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HOW TO HANDLE THE "DOCTOR LETTER" WHEN FILING A
CLAIM --
Some straight advice from Veterans' Advocate
Jim Strickland.
Veterans' advocate Jim Strickland
provides regular columns for VA Watchdog dot Org.
If you would like to contact Jim about
his columns, you can email him here...
The archive of Jim's articles
is here...
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We’ve addressed how you must take a lot of
personal responsibility for providing evidence to support your claim to
the Veterans Benefits Administration (VBA) in which you claim the
conditions exist for you to be awarded disability benefits. We know it’s
usually easier for you to seek out medical records rather than hoping VA
or your Service Officer will do it for you. We know that you must gather
copies of your medical records together and review them yourself to
ensure there aren’t errors that would undermine your plea for benefits.
The point comes when you’ll need a “Doctor Letter”. This letter is above
and beyond the data provided in your records or the report that a
Compensation & Pension (C&P) examiner might write. The primary care
provider who sees you and coordinates your care is a very important
voice in your benefits claim. A letter from this provider will carry a
lot of weight and could make a difference in your speedy and just award.
This is true for a civilian primary care provider as well as your VA
provider.
There is the constant rumor in VA circles that primary care physicians
aren’t allowed to assess or report their opinions about your disability.
Like so many other of the “rules” and “law” we get quoted to us, that
one isn’t correct. VA employees often discourage their physicians from
becoming involved in writing lengthy letters because it’ll put them
behind schedule and may cause extra work for the employees that have to
support the providers. VA docs don’t often have access to
transcriptionists and typing pools and dictation stations so if they’re
to provide you a letter, how does it get done with a minimum of fuss?
That’s pretty easy…you do the letter yourself. You then ask your
provider to review it with you and sign it. We’ve covered some of this
before and as I’d noted then, most providers are happy to sign a well
written, truthful and to the point document.
Before you yell at me…this is a perfectly legitimate process. You aren’t
putting words in the doctor’s mouth and you aren’t asking your provider
to make any statement that isn’t true and verifiable. All you’re doing
is greasing the skids so that the process of getting good information
about your medical condition to the VBA is a smoother one. In fact,
you’re making a contribution of your labor to VA and saving them time
and money. This is legal, it assists you in gaining benefits, saves the
VA some tight budget dollars and is non-fattening, a winner all around.
Having said all that, don’t tell any of the staff you’re asking your
doctor to sign a letter for you. They’re likely to try to convince you
he can’t do that or she doesn’t have the time or that it’s against the
law. Wait until you’re comfortably in a private setting and ask if you
may address the issue of some forms with him. Let her know how important
this is to you and promise to make it quick.
Here are a few of the basics to get a good document written. I’ll assume
that you’ll produce a neatly typed, spell checked document that looks as
professional as you can get it. Don’t play with fancy fonts or scripts,
no attempts at letterhead designs are necessary or desirable. Brevity is
best, keep it all short and sweet and direct. Stick with basic business
style formats and it’ll be received a lot better.
You’ll be writing this from the perspective of the provider. This can
get a bit tricky so pay close attention to your work and have a friend
or family member proof it for you.
The opening may be addressed as follows and does not have to be
addressed to VA. The first paragraph or two are routine and serve to
establish credentials and knowledge. The body contains some details and
the end brings us to the provider’s conclusions.
Date : 01/01/ 2006
Subject: Medical history of
John or Jane Doe
The Doe’s Address
Reference: C-File # and/or SSN
To who it may concern:
I am the primary care provider for John Doe. In my capacity as a primary
care provider at the Eastern Regional Central Western Veterans
Administration Clinic, I have cared for Mr. Doe since 01/01/2001.
While I’ve provided care for Mr. Doe, I’ve become familiar with his
medical history, past and present ailments and I’ve reviewed pertinent
parts of his military record that document his injury, disease and
clinical conditions related to the events that occurred.
I am aware that Mr. Doe was (injured, got ill, sustained harm) during
his active duty military service on or about 01/01/1976. The results of
this (injury, illness) have been long lasting and his condition has
worsened as he has gotten older.
For the past (state a period of time your condition has worsened) Mr.
Doe has suffered (increasing pain, inability to walk, shortness of
breath, name your symptoms here) and continues to undergo treatment by
me and specialty clinic (ortho, neuro, podiatry) physicians.
Mr. Doe’s treatments and medications are as follows;
Name a treatment (Example; Physical Therapy, how often, etc.)
Name a medication (Side Effect)
Repeat until you have it all listed.
I have observed that Mr. Doe has challenges with functions of daily
living and requires assistance in grooming and hygiene such as combing
his hair or bathing. Mr. Doe is not able to prepare meals for himself
although he is able to feed himself. He is unable to participate in
housecleaning activities and requires someone to do his laundry and
dishes and generally keep his environment clean for him. Mr. Doe is
sometimes able to complete bladder and bowel activity unaided but there
has been an increasing frequency of soiling accidents.
Mr. Doe has chronic pain due to his injury and requires (name medicine)
which often has a side effect of dizziness and nausea. His pain level is
often quite high with reports of 8 on a scale of ten.
Mr. Doe has hypertension that requires (name medicine) and this medicine
can have the side effects of a slower heart rate or dizziness as well as
frequent and urgent urination. Mr. Doe must always be near a restroom in
case of an urgent need to use that facility.
Mr. Doe gets very fatigued because of the pain that is caused by any
strenuous activity. Mr. Doe is unable to lift more than 5 pounds
consistently and can not push or pull more than 10 pounds consistently.
Standing for long periods of time (more than 10 minutes) will make him
become weak and dizzy. He is unable to reach overhead or to bend at the
waist to retrieve fallen items. Either action will upset his equilibrium
and may cause him to become dizzy and fall.
I have examined Mr. Doe’s chart and medical record and it is my opinion
that there is a medical nexus between Mr. Doe’s active duty service
connected injuries and his disability of today. It is also my opinion
that Mr. Doe is totally and permanently disabled, can not hold gainful
employment and is not a likely candidate to be rehabilitated.
Signature Block Date
Address of Clinic/Hospital
You’ll obviously have to modify the above to fit your personal situation
but the outline as you see it is effective. Get it signed, make some
copies and submit it as evidence to support your claim. The points you
should remember are that you don’t want to exaggerate your condition…the
doctor who affixes a signature to this will want it to be point-on to
your condition and isn’t likely to sign it if you’ve over-inflated your
problems. At the same time, don’t leave out the smallest detail. Your
pain is very important and you should describe it in very certain terms.
Is it aching, stabbing, deep, all the time or burning? Does pain cause
you to lose sleep? Are you angry or losing your temper because of the
level of pain? How does pain affect your family or your ability to get
along at work?
Not all providers will welcome this. A lot depends on your relationship
with your provider. They’re human too, if you’ve been a “good patient”;
on time for appointments, compliant with medications and treatments and
friendly with the doc and the staff…you’re much more likely to succeed
here than if you’re one of the complainers and fault finders.
Maybe it’s time to think about it before you need that letter…where do
you fall in those groups? If you can’t honestly say “good patient”, you
may be working against yourself.
Contact Jim
Strickland here...
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Larry Scott
