VA Mental Health Provider Venting / Problem-solving / Peer Support Thread

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If I find out that Doug Collins, the Navy Chaplain, is 100% service-connected for PTSD that will definitely make my week.

Edit: Little did I know that 'VA Claims Insider' (obviously) enjoys a much higher default Google search rating, lol

Edit #2: Is there just a 'VA Insider' website/(media site?) or did you really mean 'VA Claims Insider?'
What is a "Disabled Veteran?" What does that mean?

Clearly, this is not the same thing most regular people think about when we think about the term "disabled."

Why are so many "disabled" veterans able to work full-time jobs for the government? This....this would indeed concern me.

Let's at least change the language so most of us "regular" people can understand.
 
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Apparently, an MD in congress in committee today was saying that hyperbaric oxygen therapy has been shown in RTC's to significantly improve sequelae of (m)TBI. Any truth to this? New research? A 'proven, successful' alternative and it is 'medical malpractice' for not using this treatment at VA???

Edit: Okay, a quick Google search basically reassured me that not much has changed since I was more on top of that literature about 5-10 years ago, to wit:

Mild TBI:
For mild TBI or post-concussion syndrome, there is limited evidence to support the routine use of HBOT, with studies showing no significant improvement compared to sham treatment.

Chronic TBI:
There is some evidence suggesting potential benefits of HBOT in chronic TBI, but further research is needed to confirm these findings and determine optimal protocols
No.

But small numbers of non-VA providers, for some reason, love to cast aspersions at VA docs. I heard it through a patient once, so take it with a grain of salt, but was once told that a community (quack) neurologist had said the VA has a "cure" for dementia, but won't admit it or ever give it to veterans because...reasons?

Edit to say: yes, a person can be 100% total-and-permanent disabled and still be eligible to work.
 
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You can always find fringe MDs who either believe crazy **** based off of small n studies with ****ty methods that amplify placebo, or are willing to say anything with enough financial incentive. PhDs too, for that matter. But yeah, I haven't seen anything convincing in the hyperbaric space for mTBI.

But, as to the secret VA dementia cure. I took some with me after I left the VA. I'll sell you some vials of this murky liquid for$10k/pop.
 
It's amazing how prevalent this belief is that "every other government employee is lazy but me and my department." And somehow with 0 self-awareness about how that sounds.

Well, prevalent on one side of the aisle anyway. The one that lives in an echo chamber and believes whatever their chosen demagogue tweets out after being goaded by his handlers.
 
You can always find fringe MDs who either believe crazy **** based off of small n studies with ****ty methods that amplify placebo, or are willing to say anything with enough financial incentive. PhDs too, for that matter. But yeah, I haven't seen anything convincing in the hyperbaric space for mTBI.

But, as to the secret VA dementia cure. I took some with me after I left the VA. I'll sell you some vials of this murky liquid for$10k/pop.
Yeah. One of the physicians providing testimony was founder and CEO of some private company that does hyperbaric oxygen therapy for 'PTSD and TBI.' Should write his name down...I'm sure it will be on a big fat govt contract soon.
 
Yeah. One of the physicians providing testimony was founder and CEO of some private company that does hyperbaric oxygen therapy for 'PTSD and TBI.' Should write his name down...I'm sure it will be on a big fat govt contract soon.

Well, RFK Jr. does love him some pseudoscience, so it's a pretty good bet they'll have some funding coming their way. Time to buy some stock in companies that do homeopathy, and in companies that make drugs treating liver failure for the inevitable increase in those cases.
 
Apparently, an MD in congress in committee today was saying that hyperbaric oxygen therapy has been shown in RTC's to significantly improve sequelae of (m)TBI. Any truth to this? New research? A 'proven, successful' alternative and it is 'medical malpractice' for not using this treatment at VA???

Edit: Okay, a quick Google search basically reassured me that not much has changed since I was more on top of that literature about 5-10 years ago, to wit:

Mild TBI:
For mild TBI or post-concussion syndrome, there is limited evidence to support the routine use of HBOT, with studies showing no significant improvement compared to sham treatment.

