ptsd Filing and SMR questions

[HowIWish]

Let me start off with saying this:

I understand now how some might have thought when I asked my question about a hospitalization at the Va helping my husband get his disability I was trying to game the system or something. I didn't mean it that way at all. Back then (it feels like a lifetime ago) I saw my husband completely falling apart and I was being told by friends and family that he needed to be hospitalized. I saw it coming, and I was naive how the mental health system worked. My thought was that if he needed to be hospitalized anyway, that using the VA would help the situation in its entirety.

Yes, I was very wrong. I had read how amazing the VA's PTSD programs were, and I guess I figured getting him into the Va system then would sort of kill two birds with one stone. He could start getting help in a place he felt more comfortable by being around other vets, he could get the hospitalization he needed for much less than $2,000 a day (the price of the private hospital he had his outpatient care at) and he could go ahead and be in the VA system.

Well, if you've read my other posts you know nothing good came out of his 18 day stay at our local VAMC. It's been a nightmare ever since and keeps getting worse.

Sorry if I sound defensive. Being married to a man (whom I love very much) that has major paranoia issues has kind of made me this way. His paranoia tends to focus on me... I'm poisoning him, I'm holding him hostage, and on and on... Sometimes he has good days, and other days I spend most of my time trying to convince him I'm not working with Barrack Obama to have him put in a straight jacket. 

 

Anyway- on to my current questions! First, my husband's FDC was ready to file, we were just waiting for his SMRs. They finally came today and I was so excited. But there are NO medical records in the envelope. There is also no records pertaining to his deployment. It is basically just his enlistment paperwork, his security clearance paperwork, and his discharge papers.

On the ebenefits site where we put in his paperwork, it says the VA can get all of his medical records from DoD hospitals. Should we go ahead and file and let the VA get those records? The website says it can still be submitted as an FDC and they have access to those records. That's my first question.

My second question has to do with his ongoing care at the VAMC. This past week they told him he is now ineligible for all care and they canceled everything. They refuse to give us anything in writing, but they have canceled every single appointment he had, including his support groups. They say it's because he makes to much money. But he was already enrolled and paying co-pays! 

I've read everything I can find, and he is completely eligible for care. We were fine with paying the copays for now. The first week of February his income will be dropping by 2/3's, and then he was going to file a hardship and then they said we wouldn't have the copays anymore. 

We we really need to file his claim. The faster we file the faster (hopefully) he can be service connected and we won't have to worry about them cutting his Health benefits. Would you guys just go ahead and file now without the rest of the SMRs? There isn't going to be anything in there to really help a whole lo anyway. He didn't have any mental health issues while enlisted. Nothing became an issue until a little while after his discharge. His deployment was towards the end of his enlistment.

Also, what's the best way to fight them canceling his health benefits? The VA flagged him as a high suicide risk for 60 days of "Enhanced care," and now they're refusing him ALL care! It seems we should have something in writing so we can file an appeal, but nobody will even tell us who made this decision. This all happened yesterday, and this coming week is Christmas. I'm thinking we need to go to the VA in person Monday or Tuesday and get some explanations. 

One more thing- my husband had a PTSD screening because his outpatient psychologist was trying to get him into the 8 week inpatient PTSD program. While inpatient his psychiatrist said he did not have PTSD. That's a crock because every single professional he has seen outside of the VA has said he undoubtedly has PTSD and it is greatly complicating his other MH issues. But that does us no good with the VA. So he had this PTSD screening at the request of his VA psychologist who has been trying to get him further help within the VA. The PTSD screen doesn't say anything. He was denied getting into the program, and his psychologist told him that she has been told to make sure not to chart any diagnosis in his chart. It's just frustrating. Isn't the point of a PTSD screening to see if he has it? 

Oh well, forward we go! As always, any help is extremely appreciated. This site is invaluable. I have learned more here than anywhere else! 

 

[HowIWish]

I cannot find any record of him being given an MMPI combat related. During his inpatient stay he was given the short version of the MMPI-2, but I have been told that they will not release his scores. The PsyD that gave it to him said its against VA policy. He did tell me that the test pointed to Bipolar or schizophrenia, but the psychiatrist said that wasn't true and that it proved he had a personality disorder.

I'm not sure what they did during the PTSD screening except ask him some questions. He said they asked him multiple times about substance abuse and seemed disappointed that there was none. He went to the PTSD clinic for it.

