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This eBook will teach you how to get C-Files (paper and electronic) from the VA Regional Office.
How to Get your VA C-File




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    • CUE? Not using SMR?
      Yes, if they notice the CUE they can adjust on their own.  I just had the EED adjusted on my initial claims for asthma and left ankle, the rater looked at my entire record while processing my unadjudicated claim for diabetes.  He immediately file a cue and adjusted the EED.  I didn't have to do anything for the EED/CUE. However, my ED was actually a CU they started them in 98 vs. 97.  
    • C&P Exam Results, WTH is going on, Please Help!!!
      Agree with killemall. You got this Navy04, we can't wait for you to come back here and say DONE!    
    • Code Sheet
      Thanks Asknod My problem is finding out the code for the disability.?? PTSD Code has it at 9411&9435 Code for Unspecific Depresssive Disorder VA Notes from  PCP  has PTSD  As : SCT47505003  My Sleep Apnea Notes has the code as SCT 73430006, Some of these I get confused with Insurance Codes  for Insurance Purposes. Jbasser & Jerrel Cook had a blog talk radio show on these rating codes Last year some times Maybe I'll recheck the Archives Shows. I tried to look up the code for OSA but never found it. just the SCT #73430006..?  And I have a Boo-Coo List of NSC disability's/contentions.  with the SCT# at the end of them
    • Auto Adaptive Reimbursement
      Update. My friend talked to the head of prosthetics in Tucson(kristine) and she informed him that the VA will not cover some items like power options,automatic transmissions and a few others.(I can't remember the list of things he told me).These were all covered by the VA previously.
    • NOD / DRO or TARP?
      All, Thank you for the response's. Due to me posting all of my documents intermittently, there seems to be some confusion with the timeline and issues. I will attempt to run thru this chronologically and repost all documents including my 2015 decision which I had not previously posted and answer all questions. March 2009- Filed original Claim for the following issues and received results October 2009 (see 2009 - Rating Sheet below) I do not have the entire decision packet: TBI - 10 % SC Residuals, gallbladder removal - 0% SC Back Condition - declined SC Psoriasis - declined SC PTSD - declined SC / Stressor conceded as combat action badge. October 2010 - Filed NOD / DRO for PTSD March - 2011 - Appeal decision received. I never stated that PTSD was due to MST. The paragraph on page 2 of 2011Appeal decision below is just the last part of 10 pages that I cut out covering rules and US code that they sent in the letter. The actual decision starts at the bottom of that page. Results: PTSD declined - I did not submit any new evidence. Diagnosed as "adjustment disorder with mixed anxiety and depressed mood". Blamed on me worrying about my husband returning to Iraq, even though he had just returned??? October 2014  - Initiated following claims: (I had transferred to the North Texas VA and had finally began receiving treatment after being fed up with OKC VA. I live in southern Oklahoma, so its a drive for me to go to either one) PTSD - Re-open Claim. TBI - Request for increase. May 2015 -  I reported for C&P exams at the Dallas VA clinic for PTSD and TBI. I'm not sure if this is relevant, but I received a call while my husband and I were driving there stating that the TBI examiner had to leave early and they would have to re-schedule that exam. I protested because it is a 3 hour drive. They called me back 10 minutes later stating that he would conduct the exam. He seemed pissed the whole time. His notes stated that No TBI residuals were present.  This is also the exam where the PTSD screener stated "However, it should be pointed out that most of the symptoms the veteran described during today's MH examination certainly those common to a PTSD diagnosis- she also described during her 7/8/09 Initial PTSD examination, in Oklahoma City, three years PRIOR to her son's illness."  ( see 2015 C&P exam notes below) June 2015 - Latest decision received. Results (see 2015 - decision part 1 &2 below): TBI - Decreased to 0% SC PTSD - 50% SC May 2016 - Wondering what my best next COA should be? Would like to get PTSD effective date back to 2009 and get TBI increased to at least percentage it was before. I have about 50 days to file my NOD. Q&A: Berta: What did the C & P doc diagnose you with? 2009 - TBI (SC) and adjustment disorder with mixed anxiety and depressed mood (not SC) 2015 - No TBI residuals and PTSD w/ major depressive disorder.   Berta: Have you googled the doctor who did the C & P? I do not know the Doctor's name from 2009. But I have found several articles referring to a Dr. Gail Poyner who was conducting PTSD exams at OKC VA at the time. She was fired from the VA in 2010 for applying test to Veterans to see if they were malingering or faking. Her research paper can be found here: http://link.springer.com/article/10.1007%2Fs12207-010-9076-x?LI=true I would like to have my C-File to see if she conducted the evaluation.   Gastone: What did you claim as the PTSD Stressors in your 09 app for PTSD? Combat Action Badge   Gastone: The 1st Denial, discussed "No Evidence of Personal Assault," MST? No MST ever claimed. The paragraph that covers PTSD due to MST was just the last paragraph of 10 pages of regulations that they sent with the decision. Actual decision starts at the bottom of that page.   Gastone: Did you know anything about the DRO Process Requirement, for the N & M Evidence? I did. My fault I didn't send any. I was fed up with OKC VA and assumed they would send me for a new C&P exam. Stupid on my part.   