Disability Benefits Questionnaires

[manning01]

Cooter, I'm not sure I understand your situation fully, but to answer re the letters: There are now DBQs for almost every condition, mental & physical. The new letter format is called SNL (simplified notification letter). Basically you will not be getting the huge ponderous ratings with all the explanations as to how we determined your claim. Instead, the ratings will be short & sweet, with only grants or confirm&continue ratings listed. The actual notification letter you get will explain the decisions, but not in depth like it used to be. (ie: if you claim hypertension & none was found in either your service or treatment records, the denial will simply read along the lines of "denied because there is no diagnosed condition."). The DBQ format of the exams allows the rater to more accurately input the evaluation, and lessens the chance that a doctor will miss discussing a key element (such as range of motion for a joint or if thee's arthritis) because they are all bulleted and must be answered in the same order by the doctor as we input them into our ratings.

I just went to a C&P yesterday which was very good I do like these new forms they fill on the computer very detailed and it covered everything. So I guess a lot less of they forgot to put in a certain ROM etc and sending it back to the VAMC for more info or clarification. But my question I don't see anywhere for them to make the service connection statement like in the past i.e. most likely, least likely, is caused by military service etc. Unless they can put that in the remarks section XVII. Are they now leaving it up to the raters on review of all the evidence to make that determination?

[etihwr]

Actually Veldrina your wrong!

You stated "Also, sometimes folks put in for things that are actually the same issue, such as insomnia, memory loss, depression, anxiety and PTSD. While it sounds like 5 issues, in reality all mental conditions are one, & all those conditions are symptoms of most mental conditions (ie anxiety can appear under both depression & PTSD, insomnia can occur under anxiety, depression or PTSD, etc.). By claiming it as "a mental (or psychiatric) condition to include: PTSD, depression, sleep problems, memory problems," etc, or something like that, you can condense the issues into one."

You only have one brain so PTSD and Depression though rated as one can actually be helpful to each other. If you were to be 30% for PTSD and the rater feels worse than 30% for Depression you will be rated Depression w/PTSD at 50%. If they didn't do that, they are not doing their job. The benefit of the doubt rule should be applying. Also all the mental healh issues can come with sleep issues but they sleep issues can be rated seperately. People do get sleep studies and have been found to have restless leg syndrome and/or sleep apnea. Sleep Apnea can be linked to PTSD.

You can do a NEXUS letter to link Sleep Apnea to PTSD and Depression. Get your doctor or doctors to write the nexus letter (see attached) so you can get linked to your sleep issue. 50% for PTSD and 50% for Sleep Apnea is an 80% rating.

Am J Geriatr Psychiatry. 2010 Jun 10. [Epub ahead of print]

Sleep-Disordered Breathing in Vietnam Veterans with Posttraumatic Stress Disorder.

Yesavage JA, Kinoshita LM, Kimball T, Zeitzer J, Friedman L, Noda A, David R, Hernandez B, Lee T, Cheng J, O'Hara R.

From the Department of Veterans Affairs Health Care System (JAY, LMK, TK, JZ, TL, JC, ROH), Palo Alto, CA; Department of Psychiatry and Behavioral Sciences (JAY, LMK, TK, JZ, LF, AN, BH, TL, JC, ROH), Stanford University School of Medicine, Palo Alto, CA; and Memory Center (RD), CMRR - CHU, University of Nice Sophia, Antipolis, France.

Abstract

OBJECTIVE: To study the prevalence of sleep-disordered breathing (SDB) in Vietnam-era veterans.

METHODS: This was an observational study of Vietnam-era veterans using unattended, overnight polysomnography, cognitive testing, and genetic measures.

RESULTS: A sample of 105 Vietnam-era veterans with posttraumatic stress disorder: 69% had an Apnea Hypopnea Index >10. Their mean body mass index was 31, "obese" by Centers for Disease Control and Prevention criteria, and body mass index was significantly associated with Apnea Hypopnea Index (Spearman r = 0.41, N = 97, p < 0.0001). No significant effects of sleep-disordered breathing or apolipoprotein status were found on an extensive battery of cognitive tests.

CONCLUSION: There is a relatively high prevalence of SDB in these patients which raises the question of to what degree excess cognitive loss in older PTSD patients may be due to a high prevalence of SDB.

PMID: 20808112 [PubMed - as supplied by publisher]

Prim Care Companion J Clin Psychiatry. 2010;12(2). pii: PCC.07m00563.

Correlates of daytime sleepiness in patients with posttraumatic stress disorder and sleep disturbance.

