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depression secondary to chronic pain

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Andyman73

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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

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Andyman

I stumble across this info  maybe it might help ? if nothing else at least you know if you get award  established for the secondary  it becomes considered part of the original condition.

 

§3.310   Disabilities that are proximately due to, or aggravated by, service-connected disease or injury.

(a) General. Except as provided in §3.300(c), disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition.

(b) Aggravation of nonservice-connected disabilities. Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. The rating activity will determine the baseline and current levels of severity under the Schedule for Rating Disabilities (38 CFR part 4) and determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level.

 

 

 

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

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Buck,

Thanks for posting that.  I'm getting quite anxious with this particular claim, I'm losing sleep over it, too.

Andyman

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Just wanted to give a quick update on this claim.  I took a phone call from the VARO, yesterday afternoon.  Was on the line with her for over 2 hours.  She wanted to talk about most of the claims I currently have in progress.

Several of them are going to be denied because the evidence is not strong enough, such as only marking the yes box on a health questionaire.  2 are being deferred, 1 is being granted and 1 going to sent to scheduling for a C&P exam.

One of the deferred is the depression secondary to chronic pain.  She told me that despite the evidence I submitted from my STR and VA TRs, she can't go against what the mh examiner said, that he doesn't feel that my chronic pain, from a minor leg injury, is enough to cause my depression.  I said that the medical proof of my chronic pain is worthless, then?

While her response wasn't exactly yes, she pretty much told me that I will have to get an IMO in order for her to grant it.  I asked if my VA MH dr can write it, and then she acted surprised, as if she didn't know I was first DXd by the VA. for MDD.  She said yes, if he writes a favorable opinion, she will grant, since he has been treating me since July, and the examiner saw me only 1 time.

Also if he opines that my jaw pain is a result of clenching and grinding in response to stress, she can combine that with the depression claim, otherwise, despite half a dozen STR entries, she will deny the jaw pain contention.

Guess my fate hangs in the balance of what my MH doc will say.  Good news is that I see him tomorrow.  If he won't help me, then I see no point of continuing to see him. 

However a tiny bit of good news is that my radiculapathy claim that was going to be denied is saved, it's the one she is sending to scheduling.  My PT sessions regarding my hip pain, the PT therapist noted radicular symptoms moderate to severe in nature caused him to cease PT and recommend further eval by a physiatrist.

So that's where I stand.

Andyman

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Your 80% looking for a 30%+ rating that would bump you to 90%, right?

Then, there is the Scheduler IU claim. If you meet the Earned Income Limitations, and due solely to your SC conditions, are unable to do even Sedentary work that would provide a level of income at or above the current SGI cut of $12,400 under 65. Do you meet these requirements.

As to your Evidence of the in-service injury, everything backing up your claimed injury needs to be provided, right. Appears you didn't file an FDC, if that's the case, you probably won't get a C & P anytime in the near future.

Are you currently receiving VA treatment for DX'd physical issues Secondary to your in-service injury? Your discussion with your VA HM Clinician is documented and appears on your VMC MHV Clinician notes, right?

This past May, I had an FDC C &P for an Increase due to a Secondary issue. C & P Dr was extremely uninformed regarding my VMC Med File and very negative in regards to my request for an increased rating. This was the 1st time a C & P Dr ever discussed the VA Rating Schedule with me, during an exam.

I thought it was a very negative exam, and that was confirmed when I receive a Secondary SC 0% Award Letter 08/15. I was in the process of NODing the Decision early 12, just hadn't hit the Send Button on E-Ben. 01/03/16 went into copy E-Ben IU letter for Tax Exemptions, New Rating of 100% SMC (S-1) from 07/15 Decision. Retro's in the bank, still haven't received the Award Letter.

The Rater had to make his Decision based strictly on Medical Evidence of Record in my C-File and  my VMC Medical File, that negative C & P DBQ could not have been a positive factor.

Semper Fi

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1 hour ago, Gastone said:

Your 80% looking for a 30%+ rating that would bump you to 90%, right?