Gastone: Did you ever get a copy of your 09 PTSD C & P DBQ? No, I did not. Blue button records do not go back that far. I have requested a copy of my C-File. EBenefits states that I will get it between NOV 2017 and NOV 2018.   Gastone:  Do you currently have a VA MH Psychiatrist/Psychologist that treats you on a regular basis? I was being seen at Bohnam, TX VA. After they kept switching Dr's a few times, I now just get my meds re-filled thru my family physician. My husband is active duty, so we are on tri-care prime remote. I also qualify for VA choice, but have not used it.   Gastone: Have they given you an official PTSD DX? I have a PTSD diagnosis and receive 50% SC in 2015.   Berta: Did they have the incident reports? I faxed in two incident reports. They do not show on the evidence list, but stressor was conceded with CAB.   Flores97: Email congressman for C-File. Thank You for the advice. I emailed my congressman today and reiterated the time crunch I am under.     2011 - Appeal decision.pdf 2015 - C&P exam Notes.pdf 2015 - decision part 1.pdf 2015 - decision part 2.pdf 2009 - Rating Sheet.pdf
    • Full Knee Replacement
      I just came back from the Ortho doctor in town he said I need a full knee replacement for my service connected injury after looking at past 11 years of x-rays from the VA and what he just took today. The Marine Corps. somehow don't keep x-rays after a certain period of time. The VA says they will not do one until I'm 60 years old, all they wanted to do was give me injections for the pain. What I have now is a Torn ACL and I'm running bone on bone, and my knee cap is just about gone so here is the question. I already receive 20% for my left knee, due to the past 3 surgery's. So after having the knee replacement what will I be looking at? for an increase? Does the VA have to pay for this since I live 178 miles from the Nearest VA hospital? because they are still telling me if you were injured on active duty you must go to the VA hospital even through the VA says They will not do a knee replacement until I'm 60? I already talked to two Veterans in town at the Vet center and they had the same problem but they paid for it out of their own pocket for the surgery then filed for an increase award. So far they are still waiting for the VA to answer them back. any ideals on the best route to take? I hate to get this done out in a local hospital then fine out the VA will not pay and give me an increase for the full knee replacement. Thank for any information on this subject.
    • CUE? Not using SMR?
      I'm trying to piece together every decision and the docs from the c-file. I cannot for the life of me find the evidence listed as "treatment records from VAMC dated Sept 2003 and received 10-23-03.  Are they required to have the actual document/documents in the c-file as evidence? Also, there certainly were more progress notes about the foot conditions outside of Sept 2003. Would they have been required to get all records on condition from the VAMC?     Thanks as usual!
    • Code Sheet
      A filing for a disease secondary to an existing one is not an increase. Each disease that evolvves as a secondary is a stand alone claim. If you win, the rating diagnostic code will be an amalgam of the primary rating such as DC 7354 for hepatitis C and the second disease such as Porphyria cutanea tarda. The rating sheet would read 7354-7815. I have two like that. the other one is 7354-7700 ( 60% anemia -old 1994 DC 7700). I appealed for 100% for it based on the similarity to 4.115a (dialysis) because there was no 100% rating for porphyria phlebotomies-just 40% under DC 7704. It's called rating by analogy when there is no specific code for a disease/injury. Look at 38 CFRs 4.20 and 4.27   § 4.20 Analogous ratings. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin § 4.27 The diagnostic code numbers appearing opposite the listed ratable disabilities are arbitrary numbers for the purpose of showing the basis of the evaluation assigned and for statistical analysis in the Department of Veterans Affairs, and as will be observed, extend from 5000 to a possible 9999. Great care will be exercised in the selection of the applicable code number and in its citation on the rating sheet. No other numbers than these listed or hereafter furnished are to be employed for rating purposes, with an exception as described in this section, as to unlisted conditions. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be “built-up” as follows: The first 2 digits will be selected from that part of the schedule most closely identifying the part, or system, of the body involved; the last 2 digits will be “99” for all unlisted conditions. This procedure will facilitate a close check of new and unlisted conditions, rated by analogy. In the selection of code numbers, injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. With diseases, preference is to be given to the number assigned to the disease itself; if the rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. Thus, rheumatoid (atrophic) arthritis rated as ankylosis of the lumbar spine should be coded “5002-5240.” In this way, the exact source of each rating can be easily identified. In the citation of disabilities on rating sheets, the diagnostic terminology will be that of the medical examiner, with no attempt to translate the terms into schedule nomenclature. Residuals of diseases or therapeutic procedures will not be cited without reference to the basic disease.
    • CUE? Not using SMR?
      He had 3 0% disabilities that were combined to make the 10%. I guess that ended when he was awarded 30% PTSD IN 2003. 
    • Auto Adaptive Reimbursement
      He deals with a rep in Tucson but I think that falls under Phoenix.It was the Tucson rep that told him that they stopped doing it.I found the link you posted before I asked the question on here.I just wanted to make sure it was still an active program.I will pass this on to him.Thanks.

