Patrick428

Berta, Did he formally apply for Voc Rehab? He applied for IU and the Regional Office did a Voc Rehab on the record, no interview. And he did not apply for Voc Rehab. They set up counseling appointments upon receipt of the formal application. Most vets (unless this changed) get 2 or more one to one sessions with a counselor. No sessions Would he give you permission to scan and attach here their Reasons and Bases for the TDIU denial? I can ask the veteran and see if he would allow this to happen, or I can direct him to sign up. "does age play a role in Voc Rehab decisions" That is a good question...I dont know.... It doesn't for Chapter 35 ( DEA dependents educational benefits) I think I was already receiving Medicare or close to it when VA paid for my final Chap 35 college benefits. Does this veteran get SSA retirement or SSDI disability? This veteran has never been on SSDI, but receives FRB from SSA If he was getting SSDI ,since filing his claim and maybbe they changed that to SSA retirement when he turned 65, was the SSDI solely for his SC disabilities? I am surprised a negative TDIU decision was made regarding Voc Rehab info, when he didnt even have a face to face Voc Rehab interview....???? They made a decision based on his file or on the record about Voc Rehab, and because the VA did so, they denied his IU. Patrick428

One of the ways you can recover your medical records and other pertinant military records, is not to send an inquiry to the National Records Center in St. Louis, but to write and request them from your branch of service Personnel Command. The addresses for each branch of service: Navy: Navy Personnel Command (PERS-312E) 5720 Integrity Drive Millington, TN 38055-3120 Telephone: 901-874-4885 Air Force: Air Reserve Personnel Center HQ ARPC/DPTOCW (Contact Center) 18420 E Silver Creek Ave Bldg 390 MS 68 Buckley AFB, CO 8001 Telephone: 1-800-525-0102 Army: U.S. Army Human Resources Command Attn: AHRC-PDR-VIB 1600 Spearhead Division Avenue Dept 420 Fort Knox, KY 40122-5402 Telephone: 1-888-276-9472 Marine Corps: Headquarters U.S. Marine Corps Personnel Management Support Branch (MMSB-10) 2008 Elliot Road Quantico, VA 22134-5030 Telephone: 1-800-268-3710 Coast Guard: Commander CG PSC-bobs-mr USCG Personnel Command 4200 Wilson Blvd., Suite 1100 Arlington, VA 22203-1804 Telephone: 1-703-872-6392 Patrick428

Thank you for the reply. Ths main issue is this veteran never had a one-on-one with a Voc Rehan Counselor. He was render capable of training based a review of the record. I feel this veteran should of had an inperson evaluation so he could answer any questions about his abilities. He's a Vietnam veteran, 67 years of age, and has not work in 3 years. I tend to believe, had he been provided an inperson evaluation, then it would have been a no brainer seeing this guy cannot work. Patrick428

I'm not that up on VA Voc Rehab, but will ask a few questions. Have a Vietnam veteran who served in combat as a Marine, is 67 years old, and has been denied IU on two occasions. He received his second denial for IU based on an evaluation by Voc Rehab, done completely on record. In his decision it stated, he could work as a cab driver, Dominoes Pizza delivery man, a Limo driver, etc. This veteran never sat face-to-face with a Voc Rehab counselor to complete an evaluation. I'm wanting to know is this proper, and does age play a role in Voc Rehab decisions. This veteran is 50% PTSD, DMII, PN in 4 extremities, and tinnitus. He meets the rating requirements for IU. I read his recent C and P which was favorable, but he did not get an increase to 70%. Personally, his age being 67 and has service connected disabilities would make me think that he should have had a sit down Voc Rehab evaluation, or simply no evaluation at all. However, it is what is, and I would like comment about this. Patrick

