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DBQ - Conflict of Interest


GulfWarVet1990

Question

Is it a conflict of interest to ask a contracted VA physician complete a DBQ? I was sent to a community care physician for neurology care (my local VA wait times were 125 days), is there a conflict of interest to ask him to complete the form?  Better yet has anyone had luck getting a VA contracted provider complete a DBQ, pros and cons. Thanks. 

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4 hours ago, GulfWarVet1990 said:

Is it a conflict of interest to ask a contracted VA physician complete a DBQ?

I am not sure; I never ask but I did get a Community Care Provider to complete and fill out one of my DBQs. Due to not being able to maintain regular appointments the VA set me up with a Community Care Provider, after being treated for some time, one of my appeals finally got through the system and I needed a Medical Opinion, but the VAMC C & P exam was very negative. I felt that the NP didn't listen to me and failed to understand my appeal, so I asked my current treating Community Care Provider to fill out my DBQ and he did, and I won my appeal.

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No, its not a conflict of interest, any more than any VA doc doing a dbq which would/could result in additional benefits.  

By "community care", I speculate you mean an outside doc that the VA pays for.  The VA may or may not (probably not) pay for an exam that THEY did not order, however.  Usually community care is for a specific purpose.  I had community care to test for allergies, for example.  

 

My opinion turns on "Was the community care provider treating you for one or more conditions which you were seeking SC for?"  

Your CCP needs expertise in the field you are seeking benefits.  If you are seeking SC for sleep apnea, well dont ask a community care specialist with no experience in sleep medicine to fill it out, as it would likely not succeed.  

However, if your ccp has medical experience in the benefit sought, well ask.  Mostly, a medical license is not a prison, and doctors treat you voluntarily...and they can decline to treat you for a multitude of reasons, and high on the list is that they do not have training and experience in your conditions.  Often they refer you to someone else with experience.  

Caveat:  Many doctors "who dont regularly do va c and p exams", really dont know how to do them.  A common mistake by a private physician is to say something like, "The patients knee arthritis could have been caused by carrying excessive weight in service".  

Instead, it needs to be in "language the VA understands" which is "The paitients arthriitis is at least as likely as not due to events in the military service where he was required to carry 180 pounds of  weight long distances over a long period of time".  

And, they have to give a medical rationale as to why he makes said opinion.  

As with any c and p exam, the doctor should submit CV demonstrating he is an expert witness (and has medical knowledge of this field).  

You should review c and p exams, and "what makes a great exam".  Sometimes, doctors trying to help you will take your advice in giving VA what the va needs to grant sc, that is, a favorable exam/IMO/IME.  

I have covered some of this, but there is more on hadit and its searchable.  

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This was my point, the VAMC sent me to a local neurologist because their clinic only opened up in the afternoon and I kept missing appointments because of transportation, and it was too inconvenient for me to drive an hour and a half away. So, the neurologist was a specialist working in his field on my service-connected disability that was on appeal. The VAMC NP (NURSE PRACTITIONER) C & P examiner did not follow the DBQ, and I discussed it with my CCP (NUEROLOGIST), and he filled out the form and I won. Some CCP are specialists working in their field and they have more experience than the NP that the VAMC normally try to get to give the veteran his/her C & P exam and medical opinion. Well, it worked out for me.

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11 hours ago, pacmanx1 said:

This was my point, the VAMC sent me to a local neurologist because their clinic only opened up in the afternoon and I kept missing appointments because of transportation, and it was too inconvenient for me to drive an hour and a half away. So, the neurologist was a specialist working in his field on my service-connected disability that was on appeal. The VAMC NP (NURSE PRACTITIONER) C & P examiner did not follow the DBQ, and I discussed it with my CCP (NUEROLOGIST), and he filled out the form and I won. Some CCP are specialists working in their field and they have more experience than the NP that the VAMC normally try to get to give the veteran his/her C & P exam and medical opinion. Well, it worked out for me.

Yes, this is exactly my situation PacmanX1, the CCP is a Neurologist, a Veteran and specialist in Peripheral Neuropathy. I am already service connected for chemo induced peripheral neuropathy, 10% each both lower extremities and 20% each both upper extremities.  I plan to submit for an increase, I have good notes from my non-VA Neurologist which won my initial claim.  The CCP referred from the VA also provided good notes.  Is it necessary to submit a DBQ when I submit claim for an increase? 

