2E151

I've heard about "staged" ratings, where you would qualify for a high percentage during a certain time period. ie: you rated 50% initially, but for a period of time your condition warrants a 100%, then drops back down to 50%. I don't know if that only qualifies for an appeal though. Berta is much more knowledge about this sort of thing.

I completely agree. However, for certain conditions I know the VA bases it off how a medication controls the condition instead of a pre-medication baseline. Hypertension is one such condition; by all rights if it wasn't for my medication I'd constantly be in strokes-ville and would probably warrant a much higher rating. However, because my medications keep it in check, I'm rated at 10%. In terms of criteria for mental health issues, the 10% level indicates a constant need for medication, however the higher ratings do not. For the Veteran in question, It honestly feels like the poor guy is on psychological life-support; anti-depressants to control his depression, mood-stabilizers to control his anger, uppers to help him focus, downers to help him sleep, and anti-anxiety medications to stave off the worst of his panic attacks. I read a study a couple of years ago that the average number of prescriptions for a resident at an assisted living nursing home is somewhere around 7. Last time we talked, this Sergeant exceeded that number.

Did VA try to reduce you because of any med you were on? Not me, no. I feel I've been quite blessed all around. After getting a copy of my C-file, it indicates my PTSD is static & no future examinations. Doesn't mean its set in stone, but at least they don't have me set-up on automatic 6-month or yearly reevaluations. An individual that used to worked for me is in a situation where he was originally rated 70% for PTSD, overall. No further SC disabilities. He is a member of the National Guard and received his VA award about a year ago; the National Guard has finally figured out enough of the process and is having him sent to the MEB for a possible DOD retirement. However, since his VA C&P was over a year ago, they want him to go through the whole C&P process again, which means while they are evaluating him for DOD purposes, they will likely take the chance to reevaluate his VA rating. When he was originally rated he was in pretty terrible shape. Housebound, paranoid, and in a near constant state of panic. I'm pretty sure he didn't leave his house for more than half a year. He was tenuously holding onto full-time as an engineer during the C&P, and was fired shortly after, so I don't know if that affected his rating. At the time of the C&P in 2013 I think he was only on one anti-depressant and a metric boatload of benzos. In all honestly, I think he should have qualified for 100% at the time, he just didn't have it in him to appeal. Since his award, he hit rock bottom for awhile. Long-story short, he's moved around a good bit from job to job, but he seems to be have found a medication combination that at least allows him to leave the house do repetitive, process driven work at a call center (he used to be an engineer). However, since his original award he's doubled or tripled his medications. Somewhere above 7 or 8: mood stabilizers, multiple anti-depressants, sleeping pills, nightmare pills, Adderall, and benzos. When all of his medications click he can manage to have some kind of quality of life, probably around the 50% scale. But if he misses a dosage of something like his mood stabilizer for more than a couple of days, he starts to relapse into that irritable, anxious housebound person he was in during 2013. His concern is how the VA & DOD will evaluate him; all those medications suppress the worst part of his symptoms, but that improvement is entirely dependent on that significant amount of medications.

You are absolutely correct, this case deals directly with Irritable Bowel Syndrome. However, after reading it, it looks like it also indirectly addresses the relationship between the rating of a disability based on medication controlled symptoms. “...The Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria...” In reference to PTSD, I believe only the lower level ratings (10%) specifically mention medication as a rating criteria. In some of the other cases I've seen, they often use a version of the phrase “A Veteran's disability rating shall not be reduced unless an improvement in the disability is shown to have occurred.” Which asks the question, does medications that help with mental health symptoms indicate a legitimate improvement in the underlying disability when that improvement is significantly reliant on medications? In the case mentioned, the IBS has not been cured, but the medications provide relief from some of the symptoms. In terms of mental health, a medication like Praizion might alleviate nightmares, and Xanax may alleviate panic attacks, but the underlying condition has not improved. Just seen this going back and forth for awhile, since this case came down. Thanks for the link Berta, I'd been looking for a page that complied all the cases and its eluded me until now; I owe my own successful claim largely to you & this forum. Followed the advice from you & the other forum members, and I got what my Doctor & I felt was a proper rated the first time around.

