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    • I'm 100% disabled due to agoraphobia/panic disorder. I was totally housebound years ago, but made it back out with a lot of work, though I couldn't drive far. I've had to travel to a different state to go to a VAMC, accomplishing it by downing a bunch of prescription Xanax, headphones on Brainwave Entrainment relaxation software, and hubby doing the driving.   Hubby had a stroke recently and is unable to drive the distance any more, so I had to move to the Choice program. Ever since, the VAMC is noncooperative with me. I even had to contact my Congressman to get them to make appointments, recommended by the Medical center which performed my operation.   I wound up going by ambulance to the local ER last November, due to an inability to breathe (I had a foot-long tumor in my abdomen which was putting pressure on my asthmatic lungs). Hubby called 911, and they sent an ambulance. VAMC refuses to pay the bills involved, declaring it was not an emergency. The local hospital refused to even treat the tumor (I think because VA told them they would not pay), discharging me from the ER, after telling me to be careful the tumor doesn't explode.   I eventually wound up at an obgyn office where they freaked out and started calling all over the state to try to get me help (even trying the governor's office). They eventually suggested an immediate ride to a major Med center, where I was refused treatment, but hubby refused to take me home, so they eventually did operate and removed the tumor.   Choice takes months to make me an appointment anywhere, sometimes pretending to be working on approval, for months, for a follow-up visit with a local pulmonologist, only to inform me right before the appointment that they were unable to get 'approval' from my primary. Like huh? My primary never refused me treatment before, and they could have told me 4 months before (or even during any phone call I made to them every two weeks in attempting to get authorization #, while they put me off by telling me they were sending it over to scheduling).   I absolutely HATE dealing with them any more!!!   I've put in NODs on their refusal to pay the bills. They claim non-emergency. I received 3 notices from VA refusing to pay the bills of that ER visit. I put in NOD's on all 3. I only heard back on one. It stated it was overturned. But they only listed the one bill collector on the overturned notice (yet I was told by billing that if the 'non-emergent' was overturned on the one refusal, it applied to all bills for that visit???). Yet today I received another denial from VA of a bill from that day, this time involving the ambulance bill.   I've tried billing, and gotten nowhere. I ask to speak to a supervisor. They laugh, tell me I can call their supervisor, but the supervisor isn't going to answer the phone. I've tried every person who is supposed to be in charge at the VAMC. They tell me whatever they think I want to hear, just stringing me along, and nothing changes. I finally got hold of the supervisor, but it got me nowhere - just shining me on.   I'm going to put in another NOD on this denial of the ambulance bill. But it appears to be hopeless. There is no one willing to fix the problems here. I'm frustrated and disgusted. Afraid of needing any emergency treatment, afraid of the bills.   I've now fallen backwards with my agoraphobia, due to the stress of it all. I've lost a lot of ground, afraid to leave the house again. I need to force myself out, trying to drive a few blocks on my own, despite the fears, trying to gain back some ground. It's hard. 😥   Does anyone else have these problems dealing with these people?? It's just impossible...  
    • My psychiatrist at the VA has refused to sign paperwork for me to obtain a service dog from an organization that provides them for for disabled veterans with panic disorders, etc.  She states the VA precludes her from doing so.  I then asked her if she would submit the necessary paperwork for me to be a part of the new pilot program which the VA just announced that is for mental health that impacts mobility.  I am diagnosed (by her) with agoraphobia with panic disorder.  She mumbled that she knew nothing about it and would "look into it".  She sent me a message through secure messaging today after I reminded her and sent a message to the patient advocate because I am tired of them just increasing my klonopin every few months along with every other medication.  At this point, if I take all the klonopin she recommends I won't have a panic attack because I will be on my couch drooling all day long or asleep.  So, my question is if I can't get my worthless psychiatrist to do anything, the patient advocate seems to think that the VA doesn't pay for service dogs...........which I wasn't even asking them to do.  Sign paperwork was what I was asking for initially but with the pilot program honestly I am a perfect candidate. Who is above them?  I am not post 9/11 and have no other health insurance so just going to see someone else isn't really an option but getting drugged into addiction is not something that is something that a think is "treatment" either.  So drug me, of course, sign paperwork for a service dog....hell no?  Someone suggested I contact my congressperson, Bob whoever that is, the head of the women's clinic (not sure why that matters) and news stations (I have agoraphobia so that probably wouldn't be good for me honestly).  I just want to be able to get a service dog so I can take less drugs hopefully and go to my doctor's appoinments without my hubby or adults kids having to take me because I turn into a panic attack mess, I don't think that is so much to ask.  If anyone knows about this mysterious regulation the VA has that prevents them from signing paperwork from all of these organizations that provide service dogs for any reason, not just psychiatric I would love to know what it is! 
    • Hello my friends, As you all know I was rated 30% for MDD; 0% for migranes; and 0% for skin rash.  I asked for increases in MDD, migranes, and skin rash.  I also asked to re-open sinusitis/rhinitis and then asked for PTSD and MDD to be reopened because I was originally denied for this in 2014.  Well the decision is final today on Ebenefits, and my AB8 states that I am now 70% and it looks like they will retro me back from Dec 2014. Here is the information below.  I really appreciate the help from the members and I will continue to stick with Hadit because the fight is never over.  I am one happy lady.:))))     sinusitis (also claimed as chronic allergies) 0% Service Connected   07/14/2014 rhinitis 0% Service Connected   07/14/2014 condition of the duodenum   Not Service Connected     insomnia   Not Service Connected     shin splints, left lower extremity (akso claimed as aching pain and cramps)   Not Service Connected     post traumatic stress disorder with major depression 70% Service Connected PTSD - Personal Trauma 07/14/2014 left hand condition (also claimed as tingling sensation and numbness in fingers)   Not Service Connected     bilateral foot condition to include corns bunions, callouses, hammertoes, blisters, and pain)   Not Service Connected     left shoulder pain and popping out of place   Not Service Connected     rash on neck (now claimed as rash all over body) 0% Service Connected   10/05/2012 depression to include anxiety (also claimed as suicidal thoughts, nightmares, hallucinations, panic attacks, and short term memory loss) 30% Service Connected   08/15/2011
    • How do I file the request to amend my records per 3.1579?  What am I amending?
    • Bronco; The C&P exams are so erroneous that I have to due the CUE, I agree.  My lay opinion to my congressman and Mr. McDonald is in hopes of NOT having to go to the BVA to unscrew this mess.  What I need is a new C&P exam since this doctor jumbled both exams by mixing up body parts, wrong dates, etc. So I need to cite 38 CFR 20.1403 Rule 1403?





