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

[betrayed]

These "short version GAF's" that 1968 Army VV refers to are IMO nothing more than a number the doctor pulls out of the air our out of his A$$ after giving you a interview. In the last year I i bet I have been given 30 of them, they also determine how you are that day and that day only. Thats what I read in the DSM-IV.

[huskerfanfl]

Again,

Do not confuse the GAF with other tests. The BDI and other tests can be used to determine a diagnosis, but it is not designed to determine the functioning of a patient. The GAF indeed a snapshot of how a patient is on that particular day based on interview and observation. You are assuming that the psychatrist was told by the legal office to refuse to give you a full GAF when in reality they have been giving you full GAFs the entire time. It is more likely that the doctor knows that you do not know what the GAf actually is. I know that I have posted the information numerous times, and yet you continue to just say that the information that I posted is not correct, that you want the full blown GAf. I will tell you that mental health counselors are trained in the use of the GAf, I was trained in the use of the GAF for my Master's in Marrigae and Family Therapy, and the GAF is indeed an assessment based on observation and interview, there is no written assessment that is given to the patient

[sixthscents]

1968,

To be honest I was not aware that there were "quick" GAF's. I simply thought a GAF, was well, a GAF. I thought it was the same series of questions and evaluations. Obviously I was wrong by your response. I did not intend to offend you, I just thought they were all the same. I know the GAF they did at my C&P was essetially the same they did when I did my initial intake at PACS. I know it was the same or very similar to the GAF they did when I did my intake with pain management. I assumed the ER was the same. If I erred in this I am sorry, but.. it was an honest mistake.

Huskeerfanfl seems to disagree with that. I am not saying who is wrong or right, but I'd like to know what is the case so I'm not giving someone poor guidance. I have reccomended the ER in several instances where a second GAF was necessary, and the Pain Management clinic, if the vet already had a need to go there anyway. If these are all different then I really would like to know. Can anyone else shed some light here? I'm not diagreeing with either of you, I just want to be sure that I am putting out correct info.

I will say that I tend to agree with 1968 about how the VA uses the GAF. It seems from what I have observed that they use it against the vet when it falls against them, but ignore it if it helps their (the veteran's) claim. I have noticed a very wide margin of difference simply between raters in what were essentially the same evaluations, or what seemed to be the same to me anyway.

Subjective vs. objective is always going to be a problem with mental health though I think. Its not like any other injury where you can use an objective measureing device. So, I just dont see an answer.

[carlie]

The doctor had already fulfilled his obligation.

carlie

[huskerfanfl]

NO.....that..... is NOT what the VA Regulations states. They have an obligation AND REGULATORY REQUIREMENT to:

“VHA health care providers are required, when requested, to provide descriptive statements and opinions for VA patients with respect to patient’s medical condition, employability, and degree of disability.

*****************************************************************

So, NO, Carlie.... you are NOT correct in your statement that the doctor has already fulfilled his obligation. Let us strive to post "good information" on hadit.com so Vets are not miss-led..... VERY important.

As far as this issue..... for me, it is far from over with. The OIGVA has my official complaint. Now, we will see.

Carlie has a point, the doctor has told you to request the session documentation under the freedom of information act, as you noted the regulation states that when requested, the provider needs to provide the information. You need to do your part and do the proper paerwork to request this information. you may not like what is stated int the documentation, but that is a different issue. Maybe, instead of spending time in the forum repeating the same inforamtion over and over, you could take a few minutes to research the use of the GAF. You will find that the psychatrist is using it as it was designed. I offer this advice simply because I hate to spin your wheels over this dead end issue that you are pursuing. The IG is going to tell you that the doctor acted properly, and that if you want the documentation, you must request it. if you want to be tested further, may I suggest the MMPI-2 or the BDI. There are a few different tests that will assist you in solidfying your diagnosis. None, however, will address your level of functioning.

[carlie]

You have no case - the doctor has fufilled his obligation. If you choose to continue spinning your wheels I don't care.

People, People, People - Study the laws and regs, learn all you can ------

Much of 1968 Army' s posted info is redundant and inaccurate - the regs and laws are in black and white - vets can't bend them to suit their every need.

carlie