Your VA Secure Messages Can Matter More Than You Think

A Practical Guide to Communicating With Your Doctors and Protecting the Medical Record Behind Your VA Claim

If you receive health care through VA, one of the most useful tools available to you may already be sitting on your phone.

Secure messaging through VA.gov and the VA health care system lets you communicate directly with members of your VA health care team. Most veterans probably think of it as a convenient way to ask about a prescription, request an appointment, or send a question to their doctor.

It can do something else that is important for a disability claim.

It can help create a contemporaneous record of what is actually happening with your disability between medical appointments.

That does not mean veterans should send messages simply to create evidence. It means that when something medically significant happens, communicating that information to your health care team can serve two purposes at once: helping you obtain appropriate care and making sure your medical history accurately reflects what you were experiencing at the time.

The Problem With Relying Only on Appointments

A medical record is only as complete as the information that makes it into it.

Imagine a veteran with service-connected migraines. The veteran sees a VA provider in January and has another appointment scheduled for April.

During February and March, the veteran experiences six severe headaches that require lying down in a dark room. Two cause the veteran to leave work early. Another lasts most of the day.

Then VA cancels the April appointment and reschedules it for June.

If nobody documents what happened during those five months, the eventual medical record may contain very little showing the frequency or severity of those symptoms.

That does not necessarily mean the symptoms did not occur. But years later, when VA is reviewing the disability claim, the record may be much less helpful than it could have been.

Secure messaging provides another way to communicate what is happening while it is happening.

For example:

«“I wanted to update you because my next appointment was rescheduled. Since my last visit, I have been having severe headaches approximately two to three times per week. About once a week I have to lie down in a dark room for several hours. I have also missed work twice this month because of them. Is there anything you recommend I do before my next appointment?”»

That is useful medical communication.

It also documents the veteran's report at the time the symptoms were occurring.

Secure Messages Are Part of Your Health Care Communication

VA expressly allows veterans to use secure messaging for non-emergency communication with their health care teams.

Veterans can use messages to:

* update their providers about changes in their conditions;

* ask non-urgent medical questions;

* request referrals;

* discuss medications;

* request test results;

* ask questions about appointments; and

* communicate routine administrative issues.

VA also allows veterans to review, download, and print their medical information and secure-message conversations.

That makes secure messaging particularly useful when something happens between appointments.

When Should You Send a Message?

There is no reason to message your doctor every time you have a symptom.

But consider sending a message when something happens that you would probably tell your doctor if you were sitting in the examination room.

Examples include:

Your condition gets worse.

“My back pain has gotten significantly worse over the last three weeks. I am now having difficulty standing longer than about 15 minutes.”

You experience a significant episode.

“I had another migraine yesterday that lasted approximately five hours. I had to leave work and lie down in a dark room.”

You develop a new symptom.

“I've started having numbness down my left leg when my back pain flares.”

Medication is not working or causes side effects.

“I've been taking the medication as prescribed, but I'm still having symptoms four or five days per week.”

A condition affects your work or ordinary activities.

“My knee pain has gotten to the point that I have difficulty using the stairs at work and have started avoiding them whenever possible.”

These are things your medical provider may legitimately need to know.

They may also become important later when VA evaluates the severity and history of the disability.

Secure Messages Are Especially Useful When VA Cancels or Delays an Appointment

This is one of the situations where secure messaging can be particularly valuable.

Suppose you have been receiving regular treatment and VA cancels an appointment.

Then another appointment is unavailable for three months.

Your medical record may appear to contain a three-month gap in treatment.

Do not assume that VA will automatically understand why.

Consider sending a secure message documenting the situation:

«“My appointment scheduled for August 10 was canceled and the next available appointment I was given is November 14. I wanted to make sure my current symptoms were documented in the meantime. My back pain has continued daily and I am still having numbness in my left leg several times each week. Please let me know if there is anything I should be doing while I wait for the rescheduled appointment.”»

Notice what this accomplishes.

It documents the continued symptoms.

It documents that you were still seeking care.

It documents the canceled or delayed appointment.

And it asks your provider what you should do medically.

That is considerably more informative than allowing several months to pass with nothing appearing in the record.

Describe Symptoms. Don't Diagnose Yourself.

One of the most important rules is simple:

Tell your provider what you experience. Let the medical professionals diagnose it.

Instead of:

“I have radiculopathy secondary to my service-connected lumbar condition.”

Consider:

“I've been having pain running from my lower back down my left leg along with numbness in my foot.”

Instead of:

“My sleep apnea is aggravated by my rhinitis.”

Consider:

“When my nasal symptoms become severe, I have much more difficulty using my CPAP because I cannot breathe comfortably through my nose.”