nyc-vet

How Are Axis Figured In To Decisions?

3 posts in this topic

I'm trying to help someone do a notice of disagreement for depression. The veteran was increased from 10% to 30% but we believe it should be higher.

We were reading over the physical exam at the doctor diagnosis.

This is what it states in the diagnosis section.

Multiaxial diagnosis:

Axis I: Adjustment disorder with mixed anxiety and depressed mood (309.28)

Axis II: Defered 799.9

Axis III Deferreed to medical evaluation

Axis IV: Social isolation, unemployment, chronic concerns about pain and the negative impact of this on their energy level, low energy, health difficulties, marital conflicts

Axis V: GAF 52

How does the Axis figure into the decision? I wonder if the GAF score is what made it 30%.

Within the diagnostic impression section they say "it would appear that these distresses is chronic and would appear that the veteran would have a difficult time obtaining and maintaining employment given their physical complaints and current level of distresses.

Do you believe this is grounds for a notice of disagreement and request a higher rating? I also wonder if they bothered to read the notes in detail.

Opinions Please

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I have borrowed this wonderful information from

another web site, authored by Patrick428, who also

posts at Hadit on rare occassions.

I do not think he will mind me sharing this information

with you and I take no credit for writing it.

Hope this helps a vet.

carlie

So to start with I will describe many common terms needed to be understood and given examples when warranted.

R/O (Rule Out): Is a term found on either Axis I or II saying that there is not enough evidence to support the diagnosis at this time.

Deferred: Is a way of a clinician saying, "I just met you and I am not sure if you have this or not." Usually found when the patient has first entered the mental health system or has been out of the mental health system for a long period of time.

Secondary: Disorders that have manifested because of the first or primary disorder and also contribute to the severity of the primary disorder.

A full diagnostic example is as follows. There are varieties of how they are written, but this is the universally accepted model:

Axis I: Major depression, recurrent without psychotic features (Primary)

Generalized Anxiety Disorder (Secondary)

Axis II: Borderline Personality Disorder or None

Axis III: Ulcers and heart problems (usually medical problems that contribute to the mental disorder)

Axis IV: Psychosocial Stressors: Lose of employment and child abuse

Severity: 1 None; 2 Mild; 3 Moderate; 4 Severe; 5 Chronic

Axis V: Current GAF: 50

Highest GAF past year 60

GAF : Is referred to as Global Assessment of Functioning. This is a scale from 1 - 100 suggesting a pattern of behavior at any given movement in time. GAF is a fluid score and is never static (think of your blood pressure when applying GAF). The lower the score more problematic behavior becomes.

91 - 100 Not much happening and you can tolerate most stress very easily. (Blood pressure normal)

81 - 90 Some minor setbacks, maybe late bill that was not paid causing a flurry of minor stress, but is usually resolved. (Blood pressure slight elevated, but returns to normal rapidly)

71 -80 Minor problems within the home (work) and some stress that is enduring, but usually dealt with. They called about the bill that you forgot to pay (Blood pressure slightly elevated).

