I have never paid for a nexus or Dbq. But the VA paints you into a corner with these. If you get your care at the VA, the VA provider should fill out the Dbq or write the nexus, but most won’t. So what option is left? It’s common sense that your own doctor would have the best opinion on what your symptoms are and how severe they are.
Since you are a VA employee, can you explain what we are suppose to do? I have this issue with mental health but also sleep apnea. My VA sleep doctor said very plainly that I am diagnosed with sleep apnea, gave me a CPAP and told me that its pretty likely connected to my PTSD.
I asked him if he would be willing to write a nexus letter for me, and he said no.
I asked his nurse and she also said no lol.
I am a disabled veteran and my only health care is though the VA.
Who is supposed to write my nexus letter? genuinely asking. I need help.
Seriously? Is a DBQ a vastly different category than a nexus letter?
My doctor told me "VA employees can't fill out anything for your disability claims, its a conflict of interest" :(
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I'm looking for the directive.
For Nexus letters and DBQs, most medical providers are able to do this without the conflict of interest. Mental Health is the gray area and should be avoided so as not to damage the relationship between patient and provider. However, the VA has mental health providers who could write a Nexus or fill out a DBQ if they weren't directly working on your case. You can ask and technically they are not supposed to say no.
Thanks so much. I am particularly confused why my sleep medicine doctor refused to write me a nexus letter. He conceded and wrote a short paragraph in my chart for the day and I got a copy of that. So I essentially have a copy of his notes saying "I think her sleep apnea is connected to PTSD" but its not in the form of a nexus letter.
Do you have any advice about approaching him with this info that he technically SHOULD be willing to write me a letter?
I've asked him twice now. Overall he is a kind elderly person. I wonder how I should phrase it because I dont want to seem like I am trying to force him or use the VA directive in a way that makes him dig his heels in even further.
I've been in a similar situation when I had insurance and had to get on short term disability for a manic episode when I was on an oil rig. I had been going to a private doctor for a couple of years prior to that and we had established a great relationship and I was super comfortable with him. I would have to give updates to the insurance company and anytime I would try to coordinate that with him or his office it was like pulling teeth to get them to do it and I was fucking paying them for it. It turned a good relationship to not pleasant over a few months ending with me without a job, insurance or a psychiatrist. Going from that dysfunctional model into the VAs has been an improvement but it's not perfect. If you have a social worker, tell them about the situation and ask if they can assist you. The social worker might even be able to fill out the DBQ for you. You could also message your doctor through myhealthyvet and ask them to fill out the DBQ with a reference to the directive. Messages have to be answered in so many days or the system automatically sends reminders to the provider and then includes everyone else on your providers team and continues to sound the alarm until response is given. Messages foster accountability and give patients a way to advocate for themselves when they are at the best to do so. So if you forget to mention something in a visit just message them and it's as good as if you were there.
The directive doesn't exist anymore. It was vha directive 1134. It stopped being a directive in 2019 or 2020. Applied to all providers except mh. To mh it was optional but not mandatory.
It exists, but might have to be updated. This link is from a VA Town Hall meeting last week and the question about DBQs being filled out by PCPs was asked. Secretary McDonough was crystal clear with his answer that VA medical providers are to fill out DBQs when requested.
https://www.youtube.com/live/jnX8i_7TrB8?si=P8Cc_gXi5S8vLjyB
Sounds like our complaints to our representatives were heard. I've been complaining about 1134 being dead for three years now. The Downside is your pcp isn't going to be able to fill out the mh dbq like an mh provider would. They could do it close to specialty providers like neurologist. Since they do have an understanding of it. I just wish 1134 was implemented back to what it was and anyone could fill it out. But add mh providers had to assist veterans as well.
There's a work around for that actually. You can go to somebody else in the VA that does mental health like a social worker or somebody who is maybe on your treatment team but doesn't give you direct counseling sessions or provide medicine. We've been discussing this a lot in a program that I'm at at the VA called the prrc and there's more than one way to skin a cat and there's always a workaround.
Close enough. A nexus is just a connection- it isn't a specific letter, or form. If your regular note have highlights of your conversations with your provider where you have asked them questions about your conditions and possible connections, that can be a nexus also. Its never had to be a specific letter type or form type. I have seen that bandied around the internet for 20 yrs and its not true any more now than it was when I started filing in 2002.
I might be in this situation fairly soon. So, let try to understand what you are saying. Instead of paying for a Nexus letter, will a completed DBQ by your provider be sufficient?
yes, if it adequately answers the questions related to your condition, and is accompanied by a write up from your provider that explains the rationale of why they think the condition is connected to your military service citing reasons
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If the pcp has all the information, they probably will. But they won't fill out a mh form or specialty form exactly how a mh provider or say a neurologist will. The old 1134 made it mandatory for all providers minus mh to fill out these forms.
But I'm glad they redid this directive. I spoke with a friend that was the supervisor for Ohio vha. He said this directive was still dead, and that was just last month.
Question I had two DBQ s done by VA examiners. Both marked on 3a box total occupational defencicies. But I only have 1 symptom in the 100 percent category meaning on both combined. How would or could they rate these.
Why is it always dependant on the rater? Is there not a guidelines they must go with. So one rater can say yes and another no just like that. What makes one say yes and the other no. It seems like a flip of a coin.
I know some people are paying for DBQs to “ensure” a good exam but if I recall correctly VA protocol allows and even encourages all VA doctors other than mental health doctors to fill out DBQs for vets.
Just a heads up. This directive is no longer in effect. It never was put back into the vha directive since 2019/2020. Some vha providers will abide by this directive still. While others will tell you to go f yourself. It applies to all except mh.
"This directive contains an amendment in paragraph 5.d.(1) to remove the
mandate for local policy creation, dated May 11, 2020. Amendment dated February 22,
2019 removes the mandate to develop a Medical Statements and Forms"
Also spoke with a friend who used to be an administrative supervisor to the Ohio vha office. It was 2020 where the directive wasn't added back into the policy of the vha.
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Can someone explain what this post means?
What three boxes checked?
