VAMC Doctors and Nexus Letters


It has always been a tenet of VA law that VA doctors are independent and allowed to write nexus letters. Many are gun shy about it and would prefer not to. They figure it may come back to haunt them on their job evaluation reports. This is simply not so and reeks of hypocrisy. I have one member who got two letters from his treating hepatologists at the Oakland area VAMC. It happens and there is no approbation associated with it. In fact, the VA has now begun the practice of only letting their doctors write up PTSD evaluations and we know what that leads to. Look no further than the clusterf**k going on at Madigan down at Ft. Lewis. Pretty soon, PTSD will become a thing of the past like Polio-cured.

So what should my wondering eyes behold ,but an evening epistle from member Mike in a state south of me starting in O and ending in N with six letters which will remain nameless. He has an ongoing tête a tête  with the VA over his claim and treatment-both medically and personally. I cut and paste what I was beginning to suspect. I’m sure it extends to points east Harvey, so take heed.

 I had to water board him, but I finally got the truth out of a Dr about nexus letters. He didn’t know if it was VA wide but VISN 20 has strict rules that NO ONE writes nexus letters but C&P exam DRS. He had to sign a letter to that effect. I thought so , but no one had the guts to tell me. 

VISN 20 , or Veterans Integrated Service Network 20, encompasses Alaska, Washington, O____n, almost all of Idaho and parts of Montana and Californicatia.

http://www.visn20.med.va.gov/

Ah, yes. Time to bust out the pen and  paper or email and write the congressman/woman. This is an election year and we Vets are very important suddenly. In my opinion, its time to ask the nagging question about the non-adversarial, Veteran friendly Veterans Health Administration practice of  depriving us of this tool. If we rely on the VA medical network, does that not imply that they are the keeper of the sacred records? Are they not our go-to guy for medicine? Don’t they have more knowledge of the inner workings of our bodies than any other? Why, then, should we be forced to seek a private nexus from Dr. Bash for $6,000.00 (not guaranteed) or the Ellis Group ($350.00 for the first nex + $50.00 per each injury/disease thereafter.)? All these pesky questions and no logical answers.

The VA makes no bones about its overtures to get Vets into its system. Paying ones are even actively scouted. Why then deprive us of any meaningful avenue to proof of service connection via VA doctors? “Please use us exclusively, but we will make no effort to help you in the claims process.” Huh? If I didn’t know any better, I think we just got bitchslapped.

I beg you to inundate your pork-eating Carpetbaggers and Scalawags to do the right thing. It’s clear that this is an underhanded method of reducing claims filings. Even a dunce could equate No tickee =no laundry. I’m willing to bet that this is an “unofficial” official policy with ultimate deniability built in to it. When confronted, the VHA will undoubtedly respond with a resounding “Huh?. We never told our personnel to do that. We defy you to show us where that is written.” If VA is the only one allowed to supply a nexus for Vets under all circumstances, there will be a marked reduction in claims granted. Witness the proclivity of the VA now to always come up with  a “not at least as likely as not” or “It would be pure speculation to opine on this probability”.  The disparity between VA -hired doctors to find against us versus our ability to find doctors willing to make educated suppositions is becoming a yawning crevasse. How can two medical professionals come down on a question with such utterly diametrically opposed conclusions? Simple. The fix is in. I’m no conspiracy buff. Its a very simple case of Occams razor.

http://en.wikipedia.org/wiki/Occam’s_razor

The dichotomy of forbidding regular PCPs  to write nexus letters, but only allowing VA shrinks to write PTSD nexus letters is a formidable logic hurtle to overcome. I, for one, would be fascinated to hear a long rambling dissertation by VA PR Flacks explaining  their rationale for this. I’m almost positive it will entail alien abduction theories or Global Warming at some point or another.  Watch for some expert moonwalking during the Powerpoint presentation, too.

P.S. Legal counsel for the site says have the good doctor enter that as a note in the VISTA records (no nexus letters permitted) and then go to ROI and retrieve the damning evidence. It won’t take long to cure this deficiency.

P.P.S. Member Loyal writes:

I read your post on “nexus letters” and VA docs.  To this, I have discovered a “workaround”.  You ask the doc for a statement “for the purpose of either social security or, in my case, student loan forgiveness”.  Since the VA has nothing to do with social security or student loan forgiveness, I had no trouble getting the doc to oblige and provide the said nexus letter.    

