depression secondary to chronic pain

[Andyman73]

I finally did it.  I asked my MH doc if he thought I had enough basis for a claim.  He has me currently DXd with MDD.  He told me that while I do have MDD, he's not so sure I could be successful with that as a claim for SCD.  He asked me if I was 100%, I said no, but I am 80%.  And he asked, then, if I was being paid at 100%.  Said no, and he hmmmmm'd. 

Then I asked if chronic pain made any difference.  He said all depends.  I told him that I fell down a flight of stairs during my 5th day of boot camp back in November of '92.  Said I've been dealing with pain in my knees and lower back ever since that day.  And have developed other issues that cause more pain as well.  He asked if I have fibromyalgia, said no, not that I'm aware of.  Said most of my pain is in various joints...with only some of the pain in muscle groups only.  And that I've been dealing with radiculopathy for some time now, as well.

Then his whole countenance changed, I could see his brain working.  Told me that chronic pain plays a huge part in causing depression.  I mentioned faulty memory, sleep issues, chronic sinusitis and IBS also.  He said all those things for sure can and will and do cause depression.  He said I can't say if you'll get enough to get bumped to 100%, but I certainly do have enough for a good solid claim for depression secondary to chronic pain.

What should I submit for evidence?  Should I submit copies of every STR entry showing where I mention any pain and was prescribed something for the pain?  And every entry where I mention sleep issues, or drinking, or repeated bouts of IBS and sinusitis/URIs? 

I only filed it this past Friday, so I do have a few weeks to get this together and send it off.  Any and all suggestions are welcome, thank you in advance.

Semper Fi.

Andyman

[Andyman73]

flores,

I wrote a statement that I submitted with my evidence package.  I then wrote a 2nd statement where I wrote brief paragraphs covering all the topics I wanted to make sure we covered.  I gave the examiner one, and told him that I had sent a copy to the claims intake center, as well, to make sure the rater knew what I wanted to say, no matter what the examiner wrote.  I do have memory loss, my short term memory is virtually useless.  Which gets me into all kinds of trouble at home.  I covered that, too.

john999,

I have thought of the IMO, and certainly will if this comes back lower than 70%.  I am currently DXd by VA MH doc as MDD, and am in treatment with him.  He said that chronic pain is a very serious issue as it leads to more depression than most folks realize.  I sure hope that his opinion, submitted with my evidence, will counter that quack's words from my exam. 

Semper Fi.

Andyman

[flores97]

Andyman73, sounds like you have everything squared away, I wish you the best of luck on your claims!

[john999]

I like to get it right the first time so I don't spend years in appeals.  If you know what evidence is required to win the claim it is best to submit it all when you file.

[Vync]

Andy,
Perhaps you should take a look at the rating criteria for MH problems. Because the VA rates on impact on your life, not on the number or name of the diagnosis, it can help. I listed the regular MH table, not the one for eating disorders. I recommend you print the table and circle/highlight any of the conditions in all rows which you experience. After that, check your medical and MH treatment records to see which conditions are documented. It could give you a decent idea of what kind of rating to expect if you get SC. Having your doc opine these problems are 50/50 due to the pain can help a lot too. There are a lot of and's, or's, and semicolons. If the VA raters are supposed to grant the highest % even if only one symptom appears in that row, but as you know they likely will lowball you and you'll get the correct rating when you appeal. Spoon feed them only the details that matter so, like John999 says above, you point them to the right rating % up front and the corresponding evidence to justify it. Having your doc fill out a DBQ can help, but the MH DBQ reads like stereo instructions. Additionally, if the medication used to treat your current SC problems are causing side effects, file for those too. If your MH doc is giving you meds for your MDD and they are causing problem, might as will file for those also as secondary to MDD. Yeah, you might not be SC for it yet, but if you are being treated for it with meds and they cause a problem, might as well get a jump on it. Look up the common side effects for meds, if you take them. They could range from anything like weight gain/loss, eggroll problems, etc... It's worth the time to roll everything up and get it out of the way in one shot.

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#se38.1.4_1130

General Rating Formula for Mental Disorders

	Rating
Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.	100
Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.	70
Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.	50
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).	30
Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.	10
A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.	0

 

 

[Andyman73]

John999,

When I filed, I sent off all the evidence I could think of that might be pertinant to my claim.  All the STRs showing injuries and repeat visits due to pain from them.  And a copy of my current MDD from my VA MH doc.

Flores,

Thanks.

Vync,

According to the chart, my suicide ideation should make it easy to rate me at 70%. 

I had a therapy session yesterday, and we spoke about the exam.  He told me that it was a serious error that the examiner left out the pain related issues!

[Buck52]

The only thing about the rating of a mental disorder  they rate on all the symptoms and they don't rate on being unsociable or un attach to the public, SI is probably the best symptom as for as being rating in the high ratings  70% 100% or more  but also the mental hygiene will factor in as well as a better rating symptom ...again in my opinion it depends on what type rater rates ya.&the biggie is what the C&P Dr reports.

 

jmo

...........Buck

Edited November 24, 2015 by Buck52