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Veteran Adviser Vitaglide rejected

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    #16
    Wonderful! I am proud of you going through the official process. I hope this gets you what you want and need. I would also recommend that your PVA NSO share this as a case study with the other NSOs when they meet for their annual training. All NSOs should know about this process, as well as this specific piece of equipment and how to help appropriate Veterans get it.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      #17
      Way to go Synbat! It is well worth the effort. The VG is one of the best exercizers I have used. It does wonders for getting in shape and quieting the mind.

      I don't know what I would do with out mine.

      I think the guys down at the Seattle VA was getting them with no problem.

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        #18
        Originally posted by synbat View Post
        I hope this helps some veteran that is looking for a recourse when they believe they have not had due process when wronged. Also, once again I would like to thank Veteran Adviser and KLD. I was almost convinced to do it another way but now this gives me the chance to have a peace of mind. I have not won the appeal, in fact the battle has just started now. I am confident of the outcome even if I get turned down the first time. The case will just keep going up a higher ladder. When all is said and done, at the end of the day there will be accountability.

        Synbat

        You can stand me up at the gates of hell but I won't back down.
        Tom Petty
        Synbat,

        The clinical appeals process is so rarely used that many VA personnel and NSOs don't even know about it, which is why I wrote the article some years back. But you're exactly right---you get to be heard. And if it's denied again, you may be able to pursue it even higher so that director will need to seriously consider this. You're a trailblazer, paving the way for other vets in this fight. Thanks for walking the point on this, Synbat. Keep us posted.

        Gunner

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          #19
          Who's on first?

          Okay, I could write a few pages on what has transpired in the last few months but to the point. On December 11, I received a letter from the Director of the hospital denying the equipment. Yes, this is after sending the whole packet for the appeals process. Then the PVA called and basically said that they messed up. I was not supposed to send the reconsideration to the Director of the hospital but to the Chief of Staff. They discovered their mistake by going to the Patient Advocate of the hospital who explained that the Chief of Staff handles this.

          Is anyone reading this getting as confused as I already am? So I'm not going to write a new letter but just forward the old one to the attention of the Chief of Staff. Also, I will add the names to the people that I request to be at a hearing. Important to note, I was notified that if I wanted someone at this meeting I had to put his or her name down. This included any personal advocate, such as a PVA NSO.

          Just wanted to keep everyone up to date. This by no means is a quick process and half the time you feel like a ping-pong ball. One thing I cannot emphasize enough is that my PVA reps and the hospital personnel are not only reluctant to use this method -- to be nice -- but are ignorant about the procedures.

          All I can say is now it is up to the Chief. This is starting to get good. And by the way, who ever wrote the letter for the director of the hospital has no clue of what is going on. In fact, if anything this letter reinforces my case by reiterating, "VA Ann Arbor's policy on exercise equipment is to limit purchases to patients within a defined cardiac rehabilitation program. The only exercise equipment we provide for spinal cord injury patients is a sports wheelchair." I love that last sentence. I wonder how I ended up with my standing frame acquired from this same VA.

          On Wednesday my new letter will be going out to the Chief of Staff and within a few weeks they must reply or so I'm told. I will keep this updated but I am dealing with red tape bureaucracy--it can get deep. Happy new year!

          synbat

          Comment


            #20
            Hey Synbat, Happy New Year to you!
            Sorry I missed this, wanted to see how you were coming along here. Yep, not the first time I've heard of a veterans service organization messing up. Some say they work for the VA, but you didn't hear me say that. Also heard patient advocacy referred to as the "short circuit" between patient and higher.

            So will you get to go to the hearing? Sure would be nice to know what goes down on your behalf, seems like it should be a right. Well keep us posted, and remain vigilant .

            All the best.
            get busy living or get busy dying

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              #21
              Game on!

              Over the weekend I received the "official" decision from the Chief of Staff, upholding the original decision to deny the equipment. In all honesty I really expected this to happen. One of the reasons it has taken me so long to come back to this board and update what is going on is because of the runaround and the characters involved in this play or tragedy. If Larry, Curly and Moe think that delaying tactics or acting ignorantly superior to this vet is going to stop the pursuit, they really have another thing coming. In fact, I can not even begin to explain how ridiculous this process has been. No one, and I mean no one -- the VA and the PVA -- has a clue about how the process works.

              Here is the argument for the denial of the equipment: "your appeal was considered by... Chief of Staff; Dr. "so-and-so" reviewed your medical records, consulted with physicians in the Physical Medicine and Rehabilitation Service, and queried the medical literature. His review found that the Vitaglide device is not a recognized "standard of care" for treatment of any medical condition, and there is no evidence base in the medical literature regarding the efficacy of the device for treatment of medical conditions.... While it may provide some benefit to you, at the current time it does not meet the standard of the medical device for treatment of a medical condition. On this basis, we must support our original denial decision."

              They add, "given the large number of veterans who require VA services, we base our decisions on clinical criteria." Translation we make up the rules as we go. And that is the way it has been for the last four months working on this appeal. Now they can use as much rhetoric and semantics to try and convince themselves that the matter is resolved and that I will go away. Wrong! I still have quite a few options, such as appealing to a higher level, Washington, DC. But right now I still have some thinking to do on how I will approach this situation.