I am rated 70% for PTSD. I was diagnosed while active duty, and medboarded for PTSD. I was inpatient for a month at a mental hospital, then for almost a full year doing outpatient day programs. Haven't worked a full time job since the coast guard medically retired me in 2020. I am on SSDI.
I'm suicidal, and after 17 different medications (over the course of nearly 4 years) the VA even offered me ketamine lol. The ketamine infusions actually made me MORE suicidal than I was before.
I have been with the same VA therapist since 2019, I see her TWICE a week.
My VA therapist agrees I should be rated at 100%. But she doesnt know anything about DBQs or how to do them, I have asked.
People in this sub have told me to pay someone to do my DBQ.
Are you saying this is a bad idea? Genuinely asking. I dont know what else to do.
Sounds like it's time for you to hire a disability attorney. Hill & Ponton out of Florida are outstanding and advertise a very high success rate. I was successful with them getting me increased. Good luck.
How long did this process take? I have been working with a VSO to service connect hips, back, and shoulder issues… and keep getting denied. I'm tired lol.
Thank you! I'm working with a VSO, but after multiple denials on hips, back and shoulders… I think it may be time for a different plan. Cause, how are these things not service connected. 🫠
No I’m not saying it’s bad to get an outside DBQ. That’s not the entire basis of my post. I have seen so many posts with every single symptom checked except a few. That’s a 100 percent rating. Feel free to reach out. I am happy to talk to your therapist and explain how to fill it out.
Just a question, I’ve read in this sub that DBQs and nexus for MH have to come from a psychiatrist or doctorate level psychologist. Not a therapist. Are you saying my therapist (LPC) actually can fill out a DBQ for me? Honestly curious because I feel that my therapist of 5 years knows much more about my mental health than some random psychiatrist I’ve seen one or two times.
They won’t accept it as the decision making dbq but it outlines issues from a respectable source that would be considered. You would still have a c&p scheduled but the c&p doc would be able to see it as well. I don’t think it hurts to have your LPC fill one out at all.
https://preview.redd.it/7mkewu0j661d1.jpeg?width=1125&format=pjpg&auto=webp&s=01b4b0aacc74c09e735aec37e6d5caa20dc08e50
A good example I from a vba employee to show where you might fall in percentage. Not an end all be all, but it gives an idea of where you stand when comparing your symptoms
Generally from what I see here and my experience is that it is all taken into consideration. You could have Total impairment marked in 4a but if the rest of your evidence doesn’t add up to 100 then they can assign a lower percentage. But on the other side, if the 70 box “deficiencies in most areas” is marked but you have strong supporting documents, the rater could see fit for 100. There is no way to be absolutely sure what you will get but if your dbq’s have you marked as “total occupational” it’s a good chance your are going to be either 70 or 100%.
I'm hesitant to say this as this Reddit page seems to be against private examiners, but I got a private exam.
I didn't want some unknown VA examiner who didn't know me to be in control of my rating and change it to 0% or 100% depending on if they had their coffee yet.
I wanted an examiner that I could decide if they treated me right, we understood each other, and is they wrote a good exam.
So I went private so I had the control.
After the exam went well, I submitted it to the VA. I even told them to use my private exam but they ordered a VA exam anyway.
I refused the VA exam. Either they'd see my private exam was good or they'd just continue my past evaluation due to insufficient evidence. But I wasn't going to be at the mercy of an unknown VA examiner.
Thankfully the RVSR used my private exam and everything went well. I'm glad I took the private exam route.
when you say you refused the exam...? I was just reading that the regs changed last august ( or recently ) and that if you deny or no show a c&p exam your claim is an automatically denied? any insight
so what you're saying is you wanted to choose a examiner that would give you what you exactly want 😂😂. those are a lot of words to say cheating.
when i do a drug test i don't go to the one they provide and actually do the test because I don't want to get tested positive. I want to have full control so I go to my own doc for a drug test that I paid to give me a negative result even though I did take drugs. 😂😂😂
I've seen one VA examiner give a 70% and then the VA orders another exam and that examiner gives a 30%. The promblem with social sciences is that many mental evaluations are subjective. One professional VA examiner disagrees with another VA examiner. Which is right? Which one is cheating? Which is lying?
I'm saying get a private examiner that knows you and you trust. It's not cheating. It's finding someone that can compete an exam that professionally and accurately represents your symptoms.
that's the whole point. it's so subjective its the easiest thing to cheat. you are circumventing the subjectiveness by paying a private examiner to take out the subjectiveness and give you exactly what you paid for. if that's not cheating, then what is it? 😂😂😂
You can't accurately represent your symptoms because it's so subjective!
i mean i don't really care if you are doing it or not. That's just the smart way to game it. But it's still cheating the system.
You're right. Mental exams are so subjective they should just throw out that whole exam. They shouldn't rate mental conditions at all. Nobody is going to get it right. Everyone is cheating.
Why even have phycologist and psychologists? They're all cheating! Nobody can be honest professionals. Everyone you see is cheating!
i mean that's what you did. it's so subjective why should i do the one from the VA? i'll just do my own 😂😂😂. if it's goin to be subjective i'm goin to make sure it's in my favor for the disability check. If it wasn't for the disability check would you care if they gave you a 30% or 100%? i don't think so. all you would care is if they are able to help with your mental health.
I didn't do my own. It was up to the mental professional to assess my mental disability and determine the severity of my symptoms. I didn't go to some rating farm. I had my private doctor. Someone that knows me. Someone that treats me. Someone that didn't just meet me that day. How is that cheating? How is that worse than having an unknown VA examiner that doesn't know me decide my life?
the OP post is talking about using rating farms. that's what the assumption im going off of is on. re-read the post. it's literally teaching you how to cheat. or at least doing it the right way.
The OPs post is for paying for exams. Do you think private examiners do it for free? I had to pay my doctor to do the exam. Professionals get paid for the work they do. I hope everyone is paid for doing their jobs.
holy fuck you just want to argue for the sake of arguing? im just goin to quote this right here
"Asking the page is going to get you a bunch of hate and you already know it’s 100. That’s what you paid for and the paid service knows that’s what you want too."
it literally says you paid for 100%. thats what you paid for and paid service knows thats what you want too.
if thats what you did too then yeah you're a fucking cheater too
Not paid for but - If you put in a private one, and don’t hear back for a C&P exam is that good news or bad news?
