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Va Doctor Refused To Fill Out Physical Capacity Function Report For Ssdi

Duty to assist?

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8 replies to this topic

#1 sleeper692

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Posted 10 February 2012 - 10:57 PM

My medical doctor refused to fill out my physical capacity function report that my lawyer requested for SSDI.

Don't VA doctors have a duty to assist in these matters? I remember reading once upon a time that they are *required* to assist veteran's by filling out these forms for other agencies, particularly Social Security.

Can someone cite the regulation for me or tell me I'm wrong? My shrink didn't seem to have any problem filling it out but my PCP is being a....well, I'll leave the expletives out. Even more frustrating is that this is not the first issue she has refused to help me with that was not directly connected to the VA.

Thanks in advance,

Pete

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#2 ketchup56

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Posted 11 February 2012 - 01:05 AM

Go to vamc social worker and explain your situation to them, and they should be able to get it filled out by your pcp. This is the way i had to get mine done. Please get this form signed as soon as possible as you will never get your claim approved without it,without going to consultive exam set up by the ssa, and when you get it and it's favorable to your claim send it YOURSELF to social security.I did this and won my claim on reconsideration in 10 months, without an attorney. GOOD LUCK.

#3 sharon

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Posted 11 February 2012 - 01:23 AM

http://www.nosscr.or...ve-2008-071.pdf

(2) All medical forms completed on behalf of the veteran require that the individual sign VA Form 10-5345a, Individuals Request for a Copy of Their Own Health Information, and local procedures must be followed for obtaining this authorization. Examples of these non-VA forms include, but are not limited to:

(a) Family Medical Leave Act forms.

(b) Life insurance application forms.

© Non-VA disability retirement forms.

(d) State workers’ compensation forms.

(e) State driver’s license or handicap parking forms.

(f) Social Security Administration (SSA) examination forms.

#4 sleeper692

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Posted 11 February 2012 - 02:05 AM

Excellent advise. Thank you to both of you. I will contact my VA social worker first thing Monday morning armed with the VA directive.

I filled out the proper ROI forms so I know that is not the issue. I just think this particular doctor is unwilling to help. I'm not sure how favorable she'll be when she fills out the report after having it rammed down her throat but that's not my concern. I'm about ready to ask for a new PCP anyway as this doc really hasn't been very helpful with my medical care as it is.

Thanks again. I don't know what I would do without all the good folks on this board!!!

Pete

#5 Bonzai

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Posted 11 February 2012 - 08:00 AM

I have requested an RFC from my social worker using VA Directive 2008-071, as social workers can be thrid party sources according to SSA. She is willing to fill it out, but need an OK from her director, who is not responding her emails regarding this matter. She is going to try to get an answer one more time, and then Patient Advocate time (her advice, not mine...LOL)

#6 Notorious Kelly

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Posted 12 February 2012 - 07:20 AM

Oh, Sleeper, BTW, my doc did the RFC forms for me but Social Security dismissed them because she's an NP and not a real doctor Posted Image

#7 sleeper692

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Posted 18 February 2012 - 01:24 PM

Well, I contacted my social worker as recommended and she looked into the situation. She called me back yesterday and fed me a line of crap that left me astounded.

She said she spoke with my doctor as well as the folks at physical rehab and they both said that they "aren't trained" to fill out a residual function capacity form. So I asked how could a medical doctor who has been treating me for the past three years, with whom I just had a full workup with at the end of December, not be able to fill out a straightforward form regarding my functional capacity? She seems to be comfortable prescribing medications based on a simple written message complaining of whatever but she can't fill out a simple form to give me a hand. What's the friggin' difference?

Her response was that the doctors are here to treat and not do examinations to fill out forms. Even after I reminded her of the VA directive which specifically includes Social Security forms and the doctors duty to assist, she said she couldn't do anything more and told me to contact the patient advocate if I wished to pursue it further.

Today I noticed that my status on the SS site went from "no decision has yet been made on your claim" to " We Cannot Process Your Request At This Time." The last time it changed like that, I got a denial letter in the mail a couple of days later.