Westermeyer J, Khawaja I, Freerks M, Sutherland RJ, Engle K, Johnson D, Thuras P, Rossom R, Hurwitz T.

Mental Health Service, Minneapolis VA Medical Center, Minneapolis, Minnesota ; Department of Psychiatry, University of Minnesota, Minneapolis ; and Department of Psychology, University of Texas, Houston.

Abstract

OBJECTIVE: To assess the correlates of daytime sleepiness in patients with a lifetime diagnosis of posttraumatic stress disorder (PTSD) and ongoing sleep disturbance not due to sleep apnea or other diagnosed sleep disorders.

METHOD: The sample consisted of 26 veterans receiving mental health care at the Minneapolis VA Medical Center, Minneapolis, Minnesota. The Epworth Sleepiness Scale was the primary outcome measure. Other sleep-related instruments consisted of the Pittsburgh Sleep Quality Scale, a daily sleep log, and daily sleep actigraphy. In addition, data included 3 symptom ratings (Posttraumatic Stress Disorder Checklist, Clinician Administered PTSD Scale [CAPS], and Beck Depression Inventory). Data were collected from 2003 to 2005. Current and lifetime PTSD diagnoses were based on DSM-IV criteria and were obtained by experienced psychiatrists using the CAPS interview.

RESULTS: Univariate analyses showed that daytime sleepiness on the Epworth Sleepiness Scale was associated with daytime dysfunction on the Pittsburgh Sleep Quality Index (P < .001), less use of sleeping medication (P = .02), and more self-rated posttraumatic symptoms (P = .05). Within posttraumatic symptom categories, hypervigilance symptoms were more correlated with daytime sleepiness (P = .03) than were reexperiencing and avoidance symptoms (P = .09 for both).

CONCLUSION: In this selected sample, daytime sleepiness was most strongly and independently associated with daytime dysfunction.

PMID: 20694134 [PubMed]PMCID: PMC2910986Free PMC Article

Chest. 2009 May;135(5):1370-9.

Update on sleep and psychiatric disorders.

Sateia MJ.

Section of Sleep Medicine, Dartmouth Medical School, Section of Sleep Medicine, Lebanon, NH 03756, USA. msateia@dartmouth.edu

Abstract

Current data demonstrate a high rate of comorbidity between sleep disorders and various psychiatric illnesses, especially mood and anxiety disorders. The disturbance of sleep quality and continuity that is associated with many sleep disorders predisposes to the development or exacerbation of psychological distress and mental illness. Likewise, the presence of psychiatric illness may complicate the diagnosis and treatment of sleep disorders. This focused review examines the literature concerning the interaction between major International Classification of Sleep Disorders, 2nd edition, diagnoses and psychiatric conditions with respect to sleep findings in various psychiatric conditions, psychiatric comorbidity in sleep disorders, and reciprocal interactions, including treatment effects. The data not only underscore the high frequency of psychopathology and psychological distress in sleep disorders, and vice versa, but also suggest that combined treatment of both the mental disorder and the sleep disorder should become the standard for effective therapy for all patients.

PMID: 19420207 [PubMed - indexed for MEDLINE]Free Article

Sleep Med Rev. 2008 Jun;12(3):169-84.

Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature?

Spoormaker VI, Montgomery P.

Centre for Evidence-Based Intervention, University of Oxford, 32 Wellington Square, Oxford, OX1 2ER, United Kingdom. spoormaker@sleephealth.eu

Abstract

Sleep disturbances are often viewed as a secondary symptom of post-traumatic stress disorder (PTSD), thought to resolve once PTSD has been treated. Specific screening, diagnosis and treatment of sleep disturbances is therefore not commonly conducted in trauma centres. However, recent evidence shows that this view and consequent practices are as much unhelpful as incorrect. Several sleep disorders-nightmares, insomnia, sleep apnoea and periodic limb movements-are highly prevalent in PTSD, and several studies found disturbed sleep to be a risk factor for the subsequent development of PTSD. Moreover, sleep disturbances are a frequent residual complaint after successful PTSD treatment: a finding that applies both to psychological and pharmacological treatment. In contrast, treatment focusing on sleep does alleviate both sleep disturbances and PTSD symptom severity. A growing body of evidence shows that disturbed sleep is more than a secondary symptom of PTSD-it seems to be a core feature. Sleep-focused treatment can be incorporated into any standard PTSD treatment, and PTSD research needs to start including validated sleep measurements in longitudinal epidemiologic and treatment outcome studies. Further clinical and research implications are discussed, and possible mechanisms for the role of disturbed (REM) sleep in PTSD are described.