PTSD/dissociative type will not create a higher rating because of a subtype or specifier. All PTSD diagnoses are coded 309.81 with specifiers like dissociative, depersonalization, delayed expression, etc. What matters is the overall severity of PTSD that will determine its rating. A veteran may be diagnosed with PTSD, dissociative, but only have moderate deficits plus some problems with social and occupational impairment, may receive a rating of 50%. The VA follows percentage levels for rating all mental disorders starting at 0%, 10%, 30%, 50%, 70%, and 100%. So if a veteran was diagnosed with PTSD/dissociative and meets the criteria for 100% including Total Social and Occupational Impairment, along with supporting evidence, the veteran should be rated 100%. If it is severe, then 70%, and so on. The coding for PTSD is 309.81 regardless of the specifier. Acute Stress Disorder does have several codes, but the duration is only 6 months with no delayed onset. However, I always hope any veteran receives the highest rating possible. Patrick

dritz77, My only concern is the C and P examiner is referencing GAF scores on previous and likely outdated C and P exams. If you do not know, the GAF scale is no longer a part of DSM-5 nor is the Axis system for diagnoses. What concerns me is by referencing a GAF score, it may lead the rater to consider the GAF score as some indication of how a claim should be rated. Essentially, undo influence that is not supported in the new DSM-5. Back in the day this was a common approach to rating a claim. Much easier to do than reading the entire C-file. I've kept this formula for several years and is no logner to be used by any rating officer in determining a disability rating for mental health : "The rule of thumb for the amounts the VA assigns for psychiatric disabilities is/was: GAF Percentage 0-40=100% 41-50=70% 51-60=50% 61-70=30% 71-80=10% 81-100=0% Patrick

Undeerstand an IMO or IMHO is usually from 10 to 30 pages long and is quite different from a Nexus letter. it does not matter if a doctor is retired or not as long as they maintain an active and unrestricted license to practice medicine or psychology. I will post a Nexus letter I often use when writing them for veteans. Nexus letters are short and to the point. One does not want to give the VA any wiggle room or an out by nitpicking terms or phrases: Date: SSN or C-File: 000-00-0000 Name of Patient: Jone Doe 1111 Whichway Drive Anywhere, USA Too whom it may concern: I am Patrick428, a PhD level Licensed Psychologist with an unrestricted license to practice Psychology. I have reviewed Mr. Doe’s Service Medical Records, VA Medical Records, treatment notes, and evaluations from Dr. Susan Wannabe from the Local VAMC, in Local, North Carolina, as well as his more contemporary medical records and history. I performed a Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire (DBQ) 21-0960-3 on July 27, 2014. In my review of records and administration of the PTSD DBQ, it shows Mr. Doe has no pre-military history of trauma, abuse, brain injury, or record of any mental health treatment. Records show Mr. Doe suffers from PTSD while stationed with the 1st Battalion, 3rd Marines in the Republic of Vietnam where in June 1966 he and his team members were surrounded by a contingent of North Vietnamese soldiers when a firefight erupted wounding Mr. Doe and killing two of his squad members. There is evidence a member of his team was taken prisoner and never found. Mr. Doe suffers classic symptoms of PTSD and has been diagnosed with PTSD by the VA on September 12, 2012 by Dr. Susan Wannabee at the VA Outpatient Clinic at the Local VAMC, North Carolina. In 1998, the VA determined Mr. Doe was permanently and totally disabled for NSC Major Depression. Additionally, an exchange of letters between Mr. Doe and the Local VAMC dated October 20, 2000 shows evidence was presented to indicating his mood disorder is service related. I have concluded, and it is my opinion that it is “more likely than not” that Mr. Doe current condition of PTSD and Major Depression were caused by the above mentioned combat action during his time of military service in the Republic of Vietnam. Patrick428, Ph.D. Licensed Psychologist NC 1XXX Nowhere, North Carolina