Recently I've seen some questions floating around the 'net about how Jones v. Shinseki affects PTSD ratings. From what I've read, the case set a precedence that unless the criteria for a certain disability specifically mentions medication as a basis for the rating, the VA cannot take into account the effects of medications when rating a veteran. In the PTSD rating scale, only the 10% criteria mentions taking medication into account for that level of impairment. I'm wondering how the precedent set by Jones v. Shinseki affects veterans with a much higher & more severe level of disability. Ie: a Veteran is initially rated at 50% or 70% for a mental health condition that includes intrusive thoughts, nightmares, psychotic tendencies, severe panic attacks, etc. Over the course of his treatment he finds a combination of medications that reduces the severity of some of those symptoms & increases his quality of life. Like the scenario mentioned in Jones v. Shinseki, the underlying condition is still there but the medications are dulling some of the symptoms. Without the medications, the Veteran rated for MH is just as bad off, if not worse, than when he was initially rated, but the medication has acted as a band-aid for some of his symptoms. When that Veteran gets reevaluated, would the VA take the medication's effects into consideration for a reduction?

I know the general consensus is to get your buddy letters notarized if at all possible. Since our Bank does it for free I had the wife take her letter up and get it notarized. My question is, has anyone gotten any other parts of their claim notarized? I mean the form 21-4138 Support in Claim, the VCAA notice, the Stressor form, or anything else. After checking my local RO’s average appeal time (1700 days) I want to do anything within my power to keep it out of that category…

This was straight from a very vet friendly Examiner, so for those who doubt, the VA obviously keeping a close eye on QTC, perhaps even tightening afew screws or two.

I was worried about that too, but I when I told him my binge drinking occured in service during when my stressors occured he just kinda of dismissed it with a wave of his hand

Until I see my results from the official C&P I haven't decided whether to turn in the independent one I got from a local Clinical Psychologist yet. I suppose I'll wait and see how they match up. My independent one included a battery of tests and a DBQ. Here's the results if anyone cares to opine to WAG. Axis I: 309.81 PTSD, Delayed Onset 296.23 Major Depressive Disorder, Severe, Possible Psychotic features Alcohol Abuse by history Axis IV: Stressful work, exposure to war, strained marital relationship Axis V: 48 Comments: Often unable to engage in basic daily functioning 4A: Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and/or mood. 4B: level of impairment in each area (depression & anxiety) is severe 4. Symptoms, here I have 18 checked. I went through the MH rating scale and highlighted each one, so here's the breakdown: 30% 4 highlighted 50% 6 Hightlighted 70% 7 Highlighted 100% 2 highlighted (persistent danger of hurting self or orthers;intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene) Additionally my MMPI-2 results came back valid. My Depression Scale was T=108 My Psychasthenia Scale was T=107 Paranoia: T-94 Schizophrenia: T-86 Post Traumatic Stress Disorder Scale: PK-85 PAI Results: Depression: T-107 Suicidal Ideation: T-77 Anxiety: T-87 ANX-P: T-101 ARD-T: T-T-96