              Anyways, the gibberish that I posted above from the official denial is being dissected in my brain as I speak. Although it may not make much sense there are some very interesting words that they chose to use; queried the medical literature, the term medical condition is overused in context -- compared to the directives from the VHA that I explicitly spelled out in my NOD, notice of disagreement -- also, evidence, efficacy, some benefit, and my favorite "standard of care." Who made that one up? Where is the reference?

              For over eight months this is what I've been going through. No process, no chain of command, no accountability but plenty of red tape and bureaucracy. It almost sounds frustrating but the whole point is to make your stand. If you don't have principle, what do you have?
              I will keep this updated and I really appreciated all of the advice to keep going forward, KLD, quadvet and veteran adviser (Gunner). Any suggestions, I'm all ears. The summer is right around the corner, everyone enjoy.

              Synbat

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                #22
                Time to hit the media. Most Americans think the vets have everythng they need handed to them. I think if the truth came out, it would put many in the VA in an embarrassing situation. They'd approve it in no time rather than letting the public know what really goes on in the VA. Good luck

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                  #23
                  As I said before, you should have applied through your SCI Center VA, not your local VA. Since many VA SCI Centers were issued Vitaglides for their therapy gym as part of the OEF/OIF equipment purchased a couple of years ago, I don't see how they can claim that there is no medical benefit!

                  You need to appeal this up the chain (you can appeal all the way through the VISN and then to Washington DC VHA headquarters). Kick you PVA NSO in the butt, and give a call to Bo Rollins at the PVA national headquarters for help if yours is not doing their job.

                  (KLD)
                  The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                  Comment


                    #24
                    The never ending appeal...

                    Since my last post I wrote a letter to the VISN (Veterans Integrated Service Network). In fact, before this there was more communication between me and the VA about this appeal. To the VISN my letter contained basically a summary of being denied the Vitaglide. For you to get the full effect, here it is in black and white.


                    Dear Mr. Nuisance:

                    Thank you for your inquiries concerning provision of a Vitaglide exercise device. After review of your appeal, it has been determined that we will be unable to provide you with this equipment.

                    As you know, your request was reviewed in detail by the Chief of Physical Medicine and Rehabilitation (PM&R), as well as the Chief of Staff,... who concluded that, while such a device might be beneficial, there is no indication in the medical literature to support its use for any medical condition. In addition to these reviews, are acting VISN Chief Medical Officer reviewed your case and concurred with the previous decision.

                    We appreciate your disappointment, but want you to know that we remain committed to provide you the best medical care possible. As So and So related to, our PM&R Service can provide you with medically sound approaches to your problems, and So and So, Chief of that service, remains available to meet with you to discuss your options.

                    Sincerely,

                    Let It Go
                    Network Director

                    The last paragraph is so pathetically patronizing it is comical tragedy at its best. This is what the VA letters normally will look and sound like. They are extremely general and carry no substance. Obviously the person who wrote this letter has no clue of the documentation presented in this case. He probably has no idea what a Vitaglide is or does. There is no way on God's green earth that this person (or for that matter any of the people included in this letter) did a thorough, analytical and objective review of the case.

                    What is discouraging is that the appeals process is being circumvented by them. I only received this letter. What they did not include was the SOC (statement of the case). This is a detailed explanation of the evidence, laws and regulations used by local VA office in deciding your claim. Also with this, I should've received Substantive Appeal (VA Form 9). This is the last step in the appeals process and according to my PVA NSO it could take a year or two until I hear from them a final decision.

                    This has not deterred me one bit. Unfortunately, I have a life and sometimes it would be much easier to throw in the towel but when I'm treated like a number I won't quit. And quite frankly to many people it sounds very irrational. However, someone is going to be accountable at the end of the day.

                    I find it hard to believe that there are VA's across this country that not only prescribe them for veterans but have them in their own rehabilitation/therapy rooms. I know what you might be saying KLD but there is no reason to go to a SCC unless it's for convenience. God, that sure is an ironic statement.

                    Time to go live. I'm not dropping this until I get the final, officially official, certified denial. It is like living Catch 22. The people who are sane are considered insane, those who are insane actually have their sanity. Wonder which category I fall into at times.

                    Synbat

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                      #25
                      Keep pounding away at them.

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                        #26
                        Hey Synbat, you getting anywhere with "Mr. Let It Go"?

                        "...there is no reason to go to a SCC unless it's for convenience. God, that sure is an ironic statement."

                        Now that's just funny, I hear ya...
                        get busy living or get busy dying

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                          #27
                          Bottom line...

                          "We appreciate your disappointment".
                          get busy living or get busy dying

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                            #28
                            I noted in the Equipment forum a post that indicates that the Vitaglide is no longer on the market. You might find one used, but I don't think you will get the VA to pay for used equipment.

                            Bo Rollins is no longer the head PVA NSO in Washington. It is now Sherman Gilliams, who used to be "Veteran Advisor" here.

                            (KLD)
                            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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