Chronic TBI:
There is some evidence suggesting potential benefits of HBOT in chronic TBI, but further research is needed to confirm these findings and determine optimal protocols
Only semi related, but a Michigan psychologist (or at least she claimed to be) was just arrested after the death of a child due to a hyperbaric chamber explosion at a facility she owned. **Edited to add: the treatment was for Autism**

**Editing again to say she earned her PhD in special education. I don't know that she actually claimed to be a psychologist because now I can't find any reference to that**
 
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Yeah. One of the physicians providing testimony was founder and CEO of some private company that does hyperbaric oxygen therapy for 'PTSD and TBI.' Should write his name down...I'm sure it will be on a big fat govt contract soon.
I am shocked. No way anyone could've seen this coming...
 
What is a "Disabled Veteran?" What does that mean?

Clearly, this is not the same thing most regular people think about when we think about the term "disabled."

Why are so many "disabled" veterans able to work full-time jobs for the government? This....this would indeed concern me.

Let's at least change the language so most of us "regular" people can understand.
Disabled doesn’t mean you can’t work, either in or out of the VA. The only system where that applies is social security (and the niche of Individual Unemployability within the VA).
 
Disabled doesn’t mean you can’t work, either in or out of the VA. The only system where that applies is social security (and the niche of Individual Unemployability within the VA).
What does disabled (as in 100% disabled) actually mean in the context of veteran disability, then?

I had always thought degree of disability was supposed to be conceptually tied to a 'loss of earnings' or earning capacity associated with a condition caused by or incurred during military service.
 
What does disabled (as in 100% disabled) actually mean in the context of veteran disability, then?

I had always thought degree of disability was supposed to be conceptually tied to a 'loss of earnings' or earning capacity associated with a condition caused by or incurred during military service.

We had posted the guidelines somewhere a while back, but yeah, disability eligibility and definitions for the VA are totally different than SSDI. They only really get into trouble when they later apply for a pilot's license and perjure themselves on federal paperwork.
 
The FDA is also incredibly ridiculous and considers you unfit to fly for pretty much any mental health issue.

You can do brain surgery, you can operate commercial machinery or vehicles, you can do practically anything. But you can't fly an airplane if you're taking an SSRI.
 
The FDA is also incredibly ridiculous and considers you unfit to fly for pretty much any mental health issue.

You can do brain surgery, you can operate commercial machinery or vehicles, you can do practically anything. But you can't fly an airplane if you're taking an SSRI.

You can. There is an approved list. Also, plenty of MH diagnoses, including well-managed depression and anxiety are allowed.
 
You can. There is an approved list. Also, plenty of MH diagnoses, including well-managed depression and anxiety are allowed.

On paper, yes. In real life, it doesn't work that way. Check out the flying subs on Reddit.
 
The FDA is also incredibly ridiculous and considers you unfit to fly for pretty much any mental health issue.

You can do brain surgery, you can operate commercial machinery or vehicles, you can do practically anything. But you can't fly an airplane if you're taking an SSRI.

In all fairness, a depressed brain surgeon can only kill one person at a time. I suicidal pilot can kill a plane full of people.
 
The FDA is also incredibly ridiculous and considers you unfit to fly for pretty much any mental health issue.

You can do brain surgery, you can operate commercial machinery or vehicles, you can do practically anything. But you can't fly an airplane if you're taking an SSRI.
You actually can fly while taking SSRIs, you just essentially have to be cleared. It's not necessarily easy, but it's very possible.

Beyond that, yep, things are pretty strict when it comes to medications.

Edit: looks like this was already addressed above. Although it makes sense that a Reddit group is probably going to be comprised mostly of people who ran into problems with it.
 
On paper, yes. In real life, it doesn't work that way. Check out the flying subs on Reddit.
It does work that way. I do these evaluations.

