FROM THE FAMOUS BUGTUSSLE,

WEST VIRGINIA REGIONAL OFFICE

We have seen much and heard even more about Vets who come to us with reports of vA substituting an ARNP, PA or DBC (designated bedpan changer) as the “physician” of choice for their C&P. Paul, husband of Leigh, tells us of this bait and switch. 

Well, here’s the latest definitive law on it and it explains how vA is cranking out ARPN-generated examiner’s reports. What isn’t explained to us (or Paul) is where the signature of the doctor is on the form. Vets had better start requesting this and a summary of a doctor’s specialty. This should be done as rapidly after a C&P is done, too. This might have to be couched in an FOIA (Freedom of Information Act) format. Vets may soon discover podiatrists doing DM2 diagnoses or Registered Nurses opining on the cause of HCV. Just because a doctor signs it doesn’t mean he had anything to do with it. Unless he is directly supervising the ARNP or whoever in the same building and is not 200 miles away in BFE, the C&P is worthless. Direct supervision is what was envisioned in medical circles such as this. Here’s the M-21 language:

In its May 2010 remand, the Board instructed the RO (in pertinent part) to arrange for the Veteran to be examined by a physician with the appropriate expertise to determine the etiology of the Veteran’s fibromyalgia, to include whether her fibromyalgia is etiologically related to her service or was caused or permanently worsened by service-connected disability. The Veteran was provided with a VA examination in November 2011 conducted by a nurse practitioner, who did not provide all the requested opinions. (She only opined that the Veteran’s fibromyalgia is not caused by or a result of her service-connected disabilities.) Moreover, a physician did not review or sign the examination report. According to M21-1MR, Part III, Subpart IV, Chapter 3, Section D 18(a), an examination report must be reviewed and signed by a medical doctor when an examination has been conducted by a physician assistant or nurse practitioner.

Now you know. It’s like peeking behind the curtain and seeing the “Wizard” pulling the levers. You cannot complain when you do not know the rules of this crazy game. My hope is to remove the curtains one at a time until there is no mystery.  Today Bugtussle. Tomorrow the rest of the ROs.