cervical strain Would Appreciate An Mdd Wag

[GlassRose1500]

Hey there and thanks in advance for your time. My main question is how much weight is given to comments? The Checkmarked Impairment would indicate up to 50% - but the comments seem to read more like 70%. Would appreciate your thoughts on where you think this might land. Sorry for it being so long, stripped out as much as I could.

SECTION I:

a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)? [x ] Yes [ ] No

Diagnosis #1: Major Depression, single episode, moderate to severe ICD code: 296.22

Indicate the Axis category: [x ] Axis I [ ] Axis II

Comments, if any:The veteran's Major Depression is more likely than not secondary to her musculoskeletal condition and chronic pain from her service connected lumbarsacral/cervical strain and knee condition. She has had worsening of her pain conditions over time to the point that it has significantly interfered with her ability to care for her own needs and participate in activities which she previously enjoyed. This eventually led to depression. Clinical records clearly indicate that her depression is felt to be due to her medical conditions and chronic pain. There is a clear association between the severity of her depression and the severity of her pain and physical limitations.

b. Axis III - medical diagnoses:

ACTIVE PROBLEM

Low back strain

Arthritis of spine

Degeneration of intervertebral disc

Arthritis of knee

Chondromalacia of patella

Derangement of meniscus

Premature beats (SNOMED CT 29717002)

Paresthesia (SNOMED CT 91019004)

Paresthesia of foot (SNOMED CT 309087008)

Chronic constipation (SNOMED CT 236069009)

Esophagitis (SNOMED CT 16761005)

Neck pain (SNOMED CT 81680005)

Rectal hemorrhage (SNOMED CT 12063002)

Nausea (SNOMED CT 422587007)

Lumbar disc prolapse with radiculopathy (SNOMED CT 202735001)

Major Depressive, Single Episode

Chronic Low Back Pain (ICD-9-CM 724.2)

Bursitis/Tendonitis

Stomatitis, Aphthous * (ICD-9-CM 528.2)

Rosacea * (ICD-9-CM 695.3)

Migraine with Aura, without mention of intractable Migraine without mention of

Syncope * (ICD-9-CM 780.2)

Other specified cardiac dysrhythmias

Graves' Disease * (ICD-9-CM 242.00)

Endometriosis * (ICD-9-CM 617.9/617.0)

Pain in joint involving lower leg (ICD-9-CM 719.46)

c. Axis IV - Psychosocial and Environmental Problems (describe, if any): unemployment; chronic mental health symptoms, chronic pain, financial concerns, limited social supports; numerous medical conditions

d. Axis V - Current global assessment of functioning (GAF) score: 52 mconsistent with recent GAF (52 on 10-25-13)

Comments, if any: Veteran has moderate to serious difficulty with depression and anxiety; she has intermittent passive suicidal ideation; she has poor motivation and chronic problems with energy/concentration/focus/distractibility/interest /hoplessness/helplessness. She is social withdrawn and periodically does not leave her house for extended periods at a time. She becomes frustrated over her need for her husband to act as a caretaker. She is unable to attend to a number of ADLs, but is not neglectful of hygiene or appearance. She has frequent anxiety attacks but no panic attacks or violence. No impulsivity. She has withdrawn from activities that she previously enjoyed and frequently avoids family and friends. She has lost a number of friends due to social withdrawal. She endorses irritability and poor frustration tolerance.

3. Occupational and social impairment

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a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses?

[x ] Occupational and social impairment with reduced reliability and productivity

c. Relevant Mental Health history

MENTAL HEALTH HISTORY: No h/o mental health treatment in childhood, adolescence or during the military. SMR are negative for mental health treatment. She reports being resistant to mental health treatment and having a long history of aversion to psychotropic medications. She was therefore very resistant to referral to mental health services.

She first participating in behavioral health medicine at the VA in 2012 where she got limited treatment for chronic headaches. She was referred to mental health after having a "breakdown". She was first seen in November 2012 at which time she was diagnosed with major depression.