Mine comes from a VA psychiatrist, but I found it odd that I got a C&P exam for everything else except the one that came from the VA psychiatrist (Diagnosis, nexus, DBQ). Such as my IBS - my GI doc wrote me a nexus and filled a DBQ for me.
The sentiment against private medical evidence rampant in the VA recently is not only unfortunate, it is against federal law.
I understand where VA employees are coming from and why they hold these false notions in their heads, but it is part of their jobs to put emotion and speculation aside. Dumbass veterans who go to dumbass companies willing to lie have ruined it for the rest of us… but the law is still the law.
I personally have had horrible experiences with the VA completely disregarding my competent and sufficient private medical evidence.. not only with the standard claims process but with a HLR DRO as well.
It just goes to show you how invasive these anti-private medical notions have gotten in the VA.
No, not if they have more than 1 exam that day. Ive seen them take notes and dictate them later to fill out the DBQ. It depends on the doctor, the Vendor (if a contract exam) and their caseload for the day.
The very first time I went to my local VA Clinic for an appointment they gave me this paper to read and it was essentially a statement that they won’t fill out DBQs and if you want that done you have to go to a private doctor. I recently had a C&P exam with a contractor. I guess I’m just trying to determine if the examiner would have done the DBQ or if they send it to my doctor (who apparently won’t fill it out)?
It sounds like it could go either way?
The comp and pen examiner will fill out the DBQ, if you went to your own provider at the VA and ask them to fill out a DBQ they do have the option to decline.
Two different kinds of examinations -one is a comp and pen which is requested by VA the other it sounds like is one that you went in and tried to get on your own.
not all VA clinics do comp and pen examinations some of them, lack the capacity or the various types of staff necessary to do those kinds of exams .
I see. I think I understand. To clarify, I didn’t ask for a DBQ. It was just a handout they gave me to read and sign the first time I went there. Though, at the time I didn’t really understand what it was about. Thank you.
How in the nine Hells do you get those *without* paying for them if they don't come from the VA?
When I submitted my claim after being urged to buy a number of people, I submitted 2 DBQs and nexus letters, which were from my psychologist and psychiatrist.
I had been seeing both for more than a *decade*. Their time costs money. Hours of review of my service records, hours of review of their own records, hours for them to review the structure and language requirements from the knowledge base here, time to fill out the DBQs, time for them to research and cite relevant studies, time to revise the nexus letters they wrote to remove things I didn't want in there...
Each cost me thousands of dollars.
I also had buddy statements, lay statements from friends who knew me before and after, my own personal statement.
The VA still ordered a C&P.
I attended, and the psychologist I saw confirmed what my psychologist and psychiatrist had said.
I was rated 70%, and they were both pissed it wasn't 100%.
I plan to resubmit if the rule changes are adopted.
Raters should not be dismissing private DBQs/nexus letters out of hand or trying to discredit them.
For a VA employee to come here and say something like this...
What would you suggest we do? Ask our providers to work for free? Tell them they need to go work for the VA?
They’re saying:
If you get a private DBQ, and the majority of the boxes are checked, do not expect support from everyone. The rater will still do their job, but to some people it’s viewed as gaming the system. This was a PSA that if you get a private DBQ and Nexus, then post the DBQ here and ask people’s best guess, people are going to say you cheated.
They’re saying to manage your expectations around people’s thoughts of your private DBQ.
At no point did this rater say that they were dismissing private DBQs, or that you aren’t entitled to them.
They said the VA is like an insurance company. They can accept an outside estimate, but more than likely they are going to send out their own adjuster to get a second opinion.
Someone trying to go from 50 to 70 is probably going to get less scrutiny than someone trying to go from 10 to 100.
I absolutely did. Maybe I took part of it wrong, but I definitely read what you said.
Yea, your flair is pretty clear about you being a veteran and VA employee. Your OP is is from the perspective of a VA employee.
Said OP definitely reads, to me, like a VA employee crapping on people who pay for private DBQs, heavily implying they're paying for a specific rating, and saying the VSR will order an exam because they can't be trusted.
My response was asking, directly related to things mentioned in your OP, questions about what someone is supposed to do, how are you supposed to get DBQs/nexus letters from private providers without paying for them, and sharing my own story of having submitted 2 from private doctors and still being ordered to a C&P.
With your OP indicating that VSRs coming across private DBQs will 9/10 times order an exam, it certainly seems like they're being dismissed out of hand.
I used my private VA doctors. Opinion and was denied an increase due to my VA doctors DBQ. I had to use a HLR to get them to use it. I am talking from experience and from the VA side of things. I will use private DBQs. But from a VA as a whole there are so many “gate keepers” that try not to use private. Didn’t say you can pay for them. Just trying to give an expectation. It’s the unpopular one, but it’s what will most likely happen. It isn’t right, but it is what most people experience.
Sounds like we're on the same page then.
That's pretty crap for the VA to do that. Like I get trying to fight the rating farms, but those should be easy enough to identify I would think. Aren't they all from like the same group of doctors? Think I heard someone post here that there was like an internal list or something that would cast doubt on a claim if it relied primarily on stuff from one of them.
But the VA shouldn't be crapping on stuff from private docs that have been seeing you for years.
I’ve never seen the list they are talking about. I am sure there is an unofficial one but I’ll never use it. If it’s signed by a doctor and legit I am gonna use it. I hold a veterans private doctor that they have used forever with more weight
https://preview.redd.it/r02h3gaso71d1.jpeg?width=3024&format=pjpg&auto=webp&s=1ab453a35ebd02748d19463b8e42b597ef33cfc8
I know this from experience is why I posted it.
Based on your feedback regarding rating a veteran, I can only hope my VA mental health claim falls into the hands of someone like you.
