Pre-Op Psych Eval through VA(Veterans Administration)

[Edie0201 3]

I’m a female military veteran who has been struggling with obesity for 10+ years. Over a year ago, i began seeing a weight management doctor through the vA. I started making healthier eating decisions with the help of my doctor and attending nutrition classes. I even began seeing a physical trainer through the VA. I still wasn’t losing weight. I was 211 lbs at just 5’0”. I finally decided that I wanted to consider weight loss surgery. I was given a checklist, which I completed over the span of 10 months. All that was left for my surgery was my psych evaluation. I even exceeded the weight I was supposed to lose to meet the pre-op requirement. I’m down to 190 lbs. I’m still considered obese, just not morbidly so. Upon my psych evaluation, I was told by the psychologist that she had a moral obligation to my child(I’m a single parent) to do what was in my child’s best interest as well and that there are some instances where bariatric surgery patients become suicidal. The psychologist stated that he didn’t want to see my daughter in a few years, coming into her office, asking how she could clear me for surgery, leaving her without a mother. The psychologist also stated that she’s sure my daughter would rather have me overweight than not have me at all. She went on to decide that she recommended I continue trying to lose weight with diet and exercise, and did not clear me for surgery.

I was devastated. I do have PTSD, but have not been suicidal, nor have drug or alcohol habits/issues.

I want a second opinion but prefer one by a non-VA provider. I do feel that her opinion was biased and for some reason, personal. Even in her clinical notes, she’s very vague with providing supporting evidence of her conclusion. She also never consulted with my actual therapist, whom I’ve been in therapy with for a year.

Does anyone have any insight or words of advice? I feel so defeated...because of all the work I put in this past year to meet the requirements.

[Chrisb428 626]

I'm not sure if it is like this with all insurance or not, but a friend of mine was able to submit a recommendation letter from her therapist. The therapist stated in it how they felt the confidence boost and ability to perform tasks more easily and comfortably would play a huge part in helping with depression and mental health in general. Good luck whatever u choose to do from here, don't give up

[Matt Z 4,139]

8 hours ago, Edie0201 said:

I’m a female military veteran who has been struggling with obesity for 10+ years. Over a year ago, i began seeing a weight management doctor through the vA. I started making healthier eating decisions with the help of my doctor and attending nutrition classes. I even began seeing a physical trainer through the VA. I still wasn’t losing weight. I was 211 lbs at just 5’0”. I finally decided that I wanted to consider weight loss surgery. I was given a checklist, which I completed over the span of 10 months. All that was left for my surgery was my psych evaluation. I even exceeded the weight I was supposed to lose to meet the pre-op requirement. I’m down to 190 lbs. I’m still considered obese, just not morbidly so. Upon my psych evaluation, I was told by the psychologist that she had a moral obligation to my child(I’m a single parent) to do what was in my child’s best interest as well and that there are some instances where bariatric surgery patients become suicidal. The psychologist stated that he didn’t want to see my daughter in a few years, coming into her office, asking how she could clear me for surgery, leaving her without a mother. The psychologist also stated that she’s sure my daughter would rather have me overweight than not have me at all. She went on to decide that she recommended I continue trying to lose weight with diet and exercise, and did not clear me for surgery.

I was devastated. I do have PTSD, but have not been suicidal, nor have drug or alcohol habits/issues.

I want a second opinion but prefer one by a non-VA provider. I do feel that her opinion was biased and for some reason, personal. Even in her clinical notes, she’s very vague with providing supporting evidence of her conclusion. She also never consulted with my actual therapist, whom I’ve been in therapy with for a year.

Does anyone have any insight or words of advice? I feel so defeated...because of all the work I put in this past year to meet the requirements.

You **DO NOT** have to take that doctor's word, you are allowed a second opinion. Why would the doctor what you to be at higher risk of health issues than be healthy? You also do NOT need to see a VA doctor. You could find a doctor that works private and public sector, like my Surgeon and a few doctors around here (I work at the VA.) You should be able to have your usual therapist do the eval. That sounds so super ridiculous. Good Luck!