J Clin Psychiatry. 2007 Aug;68(8):1257-70.

Sleep disturbance in adults with posttraumatic stress disorder: a review.

Lamarche LJ, De Koninck J.

School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.

Abstract

OBJECTIVE: To present a critical review of the literature and research on sleep difficulties in adults with posttraumatic stress disorder (PTSD), more specifically the existing treatment options, and to formulate recommendations regarding future treatment approaches and research related to sleep and PTSD.

DATA SOURCES: The following databases were consulted: PsycInfo (1872-2006) and MEDLINE (1966-2006). The search was conducted using the following key terms: PTSD and sleep, PTSD and nightmares, PTSD and dreams, PTSD and insomnia, PTSD and periodic limb movement disorder, and PTSD and sleep disordered breathing. Only studies examining sleep disturbance among adults with PTSD were included, and only articles written in English were consulted.

STUDY SELECTION: Studies and reviews related to the prevalence, causes, and treatments of sleep disturbance among adults with PTSD, as well as those examining the relationship between sleep and PTSD, were selected.

CONCLUSIONS: Promising treatment options are available for treating sleep difficulties among adults with PTSD. In particular, cognitive-behavioral therapy including a component for nightmares (imagery rehearsal therapy) and insomnia has been found to significantly improve sleep disturbance among these individuals. It is proposed that with the inclusion of other components, such as a screening for other sleep disorders, relaxation exercises, positive self-talk, imagery rehearsal related to recurring images before bed, and a daytime nap, sleep-related symptoms may improve to a greater degree, which may then lead to a significant decrease in other PTSD symptoms and overall PTSD severity. The inclusion of sleep medicine specialists should also be considered for sleep medicine treatment of individuals with PTSD. Collaboration between mental health professionals and sleep medicine specialists is therefore recommended for treatment of sleep-related difficulties among individuals with PTSD.

PMID: 17854251 [PubMed - indexed for MEDLINE]

Tijdschr Psychiatr. 2007;49(9):629-38.

[sleep disturbances in post-traumatic stress disorder. An overview of the literature]

[Article in Dutch]

van Liempt S, Vermetten E, de Groen JH, Westenberg HG.

Onderzoekscentrum Militaire Geestelijke Gezondheidszorg Defensie, Centraal Miliair Hospitaal, Postbus 90.000, 3509 AA Utrecht, Netherlands. s.vanliempt@umcutrecht.nl

Abstract

BACKGROUND: Nightmares and insomnia are experienced by 70% of patients suffering from post-traumatic stress disorder (PTSD). These sleep problems are often resistant to treatment and exert a strong negative influence on the quality of life. In the last few decades several studies have reported on the characteristics of sleep disturbances in PTSD.

AIM: To provide an overview of objective features of sleep disturbances - as opposed to self-report methods - in patients with PTSD.

METHOD: Articles on this topic, published in peer-reviewed journals between 1980 and the present, were retrieved from Medline and Embase, using the search terms 'PTSD', 'sleep', 'nightmares', 'insomnia', 'polysomnography'.

RESULTS: Studies reported on changes in sleep efficiency, arousal regulation, motor activity during sleep, rem characteristics and delta sleep activity during sleep. Also, correlations were found between nightmares and sleep apnoea in ptsd. In some studies on sleep disturbance no objective sleep disturbances were found in PTSD patients. However, most studies on PTSD related sleep disturbances were conducted in small, heterogeneous groups, and results were therefore inconsistent. Even the results of larger and more homogeneous studies were sometimes contradictory.

CONCLUSION: There is a discrepancy between the clinical importance of sleep problems in PTSD and unambiguous objective sleep disorders. Future research should try to establish objective criteria for identifying the altered sleep patterns in PTSD. These criteria should help us to understand the neurobiological mechanisms of sleep disturbances in PTSD and develop new treatment strategies.

PMID: 17853372 [PubMed - indexed for MEDLINE]Free Article

case report sleep apnea PTSD.pdf

Nexus Letter.doc

[yelloownumber5]

Vel,

How about this "Generaly, pain is not a diagnosis. However, ........................"

yep!

remember, "pain" is not a compensable disability under VA regulations. But yes Coot, it would help if doc said that.

