Is it possible to obtain another medical opinion when the treatment under the Department of Veterans Affairs (VA) does not show any signs of improvement for a loved one? Herein exists the second opinion benefit in the VA system, with civilian doctors allowed under some conditions. Such knowledge is beneficial since you can help your husband procure the treatment he truly deserves.
Second opinions under the VA
A veteran may also seek a second opinion from another provider within the VA system. That usually begins with a discussion between the patient and his/her VA primary care provider where it is okay to bring up the issue of treatment which has not been effective, especially as this may happen in cases where pain continues to intensify after surgeries and medications have not managed to relieve it.
In your husband’s very case after about a year of therapies, injections, and surgeries on his tendon including cutting of the Achilles one, there is red alert for persistent pain.
The fact that he is still in worse pain three months from his last surgery is a valid reason to push for another evaluation by a different VA podiatrist or pain management specialist. VA doctors, indeed, can be the ones to brush aside continuing symptoms. There are rights given to patients to ask for further review if treatment has not given expected results from the treatment.
Seeking care through the VA community care program
The answer to whether your husband could be treated by a civilian doctor could be affirmative-albeit under certain conditions. The VA’s Community Care Program provides veterans treatment from non-VA providers under conditions where the required service cannot be gotten timely from the VA or when extra specificity is needed to treat the veteran.
Initially, this option goes through his primary care doc at the VA for a referral. Once approved, the VA will coordinate and pay for the civilian specialist appointment. You must not schedule any outside appointment without the VA’s authority; otherwise, or else you could be stuck with paying out of pocket.
Given continued significant pain and limited options within the VA until an MRI scheduled for October, the Community Care route may be worth a shot in your husband’s case, especially if there is a medical explanation for needing a faster, outside evaluation.
Using tricare reserve select for a second opinion
So he would find this an option if you have Tricare Reserve Select, and your husband is actually covered under your plan. Tricare operates independently from the VA, and civilian referrals usually depend on having a Tricare primary care manager. If your husband is just enrolled in VA care and not under Tricare, however, this avenue might not apply. However, being a dependent on your policy, then contacting Tricare might help you find out how to get a referral to a civilian podiatrist or pain specialist.
It should be understood that while a VA primary care doctor can refer to a Tricare provider, VA primary care providers cannot issue Tricare referrals; therefore, you must follow the necessary steps within the Tricare system.
What to do next
Your husband deserves a thorough and timely evaluation, especially after such an intense and painful treatment journey. Start directly from his VA primary care provider to get a second opinion and ask them whether there is an option under the Community Care Program. At the same time, reach out to Tricare to investigate whether there are any benefits through that plan.
Despite the fact that the VA says the pain should no longer be around, it still is, and that’s reason enough to keep advocating for answers.
