How does one navigate the VA healthcare system to get treatment?

SSgt Paul Esquibel — Sat, 31 Oct 2015 13:55:10 -0400

I recently separated in June, and upon my out-processing received my exit physical which stated I needed an MRI on my elbow for tendinitis. When I in-processed through the VA, they only did an X-Ray and found nothing. How can I go about getting an MRI or further treatment as I seem to be at a roadblock?

Response by SGM Steve Wettstein made Oct 31 at 2015 2:00 PM

SGM Steve Wettstein — Sat, 31 Oct 2015 14:00:57 -0400

You need to have your assigned PCM order it.

Response by MSgt Curtis Ellis made Oct 31 at 2015 4:25 PM

MSgt Curtis Ellis — Sat, 31 Oct 2015 16:25:06 -0400

You will need your VA PCM order it. Doing it through the VA PCM will ensure it is in their system. Basically, if you haven't been seen by the VA for it before, you need to begin getting seen for it so you can develop a history. After "X" amount of visits and "step-up" treatments, one of those steps will be an MRI, since you already have the X-ray accomplished through the VA (baseline)... Its odd, but their treatment seem to be based on progression and in-order-treatment-sequencing... But you definitely have to build a progressive history with them for that issue, and this doesn't happen over night. This is just my opinion and my VA experience. I hope it helps.
Oh... And patience... Don't forget or become frustrated with the patience...

Response by Sgt Spencer Sikder made Oct 31 at 2015 4:42 PM

Sgt Spencer Sikder — Sat, 31 Oct 2015 16:42:07 -0400

What did the primary care provider indicate was the result of the x-ray? After they tell me that I would ask, then what is the next course? I still have the pain. Now, the problem maybe and I will have to defer to our medical professionals on this site to chime in, but the problem maybe that there is a particular treatment protocol for the condition. You may have to endure that treatment for a period, week to 10 days for example and then be re-examined. After that visit, you may get a consult to see a specialist, another treatment plan that is more aggressive, or maybe the MRI or CT. The issue is a bit broad to give a specific example.

Response by Barbara Maxwell made Aug 5 at 2016 12:54 AM

Barbara Maxwell — Fri, 05 Aug 2016 00:54:18 -0400

See the Patient Advocate at your VA. I have been told the veterans that I have worked with go to the Advocate if they have difficulty signing up to get a PCM at their VA. Thanks for your service!

Response by SSgt Mose Carter made May 17 at 2017 7:55 PM

SSgt Mose Carter — Wed, 17 May 2017 19:55:53 -0400

If you had paperwork upon discharge saying that you needed an MRI for tendonitis in your elbow and upon checking in with VA you only got an x-ray and found nothing, you need to get a patient advocate which are at the VA installation to plead your case for you.

Response by Maj Craig Paulson made Mar 30 at 2018 11:21 AM

Maj Craig Paulson — Fri, 30 Mar 2018 11:21:11 -0400

I just refused a VES exam for a GI problem. They contracted with a PA with 1 - 5 years exp. There is enough in my file to make a dec.

I refused C&P at VA for my knee a few weeks ago because my knee had a C& P exam in August 2017. i also had a July MRI from my knee doc. They granted me 10% on my knee back dated to the MRI it took a few days. I was shocked. My last claim for my other knee and shoulder increase took 4 years.

I am starting to believe the VA folks who gather the evidence for the reviewers follow some type of checklist without paying attention to your medical evidence.

i also don’t trust contractor exams. if there medical evidence in you file supporting your claim consider skipping the exam and requesting an immediate decision. I know they scare you about refusing exam but if there is evidence in you file supporting your posn they have to consider that evidence.

Talk to a good atty or a good VSO if you can before making a decision. I am confident in my case that the BVA will look at the VA and wonder why are you sending a vet to a PA for a GI claim.