Berta, Your husband and I probably shared the same dirt. I was in Vietnam from 1965 thru part of 66, with 1/4; thn returned to Vietnam in late 66-67 with 2/26, then back with 1/4. I'm sorry for your loss and as with anyone, a needless loss. I am no stranger to losses with my first cousin to suicide in 1980 serving with the 173rd in Vietnam, and my son's auicide in December of 2013. He was a Navy Corpsmen with 2/7 during the PGW. I agree helping veterans should be a priority in working with veterans. As I said before I spent time as a Psychologist and C and P examiner for the VA. I am glad you got your justice and the benefits you deserve. I'm glad you did the leg work necessary to get these benefits. You must also understand, I personally do not have a like or dislike for Dr. Bash, however, I have a goodly number of years undoing some of his work and the work of a few others. I noticed an upswing in negative decisions using his opinions. As a matter of fact, have worked with 4 individuals 2 wanting to sue him and two who filed malpractice claims each settling out of court. I'm hoping Dr. Bash has gotten back on track. As I have and will free of charge continue to undo or clean up a mess any mental health practitioner creates whether they are with the VA, in private practice, or Dr. Bash rendering MH opinions that are beyond his area of expertise. He has been guilty of this whether or not he outsources MH opinions . There are too many BVA opinions where he and other IME have opined I mental health contentions. The BVA may not be the best of anyVA systems, but they do deny claims when's person renders an opinion out out their area of expertise. What does this do to the veteran? They spend money hoping to at least have equal footing with the BVA only to see that their claims may have had some credibility, however, only to receive a denial because the person lending an opinion was not qualified to do so. To me, this is a major injustice for the veteran, let alone being out a great deal of money after waiting years just to get a denial. I believe veterans deserve better. Anyway regards, Patrick428

Berta, I'm very happy he has helped you with your medical claims. However, if you read my post, Dr. Bash has routinely provided evaluative impressions on mental health issues with the BVA . Talk show or no talk is irrelevant. I have nearly 100 BVA rulings involving mental health opinions Bash himself lay claim to. If they were farmed out to Psychologists, then it his ethical obligation to cite his source of mental health opinions. In most BVA decisions Dr Bash lay claim to, 90% have resulted in denials based on his "mental health" opinion. Of the cases I have of Dr. Bash and others that I have retained, the BVA have pointed out Dr. Bash is formulating opinions beyond his expertise. I certainly will do not or will I ever render a medical opinion as this not my area of expertise. If Dr. Bash wants to render opinions about mental health issues, I know a few hundred APA approved Clinical Psychology programs he could attend. As for getting a good opinion from Dr. Bash, there are only two comments I can make. One, how much did it cost for these IMEs you received? I can guarantee the fee was excessive and not in line with other doctors providing the same level of work. Just because he worked for the VA does provide special privilege to charge the fees he demands. Second, you are one of the few lucky people where the outcome was positive. I consult with 17 Medical doctors, veterans attorneys, and other Mental Health practitioners. If you were to ask any of these people about the type of work being developed by Dr. Bash, you will find that for every one that received a positive outcome, there are 6 more who didn't. Most of which has do to inaccurate findings or lack of research. I posted the BVA decision for a reason. Read the findings of this BVA decision which clearly points out the lack of credible evidence, findings where Dr. Bash claimed to have performed evaluations that he never did, and the lack of credibility of his findings. This BVA decision is not an isolated reference, but rather a patten of ongoing examples where the BVA pointed out similar problems with Dr. Bash. I'm aware that Hadit essentially endorses what he does and supports him wholeheartedly. It states this under his picture on his website. However, I must remind you there two sides to every story. You have your personal story, I have 100s of veterans with another version of this story. As to the need to share comments with Dr. Bash, I have already done this twice along with a veterans law firm. And as would be expected, Dr. Bash choose not to respond. Trying to have a resonable discussion with a person who suddenly becomes deaf, is something that will not resolve anything. As I have stated, this is just my opinion based on 30+ years of experience. I'm not here seeking a referendum or a vote. I'm just pointing out the other side of the story. Im very happy for you and those who have had positive outcomes. However, spend a month with me, and maybe you will become keenly aware how pervasive are the problems are with him as well as others. As I've stated, it's just my opinion, and it can be either accepted or rejected. I work in this area of my profession, and you and others do not. It's very easy to armchair quarterback a game you have never played. No disrespect to you, however, you and I may have opinions about many things. For example people can criticize the police, yet they have never been a police officer. By the way I was a Law Enforcement officer before I became a Psychologist. Or a person can have have an opinion about being a Marine, but have never been a Marine. Likewise, I was also a Marine. However, I may express an opinion of someone who served in the Air Force, but I would never assume I am the most informed or expert about the Air Force. Since I am involved in my profession, I have much more than a casual opinion of it. Again, I am not writing about you, just responding to your post. Patrick428