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stebarbar

Denied For Ptsd

Question

C7p was 9/2012 and denied ptsd 1/2013 stating no combat action ribbon and no dx by va pshchartrist but did have dx for ptsd 5/2012 . I now have a dx's by psychiatrist and psychologist numerous times and now have a combat action ribbon which I had to apply for since I got out in 1966 and CAR wasn't issued until 1969. under medication for anxiety and depression. Can anyone tell me if I have a good chance of receiving compensation. Thanks

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14 answers to this question

Nod that decision and include the evidence. ask for reconsideration.

send it certified return recipt

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Have you tried claiming for anxiety and depression to included PTSD?

Edited by free_spirit_etc

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What he said!

Nod that decision and include the evidence. ask for reconsideration.

send it certified return recipt

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VA will only service connect and compensate for 1 mental health condition. There are many symptoms that a veteran must be diagnosed with before the actual rating of PTSD. If you have a diagnosis of PTSD and can show chronicity of the treatment, (by medical records) then I would submit a VA FM 21-0958 (NOD). You do have to be diagnosed with PTSD by a VA Doc.

You do not have to be in combat to have PTSD. Which would be a basis for a NOD if that's why they denied you.

I explain to veterans that have been rated for a mental health condition other than PTSD when they believed they should of been diagnosed with PTSD. Does it really mater what the diagnosis is, if you are receiving the treatment necessary for your condition. The VA docs will adapt a program for you based upon your needs, I would believe that would be most important.

The compensation is going to be the same regardless of the diagnosis..

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C7p was 9/2012 and denied ptsd 1/2013 stating no combat action ribbon and no dx by va pshchartrist but did have dx for ptsd 5/2012 . I now have a dx's by psychiatrist and psychologist numerous times and now have a combat action ribbon which I had to apply for since I got out in 1966 and CAR wasn't issued until 1969. under medication for anxiety and depression. Can anyone tell me if I have a good chance of receiving compensation. Thanks

“no dx by va pshchartrist but did have dx for ptsd 5/2012 . I now have a dx's by psychiatrist and psychologist numerous times and now have a combat action ribbon which I had to apply for since I got out in 1966 and CAR wasn....”