Clinical records endorse her depression as being due to her chronic pain from her service-connected conditions. She has a history of being a very strong and independent woman who has great difficulty dealing with being dependent on others for basic care. This has greatly added to her depression over time. She is seen every 2-3 months for medication management and weekly to biweekly for individual therapy. On her current medication of Remeron 15 mg q.h.s. and temazepam 22.5 mg q.h.s. There is no history of inpatient psychiatric admissions, substance abuse treatment\problems or suicide attempts.

4 months ago she endorsed passive suicidal ideation.

She continues to endorse chronic difficulties with hopelessness, helplessness, worthlessness, and guilt. She has chronic difficulties with "need for control", excessive worry, racing thoughts, feeling like a burden, social withdrawal, irritability, poor frustration tolerance and emotional detachment.

d. Relevant Legal and Behavioral history (pre-military, military, and post-military): No history of DUIs, arrest or time in jail. She is at risk for foreclosure due to losing her source of income. She continues to endorse social withdrawal, emotional detachment, irritability and poor frustration tolerance. There is no history of assault or violence.

e. Relevant Substance abuse history (pre-military, military, and post-military): ETOH: Never problematic; she thinks a glass of wine per month. Drugs: Never. Smoking: In her teens

3. Symptoms

-----------

For VA purposes, check all symptoms that apply to the Veteran's diagnoses:

[x ] Depressed mood

[x ] Anxiety

[x] Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively

[X ] Chronic sleep impairment

[x ] Mild memory loss, such as forgetting names, directions or recent

events

[X ] Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks

[x ] Flattened affect

[x ] Disturbances of motivation and mood

[x ] Difficulty in establishing and maintaining effective work and social relationships

[x ] Difficulty in adapting to stressful circumstances, including work or a worklike setting

[x ] Inability to establish and maintain effective relationships

4. Other symptoms

-----------------

Does the Veteran have any other symptoms attributable to mental disorders that are not listed above?

[x ] Yes [ ] No

If yes, describe:social withdrawl; frequent hopelessness/helplessness; chronic problems with energy/concentration/focus; ruminating thoughts; excessive worry; her need for control; social withdrawal; emotional attachment; frequent sense of worthlessness and guilt; black and white thinking

5. Competency

-------------

Is the Veteran capable of managing his or her financial affairs?

[x ] Yes [ ] No

6. Remarks, if any:

-------------------

The following gives added information reading the Veteran's employability for both sedentary and physical employment based on her mental health symptoms. Veteran is considered fully capable of managing funds in her own best interest.

Her ability to understand and follow instructions is considered mildly impaired.

Her ability to retain instructions as well as sustain concentration to perform simple tasks is considered markedly impaired. Her ability to sustain concentration to task persistence and pace is considered markedly impaired. Her ability to respond appropriately to coworkers, supervisors, or the general public is considered moderately to markedly impaired. Her ability to respond appropriately to changes in the work setting is considered markedly impaired.

Her ability to accept supervision is considered mildly impaired. Her ability to accept criticism is considered mildly impaired. Her ability to be flexible in the work setting is considered markedly impaired. Her ability to work in groups is considered moderately impaired. Her ability for impulse control in the work setting is considered moderately impaired. The veteran has poor stress tolerance and is easily overwhelmed and exhausted. For example, she was very exhausted by the end of her to our assessment.

[broncovet]

I would mention I somewhat agree with PR, but am also sympathetic. You see, the military has all these "alphabet soup" terms, which, not only change with time, but are often different with each branch of military.

As an example, I did not know what "MOS" was, as the Navy did not use that term. But, I know what it means now.

Often people want a specific detailed answer and give only general information. If you want a detailed answer, you need to give details, while if you just want a general answer, then general information will suffice.

A WAG on your rating is very specific to your symptoms. Most ratings are on symptoms..if you have a condition that is asymptomatic, then you will almost never get above zero percent for it. However, since you are wheel chair bound, you have some rather severe symptoms. You have to make sure the Va isnt suggesting some of those symptoms are NSC.