That's pretty much it, the granted issue is R ankle secondary to feet. She told me that most likely will be a 10%, unless the ROM is limited enough to warrant a higher rate.  But the radiculapathy secondary to low back involves my legs and hips.  Not sure if ROM comes into play for that, but the ROM is pretty limited for hip ROM.  She was able to authorize an exam for that due to the hips, since I was receiving PT via VA for that, just recently.   Thank the Good Lord for that, otherwise she would have continued the denial on the sciatica claim.  Hopefully it gets 20% or higher, it should retro to 04/15.

Then, there is the Scheduler IU claim. If you meet the Earned Income Limitations, and due solely to your SC conditions, are unable to do even Sedentary work that would provide a level of income at or above the current SGI cut of $12,400 under 65. Do you meet these requirements.

No, I am able to keep my current employment.  I take measures to limit the effects of my SCDs during my work day.  I got kids and mortgage and need the benefits my job provides.

As to your Evidence of the in-service injury, everything backing up your claimed injury needs to be provided, right. Appears you didn't file an FDC, if that's the case, you probably won't get a C & P anytime in the near future. 

Nope, last time I used FDC, they all went straight into the denial bin.

Are you currently receiving VA treatment for DX'd physical issues Secondary to your in-service injury? Your discussion with your VA HM Clinician is documented and appears on your VMC MHV Clinician notes, right?

This past May, I had an FDC C &P for an Increase due to a Secondary issue. C & P Dr was extremely uninformed regarding my VMC Med File and very negative in regards to my request for an increased rating. This was the 1st time a C & P Dr ever discussed the VA Rating Schedule with me, during an exam.

That's how my MH exam went, examiner totally ignored the evidence proving my chronic pain.

I thought it was a very negative exam, and that was confirmed when I receive a Secondary SC 0% Award Letter 08/15. I was in the process of NODing the Decision early 12, just hadn't hit the Send Button on E-Ben. 01/03/16 went into copy E-Ben IU letter for Tax Exemptions, New Rating of 100% SMC (S-1) from 07/15 Decision. Retro's in the bank, still haven't received the Award Letter.

What caused them to change it?

The Rater had to make his Decision based strictly on Medical Evidence of Record in my C-File and  my VMC Medical File, that negative C & P DBQ could not have been a positive factor.

No doubt.  My mh exam was for depression secondary to chronic pain, yet the chronic pain and causes of it seemed to be the only thing he didn't want to speak about...the basis for the claim to begin with!  And my sciatica claim originally denied as a FDC, was recently reopened with N&M evidence, being the MRI from my back increase claim.  The MRI shows severe narrowing of neural formamins and bulging disc.  But not good enough, since the examiner for my back marked no for the questions regarding radiculapathy.  But I had told her of the symptoms during the back exam, and she kept telling me that that needs to be a separate claim!!!  RO told me yesterday that the back DBQ and exam is one and same for radiculapathy!!!  I ask, why then did the examiner keep telling me that it needs to be a separate claim!?!?!?!!!  Was sounding like the RO didn't want to evaluate the evidence and form her own opinion.  The examiner did write in the comment section that I suffered from various radiculapathy symptoms!

Semper Fi

Gastone,

I hope and pray I won't have to go after IMOs or a lawyer, my wife won't support me if I have to go that route, even though she would benefit from it.

I'm going to lay it on heavy with my VA MH therapist tomorrow.  All we've been talking about is how I feel about what ever.  Now we need to talk about why I have problems sleeping and how my chronic pain is woven through out all of my life and daily routine.  And why the examiner felt that those issues and drinking during the service, and since then, aren't enough to grant SC.

Semper Fi.

Andyman

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Did I miss it, are you currently being treated by your VMC for the pain your linking your claim to? Sounds like the C & P Dr kind of gave you a bit of the Bums Rush in regards to your pain issues. If those issues are of record in your VMC Clinician notes, you should still be ok.

Did you complete a Stmt in support of claim, regarding your pain issues and how you and your MH Clinician believe they are Linked to your claim? If not, give consideration to completing a "Sworn Affidavit" and forwarding it to the Rating Dept, yesterday.

As far as currently working and filing for IU. Does your employer make any type of accommodations for you, based on your SC Disabilities? At this point, other than a possible Favorable DBQ completed by  sympathetic VA Clinician, not much else to do until you get the Award/Denial letter.

Semper Fi

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