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Your Mental Health Exam And The Dubious DBQ

Mental Health Exam DBQ

Benjamin KrauseHave you ever been given the ‘brush off’ by a provider when seeking a mental health exam on a DBQ?  Turns out that the VA instructs its providers to do just that very thing.

This is Part 1 of a 4 part series that exposes insider VA policy talks affecting veterans benefits without any real oversight of the tactics used to block us from our benefits regarding DBQs. I have already hit on a few issues I uncovered and decided to summarize the next posts within the four part series.

Here are the documents for your to see and download to conduct your own research:

FOIA Response – OSVA 15-04811-F

Presentation Part 1

Presentation Part 2

DMA Meeting Transcript

DMA Meeting Minutes

Cost Of Meeting Email

Total cost for the two-day meeting was $23,095. At that meeting, they discussed a conspiracy to withhold medical records from veterans, the convoluted DBQ process, and an irrational fear of veterans becoming crazed psychos.

RELATED: Paranoid VA Officials Paint Veterans As Crazed Psychos

In response to a FOIA request I sent last year, I have uncovered a secret policy that actually explains why VHA providers will not complete DBQ.  That policy is referenced in a DMA presentation that occurred at an Advisory Committee meeting October 20-21, 2014. VA stonewalled me on this request until recently, and I wanted to be sure to get the information out to you as soon as possible.

Referred to as the “No Wrong Door” policy, it instructs its front line providers to -NOT- fill out a DBQ when requested to do so by the veteran.  Instead the veteran is supposed to be redirected to the hospital C&P station.  This is in direct conflict with the instructions provided to veterans on the DBQ website. Yet, the presentation clearly states it is against VA policy for primary therapists to fill out a DBQ for their veterans.

Compare the slide presentation [click to download Advisory Committee DBQ powerpoint] with the DBQ website for yourself here [click link to VA Mental Health Exams DBQ]

This policy is being directed by the VA at the highest levels of the organization.  The effect?  To delay and discourage a veterans from filing a claim.  This is the clearest proof of the “Delay, Deny, and Hope They Die” philosophy so many veterans accuse the VA of following.  One more VA lie for the record books.

One of the big lies of the DBQ program is the burden on doctors to fill out the forms. For example, the PTSD form claims it takes a doctor 30 minutes to conduct the DBQ exam. However, like most DBQ’s, the processes required for an assessment tend to take much longer and include referrals to numerous other experts if the forms were actually filled out correctly.

We now know, according to the presentations, that most non-VA doctors will never be able to fill out the forms because of how complex they are. Do you think VA made this mistake on purpose to isolate veterans from private care providers and their primary care doctors at VA?

* * * *

I’d like to give a special thanks to my friend Eric Hughes to writing up the research outline for this topic as a wedding present to me while on my honeymoon. It was a real time saver Eric, and as always I appreciate the help!

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19 thoughts on “Your Mental Health Exam And The Dubious DBQ”