He did have health benefits with the copay. We were getting billed $5-8 for prescriptions, etc. But we got a bill yesterday and now they are billing us far above the copay rates. 

He doesn't get SSDI and doesn't qualify because he doesn't have enough work credits. He was a police officer for 18 years and is going through the disability pension process now, but it won't be a very big pension. The retirement board made changes several years ago and the disability benefits are pretty bad.

During his inpatient stay his psychiatrist made several notes about him doing all of this for financial reasons because he would be getting a 50% retirement benefit from his police pension. I have no clue where she came up with that, but he definitely will not be getting 50%. 

She also wrote that I was making him do this because I couldn't handle 5 kids on my own and wanted him home to help me. That is also crazy. Having my husband home more than doubles my workload, and I was worried about having him home all the time long before he was found unfit for duty. As I have said, I saw it coming long before anyone else. I have never had an issue taking care of the kids. We homeschool and I manage just fine! :) I managed much better when he was at work all day.

I know this is from a different thread, but Berta, his medical file is well over 700 pages and that's just since mid-October. About 20 pages of that is his heart/ blood pressure stuff. The rest is page after page of notes from this doctor. I was a critical care RRT for 12 years. I know medical records and what a chart should look like. I've never seen anything like this.

It seriously makes me think the psychiatrist has a personality disorder! Who has the time to write that many notes, all attacking the patient. Anything Objective she completely ignored. She never addressed his dilated pupils that were so bad the nurses had a neurologist consult. She never addressed his liver enzymes or blood pressure issues. (Both related to his medication.) 

And now they've canceled every future appointment with no notice and no chance to appeal, and saying he can't get benefits.

[Berta]

"what's the best way to fight them canceling his health benefits"

This is the eligibility criteria :

http://www.va.gov/healthbenefits/resources/publications/hbco/hbco_enrollment_eligibility.asp

And this is the 2016 income chart they refer to in their criteria:

http://nationalincomelimits.vaftl.us/LegacyVAThresholds/Index?FiscalYear=2016

If you tell me what VAMC this is, I can find contact info for their Director,

if -based on the above income chart,the VA should not have taken him off their roles.

You need something in writing from the VA to appeal this -if they are wrong about his income.

If the VA is correct, as to the income being too high,  as you said, in February his disability income will drop by 2/3's so then he might be eligible for VA health care again.

As you know, being a police officer puts one into very stressful situations and can cause PTSD.

Maybe that is why he did get non VA PTSD diagnosis.

You will need , in my opinion , proof of at least one incountry stressor, even with the CIB on his DD 214, and proof that he had MH issues from those stressors prior to becoming a police office.

I assume when you filed out the SF 180 for NARA that he requested ALL of his medical and Personnel military records.

 

 

 

 

 

[Buck52]

Who & What Location told you/him he was ineligible for VA Health Care?

Go check with this VAMC Hospital Director...

Or go to a Different VAMC,  if your hubby is this bad  he needs MH CARE  ASAP.

Write or email your district congressman and let him know about all these shenanigans you been told by VA Employee's? and was refused medical care by your VAMC.

This is Ridiculous for a combat veteran being treated this way.

If you have to go up the chain of command  go all the way to the top if need be & don't stop until you get the results you need &  your hubby needs.

Write your R.O. And let them know how your Hubby is being treated at his VAMC  & ask what can be done about a claim your hubby needs to file?....let your R.O. Know what all is going on.

R.O. NEEDS TO KNOW ABOUT THESE THINGS.

JMO

[MikeHunt]

19 hours ago, HowIWish said:

His DD214 has the CIB listed

Stop.

1) Fill out a 21-526EZ with a disability 'PTSD', put his name, address, his latest service period, branch and have him sign it.

2) Accompany with a 21-0781 with name, SSN, unit. Put nothing more in the first description (3E) field than "CIB. See DD 214". Have him sign.

(His stressor is presumptive with a CIB. They can get 'STRs' for you. Or not. Doesn't matter.)

Make sure they get him scheduled for an exam ASAP. The 'trick' there is to schedule a Veteran, then not send the notice. Keep calling and ask for the time and place of the exam. Insist they file a 27-0820 on the call. Check with a VSO/CVSO that has VBMS eFolder access, so they can verify notes/ Forms are inputted/uploaded.

Your next issue you need to go to one of your federal senators, and have them call VA Washington, not write the hospital, have them explain how a Veteran with a CIB isn't eligible for VHA PTSD care.  Insist they call the Washington line.

