Question:
Jim,
I am a veteran receiving care at an outpatient clinic in CA. I have been pleased with the care I get from the various providers at our VA clinic.
My question, or concern, is that when I call for an appointment with my primary care provider, I am most often thwarted by an anonymous voice who asks WHY I want to see my doctor. When I have stated that I did not feel it was appropriate to speak about my medical issues over the telephone with someone who is not my medical provider, the person at the other end of the conversation hung up on me.
I have been unsuccessful in finding an Ombudsman or patients advocate who is not a VA employee, which seems inappropriate to me. I am not sure who to ask help from, our local congressman is a man w/o military service, and generally is not helpful for individuals.
I am aware of the new regulations regarding privacy, (HIPA-sp?) but am unaware of how to ensure my privacy is protected. I do not want to have to discuss my medical needs with anyone over the telephone.
Got any ideas, or direction to proceed.
Thanks for your time.
Answer:
You bring up a number of issues.
First, any time you call for anything at your clinic you should note who you're speaking with, the time and date, what number you dialed and so on. Don't be aggressive asking, make it as matter-of-fact as you can. That person will usually only respond with a first name and that's fine, that's to protect them. Then, if you're hung up on without cause, you have recourse.
I've never been hung up on. I can't imagine why someone would do that unless you were being an argumentative jerk. Those clerks aren't paid to listen to your abuse.
I don't understand why you feel it's a violation of your rights or HIPAA rules to tell the clerk why you want to see your doctor? When you tell me that, "I am aware of the new regulations regarding privacy, (HIPA-sp?)" your statement doesn't make sense. How can you simultaneously be aware of privacy regulations but not know how to spell the acronym? I advise you study here http://www.hhs.gov/ocr/hipaa/
Those clerks work in a health system where they have access to your records. That's how hospitals and doctor's offices work. They are required to be trained in the rules and ethics of privacy as dictated by HIPAA. Many people may access your health care records, not just a physician.
Although violations happen, they're infrequent and the penalty can be severe. This isn't only the VA, it's in all health settings.
There's no violation of privacy in your call in either a VHA or civilian setting. I worked in health care for over 3 decades and it's just routine to ask a patient a few details up front so that the doc will be better prepared when you walk in.
I don't think the clerk is asking for anything intimate. If you're having a problem with your bowels, you can simply say, "I have diarrhea and I'm really sick." The clerk enters that into a computer which the caregiver will see before you arrive. The caregiver may see that and want you to proceed to the lab before you make your visit so as to save some time.
In my opinion it seems you've made the choice to argue with a routine, ordinary and harmless detail just for the sake of argument.
It makes me wonder what must happen when you call for an appointment to get your car repaired and only want to speak with the mechanic or you call to place an order for some food to to take out and won't speak with anyone but the chef.
Were I you, I'd make those calls and be overwhelmingly friendly and tell that clerk how much you appreciate what they're doing for you as you briefly explain why you want an appointment. If you attack with a smile and a positive attitude, you're going to be amazed at what you get in return.
Jim Strickland's Mailbag: Volume #52 for 2008
NOTE: Letters in my mailbag are reprinted just as they come to me. Spelling and grammar are left as is and only small corrections are made to improve readability, ensure anonymity or delete expletives that may offend some readers. This is not legal advice. You should always seek the advice of an attorney who is qualified in Veterans' law before you make any decisions about your own benefits.
07.02.08
Question:
Jim,
I was reading this News Flash I have attached and it is impressing! I have a question: If I do get an appointment to have a evaluation for Disability Compensation how can I get passed this problem of explaining my physical problems with this speech impairment I have? or should I not talk unless I'm spoken to? If he tells me to disrobe my scar's will be obvious. I will definitely need help when it comes to putting on my pants, socks & shoes. Will these people help you out like this? Can they tell the seriousness of the brain injury I have? If I do get scheduled for this I don't know if I will make a great impression? I hope these people who make these decisions are well seasoned, experienced people who can tell if your faking a disability or not? My injuries were so bad that I am surprised I even lived! I hope they don't believe that I faking it? Oh' and I'm still waiting for my answer from the Rating Board?????
Answer:
If you have a speech impairment that prevents you from being understood, you should simply make some types notes to take with you. Your letter to me is above average so that should be a help. Tell your story briefly and accurately for the examiner to read.
