Denied for PTSD and Depression after C&P examiner made diagnosis of Borderline Personality Disorder

[jcox129]

Today both my PTSD due to MST and my Major Depression claims were denied. I had my C&P on 12/17/2015. I picked up my exam notes from the records department of my local CBOC where the exam had been held, and just a few minutes later my MST coordinator called to tell me of my denial. I checked e-Benefits and it has already been finalized with notification letter sent. 

The C&P examiner did several things I find fishy and that I was uncomfortable with during the exam, and then apparently diagnosed me as Borderline Personality Disorder and reported that I don't have PTSD. I had been diagnosed with PTSD by different (civilian)doctors in both 2006 and in 2014. I am very upset by this because in her report, she states that I meet all the criteria, but that she won't count the D and E criteria because she thinks it fits better with a BPD diagnosis. I have no idea how or why she made this determination. She said my symptoms were "long-standing." Well, yes, they were, because the stressor that caused my PTSD occured 17 years ago. This is what her notes said when she denied that I have PTSD.

“The Veteran is reporting an alleged sexual assault during her time in the Army that would meet Criterion A and reporting symptoms consistent with criteria B, C, F, G, and H. However, her reported mood symptoms, anxiety, impulsivity, substance use, irritability and angry outbursts, risky behaviors, risky sexual behaviors, and social and occupational are better accounted for by her BPD diagnosis.”

“The symptoms she is reporting that would meet PTSD criteria D & E are better accounted for by her BPD diagnosis, appear to be long-standing and more of a characterological nature.”

I don't feel comfortable at this time sharing more of her C&P notes. It is still too fresh for me.

I am trying to figure out what my next step will be...filing for an appeal or a reconsideration. Any advice or insight would be greatly appreciated. 

[Buck52]

jcox129,

Your right  and its what I heard too&read a PTSD dx needs to be from a VA Dr, but you can check with VA MH and ask them to give yo a screen for DSM5 PTSD, if by chance the Private PTSD Dr that dx you has the correct credentials     you can also use his/her impression letter as evidence, and also ask them to fill in a nexus letter using the VA Criteria...your condition PTSD/MST IS LIKELY AS NOT due to your past military service.

A Nexus letter is basically the same as'' statement in support of claim''

if you have a CIB  then your good to go.

Also if the VA dx you with Combat  DSM 5 PTSD they will ask you if you want to see a therapist for counseling...take it if you possibly can  it will document your in treatment & help you cope better

I am not sure you have this service connected?

I'll put up a sample nexus letter.

 

......Buck

Edited December 24, 2015 by Buck52

[Buck52]

Example of a Nexus Letter

DATE ____________

Reference: (Veteran's name) ____________

SS# ____________________         VA File #____________________

To Whom It May Concern,

I am Dr. ____________. I am board certified to practice in my specialty. My credentials are included. I have been asked to write a statement in support of the afore mentioned veterans claim.

I have personally reviewed his medical history. (Name the Documents) I have also reviewed and have noted the circumstances and events of his military service in the years ____________ (Event or Events claimed as the cause of the condition) while he served during his military service. (List dates of service)

Mr. ___________ is a patient under my care since (enter Date). His diagnosis is _____________ (Name the Condition).

I am familiar with his history and have examined Mr.____________ often while he has been under my care. (Specify Lab Work, X-rays, Etc.)

Mr.____________ has no other known risk factors that may have precipitated his current condition.

After a review of the pertinent records it is my professional opinion that it is at least as likely as not that Mr. ____________'s condition is a direct result of his (Event) as due to his military service. (Choose the degree of likelihood with which you can concur - "at least as likely as not", "more than likely", or "highly likely")

In my personal experience and in the medical literature it is known (Give a rationale).

Signed,

Dr. ____________
(List credentials and contact information)

Please understand that the VA often uses credentials to assign probative value to the nexus letter.
While the nexus letter must be brief as possible it should be as detailed and complete as the circumstances dictate.
 

[broncovet]

Buck, that's a great letter.  You need to start a new topic so Vets can find this.  Docs dont know what to write, they often want to help Vets, but say things like,

This Veterans xxx could be caused by military service.  (Deal killer, its considered speculative.  Doctor should avoid "may" "maybe", "could" "might" "might be" in the nexus statement and replace that with "at least as likely as not".  

[PCW]

I'm sorry to hear how your C&P turned out for you. You are correct in your assertion that one must have a VA doc initially diagnose PTSD. The quickest way to get a just rating would be to get referral from your primary doc to mental health for a VA diagnosis. This may take a few meetings (I was fortunate to be diagnosed on my first appointment.). if in fact you are diagnosed with PTSD, you can ask for reconsideration of your claim with new and material evidence and go from there.  Even if you are not diagnosed with PTSD the VA may diagnose you with other mental health issues and you could open a new fully developed claim for them, If you go the NOD route it preserves your retro date (as does the reconsideration) however in both cases you still need that PTSD diagnosis and then have another MH C&P for forensic evidence purposes.

[Gastone]

Don't beat yourself up as to any missteps you think you've made so far, your new to the VA SC Claims Arena.

Let's do a what if here. If you get a Denial or a lesser SC for an existing MH issue, do you really want the same Rater to Review "Reconsider" his/her recent Decision, good luck with that? You have 12 months from the Decision Date to file your NOD, each passing month adds to your time in the Hearing Wait Line.

What ever you decide to do, DON"T wait until you think you have all your Evidence Ducks in a row, to file your NOD requesting a DRO Hearing or for that matter a BVA Hearing. Your place in line is determined by the date your NOD is received. You'll have a year or unfortunately more to supply any and all New & Material Evidence necessary to prosecute your Appeal. My DRO hearing took 4.25 years, some BVA Hearings go even longer.

Keep in mind, the VA has a regulation regarding the Receipt of New & Material Evidence, as it pertains to an "open Decision Award/Denial claim."  When N & M Evidence is received by the VA, the receipt is "Supposed" to trigger an automatic review of your Open Decided Claim by a VA Sr Rater or an actual DRO. This Review requires the Sr Rater or DRO to give "Deference" to the original rater's Decision. You could get an Award or continued Denial Decision, well before your actual DRO or BVA Hearing was on deck. This Automatic Review Decision, if not Awarded, would generate a SSOC. This Statement of Case would speak to the weakness of your N & M Evidence and give you a better idea of what you need in order to prevail.

For what it's worth, A Nam friend filed for PTSD in 12, Denied PTSD late 2012 but awarded SC 30% or so for a personality disorder. He's still waiting for his DRO Hearing from NOD filed within a week of his Denial/Award Letter.

Be sure your Direct Deposit Bank account is set up to Txt/Email you of all activity. If Awarded anything, the Retro usually hits about 2-3 weeks before you get the Official VA Decision Letter.

Semper Fi

[waccamawwild]

Just so you know you will get adequate care through the VA if you get rated Bipolar Disorder. I still think you can win your way through a DRO hearing. Good luck to you!