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Restructuring Service Connection

My suggestion has to do with how service connection (SC) is determined at the VA. It has always been a wonder to me why the VA is so adamant about your VA Primary Care Physician (PCP) NOT having access to your service medical records (SMR). If you go to a civilian/private doctor as your primary physician one of the first things they do is request any past medical records to see your medical history and thus it helps them to determine a current diagnosis of your condition. Your VA PCP in the current system must often perform that diagnosis "in the dark". My recommendation is that within 30 days (or whatever amount of days make sense), your PCP would receive your SMR records AS WELL AS any other medical records you may have that you related to them in your initial visit (in other words the VAMCs [Veterans Administration Medical Centers] would be responsible for obtaining all your medical records, NOT the VBA [Veterans Benefit Administration]). Once all the medical records have been received for review, your PCP would have a requirement to confirm your diagnosis AND either make a nexus (linking current diagnosis to service incident or disease) statement as to SC within 30 days for any condition already diagnosed by them without the medical history/awaiting the medical history for diagnosis OR place a statement in the medical record that the conditions they have diagnosed can not be ascertained to have SC. This could even be a form they would fill out with "check blocks" to structure this determination and that form becomes a part of your medical notes subject to administrative review for completeness. Subsequent diagnoses on new conditions would also require that another one of these forms be used.


What this fundamentally changes is now you, the veteran, at the least have someone you can talk to in a face-to-face conversation about the reasons they could not make an SC determination rather than have to rely on the constant correspondence writing (including NOD [Notice of Disagreement] requirements for SC) back and forth to get that determination that can delay an SC decision unnecessarily. When you talk to your PCP about this you can also ask them about what medical procedures may be necessary to confirm further any condition they could not relate back to medical service and thereby get immediately scheduled for those confirming procedures as necessary with any medical specialists. It secondly then provides your PCP with your COMPLETE medical history and thereby allows them to provide better overall care and treatment in the future. A third thing this provides is that now you, the veteran, KNOW that if your PCP has indicated SC for a compensable condition, you WILL be getting compensation. There wouldn't be this constant wondering about what will happen and the things that are now being done by veterans (i.e. pestering the VA 800 number or the VARO [Veterans Administration Regional Office] about where your claim is) would be for the most part unnecessary since you now will know much sooner whether your claim has merit. The VBA would be out of the loop entirely on making this SC determination since it is after all really a medical decision (does your current diagnosis relate to something in your service medical history). In the civilian/private world, your non-VA primary care physician makes these determinations all the time based on your medical history to help determine their diagnosis and a proper plan of care OR they schedule you for a specialist based on your medical history to help them make that determination. They of course don't need to document this though in the way the VA does and they do all that "behind the scenes".


The one drawback here is that there are some cases where a claim has been submitted by a veteran without ever going to a VA PCP. In those cases though a potential solution would be to assign and schedule a VA PCP visit to start the process. That would not be much different than what seems to occur today in those cases because I assume they often require a C&P exam anyway to provide the medical documentation needed to adjudicate the case. In this case that now scheduled VA PCP visit could take the place of the C&P one that probably would have been scheduled.


IF you feel your PCP has incorrectly determined that SC does not exist, you would be able to request that a second opinion be made in that regard. Also there should be some provisions in place to allow your PCP to change any SC denials (revise the form) based upon any new medical evidence or reassessments of medical records. Regardless of how the final SC structure ends up though, ALL SC determinations are made within the VAMC/VISN hierarchy. VISN = Veterans Integrated Service Network.


Once SC has been established by your PCP/VAMC, the case THEN and only then is forwarded to the VARO to have a rater make the administrative decision on a compensation rating based upon the medical evidence of severity and the appropriate adjudicating laws and/or regulations. In my opinion, this should drastically reduce the amount of time your case would remain at the VARO AND they would have many less cases to adjudicate since SC has already been established and is no longer their responsibility. May even reduce that backlog to a workable level OR even reduce the requirement for the number of raters needed (saves money). Any of the other administrative procedures they use to determine things like increase in ratings, benefit of the doubt, evaluation of NODs, etc. would still be in effect and handled by them. I would estimate that the need for VA C&P [Compensation and Pension] examinations may also decrease for deciding a case but do not feel enough information is yet available to make that assertion - that may depend on how liberal the VA leadership would be willing to change the regulations to allow a non-adversarial VA-veteran relationship under this new structure.


The changes suggested would require some pretty extensive changes to many VA implementing "rules" such as M21-1MR, BUT probably not require as many (or maybe even not any) extensive changes to existing underlying law and 38 CFR [Code of Federal Regulations].



34 votes
Idea No. 36