61 - 70 Minor to moderate problems such as not having the money to pay the bill and you are under pressure by your creditor to pay it. (Blood pressure is elevated and in need of attention).

51 - 60 Your being sued for not paying your bill, and your wife or husband has announced they are tired of living this way. Your kids do not know who you are anymore. (Blood pressure above 140/90 and dual medications are needed).

41 - 50 Wife or husband announces they are leaving and the bill collector has placed a lien on your property. You have called your creditor and your spouse idiots and you say to hell with them. (Blood pressure is severe and strong doses of medication are needed)

31 - 40 You threaten to kill your creditor and your spouse and everyone around you is against you. (Blood pressure is in the stroke range).

21 - 30 You bought a weapon and can of gas and your going to resolve the issue once and for all. It causes you to be either incarcerated or committed. (Blood pressure is causing severe chest pains and your stroking).

11 - 20 The best you can do is verbally babble and drool on yourself. (Blood pressure has caused a stroke).

0 - 10 You are no longer with us as you now live in a parallel universe. (It does not matter now).

It is not my intention to make light of the scale, but I wish to show the reality of the levels.

Axis I. A grouping of mental syndromes from a common etiology or pathology. What is usual found on Axis I disorders are: Mood, Sexual, Psychotic Substance Abuse, Child Disorders (except Mental Retardation), and Organic Syndromes (e.g.,Depression caused by a stroke).

Axis II. Are disorders of the Personality and Mental Retardation. Here Personality Disorders in Cluster A, B, and C are found.

Cluster A. Disorders deemed to be problems associated with peculiar behaviors(Schizoid).

Cluster B. Disorders where the individual violates the right of other people and often has little regard for others (Antisocial).

Cluster C. Disorders where dependency and inability to fit in socially with others is the common theme(Avoidant).

Personality is how one perceives, relates, and thinks about the environment and of oneself.

Personality Disorder is a maladaptive problem with the personality that causes extensive interference and ability to function in society. This is a pervasive pattern of behavior manifesting itself in the early development of an individual and prevents the individual from functioning normally in society.

Illusion: An illusion is a visual perception or misinterpretation of something real.

Hallucination: A hallucination is a false perception of a sensory experience (tactile, visual, auditory, taste, smell, or in body experience).

Delusion: Is a false belief carried to an extreme.

Psychotic. Loss of touch with reality

Depersonalization: Feelings of detachment from others. Feelings like being one's own dream.

Affect: Mood behaviors. Moods can be blunted, flat, inappropriate, labile (frequent mood changes), and restricted.

PTSD: Post-traumatic Stress Disorder. Can come in forms of mild, moderate, severe, chronic and delayed. May be seen on Axis I written as: PTSD, Chronic and Delayed.

Psychiatrist: Is Medical Doctor who specializes in mental illness and uses medications for its' treatment.

Psychologist: Is a person who performs psychological testing, assessment, and therapy.

M.S.W. Master's in Social Work and usually coordinates community-based programs and also performs therapy. But is restricted to therapy only.

Psychological Battery includes:

Personality Inventory (MMPI, etc)

Intelligence Scale (IQ test Wechsler or Stanford-Binet)

Neurological Tests (Bender-Gestalt, Wechsler Memory Test, etc).

Mood Inventories (Depression Scale; Anxiety Scales)

Trauma Scales (Mississippi, TSI)

Mental Status Examination

History

Mental Status Examinations:

Mini Mental Status exam - 20 minutes

Full Mental Status Examination - 1 hour

Specialized Tests as warranted for the purpose of narrowing the cause of many problems.

I am sure I left a few things out, but wanted you to have a general idea of the COMMON terms seen. In 98% of cases this is the information seen by the patient. Therapy modalities vary with each practitioner and as is often the case a practice or clinic is staffed with practitioners with like ideas of therapy. It should not be construed simply because a Psychiatrist or Psychologist is licensed that they are specialist in every aspect of mental illness. This is not true.

When either suggests they can handle any your problems regardless of your disorders, then seek other help. To find a good therapist this is a good rule of thumb:

1. Ask around

2. Ask your medical physician who is good at what you need to deal with.

3. Ask the local Psychology or Psychiatric Association for a referral

4. Call the respective State Board and check for Board Certification and Credentials.

5. Call the national associations ( both APA's) and get advice

6. If you are in the VA system and do not like the practitioner you have, request another.

7. Talk to other vets about their experience if they share it. Remember this is probably the most unreliable referral.

8. READ AND DON'T ASSUME

9. RESEARCH YOUR DISORDER

10. ASK QUESTIONS (Practitioners are not mind readers).

I hope this will help out in many ways. It is not all inclusive and I will from time-to-time add information that is either brought to my attention or comes to light..

Patrick

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Carlie,

Great find, that really makes it easy for us JARHEADS to understand.

Thanks, SGT Sandman

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