You sure are right about the CAB ,Marine.

My husband was Vietnam vet, USMC 1964-1968 and his DD 214 was all screwed up until he applied for a DD 215 with a DD 149.

http://www.jag.navy.mil/legal_services/documents/DD149.pdf

Just put 'Not applicable' to the injustice part and tell them you want the CAR and any other potential decorations, awards missing from your DD 214 to be corrected on a DD 215.

and mail it to where the form directs you to.

I cant tell if you have the CAR formally on a DD 215 and the 215 is what the VA needs to see.(copy and sent with proof of mailing.)

Did you ever claim PTSD in a past VA claim that was denied?

That CAR certainly is good evidence for a stressor (which VA should concede)

Has your NOD been prepared yet?

“no dx by va pshchartrist but did have dx for ptsd 5/2012 . “

The 2012 Dx, …....was that from a VA psychiatrist?

How did the VA list that as evidence in the denial? (or didnt they list it and mention it in the denial

narrative at all ?

“I now have a dx's by psychiatrist and psychologist numerous times” VA shrinks????

Do you have a copy of the last PTSD C & P exam results?

You need to carefully read over the new 2010 PTSD criteria here

Is there any other BS reason in the denial except for the 'stating no combat action ribbon' ?

That has never been a PTSD criteria.for Vietnam Vets ..but it helps prove a stressor.

Re you able to scan and attach here this entire denial as to the Evidencxe list and Reasons and Bases? It sure sounds hokey to me how they handled your claim.

Cover your name, address and C file number if you can attach it here.

BTW my husband said they (Marines being mustered out in 1968 )were all herded into a big room in Quantico to fill out forms that ended up being the info on their DD214s. Most of them had no idea what decorations and medals they had gotten so they couldn't fill out the forms properly..... and they all wanted to get the heck out of there....

Almost 30 years later he applied for a DD 149 and was stunned by what decorations they added....

to include the PUC. (your unit might have gotten that too.....)

They sent him the American Medals but told him he had to purchase the Medals from the Vietnamese Gov at a BX or PX, as our gov does not make them.

I have been derelict in not applying for his CAR. Need to do that. They will award it posthumpously.

http://en.wikipedia.org/wiki/Presidential_Unit_Citation_%28United_States%29#Vietnam_War

This is what they awarded to 3rdMARDIV (who Zumwalt turned into 1st MARDIV)

“Presidential Unit Citation”

(It is about 2/3s down the list:)_

3rd Marine Division

U.S. Marine Corps

8 March 65-15 September 67

Vietnam War

Here is the whole thing....maybe some jarhead like my husband out there never got this on their DD 214 and should have received it:

:

“For extraordinary heroism and outstanding performance of duty in action against the North Vietnamese Army and Viet Cong forces in the Republic of Vietnam from 8 March 1965 to 15 September 1967. Throughout this period, the Third Marine Division (Reinforced), operating in the five northermost provinces of the Republic of Vietnam, successfully executed its three-fold mission of occupying and defending key terrain, seeking out and destroying the enemy, and conducting an intensive pacification program. Operating in an area bordered by over 200 miles of South China Sea coastline, the mountainous Laotian border and the Demilitarized Zone, the Third Marine Division (Reinforced) successfully executed eighty major combat operations, carrying the battle to the enemy, destroying many of his forces, and capturing thousands of tons of weapons and material. In addition to these major operations, more than 125,000 offensive counterguerrilla actions, ranging from squad patrols and ambushes to company-sizes search and destroy operations, were conducted in both the coastal rice lands and the mountainous jungle inland. These bitterly contested actions routed the enemy from his well-entrenched positions, denied him access to his source of food, restricted his freedom of movement, and removed his influence from the heavily populated areas. In numerous operations, the Third marine Division (Reinforced) demonstrated the great efficacy of combined operations with units of the Army of the Republic of Vietnam. In July 1966, the Third marine Division (Reinforced) moved to the north to counter major elements of the North Vietnamese Army moving across the Demilitarized Zone into the Province of Quang Tri; its units fought a series of savage battles against the enemy, repeatedly distinguishing themselves and, time and again, forcing the enemy to retreat across the Demilitarized Zone. Imbued with an unrelenting combat spirit and initiative and undeterred by heavy hostile artillery and mortar fire, extremely difficult terrain, incessant heat and monsoon rains, the Third marine Division (Reinforced), employing courageous ground, heliborne and amphibious assaults, complemented by intense and accurate air, artillery and naval gunfire support, inflicted great losses on the enemy and denied him the political and militart victory he sought to achieve at any cost. The outstanding courage, resourcefulness and aggressive fighting spirit of the officers and men of the Third marine Division (Reinforced) in battle after battle againsta well-equipped and well-trained enemy, often numerically superior in strength, and the great humanitarianism constantly shown to the people of the Republic of Vietnam, reflected great credit upon the Marine Corps and were in keeping with the highest traditions of the United States Naval Service.[31