The second versions describe observable facts.

That is usually much more useful.

Details Matter

A message saying:

«“My migraines are bad.”»

does not provide much information.

A message saying:

«“I've had four migraines during the last two weeks. Two required me to lie down in a dark room for several hours, and I had to leave work early once.”»

provides considerably more context.

When appropriate, describe things such as:

* frequency;

* duration;

* severity;

* what triggers the symptoms;

* what makes them better or worse;

* medications or treatments you tried;

* limitations on walking, standing, sitting, lifting, sleeping, eating, concentrating, or driving;

* missed work or reduced productivity;

* whether you had to stop an activity; and

* whether another person had to help you.

Do not exaggerate.

Do not minimize.

Just describe what happened.

Don't Write Your Message Like a VA Disability Claim

Your doctor is treating you. Your doctor is not your VA rater.

Avoid sending messages filled with phrases such as:

“I experience characteristic prostrating attacks productive of severe economic inadaptability.”

That sounds like someone copied the rating schedule.

Instead, describe the actual event:

«“Yesterday's headache became so severe that I had to stop working around 1:00 p.m. I went into my bedroom, closed the curtains, and lay down until approximately 5:00 p.m. because the light and nausea were making it difficult to function.”»

Let the evidence describe the disability.

You do not need to write the rating criteria yourself.

What About Private Doctors?

The same principle applies if you receive medical care outside VA.

The difference is that VA does not automatically possess every private medical record.

VA recognizes private medical records and hospital reports as potentially important evidence in disability claims. Veterans can submit those records themselves or, in appropriate circumstances, authorize VA to attempt to obtain them.

If your private provider has a patient portal, use it appropriately.

If your condition worsens between visits, send a message.

If an appointment gets canceled, communicate with the office.

If medication is not working, tell the provider.

If a significant new symptom develops, report it.

And periodically obtain copies of your records.

For example:

«“My appointment was moved from September to December, so I wanted to update Dr. Smith in the meantime. My knee has continued giving out approximately twice a week, and I fell on the stairs last Thursday. Is there anything the doctor recommends I do before the December appointment?”»

Again, the primary purpose is medical care.

The secondary benefit is that you are creating a contemporaneous record.

Private-Care Veterans Should Take One Additional Step

Do not assume VA has your private records simply because you told VA that you see a private doctor.

When pursuing a disability claim, make sure the relevant private treatment records actually reach the Veterans Benefits Administration.

You may obtain and submit them yourself. You may also authorize VA to request certain private medical records.

Personally, I generally prefer knowing that the relevant records were actually obtained and submitted rather than assuming someone else successfully collected them.

What If You Have a Pending Claim?

Secure messaging is not a substitute for submitting evidence to your disability claim.

This distinction is important.

The Veterans Health Administration provides your medical care. The Veterans Benefits Administration decides disability compensation claims.

Do not assume that sending something to your VA doctor is the same thing as submitting evidence to VBA.

If a medical record, secure-message exchange, private treatment record, test result, or other document is important to a pending claim or appeal, make sure it is properly submitted or otherwise obtained as part of the claims record.

What Secure Messaging Cannot Do

Secure messaging is useful, but it has limits.

It does not automatically prove that a disability is service connected.

It does not turn your statement into a medical diagnosis.

It does not automatically establish that one disability caused another.

It does not replace a medical nexus opinion when one is necessary.

And it does not guarantee a particular disability rating.

What it can do is help establish a much clearer history of symptoms, treatment, limitations, and attempts to obtain medical care.

That can become extremely important when VA later asks:

When did this start?

How often was this happening?

How severe was it?

Did the condition get worse?

Was the veteran continuing to experience symptoms during this period?

A message written two years later trying to reconstruct what happened is one thing.

A message sent to your doctor the morning after it happened is something quite different.

One More Important Rule: Secure Messaging Is Not Emergency Care

VA secure messaging is intended for non-urgent communication.

Do not send a secure message and wait for a response if you need immediate medical attention.

Use the appropriate urgent or emergency medical resources instead.

The Practical Rule

My advice to veterans is simple:

Use your medical record as a medical record.

When something significant happens with your condition, tell your provider.

When your symptoms materially change, tell your provider.

When treatment is not working, tell your provider.

When an appointment is canceled and your symptoms continue, tell your provider.

When your condition begins interfering with work or ordinary activities, tell your provider.

Do it accurately and contemporaneously.

You are not trying to manufacture evidence.

You are making sure that the medical record tells the same story that you would tell your doctor if you were sitting across from them in an examination room.

Months or years later, when someone at VA reviews that record, that difference can matter.

This article provides general educational information about VA benefits and is not legal advice concerning any individual claim.