ptsd CP conducted without veteran.

[MOMO68]

Sorry for the long post but need some insight. I filed a claim IU in June 2015. I looked at my my healthvet file and found this. It states a CP Exam but I was not present as I read further it was seem like a medical opinion from a CP Exam I had in December of last year. Can someone take a look at it and give some insight into what the outcome may be? 

This is an addendum to Dr. ??? PTSD C&P evaluation of 12/12/2014, Per VBA request of 11/24/2015. Dr. ???is no longer available to complete the addendum so it was assigned to this writer. The relevant portion of form 2507 is copied below: Please have examiner ?????. provide an addendum to the examination he or she conducted on the Veteran on 12//1/2/2014. Please provide the following clarification: Please state whether or not the Veteran's service connected post traumatic stress disorder precludes her from physical or sedentary employment. DBQ PSYCH PTSD Review: Please review the Veteran's electronic folder in VBMS and state that it was reviewed in your report. The Veteran is service connected for post traumatic stress disorder (also claimed as sleep disturbances) which is currently evaluated at 70%. Please evaluate for the current level of severity of the Veteran's service connected disability. If the diagnosis rendered is different from the disability for which the Veteran is service connected, please indicate whether the Veteran's current diagnosis is a progression of the service connected disability or the original diagnosis was in error. If more than one mental disorder is diagnosed please comment on their relationship to one another and, if possible, please state which symptoms are attributed to each disorder. Additional remarks for the examiner: Veteran is claiming TDIU as a result of her service connected post traumatic stress disorder disability as well as several nonservice connected disabilities. ***Please comment on the effect of the Veteran's service connected disabilities on his or her ability to function in an occupational environment and describe any identified functional limitations. Please refrain from opining on if the veteran is unemployable or employable; instead focus and reflect on the functional impairments and how these impairments impacts occupational and employment activities. This addendum is based upon the veteran's condition around the time of Dr. ??? evaluation, determined to the best of this writer's ability, based upon his report and available contemporary documentation in the medical record. Her condition may have worsened in the ensuing 50 weeks. CPRS records indicate that this veteran was suffering from Recurrent Major Depression around the time of Dr.???? evaluation, and had been at least sporadically since 2006. She was also diagnosed with prolonged bereavement. The severity of the MDD had been rated as Mild to Moderate about 3 weeks before Dr. ???? saw her. Thus, it would have been appropriate for a MH evaluator to attempt to determine what portion of the veteran's reported level of occupational and social impairment was due to the PTSD, to the Bereavement, and to the MDD. An attempt to do so post hoc is complicated by the fact that the veteran was and apparently still is experiencing auditory and visual hallucinations that have variously been described as depressive phenomena, and as feaures of unresolved bereavement over her sister's sudden death in 2006. Because the treating psychiatrist opined that "[Anti-psychotic medication will not be prescribed because] her AVH [Auditory/Visual Hallucinations] are comforting and associated with bereavement," writer will not consider those as being contributory to veteran's reported level of social/occupational impairment. Conservatively estimating that 20% of the reported impairment can be attributed to MDD, which appears not to be service-connected, writer will review reported PTSD symptoms in attempting to opine whether these in and of themselves would have impacted employment.  Veteran was found to be somewhat withdrawn, and to be emotionally isolated from others. She had irritability, problems with concentration, and sleep disturbance. She had anxiety, suspiciousness, disturbance of motivation and mood, problems establishing relationships, and poor tolerance for stress. She avoided thinking about her trauma. These symptoms would have been expected to affect employability in that veteran would have been expected to have difficulty working in an environment that was stressful, put her in contact with large numbers of others, and put more than moderate demands on her ability to concentrate and remain alert. She would not do well in a situation within which she was expected to take initiative or to self-motivate. However, sedentary occupations within a low-stress, low social contact environment, with modest productivity demands, probably would not have been precluded by the PTSD symptoms mentioned above. Furthermore, even jobs that are modestly physically demanding would not have been precluded solely by the PTSD symptoms, albeit of course there were other, potentially limiting non-psychiatric impairments present as well. Writer opines that her capacity to work in an environment optimized for her PTSD symptoms would have been moderately impaired but not absolutely precluded.

