100% PT and doing Reservist PHA

[glashutte]

My main concern is civilian or Army provider who does PHA contacting VA due to ‘undeserving’ VA disability.
Whether they have logical reasons or not, it can still trigger the VA sleeping bear to awaken and unnecessarily audit right? 
 

What are your thoughts? 
I’ve been documenting all disabilities and medications on my PHA for years (no change in PHA) but always do it with a civilian provider.

Now I must do it with an Army provider. 
 

What are your thoughts? It’s been 5 years since my VA claim was connected. 

Edited August 25, 2023 by glashutte

[brokensoldier244th]

Civilian providers can't just upload medical to your claims file. It only gets in there if you 1. opt into that provider being able to do it (no idea how that works) or 2. we request it after you provide a 21-4142/4142a that gives us 1 yr auth to request private records for a claimed contention. 

[glashutte]

9 minutes ago, brokensoldier244th said:

Civilian providers can't just upload medical to your claims file. It only gets in there if you 1. opt into that provider being able to do it (no idea how that works) or 2. we request it after you provide a 21-4142/4142a that gives us 1 yr auth to request private records for a claimed contention. 

thanks. 

I’m not fully tracking the first comment. Is it a good thing or bad thing for 100% PT for civilian to be able to upload into medical file?

 

What about Army provider doing PHA?

 

[brokensoldier244th]

I don't know, that's up to you. Civilians can't just upload into it, though, they can only share records with VHA, so, whatever is in there is what we pull in the context of a claim. If you've never told your provider(s) they can upload to VHA and filled out some forms authorizing it then they can't. 

We can also pull Tricare/Genesis/JLV etc (active duty medical and retired) if we are working on a claim. How much weight a PHA from a Reservist would have would depend on the claim being filed. Its not all automatically loaded into your claims file though, except when you finally outprocess. Then, usually in a few weeks to a month or so we get the bulk of your STRs sent to us from the Service holding them. 

 

All of this still has to be done in the contxt of a  claim- we don't just log on for fun and upload things. Its a PITA to get logged on to half of that stuff, already. 

[glashutte]

To confirm once one ETS from reserves their entire history of PHA is uploaded into VHA?

 

in addition, can PHA army provider call VHA to report ‘suspicions’ of someone they did PHA on and has 100%? From what I know PHA just asks for total percentage and disabilities and doesn’t ask for more details. So this could be misleading to some. Especially when some provider soldiers doing PHA might  have an opinion on who deserves their VA compensation and who does not 

[brokensoldier244th]

Once you ETS the unit sends the records, or they ultimately end up and National Archives and we request them from there if they are needed for a period of service to verify something.

Anyone can call OIG and report suspicions of something. People do it all the time, but OIG doesn't investigate all of them, they couldn't. I would suspect that a provider divulging your information to VA without prior authorization would backfire on them worse than you- they'd be in violation of HIPAA among other things. 

[glashutte]

4 minutes ago, brokensoldier244th said:

Once you ETS the unit sends the records, or they ultimately end up and National Archives and we request them from there if they are needed for a period of service to verify something.

Anyone can call OIG and report suspicions of something. People do it all the time, but OIG doesn't investigate all of them, they couldn't. I would suspect that a provider divulging your information to VA without prior authorization would backfire on them worse than you- they'd be in violation of HIPAA among other things. 

For verifying something and risk being audited from that, or from being reported on ‘no factual grounds’ - how much of this is protected if one’s VA disability is 100% PT and has been 5 years since connected? (5 yr rule)