Edit: Remember that you are likely not getting the full picture on reddit comments
 
It's not just Reddit, I am friends with pilots who also had issues. But, if that's actually changing, I'm happy to hear that.
FAA evals, are pretty strict. Now whether the anyone is communicating the clearance process and how long it takes to get clearance is separate issue.
 
It's not just Reddit, I am friends with pilots who also had issues. But, if that's actually changing, I'm happy to hear that.

For people with pretty straightforward diagnoses and good management, minimal issues, in my experience. Especially for the SSRI folks, as the most common ones are on the approved list.
 
FAA evals, are pretty strict. Now whether the anyone is communicating the clearance process and how long it takes to get clearance is separate issue.
Apparently there was a scandal a few years back where the AMEs were just taking applicants for medical clearance at their word and not doing any follow-up with records, so now people in other roles can ask for proof of what the applicant disclosed if they have concerns or doubts.
 
Apparently there was a scandal a few years back where the AMEs were just taking applicants for medical clearance at their word and not doing any follow-up with records, so now people in other roles can ask for proof of what the applicant disclosed if they have concerns or doubts.

AMEs vary pretty wildly in quality. We've been told that the FAA prefers our reports as we're generally VERY thorough with records review and clinical interviewing by comparison. And yes, we will often see very discrepant self-reports with what is in the medical record. Like maybe someone failing to mention several inpatient substance abuse hospitalizations...
 
I don't know how good it is over there, but the guidelines for hormone therapy are really straightforward and people aggressively overthink them anyway. Does the person have gender dysphoria and can one reasonably assume they can make informed decisions? That's it. I can do a super fancy assessment to go over risks and benefits. Totally happy to do that. However....

List of recent referrals:
They seem young. Please send for psychological clearance.
They just had a baby. Please send for psychological clearance.
They seem to be doctor shopping (for hormones?). Please send for psychological clearance.
They seem lonely and would benefit from a support group. Please send for psychological clearance.

I am about to lose my mind.
 
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For people with pretty straightforward diagnoses and good management, minimal issues, in my experience. Especially for the SSRI folks, as the most common ones are on the approved list.

The FDA is also incredibly ridiculous and considers you unfit to fly for pretty much any mental health issue.

You can do brain surgery, you can operate commercial machinery or vehicles, you can do practically anything. But you can't fly an airplane if you're taking an SSRI.
Just read the pdf of the now public RIF for VA staff memo. Got to the end of the first paragraph just to notice that--despite all of that there edumacation and credentialses they must have leveraged to author the memo--the distinction between proper use of the word 'effect' and 'affect' somehow escaped all of them in their zeal to improve the quality of services at VA:

"...the Department will affect(sic) a VA-wide RAF in August... "
 
Just read the pdf of the now public RIF for VA staff memo. Got to the end of the first paragraph just to notice that--despite all of that there edumacation and credentialses they must have leveraged to author the memo--the distinction between proper use of the word 'effect' and 'affect' somehow escaped all of them in their zeal to improve the quality of services at VA:

"...the Department will affect(sic) a VA-wide RAF in August... "

That's one way to reach rural Vets.
 
That's one way to reach rural Vets.
I hope they literally mean that they will just be pretending to execute an RIF ('affecting' one) vs. actually executing/implementing ('effecting') one.

Maybe they're clever geniuses after all...
 
AMEs vary pretty wildly in quality. We've been told that the FAA prefers our reports as we're generally VERY thorough with records review and clinical interviewing by comparison. And yes, we will often see very discrepant self-reports with what is in the medical record. Like maybe someone failing to mention several inpatient substance abuse hospitalizations...
I was part of these evaluations during one of my practicum placements and hope to do them in the future. The inconsistencies were prevalent and people often self-reported things that the FAA does not take kindly to yet it comes out during our evaluation. On the flip side, we saw far too many people that had to go through the entire process just because somewhere in their record 20 years ago they mentioned to a medical provider they were sad because their wife passed away but they are otherwise totally fine.
 