 Guess what?  I sent this “nexus” to the VA.  The doc made the statement and it worked.   No IMO payments. A large part of it was that I had a “Veteran friendly” doc.  I can not stress enough how important it is, that the doc is Veteran friendly.  I can also suggest on how to make your doc “Veteran friendly”, that is, one who is willing to provide a nexus stament linking your claim malady to military service.  

 One doc I had was already Veteran friendly.  End of story.  The other doc was not so.  I put in  a request to change docs, to one that was.  The “Veteran unfriendly” doc called me, and wanted to know why I was changing docs.  I told her in no uncertain terms why, that I was looking for a Vet friendly doc. (This was an Indian doc..and I am guesssing she had discipline problems in the past, so she was in some trouble with the hospital admin office)

 She made it clear she did not want me to change docs.  I have an idea she would be deported back to India, because I think she was on some sort of administrative probation at the VA, with one more complaint validating  her one way ticket back to India. I told her I would withdraw my doc change request, as long as she was more “Vet friendly”.  Now, I get anything I want from her.    Ok, not anything, but most anything.    I recognize that a patient putting in a request for a different doc is a black mark and a red flag for management.  Use it wisely and with discretion.   

Ultimately, if many Vets “change docs” from unfriendly docs to friendly ones, the unfriendly ones will either become friendly or find themselves a doc with no patients.  Just an idea.

Remember my post “Change your words”?  http://asknod.wordpress.com/2012/01/06/change-your-words/  
This is a classic example of same. Loyal has an uncanny ability to bring a new approach to old problems. This is a refreshing example. Thank you for your observation and valuable contribution. This is why we’ll eventually win this battle. In numbers there is strength.
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VA claims blogger
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7 Responses to VAMC Doctors and Nexus Letters

  1. Mike says:

    VHA DIRECTIVE 2008-071 October 29, 2008

    d. Medical Statements to Support VA Benefits Claims.

    When honoring requests for medical statements by veterans for VA claims adjudication, care must be taken to avoid conflict of interest or ambiguity.
    (1) Determination of causality and disability ratings for VA benefits is exclusively a function of the Veterans Benefits Administration (VBA). VHA providers often do not have access to military medical records, and may not be familiar with all the health issues specific to military service, such as environmental exposure. As a result, they may not feel comfortable in stating causality of a current condition. However, this does not preclude VHA providers from recording any observations on the current medical status of the veteran found in the medical record,
    including their current functional status. All pertinent medical records must be available for review by VBA. NOTE: VHA continues to provide compensation and pension (C&P) examinations and reports as requested by VBA, as part of any new disability claims or review process.

    (2) Requests by a veteran for assistance in completing a VA disability claim are to be referred to VBA through official channels; however, the clinician, if requested by the veteran, must place a descriptive statement in the veteran’s medical record regarding the current status of the veteran’s existing medical condition, disease, or injury, including prognosis and degree of function. This may then be requested by VBA for the purposes of making a claim determination.

  2. Kiedove says:

    I’m wondering if any readers have used the upgraded my healthy e vet account yet–and what once can access. How far back do the digital records go?
    https://www.myhealth.va.gov/index.html
    To get an upgraded account you have to prove your id in person: “*To get an upgraded account you must complete a one-time process called In-Person Authentication (IPA). You can upgrade your account at your local VA Medical Center (VAMC) or Community Based Outpatient Clinic (CBOC).”
    My DH hasn’t upgraded his account yet.

    • asknod says:

      Here’s the latest from the right wing fishing and bait shop in Arkansas: MyhealthEvet is not on track to allow viewing of medrecs and downloading yet. The blue button is only good for downloading or viewing lab. tests and the like. Doctor’s records are rumored to be coming by the end of the year according to the chocolate-loving ladies over at the ROI. I can pry anything out of them with the toffee-almond ones.

  3. SquildlyOne says:

    The VA is denying me proper medical care the way it is, so I don’t really have any doctor visits for the opportunity to ask for a nexus.

  4. KC says:

    For PTSD, the Veteran should seek out his own doctor at (unfortunately) his own cost and have the doc completely fill out the following DBQ form.

    http://www.vba.va.gov/pubs/forms/VBA-21-0960P-3-ARE.pdf

    It may cost an office visit or two, but circumvents the VA examiner.

    • asknod says:

      VA has forbidden any private PTSD nexus letters since last year. They refuse to accept them.

      • Kiedove says:

        Thanks for that info. This form is still an incredibly useful guideline for those “macho” males and females still in denial or for reviewing one’s experiences. Punching through those mental boxes that have been erected over the years for protection and survival.

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