Do I need a new MH provider

[qwiksting]

I was changed to a MH NP back in January 2022 due to my MH Psychiatrist leaving the VA because of COVID. Prior to that, for the previous 11 years I was seeing him at the VA. This Psychiatrist had been one of the best Doctors I had. He would willingly fill out Social Security, State or County forms with no questions. My MH notes were pretty much on point. He would document pretty closely what we discussed, upload anything I would bring in, got me a sleep study and CPAP, as well as chronicle my chronic symptoms and problems. Based off of his notes, my work history, I was awarded 80% TDIU P&T.  

 A brief timeline: OIF vet 03-05.  70%ptsd, 10%tinnitus awarded Mar 05.     0% GERD (40mg Nexium 2 times a day, 5 mg RegLand 3 times a day, 20mg of Famotidine when breakthrough) with ulcers awarded after BVA circus 2012, backdated to 08. I am sure anxiety does not help this.

My TDIU was granted Sep 2013

So, since December 2005 to Sep 2021 (Last visit with Psychiatrist at the VA) my notes, which are over 700 pages MH alone were in order, and matched close enough of what my progress was/is. Now that I have a new provider, MH nurse Practitioner, I feel let down. I looked at the past 3 appointments, since she likes to schedule follow ups at 3-to-4-month intervals, and it appears I am "cured". Sleep and nightmares have improved. Nothing about intrusive thoughts appear on her report. Only a few sentences I say, and at the end of her notes it states," continue going to group on Wednesday and seeing Ron every two weeks".  Ron is a MSW at the vet center where I do group.  I typed out a summary of my day to day and how i feel typically, on our first appointment. I gave her a copy, so she could have some idea along with my prior notes who she was treating (Isn't anything you provide to the health provider, supposed to be uploaded to your record?). My med list was somewhat unchanged, only a slight increase in one and "prazosin" for the nightmares. Since then, nothing has been discussed with the exception of getting over covid back in January 2022. All other appointments have been by phone. In fact, the next appointment scheduled for April was to be by phone, but I rescheduled it a week early to get a in person appointment. The VA I go to are extremely short Doctors and rely mostly on NP. In fact, I discussed with her a form that would need to get filled out when we had our first appointment (January 22) and she said she could take care of it, except when I got the forms (Nov 22) and questioned her she refused.  She asked if I had a Primary care at the clinic. I do not use the clinic for anything except MH. I have TFL and Medicare. I don't want to take up space for less fortunate dudes. But to that extent, I called and made an appointment for a Primary care, which is scheduled for August this year. What a joke!

 

My question is, with her notes over the past year, be potentially harmful to my rating? Could a Re Exam be in my future? I am 57 , 80%TDIU P&T, with multitude of other issues I have not filed for because I did not want to pokey the bear.  My experience with the VA and NP's are not good. All board-certified Doctor diagnosis/ notes go out the window when 1 bad NP is sloppy with notes!

    

[brokensoldier244th]

After appts send a secure msg with a recap of the things that YOU said or brought up in the session. If you see something in their notes, do the same. That gets it on record. While you are not an MH provider you ARE providing a lay statement of events as you see them. If you are P&T for IU its unlikely you will get a re-review. Its been over 5 yrs, almost 10, and the threshold for requesting a re-review is considerably higher now. 

[broncovet]

As far as "changing your provider" (doc), if you are happy with the new provider, then stay with them.  If, however, you are dissatisfied with their service, then consider a change.  

 

In reference to "notes in your file being potentially harmful" to your rating, you have several things going for you.  

1.  You are P and T.  This entitles you to the full benefits under 38 CFR 3.344 sections a) and b), as far as "5 year protections of rating".  

https://www.law.cornell.edu/cfr/text/38/3.344

2.  You are over 55.  This means you are "further protected" from new exams for the purpose of a reduction.  More explained here.
https://www.woodslawyers.com/va-55-year-old-rule/

 

Because of these two rating protections, both of which should apply to you, my opinion is you need not concern yourself with a reduction "unless" you go back to work full time (substantial gainful employment).  

    The rule is (see the link in number 1, above), that you cant be reduced unless you "have actual improvement under ordinary conditions of life".  They even explain things about "prolonged rest", which you should be getting, absent a job.  In other words, you cant be reduced because you got some improvement based on prolonged rest.  

     Sleep well, there are many protections for your rating written into the regulations, as I explained, above.  

 

Edited January 17, 2023 by broncovet

[qwiksting]

Thank you for the input and giving me a ladder to climb down out of the crazy tree. My anxiety is kicking my skinny butt. I just have had such bad luck with NP's, see my previous posts about that!  The AMC, the BVA, the RO.  Man, that feels like a lifetime ago. I am sure I could go back and open the worm jar up with some 0%'s but it won't help me, only exacerbate my already symptoms I am trying to control. With the PACT act moving forward, I was downloading my private outside the VA Lung Doctor notes. As well as my Gastro Doctor notes. Just in case I get a nasty gram from the VA. I want to have something to give them to play ring-around-the BVA/RO/AMC. 

So, I guess with just a couple of NP's notes that don't accurately describe my symptoms, reexam is kind of out of the question.  As I said, I go to group every other Wednesday and see a MSW at the vet center every other Wednesday. 

[El Train]

I haven't seen a MH provider in 4 years.  She retired and I just never did another appointment.  I had a MH pharmacist call every 3 months for awhile to re-up me on meds.  Then he quit calling.  My PCP re-ups my meds now.  

I prefer to be left alone honestly.  I'm 100% P&T for PTSD alone.  I still work a sheltered environment job.  I do the best I can.  I'm not worried about a reduction but I'm not going to put in any more claims. I have quite a few lowball ratings like you.  Nothing that will kill me that I know of.   I'll be at my 5 years later this year.

[qwiksting]

This is my mindset...just leave me alone and refill my scripts.  I do not leave the house with the exception to seek healthcare or go to group at the vet center. I don't like crowds and don't have patience for stupidity.  Just leave me alone.  This is one of the problems I am having with this NP.  An appointment every 3 months? Like, I have been on my meds for 18 years or so?  It just feels weird. I get a 6-month visit, but 3? When I see her in April, I am going to bring this up. I get more out of the VET center.  To me, she is nothing more than a medication manager.

I still have a question about the typed out memo I gave her at my first visit. Why it did not make it in my records? Should i try again when I go in April, or should I try and submit it at FOI on my own?

[El Train]

44 minutes ago, qwiksting said:

This is my mindset...just leave me alone and refill my scripts.  I do not leave the house with the exception to seek healthcare or go to group at the vet center. I don't like crowds and don't have patience for stupidity.  Just leave me alone.  This is one of the problems I am having with this NP.  An appointment every 3 months? Like, I have been on my meds for 18 years or so?  It just feels weird. I get a 6-month visit, but 3? When I see her in April, I am going to bring this up. I get more out of the VET center.  To me, she is nothing more than a medication manager.

I still have a question about the typed out memo I gave her at my first visit. Why it did not make it in my records? Should i try again when I go in April, or should I try and submit it at FOI on my own?

I wouldn't mess with the memo.  They're not going to reevaluate you.  I'd be straight up with her.  Just let her know you want to just stick with the vet center.  She's getting your scripts filled through the pharmacist anyway.  Ask her if they can just call you every 3 months, or have your PCP do it.  Especially if you have been on the same ones for 18 years.  I found meds made things worse, so I quit taking them. If they work then stick with them.