What diagnostic code and rating percent did they give you for the
adjustment disorder with mixed anxiety and depression?
That is a ratable condition,if there was a service nexus.
I will try to find your past posts.
CUEs are found within decisions and rating sheets and depend on established medical evidence.
It seems to me that the examiner, in 2015, referred to established medical evidence.
Have you filed a NOD yet?
"CONCLUSIONS OF LAW
1. The criteria are not met for an effective date earlier than August 12, 2004, for the grant of service connection for adjustment disorder with mixed anxiety and depression. 38 U.S.C.A. § 5110 (West 2014); 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.400 (2015).
2. The criteria are not met for an effective date earlier than May 16, 2006, for the grant of service connection for headaches. 38 U.S.C.A. § 5110 (West 2014); 38 C.F.R. §§ 3.1, 3.105, 3.151, 3.155, 3.156, 3.400 (2015).
3. The criteria are met for an initial rating of 100 percent for adjustment disorder with mixed anxiety and depression for the period from August 12, 2004 to January 8, 2015. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.340, 4.1-4.14, 4.21, 4.126, 4.130, Diagnostic Code 9411 (2015)."
All non VA C & P PTSD DBQ's, are Trumped by the C & P DBQ. The C & P Exam is "Forensic" in nature, Could you see your Private Dr, Psychiatrist or Psychologist, indicating that they think your over reporting your symptoms.
Even with the VA, your treating MH Dr is required by VA Reg, to hand off your request for a PTSD DBQ to another MH Dr that is and has not been directly involved in your treatment. The whole Dr/Patient Trust thing comes in to play, they don't want you pissed at your treating Dr because of an unfavorable DBQ.
As to your mentioned GAF Score of 53. 5 different MH Clinician's could come up with a wide ranging GAF Score, on the same day. That's why, the VA now uses the DSM V in DXing of PTSD. GAF scores are now of little or no significance. I can't recall seeing the GAF Score mentioned on any recent VA PTSD DBQ's postings here on Hadit. The old DSM-IV, used by the VA pre 2014, actually requested the GAF estimate for PTSD (other MH conditions also) be listed.
Keep in mind, your PTSD C & P Exam is FORENSIC, nothing to do with treatment. Tell the Truth, be yourself, don't attempt to present yourself as any better or worse than you actually are, on a daily basis. Not unusual to have the Dr asked the same question 3 or more different ways.
At the very end of the C & P exam, ask the Dr what his opinion of your condition is. If he's a VA VMC Dr, your C & P DBQ should be available from the VMC Med Records Dept and actually on your MHV Med Records in about 4- 5 days.
Armorer, I hear ya, many Vets have that same initial opinion. The VA, like most Private RX Ins Providers, has an RX Formulary, that they use. I was on Lipitor (01/2006) back in 09, when I 1st got hooked up with VA. VA's Formulary called for Simvastatin and my Private Dr didn't stipulate, Lipitor only.
So I tried the Simvastatin. for about 1 yr, kept the Cholesterol #'s in check but started getting hell-latios Charley-horses late at night, in my thighs. Contacted my VA PCP, within 1 week, I started receiving the non-formulary Lipitor.
The VA can and will supply you with any RX that you need, even if it's not on the VA Formulary. You can understand them, like all RX providers, preferring to use the most cost effective drug available.
Just about all Rx's have some type of possible side-affect. the VA doesn't lock you into the (1) drug.
As to Butcher's situation. You know, all Private Hospital ER's must treat you, right. It doesn't matter what your Insurance situation is, Private, VA or Uninsured. Hospitals, unlike Private Dr's, can not refuse a Vet using the VA Emergency Room coverage. I don't think that is Butcher's problem.
VA regulations covering Non-VA Hospital ER coverage requires the Vet, Hospital ER Staff and/or the Vet's next Of-Kin, to notify the nearest VMC almost immediately, regarding the Non-VMC ER Admission. Doing so gets the entire ER Bill covered, not doing so puts you in a real Trick Bag. Given the option, Private Hospitals will go to the fastest and most lucrative payer, Insurance Companies, private Individual and lastly the VA. If the VMC doesn't have a bed or Care required by the Vet's ER Condition, the VMC Chief can authorize continued care after the the Vet is Stabilized. Otherwise, the VMC will arrange Ambulance transfer to the VMC after the VEt is stabilized.
The Rule of Thumb for Vet's, present your VA ID and request the ER Staff contact the nearest VMC. Keep your Medicare or other Medical Insurance card, hidden in your wallet (Don't mention your other Ins coverage), incase your unconscious and not accompanied by a knowledgeable family member. Both Medicare and Private Insurance companies have a sizable co-pays, 20% of $100K, would definitely FU your Day. Don't take the chance, follow the VA Rules, much easier and less stress.
VHA Directive 2013-002
Quote from the directive:
"(a) A “no wrong door” philosophy must be adopted to accommodate Veterans bringing a DBQ to a VHA facility. Veterans may ask their Primary Care Providers (PCPs) and Specialists to complete a DBQ for conditions which are already diagnosed and documented and for which the PCP or Specialist is treating the Veteran. DBQs can be completed during a routine office visit when there is sufficient time and the medical information is available. DBQs can also be completed outside of an office visit, or an appointment can be scheduled for completion. A DBQ completed by a PCP or Specialist is considered by VBA as medical evidence to support the Veteran’s claim. VHA DIRECTIVE 2013-002 January 14, 2013 3
(b) If the VHA clinician is not confident completing a DBQ or finds the DBQ requires diagnostic testing not indicated in the history or current symptoms, or would otherwise be inappropriate to complete, the VHA clinician must not complete the DBQ but assist the Veteran in filing a claim for disability benefits. Depending on local processes, this may include directing the Veteran to the Veterans On-Line Application (VONAPP); to the VA benefits call center at 1-800-827-1000; to a Veterans Service Organization representative; or to other local resources.
(c) VHA clinicians who are not disability examiners may complete DBQs via the CAPRI or SMART programs, when available. DBQs may also be completed through the Web site: http://www.benefits.va.gov/TRANSFORMATION/disabilityexams/. If a paper version of a DBQ is presented by a Veteran for completion, staff must copy the completed form to scan into the Computerized Patient Record System (CPRS). The original DBQ form must be returned to the Veteran so that the Veteran can submit it to VBA.
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