I did that thing where you sign off on the order and accidentally sign off the (unfinished) progress note draft

Sarah Jessica Parker Oops GIF by Divorce
 
Just read the pdf of the now public RIF for VA staff memo. Got to the end of the first paragraph just to notice that--despite all of that there edumacation and credentialses they must have leveraged to author the memo--the distinction between proper use of the word 'effect' and 'affect' somehow escaped all of them in their zeal to improve the quality of services at VA:

"...the Department will affect(sic) a VA-wide RAF in August... "
Link to the memo?
 
I was part of these evaluations during one of my practicum placements and hope to do them in the future. The inconsistencies were prevalent and people often self-reported things that the FAA does not take kindly to yet it comes out during our evaluation. On the flip side, we saw far too many people that had to go through the entire process just because somewhere in their record 20 years ago they mentioned to a medical provider they were sad because their wife passed away but they are otherwise totally fine.

Haven't seen any of these. I've only seen people who were diagnosed with something and treated pharmacologically, or had a hospitalization in the past. And, in case of the SSRI eval these days, especially if they're off SSRIs, it's very streamlined. If they're on, it's a quick screening, and if they don't pop anything there, they're usually good.
 
Link to the memo?
Our Service Chief sent us an email ('Summary of VHA Memoranda Distributed by Operations [BoogaBooga!] (3.10.25)') with an internal to VA link. Really no specific info yet, just looked like more of an announcement memo dated Mar 4th. They're letting the peons view it now in a spirit of transparency I suppose.
 
Haven't seen any of these. I've only seen people who were diagnosed with something and treated pharmacologically, or had a hospitalization in the past. And, in case of the SSRI eval these days, especially if they're off SSRIs, it's very streamlined. If they're on, it's a quick screening, and if they don't pop anything there, they're usually good.
The brief ones were nice. I never got a chance to do a deep dive on the development of the CogScreen, but some of the scores and ranges it produces are...unique to say the least. My memory was that it was quite sensitive and sometimes people did fine on the full testing when they spiked on the CogScreen.

I also remember a case where a pilot had paid a few thousand dollars to a previous "neuropsychologist" that said they were certified to provide the evaluations but apparently they were not... the FAA wouldn't accept the report so they had to redo it with us. I wonder if this was a case of a poor AME, lack of communication regarding the list of approved providers, or what caused it.
 
The brief ones were nice. I never got a chance to do a deep dive on the development of the CogScreen, but some of the scores and ranges it produces are...unique to say the least. My memory was that it was quite sensitive and sometimes people did fine on the full testing when they spiked on the CogScreen.

I also remember a case where a pilot had paid a few thousand dollars to a previous "neuropsychologist" that said they were certified to provide the evaluations but apparently they were not... the FAA wouldn't accept the report so they had to redo it with us. I wonder if this was a case of a poor AME, lack of communication regarding the list of approved providers, or what caused it.

The CogScreen is quite sensitive, but it's a screener, so that's where it should err. As to the wrong neuropsych, I always point people towards the publicly accessible list of authorized examiners across specialties. As to that airmen, they may have had ground to sue, depending on how that person represented themselves.
 
What does disabled (as in 100% disabled) actually mean in the context of veteran disability, then?

I had always thought degree of disability was supposed to be conceptually tied to a 'loss of earnings' or earning capacity associated with a condition caused by or incurred during military service.
That is correct, at least that's what the law says. From Wikipedia: "The amount of compensation provided—both cash payments and VA-sponsored services—is based on the veteran's 'average impairment in earnings capacity'."

In practice, disability ratings (percentages) do not correlate highly with actual loss of earning capacity, although research on the topic is limited. For example, a veteran diagnosed with obstructive sleep apnea (OSA), who has been prescribed a CPAP machine, automatically receives a 50% disability rating, even though most people with OSA who use a CPAP regularly do not exhibit any occupational impairment.

