29 Primary Care and Spine
Content
☎ (cell phone 240-506-1556) To: All veterans Date: 2015
From:
Topic: Primary Care and Spine
Independent Veteran Medical Opinion (IMO) Veteran Medical Nexus Opinion (VMNO)
for Veteran benefits
Craig N. Bash, M.D. Neuro-Radiologist www.veteransmedadvisor.com
Pages: 2 NPI or UPIN-1225123318- lic #--D43471 4938 Hampden lane, Bethesda, MD 20814 Phone: (301) 767-9525 Fax: (301) 365-2589 E-Mail: [email protected]
Primary Care and Spine
Most veterans have some sort of back injury due to the strains of service. Thus is common in clinical practice as about 80% of the neuro-imaging cases that I review involve spine issues. Unfortunately, many patients go to primary care physicians/providers (Family Practice and Internal Medicine and nurse practitioners and physician assistants) for their spine issues. I have recently noticed that primary care physicians have provided medical nexus opinions for veteran patients for the VA, which I have subsequently had to review and edit so that correct benefits can be approved. The issue of expertise involves years of training known as postgraduate years (PGYs) and I have 7 PGY years whereas the average primary care physician has only 3 PGY years and NPs/PAs have even less. It should be noted that Spine cases are difficult to understand due to their complexity and a recent New England Journal of Medicine -NEJM (March 26, 2015 page 1247) article touched on this issue by stating the following: “…. MRI should be ordered by clinicians who can interpret the results; it is discouraged at the primary care level…”. The NEJM recognizes the limitations of primary care physicians and thus in these complex spine cases the VA deciders should defer to the spine experts and the neuro-imaging.
It is not uncommon for soldier patient’s to also have life long complications from spine issues with both bowel and bladder dysfunction. Occasionally, some patients have complications that limit their ability to walk and are thus often house bound. The VA has special ratings for these situations and they are contained in the Special monthly Compensation rules (SMC). The rules are very complex. I have been working with them for 20 years but I was told by a long term VA appeals executive (BVA-AMC level) that only a handful of VA employees comp0letely understand the complex SMC rules. ***Many of these SMC codes are rated significantly above the 100% level because they involve multiple organ system simultaneously and it is the interdependence of the multiple systems that makes these codes complex and difficult for the physician and rater alike to accurately determine the level of illness. Recommendations: 1. All soldiers should seek experts, which are acceptable to the VA and have proven track record as armature VA IME/IMO physicians can complicate the claims process, which of course can be detrimental to the outcome as each word is important in the opinion. 2. In the spine area a physician with neurologic training is an absolute requirement as noted in the NEJM article above. 3. All soldiers should be aware of secondary complications from spine inquires and the need for an analysis of SMC codes. 4. All claims should be placed on the correct forms as VA has adopted a draconian rule in 2015 of “No form No benefits” Craig N. Bash M.D. Associate Professor [email protected] cell 240-506-1556 Independent Veteran Medical Opinion (IMO) Veteran Medical Nexus Opinion based on Veterans medical records for veteran benefits
From:
Topic: Primary Care and Spine
Independent Veteran Medical Opinion (IMO) Veteran Medical Nexus Opinion (VMNO)
for Veteran benefits
Craig N. Bash, M.D. Neuro-Radiologist www.veteransmedadvisor.com
Pages: 2 NPI or UPIN-1225123318- lic #--D43471 4938 Hampden lane, Bethesda, MD 20814 Phone: (301) 767-9525 Fax: (301) 365-2589 E-Mail: [email protected]
Primary Care and Spine
Most veterans have some sort of back injury due to the strains of service. Thus is common in clinical practice as about 80% of the neuro-imaging cases that I review involve spine issues. Unfortunately, many patients go to primary care physicians/providers (Family Practice and Internal Medicine and nurse practitioners and physician assistants) for their spine issues. I have recently noticed that primary care physicians have provided medical nexus opinions for veteran patients for the VA, which I have subsequently had to review and edit so that correct benefits can be approved. The issue of expertise involves years of training known as postgraduate years (PGYs) and I have 7 PGY years whereas the average primary care physician has only 3 PGY years and NPs/PAs have even less. It should be noted that Spine cases are difficult to understand due to their complexity and a recent New England Journal of Medicine -NEJM (March 26, 2015 page 1247) article touched on this issue by stating the following: “…. MRI should be ordered by clinicians who can interpret the results; it is discouraged at the primary care level…”. The NEJM recognizes the limitations of primary care physicians and thus in these complex spine cases the VA deciders should defer to the spine experts and the neuro-imaging.
It is not uncommon for soldier patient’s to also have life long complications from spine issues with both bowel and bladder dysfunction. Occasionally, some patients have complications that limit their ability to walk and are thus often house bound. The VA has special ratings for these situations and they are contained in the Special monthly Compensation rules (SMC). The rules are very complex. I have been working with them for 20 years but I was told by a long term VA appeals executive (BVA-AMC level) that only a handful of VA employees comp0letely understand the complex SMC rules. ***Many of these SMC codes are rated significantly above the 100% level because they involve multiple organ system simultaneously and it is the interdependence of the multiple systems that makes these codes complex and difficult for the physician and rater alike to accurately determine the level of illness. Recommendations: 1. All soldiers should seek experts, which are acceptable to the VA and have proven track record as armature VA IME/IMO physicians can complicate the claims process, which of course can be detrimental to the outcome as each word is important in the opinion. 2. In the spine area a physician with neurologic training is an absolute requirement as noted in the NEJM article above. 3. All soldiers should be aware of secondary complications from spine inquires and the need for an analysis of SMC codes. 4. All claims should be placed on the correct forms as VA has adopted a draconian rule in 2015 of “No form No benefits” Craig N. Bash M.D. Associate Professor [email protected] cell 240-506-1556 Independent Veteran Medical Opinion (IMO) Veteran Medical Nexus Opinion based on Veterans medical records for veteran benefits
