Complexity in Medical Evaluations

It seems to me that they try to steer you in one direction or another. The focus is so narrow it’s hard to answer questions with a simple yes or no. Generalized answers sometimes don’t suffice because the issues are pretty complex. When they turn one over to a doctor to figure out, it just doesn’t seem satisfactory to me.

Out of curiosity, I went through and counted the number of questions and sub-questions on the spine DBQ (Disability Benefits Questionnaire), and there are over 170 different types of question answers that the doctor has to handle just on the spine DBQ.

Challenges with DBQs

Most regular doctors, like the ones you go to, find it hard to take the time to fill them out properly. Most of them just check a box or two and sign. Some are hesitant to involve themselves with the VA because few understand what’s being asked of them. Others are uncomfortable making certain observations or assessments. It’s understandable, and hopefully, that will improve over time. The VA does make revisions to these DBQs, and I have seen improvements.

Detailed Documentation

Each question on the DBQ could have a hundred or more precedent cases behind it. Legally, the doctor has no idea what’s going on with those 170 different questions. Could you imagine me as a Raider sending it back to the doctor and saying, “Your discussion doesn’t satisfy the requirements discussed in Mesecquez v. McDonald”? The doctor would have no idea.

Use of Narrative Space

I prefer the old VA forms because they had some narrative space. More narrative would be good in the DBQs. Those old forms used to have narrative space for the doctor to write in observations, opinions, and discussions. Nothing precludes the doctor from doing that now, except for the little half space they give at the bottom.

When the court came out with its ruling in Kua back in 2016, it prompted The Examiner to describe pain on weight-bearing versus not weight-bearing. VA revised the DBQ to include this specific prompt to satisfy evolving legal requirements.

Reductions and Their Challenges

If they reduce someone from 20% five years ago to 10% now without a DBQ, that’s not a satisfactory comparison. The examination must be as thorough as the one that granted it, especially for disabilities in effect for five years or more. Treatment records can be used, but they typically don’t describe degrees of range of motion or additional functional loss due to pain.

Chronic Conditions and Reductions

For chronic conditions, such as certain malignancies, they might be quiescent but not inactive. The veteran is still entitled to 100%, and no future exams are scheduled for chronic malignancies. Secondary complications, such as renal failure or radiation-induced necrosis, must also be considered.

Identifying Issues

Identifying issues, including secondary conditions, is crucial when evaluating the primary condition. If it’s shown in the record, it must be addressed.

The Future of Veterans’ Claims

I hope 2019 will be a better year for veterans regarding the claims process. A lot of changes have been made to address the backlog of claims. My fear now is for appeals. If veterans elect a prompt review, they risk losing because their case might not be fully developed.

The Importance of Medical Evidence

Most veterans don’t have a good understanding of what evidence is necessary to prevail on appeal. Significant medical evidence is required. If you take the ramp for a fast decision, you risk losing due to incomplete development. Nearly a third of all appeals that were remanded were due to incomplete development.

Medical Professionals and Evaluations

There’s an undercurrent of using nurse practitioners and physician assistants for DBQs. These professionals might not be as well-trained as doctors or specialists, and they may not bring up issues pertinent to the claim. They are generally instructed to stick to the script and not offer additional observations.

Complex Cases and Evidence

When understanding the etiology of a condition and its potential relationship to military service, a more in-depth analysis is required. For instance, in asbestos cases, the workers’ compensation claim might not consider all potential exposures.

Secondary Conditions and Detailed Analysis

If a veteran has a blood disorder, it’s challenging to prove it was caused by service. You must look at all known risk factors and compare them with service-related exposures. If it’s impossible to tell, the tie goes to the runner. Detailed analysis is required to determine the cause.

The Issue with Burn Pits

Many veterans exposed to burn pits are showing up with various disorders, including cancers. The VA is still trying to come to a conclusion on the burn pits, but nothing concrete has been established.

Conclusion

Thank you all for listening. That ends this show, and now I’m going to zoom off.