That said, disability compensation has provided invaluable, much-needed help to millions of veterans over the years. Since vets risked life and limb to protect the rest of us, the program enjoys broad support among Americans.

The Wikipedia article I referenced (Veterans benefits for post-traumatic stress disorder in the United States) provides a succinct overview. It's specific to mental disorders, especially PTSD, but much of the general information applies to all disabilities.
 
That is correct, at least that's what the law says. From Wikipedia: "The amount of compensation provided—both cash payments and VA-sponsored services—is based on the veteran's 'average impairment in earnings capacity'."

In practice, disability ratings (percentages) do not correlate highly with actual loss of earning capacity, although research on the topic is limited. For example, a veteran diagnosed with obstructive sleep apnea (OSA), who has been prescribed a CPAP machine, automatically receives a 50% disability rating, even though most people with OSA who use a CPAP regularly do not exhibit any occupational impairment.

That said, disability compensation has provided invaluable, much-needed help to millions of veterans over the years. Since vets risked life and limb to protect the rest of us, the program enjoys broad support among Americans.

The Wikipedia article I referenced (Veterans benefits for post-traumatic stress disorder in the United States) provides a succinct overview. It's specific to mental disorders, especially PTSD, but much of the general information applies to all disabilities.
If it isn't--in fact--reflective of actual disability or loss of earnings then why can't we, as a society, simply talk openly and honestly about that fact as adults and, I dunno, change the legal framework to one of, "If you're one of America's millions of veterans who needs some much-needed financial help (regardless of actual disability from health conditions associated with your military service), the taxpayers are more than happy to just give you a Stipend of Appreciation for the rest of your lives?" It would save a TREMENDOUS amount of money and resources wasted on the ridiculous cat-and-mouse games of the current system. We can't just have adult conversations about this and make a decision as a society? Do we have to continue to pretend that it's about actual disability and lost wages even though, in practice, it really isn't? A lot of veterans and their families are confused about this (and who could blame them?).
 
SC for actual SC related injuries, I'm on board. Let's just reduce the massive fraud in the system and also do something about people who use a ton of healthcare resources for the sole purpose of increasing SC.
I don't think that psychologists (or others) who haven't spent a considerable amount of time providing DIRECT daily health service delivery (especially mental health services) to veteran populations in the past 10-20 years have any comprehension of just how pervasive and costly these issues are, in reality. Admitting the reality of their existence would be such political/PR suicide that I am beginning to think that these systems are going to have to collapse under the weight of these problems (and the derivative problems) before anyone in a position of authority will ever acknowledge them.
 
If it isn't--in fact--reflective of actual disability or loss of earnings then why can't we, as a society, simply talk openly and honestly about that fact as adults and, I dunno, change the legal framework to one of, "If you're one of America's millions of veterans who needs some much-needed financial help (regardless of actual disability from health conditions associated with your military service), the taxpayers are more than happy to just give you a Stipend of Appreciation for the rest of your lives?" It would save a TREMENDOUS amount of money and resources wasted on the ridiculous cat-and-mouse games of the current system. We can't just have adult conversations about this and make a decision as a society? Do we have to continue to pretend that it's about actual disability and lost wages even though, in practice, it really isn't? A lot of veterans and their families are confused about this (and who could blame them?).
Because I would bet most taxpayers are not willing to do this. When manufacturing closed down in the rust belt, disability claims spiked significantly. The truth is that a lot people in this country are surviving off of handouts due to high level economic choices.

If you put it in the hands of taxpayers to choose who gets a handout, you will just get selfish votes and only the most popular things will win. Boot straps for all the losers.
 
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Because I would bet most taxpayers are not willing to do this. When manufacturing closes down in the rust belt, disability claims spiked significantly. The truth is that a lot people in this country are surviving off of handouts due to high level economic choices.

