My posts on this blog so far have all been of a philosophical nature. This one is not. This is meant to be informative, and is written for the veteran who is looking to establish care with the VA, or to establish a service connection.
I often encounter confusion from the veterans regarding these issues. The VA offers both, and they are separate services offered by the same institution, at the same location. I can understand the confusion.
By far, the biggest and most expensive thing that the VA does is to provide ongoing medical care to our nation’s veterans. I believe we should. That is why I work for the VA. I believe in what I do. But the VA does a lot of other things, too; burials, home loans, college money, and granting service connected disabilities. It just so happens that the service connected issues are also run through the healthcare system, whereas other VA benefits are not.
I am family medicine trained and board certified. So I am a primary care physician for the VA. I am one of the front line generalists that the patients see for management of a wide variety of chronic and acute medical conditions. During the last four years of working here, I have had quite a few new patients come to me confused about why they are here. They thought they were here to establish a service connected injury or illness. That isn’t what I do, primarily.
If you have an ongoing illness or injury that you sustained because of your active military duty, you might be able to have that condition officially recognize by the VA as a “service connection.” In order to have the VA formally recognize a service connection, you have to go through a particular process. First you talk to a service officer. This may be though AMVETS, DAV, VFW, or any number of other veterans’ service organizations. Your representative form this organization will help you fill out and submit the necessary paperwork to initiate the process.
Once this is complete, you will be given an appointment to see a physician who will evaluate your claims. This is called a “Compensation and Pension” exam (C&P). It just so happens that I do these, too, although it is a small percentage of physicians who both provide routine medical care and are involved in the C&P process.
Ironically, quite a few times I have had patients come in for their C&P exam, only to find that they wanted and thought they were coming in to establish care for routine medical care.
After the C&P exam, all paper work is submitted to a board. The board decides the outcome of the request, not the medical provider.
Why would a veteran need to do this? There are a number of reasons. One is the claim my warrant a small amount of income. There may be compensation for some illnesses and injuries, depending on how severe they are, and how well you can prove they are directly as the restful of military service. Another is that it may help to qualify you for routine medical care. Yet another is that it may affect how much you pay for routine medical care at the VA, in terms of your copays.
If you are eligible for medical care through the VA but have not established yourself as a patient, call your local VA to find out how to become established. You will have to have an initial visit where you will be assigned to a PCP, and they will review your medical history, medications, give you a complete physical, and draw labs. This visit is called a “10/10.” Honestly, I don’t know why it is. I think it has to do with an archaic paper form. The VA medical records are entirely electronic at this point.
If you are a vet who is trying to establish care, or seeking to establish a service connection, and if you have an appointment pending, please make sure that you have the correct type of appointment. If you are looking to establish care, you need a 10/10.
If you are looking to establish a service connection, you need a C&P. these are entirely different exams, usually performed by entirely different people, and managed by mostly different systems.
Thursday, July 8, 2010
Saturday, July 3, 2010
Perfect Lives -- a National Change in Perspective on Personal Responsibility
I have had the unfortunate privilege to be a witness to a shift in our nation’s perspective of personal responsibility. I have had the great pleasure of knowing and taking care of hundreds of WWII vets. These old men and women almost invariably have an attitude that nobody owes them anything. I can change their blood pressure medicine and they are disproportionately grateful that I took the time to care, or that the government is willing to spend an extra penny a day, literally, on this new dose. I have guys from WWII with disfigured faces and missing limbs, who as sure as they live and breathe, believe that this was a price worth paying to defend their country. They are still not asking what their country can do for them.
Fast-forward to today’s veteran. Don’t get me wrong; I appreciate the risks and sacrifices that these young men and women are making; going to war in deserts to try to keep us safe from terrorists, in wars that no one can really prove are making a difference (albeit we all hope they are). I mourn, too, for the lives that are lost. But there is a big difference in the attitude.