[Syntax_Attack 76]

As a military veteran myself I have to say go get a second opinion. I am sure that the VA psych is very tuned in to anything that can increase suicidality since it is as you know a huge issue in the Veteran community. However this doesn't seem like someone that has a lot of experience with these types of cases. Go to your weight loss clinic (if you are doing this through the VA go to a civilian one) and ask for their list of recommended providers that can give you the required psych clearance. If you think that your VA doc might have had at least somewhat of a legitimate concern you can even ask that the civ and VA doc discuss this to address any legitimate issues. If you go with a weight loss clinics recommended doctor they should have a lot of experience and can address any concerns your VA doc has. Good Luck.

[DaleCruse 756]

First, thanks for your service. I too am a military veteran who's struggled with weight for a long time.

Second, that's so not cool that your psych eval went that way. I'm so sorry that happened to you. You don't deserve it.

If that psychiatrist told you she didn't want your kid coming to her office one day, she put her needs ahead of yours. That's so not cool.

Get a second opinion. A third opinion if necessary.

Good luck. You are not alone.

[Frustr8 7,886]

Hmmm so she would not want to explain how she cleared you for surgery and now your Daughter had no Mother? Obviously she plans to sympathize with Daughter over the fact you had a 💜attack or stroke and died? Or what would be equally bad, you had a stroke, are paralyzed, Belfast and Daughter had to put her own plans on hold, drop out of University and stay home as your caregiver, because as a single parent, you'd have no one else to turn to.
It is better to have you remain obese, your joints broke down so you can't play or do things with her that you used to do, that if the two of you go for a hike and you're lagging back , red-faced and out of breath, and she has to stop and wait for you to catch up. You're in a wheelchair at her graduation or wedding because your legs just can't,hold you,in anymore. You're wearing,black or navy blue at her wedding(assuming you're still alive) because all the pretty pastel Mother-of-the-Bride dresses don't come any larger than a 14 and as a round lady you buy what you can find. She shows her babies, your grandchildren a picture in a frame and says "This
was your Grandma" and the oldest, let's say a little girl says "Gee Mommy, I look a lot like her, I wish I had gotten to meet her. then she says words that cut your daughter to the heart, I know because I said them about an uncle I never got to meet on both sides of my family " Do you think she would have loved ME?"Yes pictures are nice to have but they never replace flesh and blood.
They will miss out on knowing you and you'll never get the chance to know themm, hold them in your arms, miss kussing the top of their little fuzzy sweet-smelling heads.
Ditch that evil maladjusted broad with the dime-store CrackerJack certificates on the wall, get somebody else who really knows you to write an approval paper or certificate. I don't know how it could be arranged but I wish you were last person she was allowed to consult with.
This hits me very hard because something similar happened to me, you were lucky she said her poisonous musings to your face. Mine told me my evaluation was perfect, shook my hand, wished me well with the upcoming surgery, told me to come back and visit her anytime. Its not that I am miss-remembering , my son who is an adult was in the room that day also. Then my ***** of an evaluation consultant sent a report 2 months later after I had finished all my other requirements. Oh and how noxious it was, she judged I was neurologically, emotionally and psychologically impaired and about as intelligent as a pile of mud. And worse my surgeon believed what she wrote, cancelled my surgery, and my time, and, money and the money of my insurance carrier counted for nothing.
But I am and will be a survivor, I established contact with another Center of Excellence hospital as they are considered the best, made sure this time EVERYTHING is in perfect order, the evaluation from their person was perfect(and I recorded it all on my cellphone for, you see I had been burned badly before) and I should be receiving my surgery in a month,or 6 weeks. I have been treated in a wonderful way at this program . Odd, when I look back , my gut told me there was something weird at Place#1, I stuffed it down, said maybe they weren't a friendly group of people, maybe I was expecting too much from something no more than a business arrangement. Learn from me --lf the music sounds off-key, it is!!
Hugs and 💞from Central Ohio.
PS watch for the conclusion of my story, you can Celebrate with me 🚩😝🚩

[Edie0201 3]

I just scheduled an appointment with a psychologist who conducts pre-bariatric surgery evals; she's completely outside of the VA(hell) umbrella, so I'm feeling hopeful. She's older, a mother, grandmother, and she is not a thin lady. The previous psychologist was a very tall and thin woman who I doubt could truly sympathize...PhD or not.

I wanted to thank you all from the bottom of my heart. This has been so stressful and I felt as though I couldn't talk to anyone, because most people don't even know this has been something I've been struggling with.

