Marijuana Moment: How A Cannabis Checkbox On VA Dental Paperwork Can Shape Veterans’ Medical Records Without Them Ever Seeing It (Op-Ed)

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“Veterans should never have to choose between being truthful with their healthcare providers and worrying that a routine checkbox could quietly become a barrier to care.”

By Mary Lynn Mathre, Veterans Action Council

The Veterans Action Council (VAC) has obtained thousands of pages of internal Department of Veterans Affairs (VA) records through the Freedom of Information Act (FOIA) as part of an ongoing series, revealing how VA develops cannabis policy and trains its clinicians—but a question has remained: Is VA actually following its own policies?

Sometimes the most important evidence doesn’t come from another FOIA request; it comes directly from veterans.

Two Veterans attending separate VAC meetings, treated at different VA facilities in states with medical cannabis programs, independently shared similar experiences. In both cases, a routine dental intake form asking about cannabis use appeared to contribute to medical documentation that later influenced healthcare decisions outside the dental clinic.

Based on VAC’s collective experience, this appears to be a new development. Cannabis-related pain contracts were common more than a decade ago, and veterans successfully pushed back. Now, similar cannabis-related restrictions appear to be emerging in VA dental care.

That raises a troubling question: Can a simple checkbox quietly shape a veteran’s medical record and, ultimately, affect future care without the veteran fully understanding how that information will be used?

It matters because VHA Directive 13151, which lays out the department’s overall approach to cannabis, says that veterans should not be denied VA healthcare solely for participating in a state-authorized medical cannabis program or disclosing cannabis use. Yet the records reviewed by VAC suggest that, in at least some states, a dental intake form may carry consequences far beyond the dentist.

From Dental Intake To Permanent Medical Record

Every day, veterans complete health questionnaires before receiving VA dental care. Along with questions about medications, tobacco use and medical history, many forms ask whether the patient uses cannabis products—including THC, CBD or synthetic cannabinoids.

There are legitimate clinical reasons for asking. Cannabis may affect anesthesia, sedation, pain management and medication interactions. Honest disclosure helps providers deliver safe care.

But the issue is not the question; it’s what happens after the answer is recorded.

The dental intake form reviewed by VAC doesn’t clearly inform veterans that their responses may become part of their permanent electronic medical record, be accessible to providers throughout the VA healthcare system or influence future clinical decisions.

Veterans can review their records through the Blue Button feature in VA’s My HealtheVet patient portal, but many don’t discover how their cannabis use has been documented until after it has already affected their care.

A notation of “cannabis use” provides little clinical context. It doesn’t distinguish between state-authorized medical cannabis, CBD-only, occasional use or daily THC use, and it doesn’t establish impairment or cannabis use disorder (CUD).

Clinical conclusions require clinical assessment, not a checkbox.

When Documentation Changes The Story

One VAC member’s experience illustrates why this matters. This veteran disclosed cannabis and CBD use during a dental visit. Later, during an unrelated ADHD evaluation, the medical record described the veteran as a “regular cannabis user,” despite no documented assessment of frequency, dosage, purpose, impairment or whether the disclosure primarily involved CBD, which was the case.

VAC is not suggesting that every cannabis disclosure leads to this outcome. Rather, this case shows how a brief intake response can become a lasting clinical characterization without documented medical reasoning.

CUD is a legitimate DSM-5 diagnosis, but a checkbox, a positive THC test or a simple admission of cannabis use cannot establish it. It requires an individualized clinical assessment using established diagnostic criteria.

When cannabis documentation influences referrals, behavioral health evaluations, prescribing decisions or access to care, the medical record should clearly document the clinical basis for those decisions.

What VA Policy Requires

These cases raise concerns because they appear to conflict with VHA Directive 13151, which states that veterans should not be denied VA healthcare solely for participating in a state-authorized medical cannabis program or disclosing cannabis use.

The directive encourages providers to discuss and document cannabis use when medically relevant. It doesn’t support using disclosure alone as a basis for denying care or creating barriers to treatment.

If documentation originating in a dental clinic contributes to delays or denials elsewhere in the VA healthcare system, that practice warrants careful review to ensure consistency with Directive 1315.

Why This Matters

These cases are about more than paperwork.

VAC is documenting veterans in multiple states who believe cannabis disclosures made during dental visits later adversely influenced unrelated healthcare decisions. While further investigation is needed to determine the extent of this practice, these patterns raise serious questions about patient safety and the accuracy of ongoing documentation.

Medical records follow veterans throughout the VA healthcare system. A note entered during one appointment may later influence decisions by primary care providers, mental health clinicians, specialists, pharmacists and others.

The issue is not whether providers should ask about cannabis. It’s whether a routine disclosure, recorded without adequate context, can quietly become a lasting clinical characterization that negatively affects future VA care.

What Veterans Should Do

Veterans should continue to answer healthcare questions honestly. Accurate information helps clinicians provide safe treatment.

At the same time, veterans should provide as much context as possible. If cannabis is used for medical purposes, that should be stated. If the product contains only CBD, that distinction matters. Frequency of use, timing of last use and the medical reason for using cannabis may also be clinically relevant.

Veterans should also periodically review their records through Blue Button, paying close attention to provider notes, diagnoses and problem lists.

If information appears inaccurate or incomplete, veterans can seek clarification through secure messaging, discuss concerns with their provider, request assistance from a patient advocate or privacy officer or formally request an amendment to their medical record.

What VA Should Do

VAC believes these cases highlight opportunities to strengthen documentation practices while reinforcing existing policy.

VA should ensure that intake forms clearly explain how disclosed information may be used, make forms relied upon in clinical decision-making available within veterans’ medical records, require individualized clinical justification whenever cannabis documentation materially affects treatment decisions and audit cannabis-related delays or denials of care to ensure compliance with Directive 1315.

The Bottom Line

The experiences shared by VAC members raise important questions about what may be happening in real-world practice. Patients outside the VA system should pay attention to this issue, as what transpires within VA will likely be spreading across the country.

VAC’s ongoing cannabis-related FOIA investigation has revealed what official VA policy says should happen.

If a routine dental intake form contributes to documentation that later affects healthcare decisions, then the issue extends far beyond just dentistry. It becomes a question of medical record accuracy, transparency and whether veterans can trust that their honest disclosures will be documented fairly and used appropriately.

Veterans should never have to choose between being truthful with their healthcare providers and worrying that a routine checkbox could quietly become a barrier to care.

A checkbox should initiate a clinical conversation, not serve as a clinical conclusion.

Mary Lynn Mathre is co-founder and president of Patients Out of Time and a founding leader of the American Cannabis Nurses Association. She is the editor of Cannabis in Medical Practice and co-editor of Women and Cannabis, and is a patient advocate and a former lietenant in the U.S. Navy Nurse Corps.

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