Battling the Storm Within

Saturday, April 9, 2016

What Your Doctor Should Write in a Letter to the VA

Chris Amidon, Veterans Advocate


A letter from your doctor to the VA in support of your claim can do wonders. While more advanced cases may require an expert medical opinion from a doctor who has experience in dealing with the VA, sometimes for less complicated claims, a correctly worded letter from your doctor may be what pushes your claim over the finish line. As most doctors aren’t familiar with what the VA is looking for, I’m writing a short guide for you to print out and show your doctor, assuming he or she is willing to write it.
  1. Identify the veteran and the purpose of your letter of support.
Example: “I am writing on behalf of veteran John Smith, who served in the U.S. Navy from April, 1992 to April, 1996. Mr. Smith suffers from Parkinson’s Disease.”
  1. Identify yourself, including your credentials and your experience. Be sure to note if you are affiliated with the VA.
Example: “I am a board-certified neurologist and am currently a resident at Florida Hospital Orlando, with 14 years experience treating neurological disorders, including many patients with Parkinson’s Disease”
  1. Explain your clinical relationship with the veteran.
Example: “Mr. Smith was referred to me in June, 2012 for his Parkinson’s Disease, and has been under my care since that time. We have met approximately once a month during this time period.
  1. State the veteran’s diagnosis. If this is a mental health diagnosis, use DSM-V diagnostic codes and format. Be sure to note the veteran’s GAF or WHODAS score (the VA and the DSM-5 now recommends WHODAS, though GAF still seems to be commonly used.) If the veteran has a score that fluctuates, explain the reasons for the fluctuation and provide a range. GAF and WHODAS scores are very important to the VA who rate the severity of the veteran’s mental health condition. Generally a GAF score of over 50 is seen as minimally disabling. If using the WHODAS, use the “complex” method that breaks down deficit by domain, which will be useful during #6 below.
  1. Describe the veteran’s current symptoms in detail (using the DSM-V criteria if for mental illness.) It is important to be thorough here, and specifically state how long the veteran has been experiencing the symptoms at what severity. Please note how the symptoms are related to your diagnosis (e.g. “Mr. Smith’s sleep disturbances are secondary to his Parkinson’s Disease.”) Also, if possible, explain how those symptoms are consistent with the veteran’s diagnosis. Please keep in mind any side effects of medication which may be disabling (e.g. “Mr. Smith’s diarrhea, while not caused directly by his Parkinson’s, is secondary to the Sinemet he takes for his Parkinson’s symptoms.”)
  1. Describe the effect that the veteran’s symptoms have on the veteran’s function. Focus on social and occupational impairments. Review the veteran’s entire list of symptoms and side effects, and think about how they affect his or her ability to function. (e.g. “Mr. Smith’s tremors are so severe that they affect his ability to hold a pencil, type on a computer, or even to feed himself.”) This is possibly the most important section of the entire letter, so please spend some time detailing the level of impairment.
  1. If the veteran’s disability is NOT currently service-connected, explain the link or “nexus” between the veteran’s symptoms and the in-service event or exposure that caused or exacerbated the veteran’s disability. Remember that the burden of proof is whether there is at least a 50/50 chance that the event or exposure caused or aggravated the disability, so use the phrase “in my opinion, it is at least as likely as not.” If you are certain, state that you have a high degree of certainty. Note where you acquired the information you used to make your decision (i.e. the veteran’s C-file, medical records, clinical interview etc.) Another extremely effective tool is to also include references to medical and academic literature which support your opinion the causal link.
When closing your letter, try and restate your opinion clearly, and include language stating what evidence you’ve reviewed to make your decision, if you know of no other information that would change your opinion, and your degree of certainty. Sign the letter, ensuring you list your credentials with your signature.
Remember that this letter may change the veteran’s life in a very real way. It can be time consuming and difficult, but this letter may mean the world to your patient.


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