Hello Johnny1985,

Semper Fidelis Army guy…USMC guy here.

MD Anderson in Houston TX is likely the worlds best CCC, especially for oral.

I know TX is a huge state, but put it this way, if my cancer was ever some rare or exotic thing, I’d be seeing about medical travel to TX to get treatment there.

That makes sense of your VA records notes being how they “half notified” you.

I was not able to get worked up through the VA as I am not 100%, and don’t qualify for dental, but I believe my VA dermatologist could have referred me out to a non-VA oral surgeon and through the “community care” or whatever it’s called program had it covered via the VA.

It’s possible, just trickier.

You may want to reach out to a CCC and ask them if they have a VA liason or are familiar with using the community care and trying to figure that out.

The VA can be great, I was able to see the UC San Diego Chief of Neurosurgery at the VA in La Jolla CA a decade ago, and that was in the normal VA appointment process. He was just my neurosurgery consult right there in the VA Hospital. I was amazed!

UCSD San Diego and VA San Diego share a medical campus there in La Jolla.


Since then my primary care doctor in the VA seems to change annually…but I have had the same dermatologist for the past 6 years.

It’s funny as the first biopsies my VA dermatologist did ended up being sent to my states flagship teaching hospital pathology as the VA did not at that time have a regional pathologist on staff. That ended up being the same CCC and pathology department that would diagnose my tongue cancer later through the civilian system.

Although this CCC did not have an oral pathologist (another reason I moved to the nearer CCC) either, and I had actually asked about having my biopsies sent to the oral pathology lab my first oral surgeon had insisted on using. They could have sent it for a second opinion AFTER their in house CCC pathology department had issued their report.

But it came back cancer, and I felt an error towards over-diagnosis was unlikely and better then an under-diagnosis and missing an early opportunity for early treatment as it’d get me into treatment as an established cancer patient early.

Since then though I believe all my post cancer diagnoses pathologist have not been oral pathologist, although my current CCC has oral pathologist on staff, and actually has the lady who is one of the chief oral pathologists of the first oral pathology lab, literally authored one of the top oral pathology textbooks, and signed my initial oral pathology report when it was potentially pre-cancerous dysplasia:

My current CCC ENT Surgeon knows her well and teaches with her and works with her, but had 100% confidence in the regular pathologist (BOTH of them CCC pathologists) getting my case right, and he is a DMD/MD who started in Dentistry to Oral Surgery to ENT to Oncology ENT sub-specialization.

So it’s funny it has only been my first biopsy that went to oral pathology, at least in terms of who signed the pathology report, and for the later biopsies there are no notes indicating consultation with an oral pathologist.

I believe my CCC has it streamlined were their regular pathologist makes the call for clear cut cases, and then if something is iffy they consult with oral pathologist, but still all in house in the same lab system. I was a bit surprised they did it that way.



This past year my skin (not tongue) biopsies were sent to a VA pathologist as they recently hired a regional pathologist.

So now the situation is a bit more understandable to me.

All of my oral surgery stuff was worked up outside the VA.

I probably could, now with a cancer diagnosis, get treated someway via the VA but we have good regiular insurance too.

I do remember that my first oral surgery consult was a wierd tricky dance just between medical and dental insurance.

Once the biopsy was done it kicked over to the medical insurance, but getting to the oral surgeon initially was …odd.

So the VA system adds another layer of complexity.

But I think they have greatly improved the programs allowing you access to care outside the VA, especially for complex issues.

A veteran service agency may be able to help you figure out how to go about using those benefits and arranging transportation and such.

Good luck, best wishes, keep the faith and please keep us up to speed on how things work out for you.

Sincerely,

Chris