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. 

[Vync]

Vynce, I think the outcome of a DRO Hearing, negative or positive,  is greatly dependent upon the effort and knowledge of the Vet. I personally don't believe that the VA has some unwritten Denial policy or that Raters just want to screw with Vets.

Self-performance appraisals are difficult for everyone. Just about any negative outcome on any of my past claims, all have 1 thing in common, me.  My Procrastination and lack of continuity of follow-up, are all on me. When I buckle down and prosecute the claim or NOD appropriately, I usually prevail. Just have to lay out all issues and evidence by the numbers, then walk the Rater or DRO t0 the correct decisions based on the Evidence of Record.

Semper Fi

Hey Gastone,
You are completely correct. In my DRO experience, I had my submission put together extremely well, but it took me months to get it prepared optimally. It was at an 8th grade reading level, only contained just enough and the right words to get my point across, and I connected all the dots for them. All they had to do was verify. I didn't go in and blindly ask if they found what they needed in my c-file. Everyone has heard the saying, "Chance favors the prepared mind", well, it is more true than most folks realize.

[Buck52]

It matters if the DRO is on your side or not  some DRO are not veteran friendly.

Luckly me I had a veteran friendly DRO, although their all supposed to follow all the rules and regulations.

If the veteran presents enough PROBATIVE medical evidence in his/her favor

What I liked about getting a DRO  Hearing  is   it gives you the chance to face them face to face and present your case, its not all that bad  kinda nerve racking at first but its just a better way to get your claim adjudicated .

My DRO Hearing was  about a VA Dr proposal to reduce my SC benefits to 0% and sever my SC.

My DRO Hearing was pretty simple  we walk in this room with long table and chair's kinda like a Jury Room...with microphones at each chair, the DRO walks in introduced himself and  the Rater Specialists  but some times a veteran don't have a rater specialist at his/her hearing.

The DRO starts to say how the Hearing will be conducted and ask you about any evidence you have to present  and give verbal presentation to favor your case , you speak back and forth to each other, before the hearing the DRO will usually ask you if you agree on a informal hearing  or if you want it formal ...I chose informal...all things said at your hearing will be recorded and you will be sent the transcript of your hearing, After the hearing the DRO will let you know of his decision then or let you know when he makes a decision you will be sent a letter in the mail...Also keep this in mind a DRO has the right to approve your claim right then and there and expedite your claim  so you will know about your decision before you leave.

and keep in mind not all DRO Hearings will turn out in your favor  it all depends on your credible probative evidence you present and how well you present your self  (attitude plays a big part) and always be open and honest with all your answers.

and be able to prove or back-up what you say.

 

 NOTE: My DAV Rep told me after the hearing he was surprised  at the outcome  because I did get emotional when I started talking about how my disability kept me from enjoying my grandchildren & kept me from working...the DAV Rep said the DRO could have just said I was depressed.& emotional unstable.

I walked out of there knowing they had expedited my claim gave me increase to a 90%combined rating and was approved for TDIU P&T using the extra scheduler CFR Regulations.

The DRO mention in his award letter that at my hearing with a DRO & Rater specialist  it is obvious this veteran S.C. disability is real and an increased instead of a decrease is warranted and this veterans S.C.disability is consider to be chronic in nature with no future exams.

In my experience I would recommend a DRO Hearing...just  keep in mind probative evidence wins.

 

.........Buck

Edited December 24, 2015 by Buck52

[Berta]

In November you told us here of a Victory you had- because the VA had awarded you an Honorable Discharge due to the sexual assaults, which has caused a prior bad paper discharge.

How the hell can they try to say you don't have PTSD,(or any other SC-able MH disability) with evidence that swayed them already,to get that bad paper discharge changed? That is NOT an easy thing to do.

Was the Honorable determined by the same VARO you deal with now or by the BVA?

“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.”

Bull crap. Those symptoms are consistent with PTSD and a myriad of other MH disabilities.

Did the Character of Discharge situation arise from your first filing of the PTSD claim? Those types of decisions can take years.

If so when was the filing date of your inital PTSD claim?

If it had been filed and denied,prior to July 2010 and then re filed again, they would have to accept, in my opinion, an IMO from a real doctor, because it would fall under the older PTSD criteria.

Of course it would help if we could read the actual C & P exam results.

Vync is right:"Check the credentials of your C&P doc"

 

 

 

 

 

 

 

[Gastone]

All my opinions from above, along with what everybody else has opined.  Getting an E-Ben Denial update, that fast after a C & P 12/17/15 is very suspect. I realize it's year end and all but I've never seen the VA move that quick. In my experience and that of other Vets I have contact with, there is usually a significant lag time after a Decision Award/Denial Letter actually arrives, before E-Ben catches up. Maybe things have really changed but I doubt it.

You may want to try and Relax, hard to do, and wait till you get the Actual DENIAL LETTER. All evidence and Raters reasons for the Denial, will be addressed in the Notification Letter, as well as your Appeal Rights. There is a chance the Rater Awarded an issue you didn't actually claim.

I may have missed it, do you know if your PTSD C & P was done by a VA Staff Psychiatrist, Psychologist Phd or a contract clinician?

Think positive, your going to get at least a 30+% SC for whatever MH issue your DX'd with, due to your Verified MSA either causing or Aggravating it.

Semper Fi

[PCW]

Being the new guy here, I have a couple of questions on the responses given on this topic (I'm trying to learn). Is a reopen/reconsideration of an initial claim the same as a DRO review with new and material evidence?  The end game of a DRO could be four years out with a denial, a reconsideration could be closed reasonably quickly with a denial, and in both cases the denial letter would suggest a strategy to win. If the initial claim is denied one could submit a FDC with all new evidence and be done in a year. Under the DRO scenario it could be another 3 plus years to get to the same point. Although retro with a favorable DRO decision might be worth waiting for.  

The problem here is the the C&P doc supplied an crappy "opinion"  that her PTSD was in reality BPD. All the rater looks at is what the C&P doc diagnosed. In my opinion the best way to fight is with solid evidence to the contrary. If she can supply the doctor notes from her private doctors, or a letter summarizing their PTSD diagnosis with a nexus, and then get a VA doc also supply a PTSD diagnosis, she would be well on her way to getting the rating she deserves. The VA diagnosis may be enough by itself, though another C&P may be requested.

Assuming that all the information can be obtained, then which process is the quickest way to achieve the rating? What are the trade offs. Remand chances?

[Buck52]

 

 PCW,

You actually can present new & material evidence with both claims  reconsideration/reopen   and also at a DRO Hearing , the thing with a DRO Hearing you can talk to them face to face, I'd say most of the time a claim can be solved at a DRO Hearing.  However its better to send in your new evidence when you request your hearing..&..make copies....and verbal favor about your claim when your there/take a witness to the fact.  present buddy letters to the DRO ect,,ect,,,Show them how your disability effects your way of life ect,,ect,,

if you request  a DRO Hearing   that don't necessarily  mean it will be 3 or 4 years before you get your Hearing  it depends on how many Hearings  are at your RO  they should send you a letter letting you know the time-line  usually its within 6months, if by chance it takes a year or more you can with draw the DRO Request and ask to have your claim re-open, the link I put up may explain this better, usually claims are on a first come first serve basis

his might help?

http://moaablogs.org/claimsassistance/2014/01/30/understanding-the-different-types-of-va-compensation-claims/

Edited December 26, 2015 by Buck52