The first psychologist, who I feel was completely cavalier and nonchalant about pissing away all the work I had done for a year with a few keystrokes on her keyboard, truly needs to reassess her responsibility to patients. In my clinical interview, she said, "You're really not that overweight. And you have a beautiful face." I just sat there completely flabbergasted. I felt like telling her, "We are going by clinical facts, not opinions. And the fact is that I have serious health risks because I am CLINICALLY classified as VERY OBESE." But I knew she was gauging my responses and going to annotate any defensive or aggressive tones. So, I just told her "Thank you, but I'm still clinically overweight, have horrible back pain from the excess weight on my 5'0 frame, and have moderate-severe sleep apnea. I need help."

After I get my surgery date(God willing), I'm going to report her to the state licensing association. What she did wasn't right. Especially because she didn't even provide clinical supporting notes and refused to speak to my therapist.

Thank you all so much! I will keep you all updated! *virtual hugs* 🤗🤗🤗

[Frustr8 7,886]

Don't you wish you'd said that was better than being scrawny and having an ugly face and an ugly attitude. I am so happy you've made arrangements for yourself. You might get a chuckle from this- got a bill recently from the place that screwed me over. After they bled money out of my primary and secondary insurance they asked for $26 from me. Guess who isn't getting a penny from me. If they try to,persue it they. too will be reported for their unethical abuse of me.
Hugs back from me and give your daughter a hug and kiss from me. If she grows up to be half the,lady her mama is, she will be twice as good as the average teenager.😛

[Edie0201 3]

Okay, it’s been a few weeks, but I wanted to update you all with what’s going on. So, I found a very reputable psychologist in my city that is in no way affiliated with the VA, who actually used to be the chief psychologist conducting pre-bariatric surgery evaluations at a local hospital that sees both military and civilian patients. She runs a private practice now. I went to see her, and was honestly nervous, because I didn’t know what to expect after my experience with the VA psychologist. Thankfully, she was amazing! And I went to her letting her know that I wanted a completely objective evaluation and that I wouldn’t be disappointed or upset if she found I wasn’t a good candidate for bariatric surgery. After the conducting an hr-long interview/evaluation, she stated that she thought I was an excellent candidate for bariatric surgery and that she would compose an in-depth report of her findings and recommendation, and fax it to both my doctor and me.

It was faxed 20 June. My weight management doctor didn’t contact me, but input notes on 20 June into my VA record, that she received the fax from “a community psychologist”, that included a pre-bariatric surgery evaluation report.

21 June, the VA psychologist input notes too. Her notes had a very ominous tone to them...almost like she was angry. She stated that I had gone against her recommendation of getting a second opinion from the specific VA psychologist she had chosen, that the “community psychologist” didn’t consult with my VA therapist(remember, neither did she, despite my therapist reaching out to her), that I “refused to consider alternate methods to bariatric surgery”, and that she was taking serious precautions because I am a veteran with PTSD, and had history of trying to commit suicide in my youth(twice, due to being sexually abused throughout my entire childhood). I’ve been yo-yoing between obese and morbid obesity for the past 10 years, mind you. And have been meeting the requirements for surgery the past 15 months...but she insistently suggests I’m being hasty and even insinuated that I’m being selfish because I’m willing to take the risk of suicidal tendencies after surgery instead of accepting my obesity and “being here” for my daughter.

She and my weight management doctor have scheduled a meeting with me for Friday, and I can’t help but feel like I’m walking into a trap. It’s truly disheartening to feel this way...especially because it’s the VA, and they’re supposed to be helping veterans salvage whatever parts of their life they have left. It certainly doesn’t feel that way.

[Jolexis 203]

I am so sorry this is happening to you. Hearing stuff like this is why I refuse to go to the VA for anything other than educational benefits. I would make an objective list with data to back you up on why you feel the surgery is the best option for you. Don't forget to include your support system and positive coping skills you have learned from working with your therapist. Before your meeting, make sure your head is clear so that you will be ready to argue your case in the best way possible! You can do this!

Edited July 5, 2018 by Jolexis

[Jolexis 203]

And don't be afraid to let her know of her bias against you

[Matt Z 4,139]

On 7/2/2018 at 6:41 PM, Edie0201 said:

Okay, it’s been a few weeks, but I wanted to update you all with what’s going on. So, I found a very reputable psychologist in my city that is in no way affiliated with the VA, who actually used to be the chief psychologist conducting pre-bariatric surgery evaluations at a local hospital that sees both military and civilian patients. She runs a private practice now. I went to see her, and was honestly nervous, because I didn’t know what to expect after my experience with the VA psychologist. Thankfully, she was amazing! And I went to her letting her know that I wanted a completely objective evaluation and that I wouldn’t be disappointed or upset if she found I wasn’t a good candidate for bariatric surgery. After the conducting an hr-long interview/evaluation, she stated that she thought I was an excellent candidate for bariatric surgery and that she would compose an in-depth report of her findings and recommendation, and fax it to both my doctor and me.