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PS Jbasser gve you good info ...to file for reconsideration, if you havent filed the NOD yet BUT you would still have to file a NOD by the Jan 2014 deadline if VA doesnt act on the request.

I personally think you have bases to file for a request that VA CUE itself,if they were aware of the CAR by the time this decision was made.

The fact that they used this statement "denied ptsd 1/2013 stating no combat action ribbon" is an absolute clear and unmistakable error (CUE) whether they knew of the CAR by time of this decision, or not.

Still we need to see the actual denial decision or a direct quote in VA's own words.

Did the C & P examiner know of the CAR?

I wonder if any of these people have any clue at all on Vietnam..........

The fact that you did get the CAR indicates to me, that you probably had a list of stressors like my husband did.

Something stinks here.........on VA's part.

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I don't know how to scan and send. I read denial and stated no service connection of anxiety disorder as ptsd disorder . I also state no dx for ptsd, no combat medal,no service treatment records and no evidence of treatment for ptsd form service to present..My VA psychiatrist did dx me for ptsd 5/2102 4 months before C&P but didn't read the VA medical records. I received my dd215 this month showing the CAR and PUC for the 1st Marine Div. On 10/12/2012 Vfw VSO sent dd215, va medical report from 5/2012 of dx for ptsd by psychiatrist. I hope this helps and I really appreciate you imput. Thanks

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"I received my dd215 this month showing the CAR and PUC for the 1st Marine Div. On 10/12/2012 "

GREAT!!!!!

"Vfw VSO sent dd215, va medical report from 5/2012 of dx for ptsd by psychiatrist. I hope this helps and I really appreciate you imput. Thanks "

That is double Great!!!! A VA dx of PTSD!!!!

I think your VSO saw that they had definitely committed a legal error.

Did the VSO ask them to reconsider? Or point out their legal errors with what he sent?

In any event I am glad to see this fast update from you here.

And I knew you probably had the PUC as well.......Thank you for your exemplary service for the US of A!!!!!!

When my husband learned from the DD215 that his unit had the PUC he was at first kind of proud of that.,and started telling me some more about his experience in Vietnam regarding the "shoot them up -Patch them up stuff"....then within a few hours all hell broke loose

because he started to talk about a lot of other stressors he had ......he died 3 months after he got the DD 215 and I bought his Vietnamese medals when when my daughter graduated from Lackland BT at their BX in Texas some years after that.

He was 100% P & T SC for PTSD, 30% AO IHD, 1151 100% As if SC CVA, and SMC, death due to AO DMII award.2009)and Nehmer AO IHD award (2013) and dead due to piss poor VA health care (FTCA settlement and 1151 award for wrongful death.(1997-1998)

What do you get the 30% for now and do you think that is enough?

.

Edited by Berta

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many thanks for your input . The vfw vso sent a 21-4138 and it looks like an appeal and he also sent a letter I received 2 mos after I got out how our best friend was shot and was in critical conditioned and another team was ambushed and don't if any casualties yet. I still feel the guilt since I left after my tour in Vietnam. I was the only x grunt in the outfit who was trained all phases of guerrilla warfare. I was previous a 0341 and got transferred to shore party 1381 and the letter was to show shore party was out with the rifle companies and took casualties .