So now I'm really pissed. I gave this form to my doctor almost two months ago. That would have been plenty of time for her to fill it out and get it back to my attorney to be submitted to SS before they reviewed my case for consideration. Now I'm guessing I've been denied yet again tho I hope its just that the SS system is down for maintenance.

I'll be calling for an appointment with the patient advocate first thing Monday morning.

Can anyone tell me how I go about requesting a different PCP? I'm done with this one.

#8 Berta

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Posted 19 February 2012 - 08:20 AM

If the Patient advocate doesn't help you, time to make an appointment with the VAMC director.

What does your lawyer think about this?

Did any past C &P exam you had cover anything to do with physical capacity functioning? Then again if they did, I assume the SSA wopuld have that info.

Many VA Patient advocates do a great job, so maybe best to see what they can do first.

I have a great friend locally who can be a very difficult VA patient.Some of his VA problems are of his own doing and he needs to just calm down. Not the case here with you at all..

He has 2 PHs, Section 1151 100%, plus SMC, and PTSD , and AO cancer- in remission, He deals with a lot.

But the last VA problem he had was totally uncalled for.

Luckily the VAMC allowed me to interfene for him and talk to the Patient advocate in his place, with his permission.

I was actually prepared to go over her head if needed, but within hours she turned the situation around for him right away by speaking to the doctor herself.

It is always good to talk to the Patient Advocate first.The ones who do a good job are truly unsung heroes of the VA.

#9 sleeper692

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Posted 19 February 2012 - 12:52 PM

Berta,

Thanks for the good advice and support. I haven't had a chance yet to talk to my lawyer as I didn't get the phone call from the social worker until late Friday afternoon. I will be giving him a call on Tuesday, after the holiday, to see if I should still pursue this or not. If my reconsideration has been denied, as I suspect by the change in my online status, then it will be time to file appeal and wait for the ALJ hearing which could easily be two years down the road. At that point, he may just send me to his own doctor for evaluation.

We sent in all my past C&P exams as well as medical records. Right now I'm waiting on an IU claim to be adjudicated. If that comes through, we'll send that letter in to SS right away. I'm just hoping that they haven't denied me at reconsideration already. Having to wait on the IU claim is another story. That claim was screwed up and I should have had that positive decision letter on Jan. 30th in time to send in before SS did my reconsideration review. Instead, the decision letter showed that the rater ignored the hard evidence from my C&P exams which clearly showed I met the criteria for IU. Now my VSO has a supervisor at the VARO reviewing the decision.

Between dealing with my VA health providers and with the incompetence at my VARO, I've probably missed turning in two very important documents that would have given great favor to my SS claim. Instead, delays and illegitimate denials on both fronts at the VA have probably cost me at the reconsideration level and is now forcing me to wait in the long line to reach an ALJ.

Anyway, I will talk to my lawyer on Tuesday and see if he can inquire about the reconsideration. If its not too late, I'll make an appointment with the Patient Advocate immediately after hearing from my attorney. That's probably where I should have gone in the first place. This particular social worker has never seemed very eager to go out of her way to get me help in other matters so I should have figured she wouldn't make anything happen with this.

Its just very, very frustrating. I so appreciate everyone's support. Once again, if it were not for my brothers and sisters at Hadit, I don't know what I'd do.

Pete





If the Patient advocate doesn't help you, time to make an appointment with the VAMC director.

What does your lawyer think about this?

Did any past C &P exam you had cover anything to do with physical capacity functioning? Then again if they did, I assume the SSA wopuld have that info.

Many VA Patient advocates do a great job, so maybe best to see what they can do first.

I have a great friend locally who can be a very difficult VA patient.Some of his VA problems are of his own doing and he needs to just calm down. Not the case here with you at all..

He has 2 PHs, Section 1151 100%, plus SMC, and PTSD , and AO cancer- in remission, He deals with a lot.

But the last VA problem he had was totally uncalled for.

Luckily the VAMC allowed me to interfene for him and talk to the Patient advocate in his place, with his permission.

I was actually prepared to go over her head if needed, but within hours she turned the situation around for him right away by speaking to the doctor herself.

It is always good to talk to the Patient Advocate first.The ones who do a good job are truly unsung heroes of the VA.






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