Posted on May 9, 2020
Can the VA refuse to treat a 100% service-connected veteran citing their case as "too complex," and also refuse to outsource them for care?
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I have a pretty 'complicated' medical case but the VA continues to refuse at times to even consult with me despite internal VA referrals for the consults. They also refuse to refer me to anyone who possibly CAN help-- or the Mission Act options don't have any providers for the care needed within hours of me. Then they refuse to cover many of the meds that outside specialists suggest, costing me >$3,000 per year out-of-pocket. Is this OK at any level and would anyone have any suggestions for how to get the needed care? This way preceeded COVID-19 issues but continues despite it. I've been told the doctors won't even agree to a telehealth or video health consult at the VA across a few departments and programs. I'd already involved a senator's office a few years back and have made almost no progress. Help, please?
Posted in these groups: 
Department of Veterans Affairs (VA)
Washington
Veteran Benefits Advisor
Team Veteran Foundation
My Veteran Community
Department of Veterans Affairs (VA) Washington Veteran Benefits Advisor Team Veteran Foundation My Veteran Community
Posted >1 y ago
Responses: 432
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I would start by contacting the patient advocate. If you get no response or don't like it, go to your State Representative (in congress) in person, with a certified letter, or email (different states treat veterans differently, so choose wisely). If that doesn't work, write to both of your Senators via certified mail. Finally, the last step is to write the President. If all this does not work, I suggest hiring a lawyer and requesting a medical review before a judge. You may end up at the Supreme Court, but you won't be alone by this time (bc you're not alone in this fight). Good luck!
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of course it all started at the rifle range with the M1 garand and the 1911 in may of 1962--russ
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i have severe hearing loss from lightship dutys before hearing protection was the norm. F2T foghorns can be heard up to five miles away and further. needless to say ringing is the silent loudness nobody else hears. i am a 70%er but wont push for more because of the fact you talk about.--russ
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I think it's time to contact your Federal representatives. I am 50%, and my son is 100% but they jerked him around for months. After our congressman called it only took 3 days to "clear up the misunderstanding.
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If nothing else, get ahold of your local V.A. iraq and Afghanistan rep and have them help you out .Also this is the number too the white house V.A. report a problem and get help. [login to see] . I hope that helps. Keep your powder dry and your spirits up.
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Hello SSgt Markland. May I ask a few questions? First, did you retire with a medical discharge? Second you should be eligible for TriCare if you retired. Third, when you say the "VA", who do you mean? The VA benefits office in your state, or the big VA in Washington DC? Who has told you the VA won't do telehealth or video? As to telehealth or video via iPhone, I have a video conference with one VA specialist that's been ongoing. Other appointments are back to in-person with masks. I'm confused by your statement, "the VA continues to refuse 'at times' to even consult...". What do you mean by that? Remember that if you seek outside treatment without the approval of the VA, the government has the right to deny any claim for out-of-pocket expenses. Another thing to consider is, should you receive treatment for your problem, and it is corrected, the VA could remove the 100% rating since you no longer have that disability. An organization that you might approach is the Paralyzed Veterans of America. I'm told they are very good. I don't know whether this helps or confuses. There are attorneys who specialize in VA disability claims. The first visit is usually free. You could get an opinion as to where you stand.
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SSgt Lisa J. Markland
Thank you for trying to help. I am primarily assigned to the Washington, DC VAMC, as well as the local CBOC for some of my care. With some of my providers within the VA, this has not been an issue, but where my case medically is very complicated (rare medical genetic condition, multiple autoimmune diseases, etc.), and even with proper referrals for care within the VA itself, various departments and centers I’ve been referred to have outright refused to treat me, some refusing to even to get on a phone call. I have spoken to people all the way up to the department chiefs, who in some cases are the ones telling me it’s just “too complicated“ for them to handle my medical needs, therefore they won’t get involved. I did not know that was an option as a 100% service connected veteran! When I propose to those people that if they wouldn’t treat me at the VA facilities they should outsource me; in some cases even years later and after multiple inquiries inside and outside of the VA, I have still been refused the care. That’s where my post came from. I don’t believe the VSOs such as PVA, although they are a good one, can help with this kind of thing, but I can check at this point and I am a life member. I have gone through more than one representative, tried to useless White House hotline that just refers me back to the DC VA, and have tried to reach out through the medical center directors office, with no luck there either. It’s been immensely frustrating, discouraging, and I can’t believe for any reason this would be allowed. I’ve even done anon camera media interview (several years back now). And for whatever it’s worth, none of this care would affect my rating, which is unrelated to the care I was seeking. I am already rated 100%, so an attorney dealing with disability claim claims would unfortunately not be appropriate either. But I sure do appreciate you chiming in and trying to help!
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A complicated medical issue is NOT going to get resolved, or even get a decent answer in a forum, especially a forum like this one where everyone is a so called expert. I am an expert as I am a VA doctor and I cannot answer your question as there are complexities and nuances that go way beyond a discussion in any forum. If you’re having issues that are beyond the complexity level of your VA hospital, use Community Care. Ask your provider for the proper consults and follow up as necessary. Also get the Patient Advocate involved.
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