  1. I am not one to post on these sites, but I thought I would put my two cents worth in on this. To Berta’s comment above, when I did my first claim in 2012 I was totally clueless. Well, I may still be, but here is my take. No one, not even the VSO knows more about your problem than you do yourself. You have to do your homework in my opinion. Particularly if you have multiple conditions and time has elapsed between discharge and claim. So, following advice from one of the recommended books on VA claims I poured over everything I could get my hands on. At that point I felt I knew a little bit about my disabilities and how it is analysed. However, I lacked confidence and went to one of the doctors that you read about from time to time on different forums. That doctor spent maybe 1 1/2 to 2 hours combined time on the phone before he even said he would take my case. It WAS expensive. But, over the long run it paid off. The doctor did not fill out a DBQ, but he wrote a detailed report. It was not until later after I had read up on MR21-1 that I realised that the doctor did a very thorough job. When I was notified by VA about C&P exam they provided DBQs. But the doctors that did the exams did not use the DBQs. They did it on their computer.
    Fast forward a couple of years and I submitted a FDC for eye problem, and had my doctor fill out DBQ. When they had me do C&P exam again the doctor this time did his write up on computer as well. The only issue I believe about DBQs is the deficiency when used by private doctor. The doctor needs to add somewhat the they believe your injury is as likely as not service connected.
    Had another C&P exam about 6 months ago and VA did not include DBQ. I talked to the doctor doing the C&P exam and he showed me his terminal and said that electronic DBQ questions were what he was responding to. So, at least with that office, a DBQ is submitted…electronically or otherwise.
    The question you want to ask yourself IMHO is, do I need a private doctor to do a IMO and/or do you give him/her the DBQ to go along with it. Either way it will likely cost money. But it also seems that either way, the VA wants to have the information that is asked about on that DBQ??
    One of my sons got out of the military a few years ago, and when he was discharged, his claim was pretty much put together and submitted at discharge. So, except for followup claims I am wondering how big of an issue the DBQ question is for current military filing a claim?
    Finally, I don’t believe in conspiracies and look at VA claim as a process. They did give me the run around time wise by saying on multiple occasions that the National Personnel Records Center would never send them my military records and SMRs. I sent them copies and the transmittal letter I received with the records 3 times. VA never conceded that point for some reason. But it worked out ok in the long run.
    Again, in order to defend your ground, you need to do your homework. I also found that worrying and fretting a lot about it helped some.
    The VA seemed fair to me. The teaching point for me is that the VSO can help dress up the claim package and make it pretty to submit, but they don’t know your aches, pains, trauma and whether any of that is service connected. Don’t get me wrong, I think there is value added in getting a good VSO to help. But, plan on doing the heavy lifting yourself. All the above applies only to a claim and not any NOD, CUE or appeals matters.

  2. Forgot to add.

    DBQ’s are the exact same form C&P examiners fill out so it is not impossibly complex because thousands of C&P exams are done every day.

    smh

  3. Got tin foil?

    VA docs barely have time to do anything except see patients. Putting the DBQ burden on them would massively increase the wait time to see them. Is that what you want because that is the end result of making VA docs fill these needless forms out.

    DBQ’s are NOT required. You don’t need them to get rated or an increase. Just go to your C&P exam.

    There is no grand conspiracy.

    What do I know? I have only been in the VA system for 20 years and not once got a roadblock in benefits because I get my ducks in a row before filing, and now that doesn’t mean a DBQ. Not only have I never been denied, I typically get more than I asked for.

    100% MH and is rated as static- Something you guys claim is near impossible. I am not in and out of the psych ward either.
    50% heachaches
    20% seizures

    You are not doing vets any favors by stoking paranoia fears over something everyone knew about. You needed a FOIA request to find out that VA docs don’t typically do DBQ’s? Seriously? That is common knowledge and was never hidden.

    Good job, Sherlock

  4. Yes. Unfortunately, as with VA employees trying to do the right thing, a minority of folks spoil it for the rest who do honorable work. And similar to bitter Veterans, many employees become bitter after years of seeing those who exploit the system and either fight it or flee it. There are many providers and employees who have negative agendas but there are many who do not. It’s important to remember that part of the outsourcing of care could possibly be driven by forces with a personal financial interest in funding their interests–similar to the school voucher program which made big money for private investors/supporting politicians. I would like to see how many of those who supported outsourcing of care under the rise of “providing timely care” actually had some personal interest in doing so.

  5. i’l will happily follow this goodwill wish:

    “Berta Simmons says
    July 2, 2015 at 12:02 pm
    Congratulations on your marriage Ben! I wish happiness to both of you! ”

    ditto

  6. It gets tougher the more info I get to keep going after the Golden Ticket. I am so glad I dumped my AMVETS VSO. Once you realize how important it is to know the system to succeed the better off you are. Success is up to each of us with the help of guys like Ben and his friends. Screw the VSOs.