I had the PTSD C&P exam today that I've been worrying about for the past couple of weeks. The wife had us on a tight schedule so we made it to the QTC building exactly at the time of the appointment. Needless to say I was a click away from full freak out mode, but I refused to take any medications. The staff was pleasant, took my paperwork, and the Doctor came out and got me and the wife almost immediately. Super friendly guy, he has a private practice and travels down to my neck of the woods once a week for QTC. I'm so glad he had the "bedside manner" he did, or I would have probably had a nervous breakdown in front of my wife. The examination was like nothing I expected. Since this was supposed to be a fully developed claim (initiated the old fashioned way over the phone) the VA obviously didn't have a lot of information to provide him with, but I brought him my 21-0781, the last couple of pages of my Statement in Support of Form (the pages talking about my current conditions), the private tests I had done locally (PAI, MPPI-2,ect) and a couple of other odds and ins. Walking into his office he said the process had been streamlined recently and that a lot of the pre-military/childhood questions had been phased out. First question was about my childhood, ("Very close-knit family, no problems") second question he asked was I depressed. ("Everyday"), any Anxiety issues ("Through the Roof"), Short Term Memory ("non-existant"), Long Term Memory ("almost as bad") when I told him the dosage of Xanax I get every month from the VA (240 1mg pills a month) I swear his jaw literally dropped. He asked the wife some pretty specific questions, stating that spouses often catch things a patient might overlook. He actually took the time to sift through my notes, he saw the part where the Cognitive Processing Therapy had made things considerably worse and agreed that it should never be the first method of treatment, that you need to learn how to cope with the symptoms before diving into the problems. He really didn't proceed how I expected: I expected him to pretty much go down the list on a DBQ. We had some casual talk about the VA in general, life experiences, and such. Two things blew my mind though: He told me that he had recieved a formal email via his boss from the VA that he provided more diagnoses for PTSD than any other clinical psychologist employed by QTC in the entire country, and that it needed to be addressed. He asked his boss, "What do you want me to do? Lie?", and of course she said No, and he responded "I just examine them and call them like I see them." Second, he asked about any substance abuse. I was honest in that I drank like a fish when I was in Mosul, and had recently began self-medicating with alcohol in the evening because of the lack of results from the previous 4 anti-depressents, that I just wanted an hour or two of happiness. He looked me dead in the face and said if your going to self medicate toss the bottles and smoke pot. He said its several times more effective and a fraction as damaging to your health. I was incredulous, me and the wife looked at each other and said if I could find some I would! He said to toss the bottles again and keep your eyes open, this is a military and a college town. Obviously I have no clue exactly how he wrote things up, I have a positive feeling but we'll just have to see how the RO interprets things. As soon as I can I'm going to try and find out how to get a copy of his exam, the regional office is only 2 hours away. If your Examiner suggests that might want to take up smoking pot, I can't imagine what he wrote down....

To make a long story short, I prematurely initiated a claim for PTSD in February by calling the 1-800 number. I was blind-sided by the letter for the claim in March, I had intended to take this year to gather all of my evidence and file next year. Well, the claim is underway and I have a C&P for PTSD on the 22nd. I'm currently spending several hours a day filing out my stressor letter, my 21-0781, getting buddy letters and other supporting evidence. At this point, I doubt anything I send to the RO will make it to the QTC office in time for the examination. I still need to get everything to the RO, that much I understand, but how should I handle the QTC? I've heard the last thing you want to do is reschedule or miss your C&P.

“We took incoming’ – a usual nature of warfare-not a stressor This is the first time I've heard of the phrase "nature of war", doesn't that contridict the new PTSD guidelines? There is no diagnosis if PTSD, Does a AXIS I diagnosis of PTSD from the VA mean a nexus has been conceded?

I hope you get a great Team Leader. I met with him this afternoon, he's a retired Army Vet. For the year I've been in treatment he's the first individual I've talked with who has served. The psychologist I went through CPT had no frame of reference other than what the VA told her. Finally glad to connect with someone who understands the military mindset of "soldier on". He hosts two group sessions for Vietnam Veterans, and his assistant hosts a mixed group of Vietnam, DS, and OIF/OEF Vets. He said that she is trying to get enough OEF/OIF veterans together to have another group. So right now its a toss up whether I'll wind up in a group with the Vet Center or the VAMC, hopefully I'll be able to keep seeing the Team Lead at the Vet Center until I get into a group. Veterans helping Veterans...how great is this!! That's really how it should be. But it seems like the only place to find that is at the Vet Centers, and I'm just blessed that I have one local and that I heard about it through Hadit. None of the Doctors I've met at the VAMC have any military service history. Berta: I just found out I can view most of my medical history through MyhealtheVet. It seems for the last couple of visits my Psychiatrist is tacking on OCPD as an Axis II (At current she has me AXIS I as PTSD, Panic Disorder without Agoraphobia, MDD Remitting) .Should this concern me? I've heard that the VA uses personality disorders as an easy out for MH compensation That and my GAF scores keep seeming to rise despite a worsening condition. At my last visit she gave me a 63 despite putting a note in that said: Notes: Pt has failed treatment thus far with citalopram, sertraline, paxil, valium, klonopin, ambien, propanolol Should I be worried?

I called the Vet Center this morning, and I'm going down this afternoon to meet the Team Lead.

You are not alone, I promise you.