Race, if u have 10 other issues, u could put them all in, but again i will stress that the more issues u bombard the V with, the less chance of getting it resolved quickly. Also, sometimes folks put in for things that are actually the same issue, such as insomnia, memory loss, depression, anxiety and PTSD. While it sounds like 5 issues, in reality all mental conditions are one, & all those conditions are symptoms of most mental conditions (ie anxiety can appear under both depression & PTSD, insomnia can occur under anxiety, depression or PTSD, etc.). By claiming it as "a mental (or psychiatric) condition to include: PTSD, depression, sleep problems, memory problems," etc, or something like that, you can condense the issues into one.

Edited July 29, 2012 by yelloownumber5

[MarkInTexas]

I find it kind of humorous that the VA would consider that a Veteran "bombards" them with multiple issues when they file a claim. Considering that many mlitary members separate, or at least used to, without any real counseling regarding existing conditions, and what options are avalable to them. And unless things have changed, there isn't any friendly separation briefing about filing claims within a certain amount of time, what benefits a Veteran is eligible for if they do file a claim prior to separation or immediately afterward. I know that it's been a long time since I separated back in 1994, and that the Internet has helped all of us tremendously. (I would not have had a clue about what benefits were out there if it weren't for the Internet to be honest.)

However, if an individual(s) is paid to do a job, and if they are taking tax payers money to do their job, for which they receive monetary compensation themselves, then they are public servants, and any attitude that a Veteran is a burden, or that their claim is a burden, simply because they filed a claim with multiple conditions is completely negligent.

What a lot of the civilians working in the VA, along with many others, fail to recognize is that our military is an all-volunteer force, and that all of these military members and veterans volunteered and gave years of their lives to serve their country to protect those same people that feel a little irritated and overwhelmed at having to review a multi-condition compensation claim. And as for the non-volunteer veterans that were drafted, I hope that these poor overworked, overburdened office workers sitting in their air conditioned offices, playing Angry Birds or checking their Facebbok status remember that the draftees were taken from their normal everyday lives, trained and sent off to war to protect them, their parents and their grandparents, and then returned later (if they were lucky enough to survive) back to their hometowns with illnesses, conditions and other conditions that would not manifest for years, even decades later.

And keep in mind that in those days, and to a lesser extent now, it was not considered popular to be disabled or to "ask" the government for assistance, even medical, for fear of the stigma of being labeled as getting government assistance. I know I personally was in turmoil over filing for quite some time before I actually sat down to start climbing the mountain of paperwork that the VA "bombards" uninformed Veterans with. (And before anybody takes it the wrong way, yes......the VA makes us "ask" them for assistance, and then prove exponentially why we need it. You can be healthy, never served a day of mlitary service in your life, and get tens of thousands of dollars of government assistance annually, including 100 percent medical/dental care, free tuition to higher education, and nobody bats an eye, and they call that an "entitlement".) We have to file for and justify ourselves each step of the way, and quite often multiple times for a single condition.

I know that just as far back as 1994, most men and women who were separating were afraid that the doctor would put something down on their exit examinations that might slight their chances at some civilian career. I know now that this was foolish youth, and that 90 percent of employers that I've encountered don't really even ask to see or request copies of military medical examinations. (Some will though.) Most veterans upon separation want to be identified as healthy and capable, and don't know about what options were/are available to them, until in many cases, it is too late.

I say this because conditions do affect us as we grow older, and what was small then, may be a major problem now. And the VA isn't exactly opening its doors to Veterans and providing counseling on how to file their claims properly, even though this would be the best and most proper way to allow a Veteran to enter the system, or better still hiring VA "counselors" who actually sit down and complete forms/applications with the Veterans. (The government provides information and counseling on just about any other program that is out there to assist claimants "before" they file a claim.) The VA is the only government entity I know of that tells you to file it, and gives a disclaimer that they'll do only what they have to do, and the rest is up to you.

If I'm wong on any of this, please somebody jump in and correct me.

I'm sorry I rambled so long. I hope that I didn't bombard you guys with too much. Have a great Sunday.

Mark

Edited August 5, 2012 by MarkInTexas

[roses15534]

I just got my rating increased from 30% to 80% and on the decision letter it stated for my fibromyalgia condition went from 10% to 40% and it said note an examination will be scheduled at a future date to evaluate the severity of your service connected fibromyalgia. Now they just did a comp and pension on it why are we doing this again? when will this be? what is it for really?

[justrluk]

roses: it's a boiler-plate response for conditions the VA thinks could improve over time. I've had the same thing for Migraines.They stated in the award letter that an appointment would be made to follow up and act as the "future exam". That was due last November and I've not heard from them on this issue since.