BTW I am also working on a PTSD increase, currently I'm 50% and shooting for 70%? Any wise thoughts are appreciated. Thank you all.

 

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I had 10% PN for each limb and I went for an increase. I walked away with 40% for each foot and 40% and 30% for uppers.  I think it is worth going for the increase.  I have agent orange DMII with PN.  I only have 20% for DM11.  Getting above 20% for DMII is really hard, but PN not so much. I got my exam from QTC.  The examiner was incompetent but so what. I got a good rating for the PN.  Do you have significant pain and numbness in your extremities?  The docs really have no idea about those issues.

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Thanks John999 - thanks for sharing. Yes, the pain is awful, shooting pain in hands, heel pain, sensitivity to hot and cold, you name it. I am writing a personal statement to accompany my claim. CIPN has affected my quality of life and work effectiveness. So I need to make sure the details are noted, I found a few examples on Hadit.  

Yup it is unfortunate when the examiner is incompetent or doesn't care. I finally received C&P notes from a previous claim, the examiners notes were poorly written, very disappointing that VA accepted such poor work.  Thanks again. 

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As stated, I was being treated by a Certified Neurologist and I asked his opinion of what the NP C & P examiner stated and wrote in my C & P exam. This was a few years ago when the VAMC was still doing the C & P exams and I was fortunate to get a copy of it and took it to my appointment and since the CCP Neurologist was treating me for well over a year’s time, I ask his opinion and would he do a more accurate medical exam/opinion on my behalf.  I know that this is something that the VARO do not want.

The VARO do not want treating physicians to do the C & P exams because they think or believe that the current or regular treating physicians would write a more favorable medical exam or opinion, like a doctor would lie for a veteran putting his or her reputation on the line to help a veteran get around the system and or even cause an interruption in his/her own livelihood. In plain language, no doctor is going to lie for a veteran no matter what and put his/her life in jeopardy of losing their license and or going to jail.

I know it is stupid, but the VARO seems to believe that every veteran is lying or at least exaggerating their systems to get compensated. I know for a fact that I could be making a lot more money if I could return to work. I worked in an office environment, and I was home by 16:00 HR every day and there was no weekends or mandatory overtime, and I would/could be fine, but my disabilities stopped all that, but the VARO doesn’t care, veterans have to shove their evidence down the VARO’s throat to get them to award their/our benefits.

If you have evidence of an increase in your symptoms, and you feel you should be increased, you should file a claim and or an appeal to get your benefits.

Sorry for the rant.

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4 hours ago, pacmanx1 said:

As stated, I was being treated by a Certified Neurologist and I asked his opinion of what the NP C & P examiner stated and wrote in my C & P exam. This was a few years ago when the VAMC was still doing the C & P exams and I was fortunate to get a copy of it and took it to my appointment and since the CCP Neurologist was treating me for well over a year’s time, I ask his opinion and would he do a more accurate medical exam/opinion on my behalf.  I know that this is something that the VARO do not want.

The VARO do not want treating physicians to do the C & P exams because they think or believe that the current or regular treating physicians would write a more favorable medical exam or opinion, like a doctor would lie for a veteran putting his or her reputation on the line to help a veteran get around the system and or even cause an interruption in his/her own livelihood. In plain language, no doctor is going to lie for a veteran no matter what and put his/her life in jeopardy of losing their license and or going to jail.

I know it is stupid, but the VARO seems to believe that every veteran is lying or at least exaggerating their systems to get compensated. I know for a fact that I could be making a lot more money if I could return to work. I worked in an office environment, and I was home by 16:00 HR every day and there was no weekends or mandatory overtime, and I would/could be fine, but my disabilities stopped all that, but the VARO doesn’t care, veterans have to shove their evidence down the VARO’s throat to get them to award their/our benefits.

If you have evidence of an increase in your symptoms, and you feel you should be increased, you should file a claim and or an appeal to get your benefits.

Sorry for the rant.

Thanks, no worries about the rant. Hadit has served us all well as a safe place to do just that. 

I will keep everyone updated. 

 

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