ptsd C & P Is Done, But I Have Questions

[Bryan2013]

After 14 months my C &P is finally done. I am a little distraught with the findings and hope to find some insight here. Previously I was at 50% combined for major depressive disorder and losing function in my right eye. I filed C & P for the following: Tinnitus, Hearing Loss, PTSD, Insomnia, Night Terrors, Trigeminal Nueralgia, migraines and TBI. I was awarded the following: 10% Tinnitus, 30% PTSD, and 10% Trigeminal Nueralgia. I was flat out denied hearing loss, even tho I have to wear hearing aids since I have been out of service and didn't before entering service. I was also denied the TBI claim. There is nothing in my packet about the night terrors, or migraines. My new percentage is 60%

Here are my questions. I don't see anything in my new claim about my eye. Do they not include that in the C & P packet? It doesnt seem that my eye was included in my computation of percentage, 30% before C & P for the eye, or is it in there and the VA math is masking it? Do they always lump Insomnia into PTSD? Why isn't there anything about Night Terrors or migraines included in the packet?

What do I do if I don't feel my rating fits the severity of my disabilities? I believe I was low balled on the Trigeminal rating. I take 3000 mg, yes three thousand, of nuerotin every day to be able to "function with high pain", this is what I said to the doctor at the C & P exam. Most days I still end up in debilitating pain from it. It helps to sleep it off, but I cant sleep most days anyways.

The migraines are frequent and excruciating. I go to the hospital several (2-4) times a month to get pain meds for them. I am prescribed anti-migraine meds and meds to kill them when they start, but even those are limited to how many I can take a month and don't always work.

I have already expressed my issues with hearing loss.

My PTSD was another thing, I have a GAF of 60 and recieved 30% for it. What does this GAF mean?

I know that I am throwing a lot at you guys and I appreciate any responses that I get.

[john999]

Well, the VA lumps in your depression with the PTSD. What you do is appeal this rating. Try and get new evidence from an IME to boost your ratings. You probably need to file a NOD and include every single disability your claimed and tell why you believe based on symptoms that you deserve more. If they left out a rating on the eye you must NOD that as well. They do lump insomnia with PTSD unless it is from some organic cause like sleep apnea. If you don't NOD all the issues you claimed the VA will just drop them. To be low balled and to have a few claimed issues left off the board is just about SOP.

[Berta]

One of the best things about the internet (for us old timers from the original electronic veterans community circa 1989) is that the VA Schedule of Ratings is now mere clicks away.

http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&sid=c130ec487ea61b8a40ad0836188b94bc&rgn=div5&view=text&node=38:1.0.1.1.5&idno=38

This is a long document but it contains the rating criteria that is reflected by each diagnostic code the VA uses.

The best thing a vet can do when they question ratings, is certainly to consider getting an IMO with some of the retro and make sure the IMO doctor has not only all available medical records but a copy of the rating schedule criteria for each disability you feel was incorrectly rated ,based on the evidence VA used (in the Evidence list included with the decision).

It as always amazes me how sometimes the most critical evidence can be missing from the evidence list, evidence that could warrant a higher rating.

But in most cases these days, a strong IMO that follows our IMO criteria here at hadit, can be the best bet, rather than building your own argument .because VA is quick to say we are not medical professionals and often will give our lay medical opinions no weight , even if we support them with treatises or other medical literature.

Do you have a proven inservice nexus for all of the disabilities they denied?

The Trigeminal Nueralgia. …..I would think that could be the cause of the migraines or associated with the eye condition but I am not a doctor. This is a very painful condition and I think the 10% is Way too low....

The TBI.... do your SMRs reflect a TBI incident?

The Gaf score ....it really doesn't mean much these days....

Are you able to scan and attach the Reasons and Bases for the award here? And the Evidence list they used? Cover your C file number,name and address before you scan it.

It would help us understand better what the VA came up with here.

This BVA decision, dated 1997,

http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp97/files2/9710364.txt

contains the rating schedule for Trigeminal Nueralgia thus:

under Diagnostic code 8405

The decision is significant because it is a remand for extraschedular considertion:

“REMAND

The veteran testified that he must leave either his work area 
or his leave the workplace when he experiences an 
exacerbation of pain due to trigeminal neuralgia; and that he 
experiences such exacerbations frequently, sometimes daily.  
He contends that the pain interferes with his ability to chew 
and that his ability to speak is affected.  He also contends 
that the pain interferes with sleep and concentration and 
that medications to relieve pain make him dizzy.  His 
representative argues on appeal that the veteran’s trigeminal 
neuralgia should be evaluated on an extraschedular basis 
because it cannot be adequately evaluated under the schedular 
criteria.  Further factual development to determine the 
extent of industrial impairment, including the effects of 
pain during exacerbations, is required.” 

Question....do you receive SSDI and if so, is it solely for any established 
SC condition you have?  
Here is another decision that might help us assess this all better if we can read
 the VA decision:
'FINDINGS OF FACT

1.  Trigeminal neuralgia is at least as likely as not related to a remote lightning
 strike in 1969.”

In Part:
 Trigeminal neuralgia 

The Veteran contends that in July 1969 at a missile base in Rockville, Maryland,
 the guard shack he was in was struck by lightning, and that he currently has 
numerous neurological residuals from this event, to include trigeminal neuralgia.  
He asserts he was rendered unconscious by the strike.  A fellow serviceman has provided
 a statement to the effect that he witnessed the strike and waited with the Veteran for 
the ambulance to arrive.  In his written statement he indicates that he initially thought 
the Veteran had died, but that "there was a medical person assign to the Company
 that helped [the Veteran] to breathe," before the ambulance arrived.  