When SS rates you as disabled, this suggests strongly you are also 100percent VA. However, if SS rates you disabled for conditions the VA considers non service connected, then you have a problem.

[broncovet]

Well, you dont want "them" to have your C file. You want a copy of your C file. This assumes the DAV will move with smooth perfection to ferret out all your conditions and apply for them all for you. We have found time after time the DAV, VFW, MOPH, etc, etc, neglects to do this one or more times. Did you know the head honchos of DAV earn about 350,000 per year??

Did you also know that the DAV is sworn to "cooperate with VA"?? Much of the time cooperating with the VA is in conflict with helping the Veteran, and, when the two are in conflict, guess which one wins?? Hint: Its not the Vet.

[GlassRose1500]

Sorry, I meant that when I requested the file, the powers that be had it, and sent it to me. After pouring over it myself I shared it with my DAV rep and he pointed out some things I hadn't considered. And there are some things I didn't pursue. Like fairly clear ties to the beginnings of my endometriosis and graves disease. And very clear incidents that are very likely the cause of the cervical spine issues I go to physical therapy and get deep tissue dry needling for every week.

I know this is going to sound pathetic, but even though I know better now, I .... I'm tired and overwhelmed by just trying to get out of bed. I'm tired of fighting (my teeth are dull and I'm out of nails to throw). So I allowed the DAV Rep to help craft this claim based on impairments that are the most defendable, and I am fairly well resigned to accepting the outcome. I'm hopeful it'll be a good outcome. If I had it to do again, I would have included all potential service connections to avoid the future potential of having to reopen all conditions for examination and potential reduction by claiming something in the future.

EDIT: BroncoVet I seriously DIDN'T know that. Those are good facts to know. I feel like my guy has been on my side, and I was pretty involved during the crafting of my claim. but I've been pretty complacent since then. Thanks for sharing that. Are there veteran's service organizations that are NOT so sworn (to cooperate with the VA)?

Edited November 11, 2013 by GlassRose1500

[john999]

I think the facts as they are could get 100%/TDIU out of your condition, but you may need an IMO down the line. I would wait for my MDD rating and then shop around for private shrink to get an opinion and file for reconsideration or NOD. I started at 10% and got my mental health rating bumped up to 70% and TDIU. The VA alone would never have provided evidence but IMO/IME doctors did the trick.

If I was you and I did not get the rating I wanted I would hire a lawyer. Don't fool around with these guys at DAV etc. From the way you describe your condition you should be TDIU or 100% in my eyes. If a good VA lawyer could not get 100% out of your claim they should retire and quit the law.

I understand the long term corrosive effect of chronic pain and disability. Depression and pain/disability go hand-in-hand.

John

[GlassRose1500]

Thanks for that John. I agree on the IMOs not only as evidence but because I need help. I can't live with this incessant pain. I recently became eligible for Medicare, and elected to go with a replacement HMO plan that will let me see specialists without referrals.

I have three priorities for these non VA docs.

I need more than the x ray of my cervical spine the VA has authorized. Despite serious symptops (like episodes where food gets stuck when I swallow), and being treated presumptively for herniated cervical disks by the physical therapist and VA referred Chiropractor, I'd like to really see what's going on in there - so I'll be asking for an MRI and a suitable treatment plan.

I can't live with this much pain. I'll be seeking an IMO for my lumbar spine with radiculopathy with some hope of treatment that reduces the pain. Or at the very least manages the pain better.

And I'd like some treatment for my Depression beyond ACT therapy (sorry, I don't know what it stands for). My Psychiatrist believes I should be recieving more help ... psychoanalysis...? not sure I have that right - but he isn't able to provide it on an outpatient basis due to VA guidelines and limited number of providers.

And on another note - I'm touched by the warm welcome. And the really great information and advice. Thanks so much to all of you.

Edited November 11, 2013 by GlassRose1500

[john999]

Chronic pain will just break you down, so that is why I recommend getting legal help with your claim if you don't get TDIU or 100%. If mistakes are made in the beginning of a claim it can take years to fix it. Even good claims can take years if not decades to win if the VA makes up their mind to deny.