It was faxed 20 June. My weight management doctor didn’t contact me, but input notes on 20 June into my VA record, that she received the fax from “a community psychologist”, that included a pre-bariatric surgery evaluation report.

21 June, the VA psychologist input notes too. Her notes had a very ominous tone to them...almost like she was angry. She stated that I had gone against her recommendation of getting a second opinion from the specific VA psychologist she had chosen, that the “community psychologist” didn’t consult with my VA therapist(remember, neither did she, despite my therapist reaching out to her), that I “refused to consider alternate methods to bariatric surgery”, and that she was taking serious precautions because I am a veteran with PTSD, and had history of trying to commit suicide in my youth(twice, due to being sexually abused throughout my entire childhood). I’ve been yo-yoing between obese and morbid obesity for the past 10 years, mind you. And have been meeting the requirements for surgery the past 15 months...but she insistently suggests I’m being hasty and even insinuated that I’m being selfish because I’m willing to take the risk of suicidal tendencies after surgery instead of accepting my obesity and “being here” for my daughter.

She and my weight management doctor have scheduled a meeting with me for Friday, and I can’t help but feel like I’m walking into a trap. It’s truly disheartening to feel this way...especially because it’s the VA, and they’re supposed to be helping veterans salvage whatever parts of their life they have left. It certainly doesn’t feel that way.

If the meeting doesn't go how you want, you look that doctor in the face and tell them you are firing them, and want another doctor that doesn't have an unhealthy bias and gets mad when another professional provides an answer that is contradictory to what they stated. Don't let them make you feel like you aren't the one in control. You don't work for them, they work for you. You are allowed a second opinion.

Hell, call the other psy and let them know what's going on, ask if they would be open to being on the phone for that meeting so that they can put their inputs into the conversation.

[BostonWLKC 807]

On 07/05/2018 at 13:41, Matt Z said:

If the meeting doesn't go how you want, you look that doctor in the face and tell them you are firing them, and want another doctor that doesn't have an unhealthy bias and gets mad when another professional provides an answer that is contradictory to what they stated. Don't let them make you feel like you aren't the one in control. You don't work for them, they work for you. You are allowed a second opinion.



Hell, call the other psy and let them know what's going on, ask if they would be open to being on the phone for that meeting so that they can put their inputs into the conversation.

I second Matt! Get the other therapist on the phone so you have someone in your corner

Good luck

[Edie0201 3]

Hi, everyone! It's been 4 months since I last posted, but just wanted to update the folks that took the time to respond. Also, in case any other fellow vets might find something useful to take from this.

I was devastated. And it's taken me this long to openly discuss it, but here it goes:

Well, that "meeting" was exactly what I feared it to be...no, actually it was worse. Firstly, I went in and audio recorded the entire interaction from when they went to get me in the waiting area, until I passed the threshold of the doors, exiting the hospital.

The psychologist started off with saying that I had gone against protocol and sought a second opinion from someone who did not have extensive access to my records as VA psychologists do, and therefore, the external psychologist was not able to consider pertinent information in the evaluation. I retorted: Actually, the external psychologist WAS provided my records from the VA, AND she had been the chief evaluating psychologist for bariatric surgeries at the biggest military hospital in my city. She then said that the issue was that the psychologist had never consulted with the bariatric team and because "standard procedure" is for them to do so, they couldn't consider her recommendation for surgery as valid.

The VA psychologist then went on to say that because I didn't address my concerns about utilizing the psychologist she recommended, with her directly...that that indicated my lack of coping skills and possibly paranoia of personal vendettas.

In a completely calm and objective tone and manner, I told her that I disagreed with that statement as well, and that I sought a second opinion from someone other than who she suggested because after listening to her unprofessional comments and anecdotal reasons for why she "didn't think" I was a good candidate for surgery, I didn't trust her professional opinion in any regard, to include her suggestion from whom I'd receive a second opinion.