Seriously, let’s compare these two scenarios: 1. A man is willing to sacrifice his life, his limbs, his future with no expectation whatsoever of compensation. 2. A man is willing to make the same sacrifices with the full expectation that if anything happens to him, he will be taken care of for the rest of his life.
Who am I to criticize? I am grateful for the men and women who go to war for us. I never joined the military, because I never wanted that kind of a risk. Ironically, I am a bit of a pacifist, although I firmly support national defense. But seriously, the magnitude of those two sacrifices are not the same.
Does that mean that I don’t think we should take care of our injured? No, not at all. I whole-heartedly believe that if we put our young men and women in harm’s way, then we owe it to take care of them. It is one of the reasons I chose to work for the V.A. The troublesome issue is the attitude of the recipient.
The majority of the young men and women coming to the VA as new vets are smart, hard-working and earnest individuals. Unfortunately, it is my experience that the expectations have changed. Whereas 98% of the WWII vets expect nothing, about a third of the new young veterans expect everything. They can have minor ailments, such as an annoying persistent tendonitis, and expect disability, or demand an MRI when it is not indicated and would serve no purpose. I have old guys in their 80’s who have never asked for a thing in return for major injuries, and young guys who want the world for minor ailments. The new vets are often late for their appointments, or don’t show and expect speedy treatment anyway.
It’s not just the veterans. This is reflective of a broader change in our national thinking. It’s a lack of personal responsibility. Got chronic back pain? Go on disability -- why work? Something went wrong? Sue somebody. Nothing should ever go wrong. Nothing should ever go wrong with your life or your health. If it isn’t perfect, then it is somebody else’s fault. And if it is somebody else’s fault, then get a lawyer.
I hope that this trend changes. If we continue to think this way, it will be our downfall. We must be responsible for our own actions. Everyone should feel compelled to contribute to society, to do at least some kind of work. We have to stop demanding that our lives be perfect.
Fast-forward to today’s veteran. Don’t get me wrong; I appreciate the risks and sacrifices that these young men and women are making; going to war in deserts to try to keep us safe from terrorists, in wars that no one can really prove are making a difference (albeit we all hope they are). I mourn, too, for the lives that are lost. But there is a big difference in the attitude.
Seriously, let’s compare these two scenarios: 1. A man is willing to sacrifice his life, his limbs, his future with no expectation whatsoever of compensation. 2. A man is willing to make the same sacrifices with the full expectation that if anything happens to him, he will be taken care of for the rest of his life.
Who am I to criticize? I am grateful for the men and women who go to war for us. I never joined the military, because I never wanted that kind of a risk. Ironically, I am a bit of a pacifist, although I firmly support national defense. But seriously, the magnitude of those two sacrifices are not the same.
Does that mean that I don’t think we should take care of our injured? No, not at all. I whole-heartedly believe that if we put our young men and women in harm’s way, then we owe it to take care of them. It is one of the reasons I chose to work for the V.A. The troublesome issue is the attitude of the recipient.
The majority of the young men and women coming to the VA as new vets are smart, hard-working and earnest individuals. Unfortunately, it is my experience that the expectations have changed. Whereas 98% of the WWII vets expect nothing, about a third of the new young veterans expect everything. They can have minor ailments, such as an annoying persistent tendonitis, and expect disability, or demand an MRI when it is not indicated and would serve no purpose. I have old guys in their 80’s who have never asked for a thing in return for major injuries, and young guys who want the world for minor ailments. The new vets are often late for their appointments, or don’t show and expect speedy treatment anyway.
It’s not just the veterans. This is reflective of a broader change in our national thinking. It’s a lack of personal responsibility. Got chronic back pain? Go on disability -- why work? Something went wrong? Sue somebody. Nothing should ever go wrong. Nothing should ever go wrong with your life or your health. If it isn’t perfect, then it is somebody else’s fault. And if it is somebody else’s fault, then get a lawyer.
I hope that this trend changes. If we continue to think this way, it will be our downfall. We must be responsible for our own actions. Everyone should feel compelled to contribute to society, to do at least some kind of work. We have to stop demanding that our lives be perfect.
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