Edited December 5, 2015 by MOMO68

[Berta]

This seems to me to result from the inadequate C & P exams many vets get and is an attempt to resolve that with the new addendum.

This seems to be a key statement:

"Writer opines that her capacity to work in an environment optimized for her PTSD symptoms would have been moderately impaired but not absolutely precluded."

Do you get SSDI and if so is that solely for the SC PTSD.?

If so , does VA know that?

Were you ever turned down by VA Voc Rehab solely due to their determination that your SCs made Voc Rehab unfeasible?

The exam also states this:

"Please refrain from opining on if the veteran is unemployable or employable; instead focus and reflect on the functional impairments and how these impairments impacts occupational and employment activities"

Do you have documentation showing you have missed time from work or had problems in the work environment solely due to your PTSD? Have you often been late for work or have any SC meds or the sleep disturbances been noted in any of your personnel files,post service, regarding their affect on your  most recent employment.?

Did this result from the 70% rating? That award letter would contain their reason for not considering you for TDIU at that time (unless they sent you the TDIU form with the 70% decision,in order to consider you for it.)

 

[MOMO68]

Thanks Berta for your quick response. I agree this is inadequate exam. It's from an exam  for IU they  did last year that lasted for only 5 minutes. the CP doctor did not conduct a thorough exam due to I had breast cancer surgery two days prior. So he told me to go home and he would complete exam. No I do not receive SSDI. But I do have a letter form Voc Rehab that states I am not feasible for Voc Rehab due to SC and NSC disabilities. I am currently medically retired. I am taking meds for sleep disturbance and other mental disorders. I applied for TDIU after given the 70% rating I was working at the time. 

 

[Gastone]

The old "Ability to do Sedentary Work" strikes again. How can you, a lay person, rebut a medical opinion? You could attempt to find a sympathetic Psychiatist, could be difficult if not impossible.

Give the VA Vocational Rehabilitation Program serious consideration. Would only cost you some time and might lead to a Voc Rehab Denial Letter indicating that due to your SC condition your unable to do even Sedentary "SGI" producing work. At this point, your looking at a NOD Filing requesting a DRO or BVA traditional appeal. All of which will take considerably longer than a year.

My lay read of your above addendum, you've got a "Proof" problem. Original PTSD C&P Psychiatrist or Psychologist Phd didn't indicate that your MH condition precluded you from earning a "SGI" level income. No mention of "IU Claim Inferred" in your original PTSD 70% Award, right. Being unemployed or under-employed won't get the IU. What Evidence of Record at the time of original award or recent denial, indicated that you were or are now, unable to do Sedentary SGI producing work?

Semper Fi

[TiredVeteran]

 So he told me to go home and he would complete exam. No I do not receive SSDI. But I do have a letter form Voc Rehab that states I am not feasible for Voc Rehab due to SC and NSC disabilities. I am currently medically retired. I am taking meds for sleep disturbance and other mental disorders. I applied for TDIU after given the 70% rating I was working at the time. 

 

You might consider asking for another CP exam.  Jimmy has had those exams with him not present. Usually didn't turn out favorably.  That letter from Vocational Rehab, does it clarify which disabilities are blocking rehab? You are already deemed medically disabled, not suitable for rehab, so apply for Independent Living through Voc Rehab. I am not an expert in anything, but do empathize with your situation. If the reason for your medical retirement is your SC conditions, that might help as well. 

[MOMO68]

Update. New CP conducted. Dr said PTSD conditions has gotten worse. VSO  informed claim has been Denied because evidence submitted was not considered new and material to refute the previously denial. How can a voc rehab not feasible for service connected disability Ietter I submitted  not be considered new and material evidence?

Edited February 4, 2016 by MOMO68

[iceturkee]

13 hours ago, MOMO68 said:

Update. New CP conducted. Dr said PTSD conditions has gotten worse. VSO  informed claim has been Denied because evidence submitted was not considered new and material to refute the previously denial. How can a voc rehab I never submitted  not be considered new and material evidence?

i applied for voc rehab when my back rating increased to 40 percent. my counselor indicated she wanted to get me approvided, despite serious medical issues. a few days later she responded to an email i sent. then i never heard from her again. i never heard from voc rehab again. but they sure wanted to make it sound like it was my fault during my IU application. however, i got the IU and determined to be P&T.