Jbasser, Read my post and the BVA decision I posted. It clearly stated Sleep apnea was claimed as a secondary contention to Depression. The good doctor got slammed for his opinion by the BVA. An opinion he formulated himself. This is not just one isolated instance. I think I have a very good understanding of mental health. Second, I'm not advertising. I'm retired and do work for veterans free of charge. I saw a post on here and took issue with it based on my long term involvement in Psychology. Dr. Bash does have people he refers work. Not in all cases when it is about mental health. Many BVA decisions he was involved concerning mental disorders are opinions he claims were his own. Little wonder most were denied. Maybe this why he now outsources mental health work. You may or may not agree with my opinion. That's life. But understand, I may have been born at night, but it wan't last night. Patrick428

Stretch, If you read the link to a BVA decision I posted you will see Dr. Bash rendering as opinion about Sleep Apnea secondary to Depression. If you check his website you will see this statement. http://www.veteransmedadvisor.com "Note: Remember, Dr. Bash may be available to help in the claims process for clients who suffer from PTSD or other psychiatric disorders if, and only if, the client already has a diagnosis of the exact disorder." This is clearly out of his area of expertise. Stating a veteran must have a diagnosis of PTSD a or other mental disorder in order to evaluate claims and assist in the claims process is quid pro quo for any IME. No doctor is going to do an IME without a diagnosis. An IME is not the same as filing a DBQ. An IME is and evaluation with review of records ending in an opinion concerning mental health or medical conditions. In this respect, Dr. Bash renders opinions about mental problems. To the best of my knowledge Dr. Bash does not "farm" out mental health evaluations. I have read too many BVA decisions where he is sited giving opinions on mental health claims. Patrick428

Stretch and others, Unlike many doctors who charge for IMEs or IMHO, I do not charge anything to any veteran who needs help with their claim or assistance in reconstituting mistakes made by VA MH clinicians, private providers who have little or no experience with veterans, or individuals who write IMEs or MHO. I post what I did based on a long term history of redoing messes created by other practitioners, including Dr. Bash. Again, it is only my opinion. All one has to do is research Dr. Bash's record with the BVA. Second, and I will repeat when it comes to Mental Heath diagnoses, ONLY a Clinicall Psychologist or Psychiatrist, or those they sign off on can diagnose or render an opinion pertaining to a claim. This does not include Internal Medicine Specilists, Radiologists, Family Doctors, Surgeons, LPCs, grandma, or a buddy who is a veteran. Finally, for anyone suggesting I'm here to conduct business would be wrong. I'm retired, but still maintain active licenses to practice Psychology, and have been a certified expert in PTSD clinically and forensically for over 30-years. One may ask why I do what I do for free? I do it because I was helped by a doctor who assisted me in obtaining the ratings I felt I rated free of charge. It follows the old adage, "It was done for me, and I just pass it forward." Nothing more, nothing less. Like many of you, I'm a two tour Vietnam veteran who served in the Matine Corps; wounded twice; 100% P and T with SMC-S. In other words, been there, done that, and have the T-shirt. Just because I'm a Psychologist does not translate into I did not have a life before Psychology. Patrick428

