Obtaining Records and Filing Exposure Claims

As we continue to address reader inquiries, we thought that this topic would be of benefit especially to Lejeune exposure victims.

I recently learned that so many of us are having trouble getting medical records from our doctors to move forward with the application process.  It would be very nice to have helpful article & possible advice given what we can do to force our medical records to be sent? At least we wouldn’t feel alone and defeated? I know my own situation with doctor’s offices lagging on sending records has caused me urgent problems. They hold my life in their hands by not sending my medical records.

Indeed, personal medical records management can be a bit exhausting. We’ll offer some tips on how to make that easier. In addition, we think this is also a great opportunity to offer a refresher on the claims process as it pertains to Camp Lejeune contamination (many of the steps for other locations through the VA should be similar).

First, some medical records management tips. Here are some items that you should always keep track of:

• Current medications/prescriptions
• Immunizations
• Allergies
• Health history – family history, past procedures/surgeries, illnesses, injuries, etc.
• Test/lab results

Additional items to keep copies of:

• Medical bills you receive from healthcare providers, labs, hospitals.
• Insurance claims you file with the insurance company.
• Insurance claims that have been paid by your insurance company.
• Medical bills you have paid.
• All prescription drug information – past and current.
• Receipts for out-of-pocket expenses.
• Test results from medical providers.
• Hospital discharge orders/documents.
• Travel expenses if you travel for appointments/procedures (you may be able to count mileage, etc.).

HIPAA allows providers 30 days to complete a record request, plus a single 30-day extension with an explanation of the delay. Here are tips on how to get your medical records quickly and accurately:

1. Visit the provider in person
2. Bring authorization form for release (fill this out online or download and complete prior to visit)
3. Have detailed contact information for destination

You can also ask the most current provider to contact your prior providers to request records, which may speed up the process. In addition to expediting requests between providers and other recipients, we highly recommend that you use the following steps for yourself.

1. Make a list of ALL of your providers (hospitals, general physicians, specialists, surgeons, etc.).
2. Call, visit or email each office and request your medical records (sometimes calling ahead with a visit expedites the process).
3. Fill out and submit a medical records authorization form for release.
4. Determine what records you need – we suggest getting the full record (including lab reports and any imaging) vs. simple summaries.
5. Ask what formats are available for receipt of records (searchable pdf files and images on CD, DVD, or flash drive are ideal).
6. Check to see if there is a fee involved. Usually, the first personal copy request is free.

You should keep a full copy of all of your medical records at home with you just in case you need them for medical, legal or other purposes. If a location only offers paper copies that are physically mailed to you, use a scanner and scan them to a CD or flash drive and place them in a fireproof lock box for safe keeping.  You never know when you might need a copy.

Process of Filing Claims for Lejeune Toxic Water Contamination:

For filing a claim for a presumptive illness covered by the VA for Camp Lejeune, there are only 2 steps:

• Your military records showing you served at Camp Lejeune or MCAS New River for at least 30 days from August 1953 through December 1987 while on active duty, or in the National Guard or Reserves (typically a DD-214 form). A good way to get these records online is through the National Archives site here: https://www.archives.gov/veterans/military-service-records
• Evidence stating that you have 1 or more of the 8 illnesses on the presumptive conditions list (your records and/or doctor letter)

Now, for filing claims for any other illnesses not covered as presumptive with the VA but included in the 2012 Lejeune law, it will be good to have all of your medical records in order to provide what is required, plus:

• Your military records showing you served at Camp Lejeune or MCAS New River for at least 30 days from August 1953 through December 1987 while on active duty, or in the National Guard or Reserves (typically a DD-214 form). A good way to get these records online is through the National Archives site here: https://www.archives.gov/veterans/military-service-records
• Evidence stating that you have 1 or more of the 8 illnesses on the presumptive conditions list (your records and/or doctor letter).
• A Nexus Letter – this is a letter from a doctor that states that your illness “more likely than not” was derived from contamination exposure.

The following is an example of a Nexus Letter from Jim Strickland of VA Watchdog:

Date : 01/01/ 2006

Subject: Medical history of
John or Jane Doe
The Doe’s Address

Reference: C-File # and/or SSN

To whom it may concern:

I am the primary care provider for John Doe. In my capacity as a primary care provider at the Eastern Regional Central Western Veterans Administration Clinic, I have cared for Mr. Doe since 01/01/2001.

While I’ve provided care for Mr. Doe, I’ve become familiar with his medical history, past and present ailments, and I’ve reviewed pertinent parts of his military record that document his injury, disease, and clinical conditions related to the events that occurred.

I am aware that Mr. Doe was (injured, got ill, sustained harm) during his active duty military service on or about 01/01/1976. The results of this (injury, illness) have been long lasting and his condition has worsened as he has gotten older.