Really, the only 'trick' they can pull is diagnosing someone with anti social personality disorder, which the VA doesn't treat. They will do this.

Good luck.

[MikeHunt]

29. Evaluating Evidence of an In-Service Stressor, Continued

(M21-1MR, Part III, Subpart iv, Chapter 4, Section H)

 

d. Action to Take if Veteran Received Combat Decoration but Does Not State Nature of Stressor

If a veteran received one of the combat decorations cited in M21-1MR, Part III, Subpart iv, 4.H.29.c but does not expressly state the nature of the stressor   assume the stressor is combat related order an examination, if necessary to decide the claim, and in the examination request state that VA has verified the veteran’s combat service, and specify any details regarding the combat stressor contained in the record.

 

[HowIWish]

I'm going to try to answer everything in order so I don't leave anything out!

Berta:

The VA originally told us he qualified but he would have to pay copays based on his income. We had no problem with that. They also told us to go in February and file the hardship paperwork and then he wouldn't have to pay copays. 

Now they're just cutting him off. We both plan on going up there Tuesday and spend all day if necessary to get an explanation and something in writing. It seems crazy to me that they flagged his chart for the "High suicide risk" enhanced care for 60 days on November 1st, and now they're trying to say he's not even allowed to go to his suicide support group. Even if he made a million dollars a year, wouldn't a veteran be allowed to go to the suicide support group? And the Anger Management support group?

This is all at the Dayton VA in Ohio.

My husband was a police officer prior to enlisting, and then went back to it after he was discharged. We have his entire personnel record that his Captain gave him to try to help him out. He's never been involved in anything very traumatic at his job. No shootings or stabbings or anything. That won't be too difficult to prove. He first worked in a tiny town where he just did traffic, then he moved to a bigger department, but not a very bad area. His non-VA medical records specifically cite Iraq as the cause of his PTSD. (I know his non-VA records don't really matter, but they're more accurate.)

Really the only issue he had at work was that the dead bodies would set him off because he would have flashbacks from Iraq and those flashbacks could trigger a manic episode. Or a depressive episode. Then he would become obsessed with killing himself. He can get psychotic and he's not in reality anymore and starts believing really crazy things, then he becomes obsessed with killing himself. It's really scary, and not at all safe for him to continue being triggered over and over while carrying a gun.

His issues are pretty simple outside of the Va. The VA's preoccupation with keeping him from having a compensable claim is what has drastically affected his treatment there. 

One of the absurd things about his inpatient stay is that they flagged him with the 60 day suicide risk, they said he wasn't allowed around guns for 90 days, but they said he could go back to work as a cop. The only restriction she put on him was going to dead body calls- suicides, found down, etc... Because it "triggered" him. (The doctor literally wrote this in his chart.) So according to the VA, he doesn't have PTSD, he isn't to be around guns for 90 days, but he can go work as a cop and carry a gun 60 hours a week, but not answer dead body calls because it's traumatic for him because of his personality disorder- NOT PTSD. 

When I requested his records from NARA I specifically wrote that we wanted all medical records and personnel records. I used the instructions I found online for vets applying for benefits.

Buck:

This is all going on at the Dayton VA. Last week after one of his support groups, a social worker called him into her office as he was leaving and told him he didn't qualify for benefits. He got really upset and I guess made a bit of a scene. He's trying so hard to make progress and he's getting really frustrated with all of this.

I haven't contacted our congressman. I was told in another thread not to, so I've been holding off. But I have kept records of everything that's happened in case we need to.

I'm not sure what an R.O. is.

MikeHunt:

We already filled out his intent to file, and his FDC is almost ready to file. Does he really not need to describe his stressors? I can change allow that and he can just put in CIB instead.

We finally got his ebenefits access upgraded to premium, so if they schedule a C&P it should show up on there, right? I can just check it every few days! 

And they've already diagnosed him with a personality disorder. They say he has Paranoid Personality Disorder. But they put him on 4 mg of Risperdal a day and it helped a lot. The Va doctor ended up eventually diagnosing him with MDD with psychosis, and a personality disorder, and said she ruled out PTSD. None of that diagnosis makes one bit of sense compared to how they are treating his illness. 

Then his outpatient Dr (non-VA) increased him to 5 mg. He is doing better, but he's far from stable. He needs those support groups. He needs his weekly counseling. And they just took it all without any warning.