Very Odd Imo Can An Examiner Refuse To Give Weight

[Hoppy]

We have been trying to get a review of the SMR for two months from a psychologist who has been treating this veteran. After to talking to a social worker it became appearant that there was no way the psychologist was going to cooperate. When leaving the social workers office the veteran tells me he wants to see a psychiatrist who he had seen one time about a week ago. The psychiatrist says he will see the veteran for ten minutes because he had a no show for an appointment. I was not prepared and brought no written explanation of what a nexus statement was.

The psychiatrist agrees to read the SMR and determine if the veteran had a panic disorder in the military. The psychiatrist told me has never done C&P exams. He agreed to read the SMR over the next couple days and write an opinion. He later calls the veteran and asks him what he wants in the report. The veteran barely functions and has no idea what to say.

We get the report and the psychiatrist says that he meets the DSM IV requirement for recurrent panic attacks. However. he could not definitely say that he had a panic disorder. When the diagnosis of recurrent panic attacks is established all that is required for panic disorder is a one month period where there is a change in behavior after a panic attack. The veteran told a doctor in the military that he went UA five months because of panic attacks.

Does a doctor have to give weight to the statement made by the veteran to military doctors. Is this type of situation covered anywhere in the M-21 or anywhere else.

We are going to send the file back to him and ask for a simple opinion if the current diagnosis of panic disorder is related to the panic attacks in the military.

[sharon]

Did the veteran receive any mental health treatment while in the military. His saying that he was UA for five months due to panic attacks is counted as personal history. Was there a diagonsis by he doctor after the statement was made?

It would help to get lay statements from individuals that can attest to his symptoms at the time. An IMO will help as long as it is creditable.

[Berta]

Hoppy- I strongly suggest this doc follow the IMO guide I posted here many times.

But-

"The veteran told a doctor in the military that he went UA five months because of panic attacks.

Does a doctor have to give weight to the statement made by the veteran to military doctors. Is this type of situation covered anywhere in the M-21 or anywhere else."

Is there proof of the AWOL? Did he receive any documented reprimand or something that would show why he was AWOL?

Is this all involving a Character of Discharge claim?

No one at VA can be expected to give weight to most statements a vet makes him or her self-

They DO have to consider his lay testimony to this doctor but this has become a key way for the VA to deny-

saying the documentation was solely based on a self report by the veteran.

We had a case here at hadit many years ago and the VA rejected a very costly medical opinion that the veteran got- because it was all based on what the vet told the doctor but the vet had no proof of any of it.

I posted the VA's evidentiary case law regs here- they are under 38 CFR 4.6-

and also within M21-1 many times

if I have time I will find those posts-

You need to make sure to remind VA of their own regs-

and have the doctor comply as best as he can with the IMO format I posted here.

"The veteran told a doctor in the military that he went UA five months because of panic attacks"

where was he treated while AWOL? Can he obtain that documentation?

The doc can only do so much here on an IMO and could possibly make a strong nexus statement- but the VA wants proof positive all the time.

Can he obtin buddy statements or family statements that his panic attacks caused the AWOL?

Have you seen yourself, copy of this veteran's DD 214?

[Hoppy]

Berta & Sharon

This veteran was seen by Navy clinicians about 20 times for complaints that meet the DSM IV criteria for panic attacks, The funny thing is that panic attacks were not in the DSM II at the time he was in the service. His symptoms are classic panic attacks before they even appeared in the DSM. Under the DSM II panic attacks were considered due to underlying personality disorders and people were discharged without compensation or treatment. With the publication of the DSM III in 1980 military personal were given medical discharges and are compensated if the symptoms persist.

Panic attacks are not necessarily disabling. Panic disorder involves a person response to how they adapt after experiencing panic attacks. It is common for people to make drastic lifestyle changes to try and stop the attacks. However, the attacks often continue.

I am dealing only with disability compensation.

I am aware of the problem with IMO's based on subjective history. I am purposely seeking an IMO review of the SMR only whereby the veteran does not even speak to the examiner. This would disallow the veteran from prejudicing the record with a current statement. It is my position that they need to take his statement that was recorded in the SMR at face value that the panic attacks caused him to go UA. This is significant change in behavior that meets the DSM IV requirement for the diagnosis of panic disorder. He actually went UA three times. He made a statement that is recorded in the SMR that he went UA because the military doctors were not doing enough to stop the attacks. He said and it was recorded in the SMR that when he made complaints about the attacks that the doctor told them they were in his head and offered no other attempt to assist him. He was discharged for going UA. I have the personnel file and it supports all the disciplinary actions and the UA events. He was actually AWOL during the five months. They dropped the AWOL charge to UA.