For the past (state a period of time your condition has worsened) Mr. Doe has suffered (increasing pain, inability to walk, shortness of breath, name your symptoms here) and continues to undergo treatment by me and specialty clinic (ortho, neuro, podiatry) physicians.

Mr. Doe’s treatments and medications are as follows;

Name a treatment (Example; Physical Therapy, how often, etc.)
Name a medication (Side Effect)
Repeat until you have it all listed.

I have observed that Mr. Doe has challenges with functions of daily living and requires assistance in grooming and hygiene such as combing his hair or bathing. Mr. Doe is not able to prepare meals for himself although he is able to feed himself. He is unable to participate in housecleaning activities and requires someone to do his laundry and dishes and generally keep his environment clean for him. Mr. Doe is sometimes able to complete bladder and bowel activity unaided but there has been an increasing frequency of soiling accidents.

Mr. Doe has chronic pain due to his injury and requires (name medicine) which often has a side effect of dizziness and nausea. His pain level is often quite high with reports of 8 on a scale of ten.

Mr. Doe has hypertension that requires (name medicine) and this medicine can have the side effects of a slower heart rate or dizziness as well as frequent and urgent urination. Mr. Doe must always be near a restroom in case of an urgent need to use that facility.

Mr. Doe gets very fatigued because of the pain that is caused by any strenuous activity. Mr. Doe is unable to lift more than 5 pounds consistently and can not push or pull more than 10 pounds consistently. Standing for long periods of time (more than 10 minutes) will make him become weak and dizzy. He is unable to reach overhead or to bend at the waist to retrieve fallen items. Either action will upset his equilibrium and may cause him to become dizzy and fall.

I have examined Mr. Doe’s chart and medical record and it is my opinion that there is a medical nexus between Mr. Doe’s active duty service connected injuries and his disability of today. It is also my opinion that Mr. Doe is totally and permanently disabled, can not hold gainful employment and is not a likely candidate to be rehabilitated.

Signature Block / Date

Address of Clinic/Hospital

For full details on filing your military claim, civilian claim, or claims for family members, visit these resources:

• Civilian Exposure Resource: VA Claims Process and Forms for Contaminated Drinking Water at Camp Lejeune
• Civilian Exposure Resource: VA Camp Lejeune Family Member Program
• Civilian Exposure Resource: Camp Lejeune – Water Contamination – Public Health – VA
• U.S. Department of Labor – Office of Workers’ Compensation Programs (OWCP) – Division of Federal Employees’ Compensation (DFEC)

Note: You may also consider turning to a local VSO or VA representative for help in preparing and submitting your claim.

Finally, for some context on the difference in presumptive vs. normal process above, here’s what Brad Flohr (VA representative) said at a meeting recently about how someone is determined to be service-connected:

There’s three things, basically.  One, there has to be evidence of a disability.  Two, there has to be evidence of something in service:  an injury, a disease, or in this type of situation, an exposure.  And then the third element, which is the most difficult, is getting a medical nexus, or a link, from the medical profession between what the current disease is and what occurred in service.  We have a number of presumptions.  We have 21 cancers presumed for radiation exposed veterans, atomic veterans, who were at the nuclear tests and places like that.  We have presumptions for prisoners of war.  We have presumptions for mustard gas.  We have presumptions for Gulf War.  We have lots of presumptions.  What the presumption does, basically, is eliminates that last requirement, the third requirement, of having to provide medical link. That’s what Camp Lejeune nexus does as well.  It removes the requirement that there be positive evidence of an association medically.  It’s presumed that it is.  We’ll look at any — all and any new studies, and if it looks like there’s good evidence to support adding to the list, we do so. That’s what we want to do. – CDC/Lejeune Meeting 1-21-17

Keep in mind that your doctor may offer/indicate a nexus letter, but that doesn’t mean VA doctors part of the approval process will agree. In the case of Camp Lejeune, an extremely high percentage of claims were initially denied by “VA subject matter experts” until the recently revised rule making 8 health conditions presumptive (ie not requiring nexus proof from claimants as long as they served on base for a minimum time during contamination period). These 8 conditions for Camp Lejeune are – adult leukemia, aplastic anemia and other myelodysplastic syndromes, bladder cancer, kidney cancer, liver cancer, multiple myeloma, Non-Hodgkin’s lymphoma, and Parkinson’s disease. Outside of these conditions, the above claims process (including nexus) applies.  Duration for decisions and appeals continue to take quite some time.

Reader Feedback: We want to hear from you. What has your experience been with obtaining medical records? What has your experience been regarding the VA claims process? If you have any thoughts or tips to share that may be of benefit to other readers, please add your comments below. We may add some of your tips and successes to this article. Thank you.