I do IMHOs for a number of veterans. Clearly understand, this is only my opinion, and it is up to each individual veteran to decide for themselves what is in their best interest. However, I would not suggest using Dr. Bash for an IME. One, he is not well regarded by the VA across the board, and two he charges an exorbinate fee for his services. If your willing to part with $1500 to $7000 for an IME from him, be my guest. Second, he's a radiologist and any opinions concerning PTSD or other mental disorders are moot. The VA has a hard and fast rule that only a Private or VA Psychiatrist or Clinical Psychologist can render an opinion for the VA about Mental Health issues. I can assure you, I have performed IMNOs for veterans who used Dr. Bash, and can with some degree of reliability say, most of his opinions on mental health are denied by the VA. I am not sure of his ability with medical issues, however, when any person, or organization touts they aid or can do wonders for your claim, probably can't. I am currently reviewing a IME from a Dr. Bush of Williamson, GA, who wrote a 20-page report trying to undo what Dr. Bash provided as an IME. My part is writing a mental health opinion, again attempting to undo a Mental Health Evaluation from Dr. Bash. I do not know Dr. Bash, and for all practicle purpsoes may be a very fine physician. I worked for the VA as a Clinical Psychologist and a C and P examiner for several years. I am not tooting my own horn, but I have seen his work. Need I say more? Here's BVA decision denying a veteran SC for Sleep Apnea secondary to SC Depression, who used Dr. Bash for IME. It's interesting reading and there are many more BVA decisions with similar outcomes referencing Dr. Bash. http://www.va.gov/vetapp10/files2/1016260.txt If a veteran is seeking an IME, I suggest going to a Specialist at a University Medical Center and having it done. First, University doctors do not have an agenda, nor are they in it for the bucks. Additionally you will get a credible IME based on current and up-to-date medical information and procedures. JMHO, Patrick428

Hedgy, Don't be discouraged, as a C and P exam is only one part of many parts in rendering a decision. If your examner was not a specialist in Gastroenterology, and your treatment specialist is, the VA will generally takes the conclusions of your treating specialist. I had the similar problem with Parkinson's Disease. My Neurologist wrote what I consider an fabulous DBQ. However, the VA sent me to a C and P with an Internal Medcine Specialist. He tried to undercut my Neurologist at every step. When the decision came, the raters determined that one, I should have never sent to a C and P, as they took my Neurologist's information and treatment records over that of the C and P examiner. The decisions basically said, "since your Neurologist is your treating specialist and has been treating you for Parkinson's Disease, the C and P was not considered and we established service connection based on your treatment specialists DBQ and treatment notes. I was granted 70% for Presumptve Parkinson's due to Agent Orange. On a side note, I did my stint as a MH C and P examiner for the VA. Often as is the case, the C and P examiner may not have read your C-file and based his/her conclusions on simply what he/she had on hand. Let the raters do their job. If they feel the C and P was inadequate, they will no doubt give greater weight to your treatment specialist. Patrick428

Take your C and P, and sit down and find all errors you feel are not correct. Then one-by-one quote the error and then provide evidence to correct the errors. Understand you are not a medical doctor, and generally their opinions hold hard and fast. However, if you have medical evidence contrary to the examiners findings, list this in your letter of corrections and then attach this medical evidence to your letter of corrections. Do not send it the C and P unit, but send it to the RO handling your claim. If they have a Claims Coach see that this information gets to this individual, then request once the CC has gone over it, to send it to the Supervisor over all the DROs in your Regional Office. Here are three options you can also do: Complain to the Patient Advocate at your VAMC (if they are good) Send a complaint: via iris.va.gov or send it to: If your location of residence is: AL, CT, DE, DC, FL, GA, IN, KY, ME, MA, MI, MS, NH, NJ, NY, NC, OH, PA, RI, SC, TN, VT, VA, WV DVA, Evidence Intake Ctr, POB 4444, Newnan GA 30271-0020 or fax toll free to 844-531-7818 or All other States: DVA, Evidence Intake Ctr, POB 4444, Janesville, WI, 53547-4444 or Fax toll free to 844-822-5246 Patrick428