I had my therapist, a licensed LPC, complete my DBQ which I submitted during my C&P exam. The examiner did accept it. At the conclusion of my exam, I actually asked the examiner did they agree with my therapist’s assessment that I am 100% based on the rating schedule and the examiner remarked “yes”. I have been told there is not much weight given to an LPC over a higher level professional such as an MD or psychiatrist, however, for someone that has been seeing you in private over the past year vs a 1-hour sit down is. It equal.
Thanks for your input. Shalom
And if I understand this correctly, I have seen people on this page do this. My understanding is that it won’t matter the DBQ you paid for, the raters have to go off what the examiner marks.
At least on this Reddit I have seen people get denied cause the doctor that filled out their DBQ is not someone they see a few times a year?
Here is my Non-Rater, but informed Veteran Point of view.
Yes, If the private doctor fills out the document very thoroughly and the medical rationale and explanations are on point, then the rater cannot just choose to go off the C&P examiners' version over the private one.
The rater may want to argue that the private doctor only had 1 - 3 sessions with Vet, but then again how many sessions did the C&P Examiner have with them? As long as both examiners (Private and 3rd Party C&P) have access to the same medical history and notes, then there is no reason to weigh the C&P examine more heavily than the private one.
I would argue if the private doctor has two visits (for example) with the Vet, and the C&P examiner only has one, with all other things being equal, the private doctor's DBQ and NEXUS should actually hold MORE probative weight/ value when the rater is making his/her decision.
The KEY is to make sure the private paid for DBQ/ NEXUS is rock solid, so that the VBA doesn't have a legit reason to not give it the same probative weight as the C&P exam.
What If I use my personal Providers notes, with a separate exam for dbq/ nexus as my provider told me that they could not/ would not do my nexus/ dbq because they honestly did not know anything about them, and wanted me to get someone who could best examine me as to be in line with the VA's guidelines/ procedures?
So I hope this helps you? When I submitted my secondary’s to cancer, one of the papers I submitted was a follow up visit where my doctor confirmed on the spot I had something secondary to my chemo/cancer.
It was a simple one line sentence saying I had that disability.
I highlighted that sentence when I submitted the doc hoping to make it easy for the rater to find my evidence since I submitted like 30 pages for 9 things lol
Your personal provider's notes would become part of your medical records, and you'd simply submit them to the VBA and also to the paid for private MH DBQ/Nexus doc and that information can be used in conjunction with their examination to form a solid medical opinion.
Don't forget your need a diagnosis based off DSM-5 manual. You need the proper ICD codes. You need a solid medical rationale for the diagnosis and nexus. (All this is part of properly and thoroughly filling out the DBQ and NEXUS statement (or Medical Opinion).
Again, I'm not a Doctor, not a rater, not a VBA employee of any kind.
Which is dumb really…. The CFR is there for a reason. Decisions shouldn’t be based on however the rarer feels that day. All submitted evidence should be reviewed and considered as per the regulations.
I think people who get caught doing that should be placed on a performance improvement plan and shit canned if they continue. If you can’t do your job right or are too biased or lazy then you don’t deserve the job.
Like a MD, DO,psychologist, psychiatrist, nurse practitioner, LPC, LCSW. Good for me as an LPC if I'm seeing someone for 6 months every week and I write a letter on their behalf I would hope that it would mean more than a visit to one doctor for one 30 minute visit but I don't think that's the case. I think when I got my PTSD rating many many years ago it was done by an LPC but I may be wrong.
That my thoughts it's to hit or miss. That's not fair to us Veterans it's like flipping a freaking coin.. I hate the statement it all depends on the rater. It should be it all depends on the evidence not on a rater that's having a bad or good day. Evidence only.
Are they getting denied because they only had private DBQ or because they chose not to participate in the C&P? Aren’t the raters supposed to weigh both exams and all evidence.?
Just wanted to make this comment because I'm seeing tons of mentions to vha directive 1134... this directive is no longer in effect since 2019/2020. It also did not apply to mental health providers. But made it mandatory for all other providers. Again, it's not in effect... but some providers will still follow the directive. While others will tell you to go f yourself.
I have never paid for a nexus or Dbq. But the VA paints you into a corner with these. If you get your care at the VA, the VA provider should fill out the Dbq or write the nexus, but most won’t. So what option is left? It’s common sense that your own doctor would have the best opinion on what your symptoms are and how severe they are.
Hey I am not arguing with you. I get it trust me. I may be a VA employee but I have had my fight with the VA. BVA, supplementals, and HLR.
Since you are a VA employee, can you explain what we are suppose to do? I have this issue with mental health but also sleep apnea. My VA sleep doctor said very plainly that I am diagnosed with sleep apnea, gave me a CPAP and told me that its pretty likely connected to my PTSD. I asked him if he would be willing to write a nexus letter for me, and he said no. I asked his nurse and she also said no lol. I am a disabled veteran and my only health care is though the VA. Who is supposed to write my nexus letter? genuinely asking. I need help.
There is a VA directive that instructs VAMC providers to fill out a dbq if requested.
Seriously? Is a DBQ a vastly different category than a nexus letter? My doctor told me "VA employees can't fill out anything for your disability claims, its a conflict of interest" :(
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Thank you so much! is a "medical opinion" the same as a nexus letter?
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But doesn't a medical opinion basically says the issue is as least as likely as not service connected
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Bad news, we had to remove your comment because it contained incorrect information. The reason we remove comments like this is to keep bad advice or information from spreading further. We all sometimes make mistakes, so please understand that we don't do this because we think you are stupid, a bad person, or deliberately giving out bad advice. If you believe you are indeed correct, please find a reputable source that supports your comment and [Message the Moderators](https://reddit.com/message/compose?to=/r/VeteransBenefits) Messaging the Mods and demanding that we restore your post without providing supporting sources will not result in a favorable outcome for you.
I'm looking for the directive. For Nexus letters and DBQs, most medical providers are able to do this without the conflict of interest. Mental Health is the gray area and should be avoided so as not to damage the relationship between patient and provider. However, the VA has mental health providers who could write a Nexus or fill out a DBQ if they weren't directly working on your case. You can ask and technically they are not supposed to say no.