If you put it in the hands of taxpayers to choose who gets a handout, you will just get selfish votes and only the most popular things will win. Boot straps for all the losers.
I mean, I'd argue that--at the end of the day--the taxpayers have the right to decide the issue (whether I would agree with what they ultimately decide or not).

I just wish we could have honest conversations about the topic but it's impossible for people to even make honest arguments (to properly debate the issue) if we can't even agree what proposal/law regarding 'veteran benefits' we're even discussing in the first place.

Are we wanting only to provide compensation for service-related disabilities that actually cause impairment and loss of earning capacity or are s/c benefits supposed to function as a "thank you for your service/sacrifice" stipend unrelated to actual impairment and loss of earning capacity? Which is it? It can't be both. Are we supposed to just pretend not to understand the difference?
 
I mean, I'd argue that--at the end of the day--the taxpayers have the right to decide the issue (whether I would agree with what they ultimately decide or not).

I just wish we could have honest conversations about the topic but it's impossible for people to even make honest arguments (to properly debate the issue) if we can't even agree what proposal/law regarding 'veteran benefits' we're even discussing in the first place.

Are we wanting only to provide compensation for service-related disabilities that actually cause impairment and loss of earning capacity or are s/c benefits supposed to function as a "thank you for your service/sacrifice" stipend unrelated to actual impairment and loss of earning capacity? Which is it? It can't be both. Are we supposed to just pretend not to understand the difference?

I mean, they can get what very few people in this country can get, good healthcare and a pension with enough service time. Seems like enough of an "attaboy" for me for just the service part. It's a job, you're old enough to weigh the pros and cons when you sign up.
 
Did anyone else get a RIF related email today? To be clear not an email firing them (reducing them I suppose) but one asking for SF-50 info for RIF decisions?

I did not but a psychologist friend in another VISN did. It's wild how scattershot this all is.
 
That federal judge declared an injunction against RIF that doesn't go through proper procedure, so I think they need Congressional approval now? Idk.
 
Did anyone else get a RIF related email today? To be clear not an email firing them (reducing them I suppose) but one asking for SF-50 info for RIF decisions?

I did not but a psychologist friend in another VISN did. It's wild how scattershot this all is.
So...someone (presumably) from their chain of command/admin in their organization is asking them to...what...log into their own eOPF account, look up their most recent SF-50 document, download it as a .pdf file and then reply to their email with that .pdf file as an attachment?

Sounds...interesting.

If I got something like that, I'd be tempted to report it as a phishing attempt and even if it came back as 'legit' would create a paper trail informing supervisor(s) and maybe even union reps of the situation and requesting guidance.

Why would a legit authority have to ask YOU to do this? (By 'you' I just mean the person who got this email).

This is the same system/account (eOPF) that the org has forced me to create a minimum-length 25-character password or something to protect access to and to rotate said password every 6 months because 'security,' lol.
 
So...someone (presumably) from their chain of command/admin in their organization is asking them to...what...log into their own eOPF account, look up their most recent SF-50 document, download it as a .pdf file and then reply to their email with that .pdf file as an attachment?

Sounds...interesting.

If I got something like that, I'd be tempted to report it as a phishing attempt and even if it came back as 'legit' would create a paper trail informing supervisor(s) and maybe even union reps of the situation and requesting guidance.

Why would a legit authority have to ask YOU to do this? (By 'you' I just mean the person who got this email).

This is the same system/account (eOPF) that the org has forced me to create a minimum-length 25-character password or something to protect access to and to rotate said password every 6 months because 'security,' lol.
Not quite attaching a PDF it was asking them to validate that the information in blocks 23, 24, 26, 31, and 34 is accurate. Presumably because those blocks contain the factors used for RIF.

Still bizarre that it has come to the point a VISN is making employees responsible for information that will be used to terminate their employment.
 
Well, prevalent on one side of the aisle anyway. The one that lives in an echo chamber and believes whatever their chosen demagogue tweets out after being goaded by his handlers.
It's not like they are advocating to inject bleach or something....
 
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