  7. >>Do you think VA made this mistake on purpose to isolate veterans from private care providers and their primary care doctors at VA?

    no question about it. you and most veterans and many in Congress(they’ve been told for years) know this to be true. we all know it, and as it gets worse, VA digs in deeper, especially the ROBenefits dept.

    how many of us in the last 4 DECADES have left a VA appt scratching our heads asking…”WTH just happened, that doesn’t make any sense…”. we go into those appointments year after year, knowing more and more about Title 38 and the laws the VA is *supposed* to follow, and when we leave the appt and get home, all of a sudden, it hits you, “WTH, i just got smoke-n-mirrored”.

    we’ve got to build Ben’s reports results, CVA reports results, the many other investigative reports on this VA thuggery into a large political point. otherwise, VA will continue on its current path trampling veterans under its feet, especially regarding benefits. veterans cannot afford the legal route, time or money, for justice as the VA has created their own legal blackhole. and veterans who have been tossed into the VA legal blackhole just to get their due benefits, know exactly what i’m trying to express.

    standing on opposite poles of political parties, Bernie Sanders–Senate Committee on Veterans’ Affairs, and Representative Jeff Miller–Chairman of the House Committee on Veterans’ Affairs, as the VA continues to ask for mo monies and VA legals at Central Office divise new ways to defraud veterans, how is it that these two poweful men and no one else in Congress, can reign in the VA corruptness?

    remember this? just one in thousands of reports over the years.
    https://www.veteranstoday.com/2007/10/15/va-develops-new-scheme-to-defraud-veterans/

    with that said, a national referendom needs to be put the American people (not the Supreme court, the American people) to vote on cleaning up the VA system. i’m willing to bet the American people will stand behind the veterans and put a loud knock on Washington’s doors. if not, just pass the word not to join the military then as America won’t back the military when they get injured/sick on duty. Congress and the American people can find someone else to do the dirty heavy lifting for them.

    >>”Paranoid VA Officials Paint Veterans As Crazed Psychos”, so this is what we veterans get for coming together & standing up for our rights, rights and laws granted by American Congress no less. i guess the VA labels Congressman Miller & Senator Sanders as crazed men too, for standing up for veterans rights? that word “Paranoid” should be changed to “Corrupt”!

    99.9% of veterans aren’t crazy at all, we’re simply burnt out and frustrated with this continuing corrupt VA with no justice in sight, PERIOD.

  8. Sandra Demoruelle

    Regarding getting your PCP to use MyHealtheVet, we asked our Senator Brian Schatz to look into it, so may get our nonVA PCP’s notes online eventually. Good luck as it is now a requirement to have the notes available via the “Blue Button.”

    1. What I’ve run into is needing VA and non-VA provider’s notes from several years ago (the Blue Button only goes back to January 1, 2013). I asked several times at the Hilo VA Clinic about how to get these records and was told that I needed a Premium Account. Um, I’ve had that since 2007, so that’s not the issue. I finally contacted the help desk at MyHealthVA.gov and several weeks later got a nice message saying that I should submit a Privacy Act request for the older records. Did that and the records arrived within 2 weeks of my request. The question, really, is why do I even bother to ask the people at the front desk of the Hilo VA???

  9. Vassilis Margaris

    Same old shit, Ben , My case is only 6 years old and I am already Pissed and fed up
    with these M.F.s (Mighty Folks)
    Vass Margaris

  10. Congratulations on your marriage Ben! I wish happiness to both of you!

    ” Do you think VA made this mistake on purpose to isolate veterans from private care providers and their primary care doctors at VA?”

    Absolutely.

    MANY MANY claims these days only garner awards if the veteran has gotten a formal independent medical opinion from a real doctor, with expertise in the field of disability.