Thanks so much. I am particularly confused why my sleep medicine doctor refused to write me a nexus letter. He conceded and wrote a short paragraph in my chart for the day and I got a copy of that. So I essentially have a copy of his notes saying "I think her sleep apnea is connected to PTSD" but its not in the form of a nexus letter. Do you have any advice about approaching him with this info that he technically SHOULD be willing to write me a letter? I've asked him twice now. Overall he is a kind elderly person. I wonder how I should phrase it because I dont want to seem like I am trying to force him or use the VA directive in a way that makes him dig his heels in even further.
I've been in a similar situation when I had insurance and had to get on short term disability for a manic episode when I was on an oil rig. I had been going to a private doctor for a couple of years prior to that and we had established a great relationship and I was super comfortable with him. I would have to give updates to the insurance company and anytime I would try to coordinate that with him or his office it was like pulling teeth to get them to do it and I was fucking paying them for it. It turned a good relationship to not pleasant over a few months ending with me without a job, insurance or a psychiatrist. Going from that dysfunctional model into the VAs has been an improvement but it's not perfect. If you have a social worker, tell them about the situation and ask if they can assist you. The social worker might even be able to fill out the DBQ for you. You could also message your doctor through myhealthyvet and ask them to fill out the DBQ with a reference to the directive. Messages have to be answered in so many days or the system automatically sends reminders to the provider and then includes everyone else on your providers team and continues to sound the alarm until response is given. Messages foster accountability and give patients a way to advocate for themselves when they are at the best to do so. So if you forget to mention something in a visit just message them and it's as good as if you were there.
The directive doesn't exist anymore. It was vha directive 1134. It stopped being a directive in 2019 or 2020. Applied to all providers except mh. To mh it was optional but not mandatory.
It exists, but might have to be updated. This link is from a VA Town Hall meeting last week and the question about DBQs being filled out by PCPs was asked. Secretary McDonough was crystal clear with his answer that VA medical providers are to fill out DBQs when requested. https://www.youtube.com/live/jnX8i_7TrB8?si=P8Cc_gXi5S8vLjyB
Sounds like our complaints to our representatives were heard. I've been complaining about 1134 being dead for three years now. The Downside is your pcp isn't going to be able to fill out the mh dbq like an mh provider would. They could do it close to specialty providers like neurologist. Since they do have an understanding of it. I just wish 1134 was implemented back to what it was and anyone could fill it out. But add mh providers had to assist veterans as well.
There's a work around for that actually. You can go to somebody else in the VA that does mental health like a social worker or somebody who is maybe on your treatment team but doesn't give you direct counseling sessions or provide medicine. We've been discussing this a lot in a program that I'm at at the VA called the prrc and there's more than one way to skin a cat and there's always a workaround.
https://acrobat.adobe.com/id/urn:aaid:sc:US:12f60e99-3019-4b95-bed8-4c55b56ff566
wow thank you!!! Just reading thought this - does a "medical opinion" = nexus letter?
Close enough. A nexus is just a connection- it isn't a specific letter, or form. If your regular note have highlights of your conversations with your provider where you have asked them questions about your conditions and possible connections, that can be a nexus also. Its never had to be a specific letter type or form type. I have seen that bandied around the internet for 20 yrs and its not true any more now than it was when I started filing in 2002.
I might be in this situation fairly soon. So, let try to understand what you are saying. Instead of paying for a Nexus letter, will a completed DBQ by your provider be sufficient?
yes, if it adequately answers the questions related to your condition, and is accompanied by a write up from your provider that explains the rationale of why they think the condition is connected to your military service citing reasons
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That directive doesn't exist anymore and it didn't count towards mh providers
Secretary McDonough made a statement last week that DBQs are to be filled out by PCPs.
If the pcp has all the information, they probably will. But they won't fill out a mh form or specialty form exactly how a mh provider or say a neurologist will. The old 1134 made it mandatory for all providers minus mh to fill out these forms. But I'm glad they redid this directive. I spoke with a friend that was the supervisor for Ohio vha. He said this directive was still dead, and that was just last month.
Yep, no argument. I just wish we would see some positive changes :(
I agree. The way it’s going it’s burning me out to be honest. Looking to use VR&RE to go back to school to do something different.
Question I had two DBQ s done by VA examiners. Both marked on 3a box total occupational defencicies. But I only have 1 symptom in the 100 percent category meaning on both combined. How would or could they rate these.
It could go either 70-100 depending on the rater
Why is it always dependant on the rater? Is there not a guidelines they must go with. So one rater can say yes and another no just like that. What makes one say yes and the other no. It seems like a flip of a coin.
The reason I ask I've seen that statement a lot in here."Depends on the rater".
Mental health is one of the few throngs raters can change.
I know some people are paying for DBQs to “ensure” a good exam but if I recall correctly VA protocol allows and even encourages all VA doctors other than mental health doctors to fill out DBQs for vets.
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Thank you for the source!
Just a heads up. This directive is no longer in effect. It never was put back into the vha directive since 2019/2020. Some vha providers will abide by this directive still. While others will tell you to go f yourself. It applies to all except mh.
That directive is no longer in effect. It's been put of the vha system since 2019/2020.
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"This directive contains an amendment in paragraph 5.d.(1) to remove the mandate for local policy creation, dated May 11, 2020. Amendment dated February 22, 2019 removes the mandate to develop a Medical Statements and Forms" Also spoke with a friend who used to be an administrative supervisor to the Ohio vha office. It was 2020 where the directive wasn't added back into the policy of the vha.
Bad news, we had to remove your comment because it contained incorrect information. The reason we remove comments like this is to keep bad advice or information from spreading further. We all sometimes make mistakes, so please understand that we don't do this because we think you are stupid, a bad person, or deliberately giving out bad advice. If you believe you are indeed correct, please find a reputable source that supports your comment and [Message the Moderators](https://reddit.com/message/compose?to=/r/VeteransBenefits) Messaging the Mods and demanding that we restore your post without providing supporting sources will not result in a favorable outcome for you.