I wish I could tell you that the examiners were all very professional and that you'll be treated fairly. Unfortunately, I receive quite a few reports that examiners aren't always on top of their game. Get your exam done, hope for the best and be prepared to appeal.
Question:
Jim,
please help. I just received notification from my VARO that in response to my request for an increase in my present 50% the VA is PROPOSING to decrease my rating down to 20%!
They told me I had 30-days to request a personal hearing, which I did. Also, "if we do not receive additional evidence from you within 60-days, we will reduce your evaluation". Assuming it will take longer to be scheduled for a hearing, does my request for the hearing negate the need to submit "additional evidence" within the 60-day time limit? Which would be before the hearing.
I had a cervical spine injury while on active duty during January 2003 and was treated at our base medical facility. I retired the following April and several months later my cervical difficulties surged back with a vengeance. I had an MRI and was tested and treated at a local Boston area VHA. I filed for VA compensation myself (DYI) in October 2003. I had a C&P exam in and was granted my 50% award in June 2004. My request process was relatively easy due to the short time frame and available documentation.
My award was granted for "SC for cervical spine spondylosis to include disc bulge of C4-5, C5-6, and C6-7, right sided disc herniation of C6-7 and neural foramina narrowing right side C4-5 and bilaterally at C5-6 and C6-7.
The 2004 award letter also stated I was assigned 50% because the incapacitating episode had lasted for 4-weeks and that 60% would have been assigned if it had lasted 6-weeks or more.
I continued to have moderate difficulties and then in July of last year I started to have a new and much worse and longer duration incapacitating episode. The worst of which lasted for ten weeks. I'm an old salt, but damn it was bad. Again I had acute pain, from neck radiating down through my left shoulder, down left arm and swollen left hand, numbness, and reduced strength. I was housebound, sleeping sitting up and had to use the maximum daily dosage of Oxycodone allowed. I could not work and needed family members to drive me to doctors appointments. Over a period of five weeks in September I had three ESI neck injections, which alleviated the acute systems by early October. I then waned myself off the Oxycodone because I felt I was getting addicted to them.
I filed for a rating increase a few weeks later, in October, based on my increased difficulties and the 6-week episode duration statement in my June 04 award letter. I had a C&P exam in November (within 30-days) and expected an easy jump up to 60% though I asked for an unspecified increase.
The VA now claims my conduction has improved, but I don't understand the rational. I thought my medical documentation and obvious systems during the C&P was conclusive. The rating official wrote:
"Private medical records showed your complaints of neck and bilateral upper extremity pain in July 2007. You had decreased sensation to light touch in the C2-C7 distribution on the left. Motor strength was 5 out of 5 bilaterally with normal reflexes. You were diagnosed with cervical Radiculopathy. MRI scanning showed spondylosis and disc bulging at C2-C7. It was noted that you had an actual decrease in size of the right posteriolateral disc bulge at C5-C6 and an increase in the size of the disc bulge at C5-C6".
Note the above "You were diagnosed with cervical Radiculopathy" (by a board certified Orthopedic Surgeon) statement. But the last sentence of the C&P examiners narrative states "There was no diagnosis of cervical Radiculopathy rendered at this examination". Also above , note the "increase" and "decrease" of disc bulges at C5-C6.
The clock is ticking and I have to get my ducks lined up. Through I'm not sure in what order.
Through I included documentation from my PCP with my increase request the reduction proposal letter noted the need for a more detailed statement from my PCP. First duck, I'll write a letter using your template and ask my PCP to sign it. Next I have to get my head around the cervical disc terminology, which I don't quite understand. I have noticed though that my June 04 award letter referenced disc bulging from C4 to C6 but the reduction letter noted MRI scanning showed bulging from C2 to C7.
Thank you for reading all of this. I have the highest regard for you advice . . . please help.
Answer:
It never ceases to amaze me the length they'll go to to harass a guy.
OK...you timely replied and I'll assume you did so using certified mail.
I'm going to strongly advise you to get an Independent Medical Opinion...an IME. The IME is an ultimate weapon and it sounds as if you may need it.
I don't always suggest going straight to an IME. It can be expensive and if not done perfectly, it may be ignored. But in your case, it sounds as if there is a push to cut you back so you should go ahead with your heaviest artillery.
