Clinical Appeal

[Oceanbound]

I filed a clinical appeal to get treatment as well as caled the White House Hotline. Got the letter back from the local VA saying that they had an "expect" look at my medical file and agreed with the VA doctor that Hyperbaric oxygen therapy isn't necessary for me because they don't want to pay for it.

Have yet to hear back from the White House hotline. Will be filing complaints to my senators and congressman this weekend about VA denying me this treatment and pressing this issue further to I get it.

[Berta]

The VA certainly has offered this therapy to veterans. It appears in some BVA decisions, but these were not denials of treatment.

This November 2017 link expands the use of Hyperbaric oxygen therapy to some veterans ,with PTSD, and lists what other disabilities they use HBOT therapy for:

https://www.va.gov/opa/pressrel/pressrelease.cfm?id=3978

This very recent VA directive has information on appealing a clinical decision.

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9041

Can you scan and attach here ,the letter they sent ?

Cover your C file #, name, address prior to  scanning it.

 

 

 

[Berta]

to add :

 

Who is considered a candidate for HBOT?

Because HBOT is used for a specific range of illnesses or diseases, the doctor will evaluate your medical history to determine if you qualify for treatment.

"Certain non-healing diabetic ulcers, recurring bone infections, non-healing skin grafts and injuries secondary to radiation therapy are some of the indications for qualifying for HBOT treatment. Only a specially trained, certified physician can specifically determine if a patient qualifies for treatment."

https://www.beaumont.org/services/hyperbaric-oxygen-therapy/hyperbaric-oxygen-therapy-frequently-asked-questions

The last statement this org made, makes sense. 

Was the VA doctor "specially trained"and certified in being able to determine if you qualified for HBOT?

Have you googled that doctor to see what background they had to be qualified to determine you were not qualified for treatment?

 

 

 

[broncovet]

Im no expert, but that sounds like a MEDICAL decision to me.  Please allow an unrelated, but relevant example.  

   For instances, say If I go to the ER (Im 100 percent so I have nearly top priority), and I have a sore throat.

    Someone with 0 percent, and a lower priority comes in and they have been in an accident and are bleeding with life threatening injuries.  Who gets served first?  The one with more medically necessary, of course.  The bleeding guy goes to the front, and my sore throat, along with another Vet's sprained ankle, and another Vet with a speck in his eye, go to the back.  

     Its a medical decision, they dont ask us:  "Hey here comes a guy with a heart attack, is it ok, if he goes in front of your sore throat?"  They just treat them in medical priority order.   Usually that is the decision of the triage nurse.  She evaluates you, quickly, and decides if you must see the doc immediately, or can you get in line.  

     In a similar way, our treatments are a medical decision.  HBOT?  Pills? Wait and see?  Something else?  The doc makes that decision on our treatment, given his training and experience.  

    I have a family member who is an MD.  She tells me she was in the ER, and here comes a General.  

She treats in medical priority order.  Period.  The General got mad because "he had to wait", while some private's came in and got treated before him.  

     It was a big deal.  She had to spend hours on investigations, etc.  In the end, she told em she treated in order of medical emergency, not rank.  That private has a family who loves them the same as a general.  His life is not worth less.  She continues to treat, and instruct new doctors to treat in medical emergency order, not in rank, and not in order of "who got there first".  She told them they would also appreciate that, if one of their family members was in a car wreck.