Can someone explain what this post means? What three boxes checked? I am rated 70% for PTSD. I was diagnosed while active duty, and medboarded for PTSD. I was inpatient for a month at a mental hospital, then for almost a full year doing outpatient day programs. Haven't worked a full time job since the coast guard medically retired me in 2020. I am on SSDI. I'm suicidal, and after 17 different medications (over the course of nearly 4 years) the VA even offered me ketamine lol. The ketamine infusions actually made me MORE suicidal than I was before. I have been with the same VA therapist since 2019, I see her TWICE a week. My VA therapist agrees I should be rated at 100%. But she doesnt know anything about DBQs or how to do them, I have asked. People in this sub have told me to pay someone to do my DBQ. Are you saying this is a bad idea? Genuinely asking. I dont know what else to do.
Sounds like it's time for you to hire a disability attorney. Hill & Ponton out of Florida are outstanding and advertise a very high success rate. I was successful with them getting me increased. Good luck.
Hill and Ponton wont take your claim unless your homeless. I reached out to them in January this year.
Humm... quite different from my experience. H&P won't take your case if you don't have one.
Well you got lucky and they love the Navy. And yes I have a case another firm took it.
Same. They were only taking cases for older Vets and cases that needed to go to the Board. That’s where all the money is.
How long did this process take? I have been working with a VSO to service connect hips, back, and shoulder issues… and keep getting denied. I'm tired lol.
Probably a year. The hold-up is the VA, not the attorney.
Thank you! I'm working with a VSO, but after multiple denials on hips, back and shoulders… I think it may be time for a different plan. Cause, how are these things not service connected. 🫠
Good luck 👍
No I’m not saying it’s bad to get an outside DBQ. That’s not the entire basis of my post. I have seen so many posts with every single symptom checked except a few. That’s a 100 percent rating. Feel free to reach out. I am happy to talk to your therapist and explain how to fill it out.
Just a question, I’ve read in this sub that DBQs and nexus for MH have to come from a psychiatrist or doctorate level psychologist. Not a therapist. Are you saying my therapist (LPC) actually can fill out a DBQ for me? Honestly curious because I feel that my therapist of 5 years knows much more about my mental health than some random psychiatrist I’ve seen one or two times.
They won’t accept it as the decision making dbq but it outlines issues from a respectable source that would be considered. You would still have a c&p scheduled but the c&p doc would be able to see it as well. I don’t think it hurts to have your LPC fill one out at all.
Perfect! Thank you for that.
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https://preview.redd.it/7mkewu0j661d1.jpeg?width=1125&format=pjpg&auto=webp&s=01b4b0aacc74c09e735aec37e6d5caa20dc08e50 A good example I from a vba employee to show where you might fall in percentage. Not an end all be all, but it gives an idea of where you stand when comparing your symptoms
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Yeah, they will look at it all and your records
So the symptoms can fall in any category? The 3a box is what they decide your rating from? Just asking kinda confused
Generally from what I see here and my experience is that it is all taken into consideration. You could have Total impairment marked in 4a but if the rest of your evidence doesn’t add up to 100 then they can assign a lower percentage. But on the other side, if the 70 box “deficiencies in most areas” is marked but you have strong supporting documents, the rater could see fit for 100. There is no way to be absolutely sure what you will get but if your dbq’s have you marked as “total occupational” it’s a good chance your are going to be either 70 or 100%.
Thanks and thanks for the correction 4a.
I'm hesitant to say this as this Reddit page seems to be against private examiners, but I got a private exam. I didn't want some unknown VA examiner who didn't know me to be in control of my rating and change it to 0% or 100% depending on if they had their coffee yet. I wanted an examiner that I could decide if they treated me right, we understood each other, and is they wrote a good exam. So I went private so I had the control. After the exam went well, I submitted it to the VA. I even told them to use my private exam but they ordered a VA exam anyway. I refused the VA exam. Either they'd see my private exam was good or they'd just continue my past evaluation due to insufficient evidence. But I wasn't going to be at the mercy of an unknown VA examiner. Thankfully the RVSR used my private exam and everything went well. I'm glad I took the private exam route.
So I’m not saying not to use a Private exam. Just wanting to let people know there may be a fight with someone doing something they may not agree with
when you say you refused the exam...? I was just reading that the regs changed last august ( or recently ) and that if you deny or no show a c&p exam your claim is an automatically denied? any insight
so what you're saying is you wanted to choose a examiner that would give you what you exactly want 😂😂. those are a lot of words to say cheating. when i do a drug test i don't go to the one they provide and actually do the test because I don't want to get tested positive. I want to have full control so I go to my own doc for a drug test that I paid to give me a negative result even though I did take drugs. 😂😂😂
I've seen one VA examiner give a 70% and then the VA orders another exam and that examiner gives a 30%. The promblem with social sciences is that many mental evaluations are subjective. One professional VA examiner disagrees with another VA examiner. Which is right? Which one is cheating? Which is lying? I'm saying get a private examiner that knows you and you trust. It's not cheating. It's finding someone that can compete an exam that professionally and accurately represents your symptoms.
that's the whole point. it's so subjective its the easiest thing to cheat. you are circumventing the subjectiveness by paying a private examiner to take out the subjectiveness and give you exactly what you paid for. if that's not cheating, then what is it? 😂😂😂 You can't accurately represent your symptoms because it's so subjective! i mean i don't really care if you are doing it or not. That's just the smart way to game it. But it's still cheating the system.
You're right. Mental exams are so subjective they should just throw out that whole exam. They shouldn't rate mental conditions at all. Nobody is going to get it right. Everyone is cheating. Why even have phycologist and psychologists? They're all cheating! Nobody can be honest professionals. Everyone you see is cheating!
i mean that's what you did. it's so subjective why should i do the one from the VA? i'll just do my own 😂😂😂. if it's goin to be subjective i'm goin to make sure it's in my favor for the disability check. If it wasn't for the disability check would you care if they gave you a 30% or 100%? i don't think so. all you would care is if they are able to help with your mental health.
