptive statement and opinion with respect to that patient's medical condition, employability, and degree of disability.

from

VHA Practitioner’s Guide to Information Law

http://www.vehu.med.va.gov/vehu/vehu2005/p...r-%20FinalA.pdf

Allan originally posted this in social chat and only 19 people have read it

During my last appointment with new a psychiatrist I wrote him a 6 page letter with my complete medical background, my vocational rehabilitation background. I ended the letter with this:

Even though I feel this may be unusual, I don’t feel it’s unfair to ask you your opinion; do I have the capacity to work? I don’t expect you to answer this immediately, I would like for you to take all the time necessary before coming to your conclusion. I also have to ask you consider the following:

Can you reasonably expect a man to work who has had 112 days in a medical facility in 2006, Can you reasonably expect employer to put up with this? Can you reasonably expect a man who is in chronic pain to work? Can you reasonably expect a man who is mentally incapacitated to work? Can you reasonably expect a man who has panic attacks and angina attacks every time he has stress or does any strenuous to work?

Can you reasonably expect a man who is under the influence of Fentanyl 75mcg/h twenty-four hours a day along with Oxycodone and Clonazepam to work? Can you reasonably expect a man to drive a vehicle to get back and forth as he is always under the influence and would be breaking the law?

When I got a copy of the progress notes from that visit, at the end of the progress note he noted the 6 page letter and stated he would address this at our next visit, and words to the effect he did not want this to become a dominant factor in my treatment. I will now print this entire manual out and take it to the doctor during my next visit. I will pull it out only if he does not answer my question.

Allan you have provided one hell of a piece of ammunition to use in our battles with the VA. When I was in the pysch ward last time I asked my doctor the same question and he stated that his opinion did not matter. I sure wish I had this document then.

directive_2000_029.pdf

practioners_guide_to_information_law.pdf

VA_HIPAATRAINpage17of26.pdf

Edited March 12, 2007 by Tbird

[Objee]

sorry it says they are required to provide a statement click and enlarge

Betrayed,

You have disclosed an interesting legal point. The Practitioners Guide

mandates the VHA medical opinion within itself. The "See VHA Directive"

can be interpreted as either the authority or merely a reference.

It would be up to a court to decide, but I would use the Practitioners Guide

as the suthority since it's still in effect.

e.g. "I give this medical opinion freely, on a reasonable degree of medical

certainty and under the authority of the VHA Practitioners Guide to Information

Law."

Ralph

[betrayed]

Betrayed,

but I would use the Practitioners Guide

as the authority since it's still in effect.

Ralph

Thats what I am gonna do, I already set the stage at my last appointment with the 6 page letter. In his progress notes he noted my letter and said would discuss at next appointment. I am taking the Practioners Guide with me to show him.

[betrayed]

heres another from another VA Manual page 17 of 26

VA_HIPAATRAINpage17of26.pdf

[Objee]

Army,

Even without referencing the CFR/USC, Betrayed's good work leaves us with this:

Citations requiring VA physicians to write opinions for patients

VHA Directive 2000-029 (Expired 9/2006, but currently incorporated as a reference) *

VHA Privacy Policy Training (Text Version FY 07) * page 17, “Other Disclosures. . .”

VHA Practitioners Guide to Information Law, Section III – “Disclosures. . .”, Para. 3.A.

If we can nurture good relationships with the needed physicians, this WILL be a cheap source

of IMOs and we can probably get to write at least the draft version of each IMO!!

Ralph

If you look at the directive, itself, dated September 22, 2000, it says that this directive expires September 31, 2005. Hmmm? I downloaded the directive and read it and on page one, "THIS VHA DIRECTIVE EXPIRES SEPTEMBER 31, 2005". Of course, there is only 30 days in September.

I am doing some more research on this to see if there is an update. If there isn't an updated directive, then this directive is "history" and no longer applies.

I attached the directive to this post. Its an Acrobat file.

BETRAYED: I just saw your post, below, saying that it has expired. Hmmm? What you attached, that "Guide" is a guide and references the expired directive. Plus, guides don't mean much.... just a guide, not a regulation or directive, or PL.

I am still looking for more on this.

I haven't looked at it, yet, but I believe the PL is 38 CFR Section 17.38.I'll try to locate it.

[Hoppy]

When seeking a statement from doctors at the VA hospital I encountered different reactions depending on the doctor. The first doctor listened to what I had to say then disputed the validity of the diagnosis made by the doctors who treated me in the military. He invented a new diagnosis of a transitory, temporary virus that was caused by contaminants in the drinking water. The doctor refused to write a letter for me. I immediately wrote a letter to the RO indicating that this doctor based his new diagnosis on theory and speculation and never say any symptoms of the either the original condition or the condition he "invented". The doctors assesment was clearly illegal according to the M-21. I sent this letter to the RO because I was afraid that this doctor put a notation of his opinion in my treatment file.

The next doctor I saw was very eager to assit and made a notation in my treatment records whiich I got a copy of and sent to the RO. He would not write a letter. I did take a written letter for him to sign and told him what I wanted the notation in the treatment file to specifically say. The doctors original notation was very favorable. However he did not mention that he based his decision after review of the SMR. I told him to specifically write that he reviewed the SMR and based his decison on the symptoms noted by military doctors and not the subjective recollections of the veteran as to what symptoms occurrred while in the military. I was not a combat veteran and thus the fact that the assesment made by this doctor was based on the recorded symptoms in the military was important. The doctor added this statement as I requested. He specifically mentioned the date and place of the exam noted in the SMR that he based his assesment on.

I understand now that there is a specific form that the doctor should fill out. It is an extension of the original nexus letter that was developed by the VA about the nthe time of directive 2000-029. The new form is more comprehensive than just a statement and requires listings of documents reviewed by the doctor making the assesment. I would strongly suggest that you find this form and make sure the doctor uses it.

Edited February 16, 2007 by Hoppy

[Hoppy]

I have mentioned this document several time and somebody else knew how to get it. I will do some research and try to find it then keep a record of it. I am sure this will come up again and again.