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.
If you are a vet who needs money, just lie to to the comp and pen doctor.
ReplyDeleteAlthough I think that anonymous is painting all veterans with too broad of a brush, he brings up a good point. The C&P exam, in some cases, involves a simple series of questions that the examiner asks. Too often it seems, for expediency, the final (compensation) decision is based simply off of the C&P examiner's notes rather than digging into the medical tests and diagnosis made by the doctors to verify and arrive at a fair evaluation rating for the veteran. This can create problems that cut both ways by establishing undeserved allocations to veterans that embellish (or actually lie) about their problems or by ignoring veterans who trully deserve service connected compensations. To give an example, in my C&P exam for ischemic heart disease, the examiner asked, "Can you walk up 1 flight of stairs?" Because I live in a 1st floor apartment, I answered, "Well, yes, but I am exhausted and start to experience mild angina when I do." Another question was, "Can you lift 20 lbs.?" I answered, truthfully, "Yes, I can bend down and lift it but with difficulty and cannot walk or carry it anywhere without experiencing exhaustion and angina."
ReplyDeleteThe following week I requested copies of the notes from my C&P exam and the examiner had written down, "Patient says he can lift 20 lbs., and can walk up a flight of stairs." Despite the fact that I have had open heart surgery in the past and most recently the VA had unsuccessfully tried to operate to install stents, leaving me with 1- 100% blocked artery and another 90% blocked artery (the 1st closed and died, the 2nd inoperable due to the locations of the blockage. The surgeon told me that "we'll just have to pursue a strategy of medication and try to train my heart to work at a lower rate (55-60 beats per minute)".
Despite that, the examining board only looked at the C&P examiner's notes and gave me the lowest rating allowable, 10%.
This last weekend I ran into a VA patient who said he was rated at 100% due to PTSD. Although he served in the VN era like me, he was never in combat but during a hospital stay for dysentary was exposed to veterans who were terribly wounded by shrapnel and bullets. He said he still experiences nightmares from all that and the compensation examiners agreed, giving 100% disability (although he seemed fine to me). He was talking about going scuba diving with his sons.
I'm not going to judge, but I think that sometimes cases could be evaluated more judiciously.