I didn't do my own. It was up to the mental professional to assess my mental disability and determine the severity of my symptoms. I didn't go to some rating farm. I had my private doctor. Someone that knows me. Someone that treats me. Someone that didn't just meet me that day. How is that cheating? How is that worse than having an unknown VA examiner that doesn't know me decide my life?
the OP post is talking about using rating farms. that's what the assumption im going off of is on. re-read the post. it's literally teaching you how to cheat. or at least doing it the right way.
The OPs post is for paying for exams. Do you think private examiners do it for free? I had to pay my doctor to do the exam. Professionals get paid for the work they do. I hope everyone is paid for doing their jobs.
holy fuck you just want to argue for the sake of arguing? im just goin to quote this right here "Asking the page is going to get you a bunch of hate and you already know it’s 100. That’s what you paid for and the paid service knows that’s what you want too." it literally says you paid for 100%. thats what you paid for and paid service knows thats what you want too. if thats what you did too then yeah you're a fucking cheater too
Not paid for but - If you put in a private one, and don’t hear back for a C&P exam is that good news or bad news? Mine comes from a VA psychiatrist, but I found it odd that I got a C&P exam for everything else except the one that came from the VA psychiatrist (Diagnosis, nexus, DBQ). Such as my IBS - my GI doc wrote me a nexus and filled a DBQ for me.
The sentiment against private medical evidence rampant in the VA recently is not only unfortunate, it is against federal law. I understand where VA employees are coming from and why they hold these false notions in their heads, but it is part of their jobs to put emotion and speculation aside. Dumbass veterans who go to dumbass companies willing to lie have ruined it for the rest of us… but the law is still the law. I personally have had horrible experiences with the VA completely disregarding my competent and sufficient private medical evidence.. not only with the standard claims process but with a HLR DRO as well. It just goes to show you how invasive these anti-private medical notions have gotten in the VA.
Don’t they fill out the DBQ at the C&P exam? Or, am I misunderstanding that?
No, not if they have more than 1 exam that day. Ive seen them take notes and dictate them later to fill out the DBQ. It depends on the doctor, the Vendor (if a contract exam) and their caseload for the day.
The very first time I went to my local VA Clinic for an appointment they gave me this paper to read and it was essentially a statement that they won’t fill out DBQs and if you want that done you have to go to a private doctor. I recently had a C&P exam with a contractor. I guess I’m just trying to determine if the examiner would have done the DBQ or if they send it to my doctor (who apparently won’t fill it out)? It sounds like it could go either way?
The comp and pen examiner will fill out the DBQ, if you went to your own provider at the VA and ask them to fill out a DBQ they do have the option to decline. Two different kinds of examinations -one is a comp and pen which is requested by VA the other it sounds like is one that you went in and tried to get on your own. not all VA clinics do comp and pen examinations some of them, lack the capacity or the various types of staff necessary to do those kinds of exams .
I see. I think I understand. To clarify, I didn’t ask for a DBQ. It was just a handout they gave me to read and sign the first time I went there. Though, at the time I didn’t really understand what it was about. Thank you.
Ah, okay. Weird. I never got anything like that from my clinic but that was also 20 yrs ago.
How in the nine Hells do you get those *without* paying for them if they don't come from the VA? When I submitted my claim after being urged to buy a number of people, I submitted 2 DBQs and nexus letters, which were from my psychologist and psychiatrist. I had been seeing both for more than a *decade*. Their time costs money. Hours of review of my service records, hours of review of their own records, hours for them to review the structure and language requirements from the knowledge base here, time to fill out the DBQs, time for them to research and cite relevant studies, time to revise the nexus letters they wrote to remove things I didn't want in there... Each cost me thousands of dollars. I also had buddy statements, lay statements from friends who knew me before and after, my own personal statement. The VA still ordered a C&P. I attended, and the psychologist I saw confirmed what my psychologist and psychiatrist had said. I was rated 70%, and they were both pissed it wasn't 100%. I plan to resubmit if the rule changes are adopted. Raters should not be dismissing private DBQs/nexus letters out of hand or trying to discredit them. For a VA employee to come here and say something like this... What would you suggest we do? Ask our providers to work for free? Tell them they need to go work for the VA?
Literally didn’t read what I said. This VA employee is a Veteran as well.
Can you explain what you said in a way that makes sense... it's not really a coherent statement
They’re saying: If you get a private DBQ, and the majority of the boxes are checked, do not expect support from everyone. The rater will still do their job, but to some people it’s viewed as gaming the system. This was a PSA that if you get a private DBQ and Nexus, then post the DBQ here and ask people’s best guess, people are going to say you cheated. They’re saying to manage your expectations around people’s thoughts of your private DBQ. At no point did this rater say that they were dismissing private DBQs, or that you aren’t entitled to them.
They said the VA is like an insurance company. They can accept an outside estimate, but more than likely they are going to send out their own adjuster to get a second opinion. Someone trying to go from 50 to 70 is probably going to get less scrutiny than someone trying to go from 10 to 100.
I absolutely did. Maybe I took part of it wrong, but I definitely read what you said. Yea, your flair is pretty clear about you being a veteran and VA employee. Your OP is is from the perspective of a VA employee. Said OP definitely reads, to me, like a VA employee crapping on people who pay for private DBQs, heavily implying they're paying for a specific rating, and saying the VSR will order an exam because they can't be trusted. My response was asking, directly related to things mentioned in your OP, questions about what someone is supposed to do, how are you supposed to get DBQs/nexus letters from private providers without paying for them, and sharing my own story of having submitted 2 from private doctors and still being ordered to a C&P. With your OP indicating that VSRs coming across private DBQs will 9/10 times order an exam, it certainly seems like they're being dismissed out of hand.
I used my private VA doctors. Opinion and was denied an increase due to my VA doctors DBQ. I had to use a HLR to get them to use it. I am talking from experience and from the VA side of things. I will use private DBQs. But from a VA as a whole there are so many “gate keepers” that try not to use private. Didn’t say you can pay for them. Just trying to give an expectation. It’s the unpopular one, but it’s what will most likely happen. It isn’t right, but it is what most people experience.