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I am surprised the VSO didnt request a reconsideration with the new evidence or call a CUE on them.

"I received my dd215 this month showing the CAR and PUC for the 1st Marine Div. On 10/12/2012 "

That is extraordinary new evidence! Make sure the VA has a copy of the DD 215.DId the VSO send in a copy of it with the 21-4138?

My husbands DD 215 was sent to VA over 20 years ago .I think their only mention of it (I had numerous claims since he died) was in my AO IHD award letter in 2012. He had been SCed for PTSD in 1983 so it was not an issue for his claim but will be in your case.

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Also I read somewhere that if you were in combat, they have to give more weight to what you tell them happened to cause your ptsd.

example I was shot at and knocked off of a tank by a sniper, but my ceramic plate saved me. they should not question that this actually occured .

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“they should not question that this actually occured . “ As long as there is a PTSD diagnosis from a VA MH professional.

you are correct in this respect :

“in the absence of clear and convincing evidence to 
the contrary, and provided the claimed stressor is consistent with the 
places, types, and circumstances of the veteran's service, the 
veteran's lay testimony alone may establish the occurrence of the 
claimed in-service stressor.”
from:http://www.hadit.com/forums/topic/51579-new-post-july-13-2010-new-regs-ptsd/

But they might.

The new PTSD regs and info in the above hadit link have helped OIF/OEF vets more than they helped Vietnam veterans,unless their claims for PTSD were filed within the specific dates...that should be in one of those links.

Also more info here.

Many vet lawyers, reps, veterans themselves and advocates like me fought these regs when they were published in the Federal Register for comments.

We were specifically alarmed at the required PTSD diagnosis that must come from a VA MH professional. An independent medical opinion diagnosing PTSD would not conform to the new regs.

The VA is probably the best in the world, in diagnosing and treating PTSD.

However, an arbitrary C & P, failing to diagnosis PTSD,when in fact the vet does HAVE PTSD from service, can save the VA big bucks.

Also Vietnam vets and other war vets still seem to need absolute proof of their stressor,unless they have the CAR,CIB,of PH on their DD 214.

Fortunately the internet has made it easier than it used to be for vets to not only get their inservice records but also find a buddy through their unit web sites,or even just by goggling the buddy's name.

A buddy who can give an eye witness account, placing them and the claimant at the same place and time of a stressor, can turn the tide on some PTSD claims whereby VA questioned the inservice stressor.

Also if the VA says they checked with JSRRC and JSRRC found no record of the stressor event, I say best that the vet write to JSRRC themselves (maybe VA just said they checked but didnt) or they can check the unit's history on line.

Obviously your situation might have occurred during a skirmish or battle,or even a brief incoming incident and it should be documented in the unit's morning reports.

But the circumstances alone,if they conform to the new PTSD regs, might get VA to concede this stressor.

I assume you were not seen by a medic or corpsman when this happened as,fortunately you sustained no injuries, and I have no doubt that this was a major stressful incident for you.

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I just got my psychiatrist notes and he dx'd for the 5 th time and 15 dx'x by psychologist. he said on 12/18/2013 ptsd symptoms anxious,easily startled,hpervigilant,having nightmares,having intrusive thoughts,mood status abnormal, agitated and irritabl but insightful. sleep fair. phq-2 screen score was 2 which ngative screen for depression.He little interest several days and feeling down or hopeless several days. this was wrong and should of been most days. I probably didn't communicate probably. he prescribed addl medicine buspar for anxiety and current medicine for depression and sleep disorder. Will this make a difference with the NOD and will dsm 5. THanks again.

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Was going to comment on the CAR (combat action ribbon) but Berta covered all the bases! At the time I retired, 2004, this award must mention the awardee BY NAME. I have an awards ALMAR (message the Marine Corps uses) that lists me and about 20 other Marines when we were awarded the CAR for action in Iraq. The regs were obviously non-existent or very different for Vietnam vets but as long as you have the papers you do, you should be in great shape moving forward.

Good luck and so sorry you have hit a bump in the road...Keep fighting, you will prevail!

LC

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