Trigeminal neuralgia was initially diagnosed in March 2002.  In an April 2004 neurology 
note, the Veteran's treating neurologist attributed the trigeminal neuralgia to the 
remote lightening strike.  Similarly, the report of an August 2010 compensation and 
pension examination conducted pursuant to the Veteran's claim for service connection 
for migraine headaches, reflects the Veteran's history of having had symptoms such as 
headaches, shakiness, vertigo, hearing voices and smelling smoke ever since the lightning
 strike.  In opining that the Veteran's headaches and vertigo were related to this 
incident, the examiner commented that the Veteran had had a "very bad lightning injury which affected the whole body.  Several neurological dysfunctions, including headache have been reported after lightning injury."  
and:
In the memorandum decision, the Court pointed to a 2002 medical record which reads, 
"After he woke up from the lightening injury, he had tinnitus, vertigo, and facial pain,"
 for the proposition that the Board should consider the trigeminal neuralgia to be
 inextricably intertwined with the Veteran's vertigo and migraine claims, as all may 
have a common etiology.”

( obviously the veteran had to file at some point with the CAVC)
“Thus, reasonable doubt is resolved in the Veteran's favor, and the appeal 
for service connection for trigeminal neuralgia is granted.”
http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp13/Files3/1329134.txt
Question:
Did you have any incident inservice that caused you to believe you have a TBI,
 and did the VA give you a TBI C & P exam?
It seems obvious to me that the migraines can be associated with the 
trigeninal neuralgia and that, if there evidence evidence of any TBI, 
the TBI would have to be rated separately.
These are 2 more BVA decision which have some rating info in them:
http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp11/Files2/1119734.txt
http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp12/Files6/1241338.txt

Your Trigeminal Nueralgia.... In my opinion, and/or  higher migraine rating could boost
 you  closer to TDIU consideration if you are unemployed.

“I was flat out denied hearing loss” that too concerns me.
I regret I gave you a lot to read here because the Trigeminal Nueralgia is 
not a disability I am familiar with and I wanted to look it up. 

I learned it can stem from many types of accidents,injuries,(which could certainly

 cause TBI as well) and even dental issues and can be excruciatingly painful.....

One more question .....The eye disorder....is it called nystagmus ?

Edited December 10, 2013 by Berta

[Navy04]

Bryan,

The VA lumps conditions: My PTSD 30% consists of PTSD, Depression, OCD, Insomnia, Anxiety and Night Mares, Just like my Crohn's Disease and GERD are lumped together too. The VA regs does not allow Pyramiding Conditions, even though the DRs treat all these conditions separately. I have 30% for Migraines and the VA gave that to me with out me even applying for Migraines, but they saw in my STRs that I had a lot of headaches. My GAF was 42 or 45 don't remember exactly in Feb 13 and the VA only gave me 30% for PTSD and mine was diagnosed in Combat, served in Iraq and Afghanistan. The VA is suppose to be going away from the GAF scores, a GAF score is a function score the Mental Health Docs attach to patients to describe their level of functioning in life examples: Employment, Family life, public life, friends etc. If you read on here you will find out that all raters for the VA rate differently. Sometimes we get good %s from the start, yet most of us get low balled and have to appeal as most Service Connected conditions usually get worse over time and then we have to go fight with the VA again. God bless you and keep us updated and we hope you the best.

[Bryan2013]

Man you guys are fast. Thanks for all the replies. I am still trying to catch all the lingo, but NOD = Notice of Disability?

Berta I am scanning the packet into my computer right now. It will take a few but I will have it done tonight.

[Bryan2013]

Berta

Your font changed mid post and I almost didn't see the questions/comments at the bottom. The root cause of all of this is from an IED explosion. I was about 3 feet away from it, when it went off. Knocked me to the ground and unconscious for a few minutes. This is the incident that leads to me to believe that I have suffered a TBI. Lucky to be alive, I guess. The eye condition is just total loss of visual field due to shrapnel to the oribtal. I have 20/10 in the other eye and am led to believe this is why I don't have a higher rating for this. This excerpt from the Trigeminal Neuralgia claim you posted describes my daily life: "

The veteran testified that he must leave either his work area 
or his leave the workplace when he experiences an 
exacerbation of pain due to trigeminal neuralgia; and that he 
experiences such exacerbations frequently, sometimes daily.  
He contends that the pain interferes with his ability to chew 
and that his ability to speak is affected.  He also contends 
that the pain interferes with sleep and concentration"

I tried to explain this to the doctor but she didn't really seem to understand/care. I have left work several times due to pain and when I was unable to leave work I would sit in a dark, quiet room to help deal with the pain. My migraines could stem from the damage to my Trigeminal although they have never been linked in any of my treatment records.

Lastly, I am unemployed. I have been for nearly two years, just surviving on VA checks. I filed for SSDI this year and was denied shortly before getting my new VA rating, although it is my understanding everyone gets denied their first time through. I have had jobs in the 7 years since medical retirement and all of them have ended in the same result, terminated for attendance. I have 5 VA doctors to keep up with and most want to see me on a nearly monthly basis. Missing one day a week for doctors appointments or pain and having to leave early due to pain, tends to get people fired quickly.

Sorry I did not get the VA packet uploaded. I havent been to sleep in nearly 55 hours and my body is crashing. I will try my best to get it loaded tomorrow, If I can remember to.

Bryan.