    The IMO (or IME if one to one exam )is needed )must conform to the criteria I posted here at http://www.hadit.com:

    https://www.hadit.com/forums/topic/53826-read-first-if-getting-an-imo/

    Ve knows of course that most vets and their survivors cannot afford IMos which can be quite costly, yet some private doctors will do one for free or very low cost but they need to spend time on them to fit into the IMO criteria VA will accept.

    I developed this article from 2 IMOs I got from Dr. Craig Bash about 10 years ago.

    Although VA accepted and agreed (after a battle) to my medical lay opinions for my FTCA case (wrongful death settlement) I knew I might have problems with a newer claim I filed,..(.undiagnosed and untreated DMII from Ao exposure contributing to the veterans death)

    You cannot file FTCA and 1151 for the same death twice so I shaped this as a claim for direct SC, yet the diagnosis nor any treatment of it ever appears in the veteran’s VA med recs.

    I did extensive work for this claim and studied endocrinology. Dr. Bash agreed after reading my initial brief email to him that it sounded good.I sure was not going to pay the thousands these IMos cost, until I was 100% sure the claim would succeed and was able to prepare a detailed cover letter ,sent with the medical records, to prove my husband had DMII tht VA had never diagnosed and treated but could have..

    The claim was successful.

    Any doctor doing an IMO should have, in many cases unless presumptives, a copy of your SMRs, and also definitely a copy of all of your VA and non VA medical records.

    They should be aware of any SSDI findings and also have a copy of the SOC or SSOC that denied the claim or denied a higher rating and a copy of the actual C & P exam..

    With a lousy C & P exam and then a valid IMO, the veteran has caused the weight of the evidence to be equal, and the Benefit of Doubt should kick in……should….. but VA has a scam I have been victimized over for every personal claim I ever had.Many of you too as well,if they failed to even consider any probative evidence you sent to them.The key word is Probative.

    My DMII AO death award took over 6 years because VA would not even read my IMOs. The BVA sure did.

    I have since then filed CUEs against them ( one still pending) within the appellate period and have been successful so far in forcing them to read my evidence (if they didnt and denied the claims) by citing CUE under 38 USC 5109 and stating their legal error was violation of 38 CFR 4.6.and they should go CUE themselves.

    If I had tried that tactic in 2005 my DMII claim would not have gone to the BVA.

    Personally I think someone pretended to be a C & P doctor for the last ridiculous decision I got on a Sec 1151 HBP claim.

    I filed CUE immediately via the director against them and they read my evidence from a Top Cardio doctor in VACO.They awarded a a month after the denial.

    We are being scammed and snookered out of even the most basic rights we have as claimants.

    And there are high fiving at VAROs every time they get away with this crap.
    And probably if a claimant dies too.

    lets face it a denial gets the claim off a raters desk, and then by time they even get to the NOD someone else is stuck with it and can deny again., particularly if they keep ignoring probative evidence, so the claim gets onto the hamster wheel, and the raters have insured job security for themselves,knowing eventual remands will come back to their RO.I emailed Sec Bob that this is a major cause of the backlog and it is deliberate.

    I think they have been directed by management to ignore our evidence,or otherwise they are just plain incompetent or illiterate.

    No regulation for the Go CUE Yourself tactic, I made it up…because ,ever since I graduated froma Military school (I am a civilian) I learned if the en drops a weapon, you pick it up and use it against them.

    VA isnt the enemy for us, TIME is. so basically those regs can be used against them the same way they use them against us.