Her face turned red and when she began to speak, she was visibly upset. Her face started to twitch and she began stammering. The social worker sitting in saw it. The weight management doctor saw it. They looked at each other nervously, but didn't want to focus too much attention on it, so the weight management doctor tried to chime in, saying, "What I think Dr. Nutcase*(VA psychologist) is trying to say is..." Then the VA psychologist halfway stood up and put her hand in the weight management doctor's face, motioning for her to stop talking. Still stammering and with her hands starting to tremble beyond her control, she says, " I can see you're very angry and enraged. And you don't have any faith in my professional abilities, but I stand by my findings. You have proven to me, especially now, that instead of dealing with issues, you become paranoid and you run away from them. I do not think that someone in your mental state is ready for everything that comes with bariatric surgery. You've already proven you can lose weight on your own, by evidence of meeting the requirement for bariatric surgery. I suggest continuing what modifications you made to obtain that goal. But, no, I do not think you are mentally fit for this type of surgery. And I stand by that.

I retorted: (Again, calmly, objectively, and with tact) Dr., if you suspected that I was so mentally unwell that I should be barred from bariatric surgery, but still managed to inform me of your decision over the phone(where as a supremely concerned psychologist you could not monitor my response) and I after I clearly told you I was driving...does that not doubly contradict what you're claiming? If I am so "mentally unfit" and your biggest cited reason is for purported fear that I'll commit suicide, why, as a professional, ethical, and morally responsible psychologist, would you risk putting me in harm's way? I mean, if what you say is true, and you're truly just concerned for my mental health and that I am alive for my daughter...why would you inform me of my denial, after 15 months of work that I put in meeting requirements...and you suspect me to be suicidal and mentally unwell, while I am operating a motor vehicle. Why would you do that? It's a rhetorical question, Dr. I merely want to show you yet another instance where you have contradicted yourself.

Her hands were still trembling and she was still stammering. " I didn't realize you said you were driving. I'm sorry for that. I was wrong. I believe you that you told me you were driving. I'm not saying you're lying. I was wrong. I'm sorry."

She then went on to say, " I can see how upset and angry you are. I am sorry for making you feel that way. I can see how distressed that situation made you feel. I'm going to let you have a moment with these other ladies because it seems as though you no longer are open to hearing my professional opinion, but I stand by it. I understand if you don't want to work with me, but always know that my door is always open." She nervously got up and with her back to the door, stepped out. In other words, she acted as though she was in fear.

You guys...I couldn't believe my eyes. I couldn't believe this was happening. It was so crazy of a display, that I just sat there stunned, waiting to see how the social worker and weight management doctor would respond. After a bunch of bullshit "you should be proud of all that you have accomplished in these 15 months. You lost the 5% requirement. Just keep going", the weight management doctor said, "Unfortunately, she is my colleague and I have to support her recommendation of not allowing you to move forward with surgery."

I kept my composure until I left the hospital, but as soon as I got into my car, I collapsed in tears. I felt so...failed.

It didn't end there. Oh, no. The VA psychologist was apparently in a hurry to leave the meeting to rush back to her office to input her medical notes in my record. She stated that I was aggressive and verbally attacked and debased her constantly throughout the meeting. That I was unwilling to use proper coping skills. AND, that I was "mentally unstable to the degree" of not trusting my own ability to safely operate a vehicle when faced with a distressful situation. She closed with, "It is because of these observations and my concern for her mental health that I recommend the patient not be considered for bariatric surgery."

This is a part of my medical record now...that all other medical professionals will see and take as truth just because it's endorsed by someone with a Phd.

It's been really hard, everyone. Because what disheartened me the most was realizing that if she did that with me just because I challenged her, what else has she done? What other veterans has she screwed over with her "professional findings", which was really just an ego trip and abuse of authority. And, honestly, after seeing that awful display, I'm convinced she is probably no stranger to mental illnesses, in more ways than one.

On the bright side, I'm still here...I haven't gained any of my weight back that I lost while meeting my requirements, I'm kicking butt being a great mama to my little girl, and my mom just had her bariatric surgery(the sleeve) done yesterday. I'll be taking care of her(she's 56), just making sure she doesn't have any issues for the first two weeks post-op. In solidarity, my daughter and I made a commitment to my mom that we would join her in completely changing our lifestyle to support her as a family.

Thank you all for sharing your insights and for just caring. You all remain in my prayers and well wishes. <3

[elcee 3,341]

OMG!

What an ass