The military did not treat this disorder in the 70's. He was discharged with a report from a psychiatrist that he would not benefit from treatment. This view has changed drastically and the interenet is full of treatment plans for panic attacks and panic disorder. Treatment is not always productive. In this veterans case he went untreated for 30 years and developed major depression in association with panic disorder which was diagnosed in 2005. The current diagnosis with depression is well documented and established.

The reason why I am seeking a diagnosis of panic disorder while in the service is that Panic Disorder is known to be chronic. Even if a person initially responds to treatment the symptoms and disorder can reoccur for no apparent reason anytime later in life.

I thought it was obvious that he had a valid history of panic disorder in the military. I wanted to cite:

For the showing of chronic disease

in service, (or within a presumptive period per § 3.307),

there is required a combination of manifestations sufficient

to identify the disease entity, and sufficient observation to

establish chronicity at the time, as distinguished from

merely isolated findings or a diagnosis including the word

"chronic."

38 C.F.R. § 3.303(. Subsequent manifestations of the same

chronic disease at any later date, however remote, are

service connected, unless clearly attributable to

intercurrent causes. Id.

Edited March 5, 2009 by Hoppy

[Berta]

Hoppy-what is his present diagnosed mental disability?

[poolguy11550]

Berta & Sharon

I am purposely seeking an IMO review of the SMR only whereby the veteran does not even speak to the examiner. This would disallow the veteran from prejudicing the record with a current statement. It is my position that they need to take his statement that was recorded in the SMR at face value that the panic attacks caused him to go UA.

The veteran needs to set down with the Dr. and go over the whole medical history and then have the Dr. opine on the facts. Mental health professionals are usually the best at determining deception. What will be needed in this case is a strong IMO where the examiner states that he/she believes that the UA's were a product of in-service panic disorder. The only way for a Dr. to determine that is to set down with the veteran and ask some specific questions relating to such and observing the veteran's reaction and reasoning. This process should be well described in the examiner's opinion.

[Hoppy]

Berta,

Where can I find the IMO guide you mentioned?

His present diagnosis is

Axis I Panic disorder W/o agoraphobia

Major Depression D/O, Recurrent, mild

Axis II dererred

Axis III no diagnosis

Axis IV economic problems, occupational problems

Axis V GAF 45

poolguy,

You posted "The veteran needs to set down with the Dr. and go over the whole medical history and then have the Dr. opine on the facts. Mental health professionals are usually the best at determining deception. What will be needed in this case is a strong IMO where the examiner states that he/she believes that the UA's were a product of in-service panic disorder. The only way for a Dr. to determine that is to set down with the veteran and ask some specific questions relating to such and observing the veteran's reaction and reasoning. This process should be well described in the examiner's opinion"

My response

Asking someone questions thirty years later is not reliable in my book. The statements he made to military clinicians are very clear. He made statement three times over a period of 10 months that he did not feel the military doctors were doing enough to treat his problems and that is why he went UA. There are no other medical issues noted in the SMR or any subjective history given to the military doctors that would confuse the issue.

Consider that this was a peace time veteran who voluntarily enlisted in the Navy. I would think that there would need to be something in the SMR that would first cause an examiner to suspect possible deception before more analysis was necessary. I would get an attorney to represent this veteran before I allowed him to try and remember what happened thirty years ago. Additionally, the veteran is confused about what happens to him on a day to day basis as it is. I see this guy three times a week and spend a couple hours with him.

Why would I have to address or prove to some degree that the statements in the military "were not deceptive". What evedentiary stsndard would I ask a doctor to adhere to when testing for deception. Beyond a reasonable doubt"? Clearly? More likely than not? I do not even know why a veterans advocate would even bring the issue of deception up. I would think that this would only be an issue for the VA to show cause to investigate or for that matter prove. It just seems like more issues that I would have to pay the doctor to write up.

I have personally had a psychologist write a report that they detected deception in statements I made during an ink blot test. I took offense to this test result and got an opinion from another psychologist at the same hospital that the test they used was not appropriate to test for deception.

WHEN PANIC RECURS

At the NIH conference on panic disorder, the panel recommended that patients be carefully evaluated for other conditions that may be present along with panic disorder. These may influence the choice of treatment, the panel noted. Among the conditions that are frequently found to coexist with panic disorder are:

Depression. About half of panic disorder patients will have an episode of clinical depression sometime during their lives. Major depression is marked by persistent sadness or feelings of emptiness, a sense of hopelessness, and other symptoms.

Edited March 6, 2009 by Hoppy