  11. It seems to me, the DOD, VA, VAOIG and other federal agencies, (and non-federal agencies), just keep changing job titles. It’s fact, Griffin is stepping down after decades with the government. But, will he really retire? It’s my opinion, he, like so many others, will wait a short time. Then be reinstated somewhere else.
    As far as the BDQ, I’m not sure as to what this means. Maybe because my situation was different. The VA screwed up on me for 23 years. I’m a “dual service veteran”. Army first then Navy. With a split of approximately 5 1/2 years. When it came time for a C&P (which I never had) my case was settled quickly. By only using my Navy records, the VA for 23 years thought I’d never been to Vietnam. Needless to say, the ‘disabilities’ were incorrect. When I found this out, 23 years later, the VA quickly changed the one disability to what it should have been, PTSD instead of “hysterical neurosis conversion type, competent. (Competent meant I could take care of my own money, the other meant, in laymen terms, I was crazy.) All this due to the VA not looking into my Army medical records, copy of my 201 file and my Army DD 214. Even though they had these “records” in their possession all the while. How’s that for incompetence?! I thought it had been taken care of in 2005-6. But no, it has taken another ten (10) years for medical to catch up to this FUBAR! And each 6 months or so, my wife and I have to make sure SOMEONE in the VA hasn’t changed something in my file.
    This has been a short synopsis of what I have gone through. And I do mean short. When I tell friends what happened, they are surprised. If it hadn’t been for me finding a “brother” who was in Nam with me. Who knows how it would’ve turned out. I guess I’d still be classified as “CRAZY”!

  12. I don’t understand any of this DBQ stuff. The PCP I have at the VA won’t use My Healthy Vet. You know, the VA web site that vets can use for medical info. and write to their PCP? The PCP I’ve got has even told me he won’t use it. What’s the use in going to all the trouble to get that My Healthy Vet if you can’t even use the damn thing? On this DBQ stuff, I have noticed that it’s discussed somewhat in the 2014 Veterans Benefits Manual from the NVLSP. From the way Ben has described it, I’m still reminded of how the VA hasn’t changed its adversarial ways towards veterans. I still remember how it did us ‘Nam vets from back 45 years ago. You would think that would change by now. It’s a national disgrace at the way veterans are still being treated these days.

    1. Dennis, file a complaint with the Director of the VAMC where you are a patient regarding this doctor if you sincerely want to use “secure messaging.” All members of your health team are supposed to be on it and respond to your inquiries.

      However, I would like to remind you nothing seems to be secure these days in the world of the Internet. Also be aware, it is only secure between you and the VA, not who you are necessarily attempting to contact. For example, a clerk assigned to your health team can read the message or it can be used in studies and other statistical data (such as how many veterans are asking for a renewal of opiates).

      I use it only to say, “have the doctor call me.” Since, I live in a one party recording state, when he or she calls, I record the conversation.

  13. What does DBQ mean? Also I had car and home insurance with USAA for a time but when I needed help they refused to give me the help (The roof of my house was damaged in a winter storm, but when I asked for help to repair it I was told that the roof was just old and threatened to cancel my insurance if I didn’t get the roof fixed by a certain date. The date came and went, my insurance was canceled, and I was left with a very negative impression of USAA.) I have switched to a different insurance company for both car and house and the city where I live is helping me fix the roof under a rehabilitation program for my neighborhood.

  14. I don’t think things are going to get any better with this type of garbage at the VA since Prez inked a deal with USAA prez Joe Robles at the end of March to head the new Blue Ribbon committee to fix the VA

    Now its former USAA CEO and President Joe Robles Jr.’s turn to get back into the action. The retired Army major-general also has answered a call from the White House. Robles, who has only been retired one month, has agreed to serve as chairman of the Veterans Affairs Department’s newly formed MyVA Advisory Committee, an initiative to take one of the federal government’s worst performing bureaucracies and make it more service friendly and responsive to the people it’s meant to serve: men and women who have served in the U.S. military.
    former USAA CEO and President Joe Robles Jr.

    Former USAA CEO and President Joe Robles Jr.

    Robles will head a blue ribbon panel of former military leaders, business executives and health care experts. It’s a major undertaking and one that comes with serious risk of failure or at least frustration. No federal agency has proven less receptive to reform and modernization or more resistant to change. No nation claims to value its veterans more than the United States, yet no country seems to fail its veterans with the same inexplicable predictability.

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