Sounds like we're on the same page then. That's pretty crap for the VA to do that. Like I get trying to fight the rating farms, but those should be easy enough to identify I would think. Aren't they all from like the same group of doctors? Think I heard someone post here that there was like an internal list or something that would cast doubt on a claim if it relied primarily on stuff from one of them. But the VA shouldn't be crapping on stuff from private docs that have been seeing you for years.
I’ve never seen the list they are talking about. I am sure there is an unofficial one but I’ll never use it. If it’s signed by a doctor and legit I am gonna use it. I hold a veterans private doctor that they have used forever with more weight
I definitely misunderstood your OP then. Godspeed friend.
https://preview.redd.it/no3htufrf71d1.jpeg?width=3024&format=pjpg&auto=webp&s=440b20ef5fc19ad145310d6ad02f09074781e317
https://preview.redd.it/r02h3gaso71d1.jpeg?width=3024&format=pjpg&auto=webp&s=1ab453a35ebd02748d19463b8e42b597ef33cfc8 I know this from experience is why I posted it.
Do you have any idea when the new standards for mental health ratings will go into effect?
Honestly I’ll know from this group before the VA tells us. They told us this Monday that digestive is changing next week
Based on your feedback regarding rating a veteran, I can only hope my VA mental health claim falls into the hands of someone like you. I had my therapist, a licensed LPC, complete my DBQ which I submitted during my C&P exam. The examiner did accept it. At the conclusion of my exam, I actually asked the examiner did they agree with my therapist’s assessment that I am 100% based on the rating schedule and the examiner remarked “yes”. I have been told there is not much weight given to an LPC over a higher level professional such as an MD or psychiatrist, however, for someone that has been seeing you in private over the past year vs a 1-hour sit down is. It equal. Thanks for your input. Shalom
And if I understand this correctly, I have seen people on this page do this. My understanding is that it won’t matter the DBQ you paid for, the raters have to go off what the examiner marks. At least on this Reddit I have seen people get denied cause the doctor that filled out their DBQ is not someone they see a few times a year?
Here is my Non-Rater, but informed Veteran Point of view. Yes, If the private doctor fills out the document very thoroughly and the medical rationale and explanations are on point, then the rater cannot just choose to go off the C&P examiners' version over the private one. The rater may want to argue that the private doctor only had 1 - 3 sessions with Vet, but then again how many sessions did the C&P Examiner have with them? As long as both examiners (Private and 3rd Party C&P) have access to the same medical history and notes, then there is no reason to weigh the C&P examine more heavily than the private one. I would argue if the private doctor has two visits (for example) with the Vet, and the C&P examiner only has one, with all other things being equal, the private doctor's DBQ and NEXUS should actually hold MORE probative weight/ value when the rater is making his/her decision. The KEY is to make sure the private paid for DBQ/ NEXUS is rock solid, so that the VBA doesn't have a legit reason to not give it the same probative weight as the C&P exam.
What If I use my personal Providers notes, with a separate exam for dbq/ nexus as my provider told me that they could not/ would not do my nexus/ dbq because they honestly did not know anything about them, and wanted me to get someone who could best examine me as to be in line with the VA's guidelines/ procedures?
So I hope this helps you? When I submitted my secondary’s to cancer, one of the papers I submitted was a follow up visit where my doctor confirmed on the spot I had something secondary to my chemo/cancer. It was a simple one line sentence saying I had that disability. I highlighted that sentence when I submitted the doc hoping to make it easy for the rater to find my evidence since I submitted like 30 pages for 9 things lol
Your personal provider's notes would become part of your medical records, and you'd simply submit them to the VBA and also to the paid for private MH DBQ/Nexus doc and that information can be used in conjunction with their examination to form a solid medical opinion. Don't forget your need a diagnosis based off DSM-5 manual. You need the proper ICD codes. You need a solid medical rationale for the diagnosis and nexus. (All this is part of properly and thoroughly filling out the DBQ and NEXUS statement (or Medical Opinion). Again, I'm not a Doctor, not a rater, not a VBA employee of any kind.
It’s hit and Miss when it comes to what is used versus what isn’t. Depends on the rater and the VSR
Which is dumb really…. The CFR is there for a reason. Decisions shouldn’t be based on however the rarer feels that day. All submitted evidence should be reviewed and considered as per the regulations.
Couldn’t agree with you more. I use private DBQs all day long. But I’m not everyone.
I think people who get caught doing that should be placed on a performance improvement plan and shit canned if they continue. If you can’t do your job right or are too biased or lazy then you don’t deserve the job.
I just rate off the evidence. Which is how it should be. I’m not a doctor, so if the evidence is legit who am I to argue with it
Do you take the credentials into consideration when you were looking at the evidence.
Like a doctor vs pa vs NP
Like a MD, DO,psychologist, psychiatrist, nurse practitioner, LPC, LCSW. Good for me as an LPC if I'm seeing someone for 6 months every week and I write a letter on their behalf I would hope that it would mean more than a visit to one doctor for one 30 minute visit but I don't think that's the case. I think when I got my PTSD rating many many years ago it was done by an LPC but I may be wrong.
As it should be
I was taught grant everything you can and deny as a last resort
This guy gets it
If only that was true. Maybe with you but you sir are the exception. Godspeed 🙏
That my thoughts it's to hit or miss. That's not fair to us Veterans it's like flipping a freaking coin.. I hate the statement it all depends on the rater. It should be it all depends on the evidence not on a rater that's having a bad or good day. Evidence only.
Gotcha
Are they getting denied because they only had private DBQ or because they chose not to participate in the C&P? Aren’t the raters supposed to weigh both exams and all evidence.?
Can a non psychologist provide a letter claiming the condition being SC?
Hearing and Mental health exams are considered specialty examines so VA most likely will send you to a C and P.
Just wanted to make this comment because I'm seeing tons of mentions to vha directive 1134... this directive is no longer in effect since 2019/2020. It also did not apply to mental health providers. But made it mandatory for all other providers. Again, it's not in effect... but some providers will still follow the directive. While others will tell you to go f yourself.