Denied On Depression.

[Scout Swimmer]

Just got off the phone with my DAV POA, in which he informed me I was denied. He explained they looked at it as a single traumatic event or diagnoses from the military, not as a secondary to my TBI, in which my mental health practitioner clearly stated and which I have 45 pages of supporting evidence stating exactly that. The rep from the DAV told me it was written up wrong. He is talking with the rater as we speak to change it. I'm pretty upset.

[john999]

A doctor has to say that your depression is secondary to your TBI. The VA will not make the logical jump. If your shrink said your depression is secondary to your TBI then I think you can win this on appeal. The VA told one of our wounded warriors that he never was treated for PTSD in service, so he was denied. This is BS, but has to be appealed. They did not read your claim or they just want to hold onto the money for a while.

[63SIERRA]

A pro veteran attorney, who is well know told me abt the " codes". Once you request them (in writing). The RO will see that someone has "put you wise". THEY WILL KNOW WHY YOUR REQUESTING THOSE CODES>

If thier foundation of denial was built on shaky ground, they will start trying to shore it up. If they messed up they wont have much to use to shore it up with, and it will collapse.

Big insurance companies are trying to do something similar to what the va is doing. They have developed a claims system, where all of the information is put into a high dollar computor system, and then it spits out a claim value, according to different factors such as loss of wages, damages ect. If independant reviewers inspect thier system, COLOSSUS I believe it is called, all looks fine, because if they feed into the system, for instance, insured required 6 weeks of physical therapy, and pain meds for his whiplash., The computer will spit out a fair payment for that care. HERE THE PROBLEM ... JUST LIKE THE VAS.. IF THE PERSON FEEDING INFORMATION INTO THE SYSTEM, IS FEEDING IN THE WRONG INFORMATION, THE COMPUTER SYSTEM CANNOT GIVE A FAIR RESULT .

Now you ask, well why would they not feed the correct info into the system? BOTTOM LINE.When the adjuster goes to get a sign off to pay the claim, bossman looks at the bottom line payout, and CRAPS ALL OVER HIMSELF. So worker bee goes back to the mound. Worker bee starts feeding lesser paying CODES into the computer. When the payout becomes tolerable to bossman, and doesnt cause him to crap his tighty whities, then the claim is approved.

va is essentially doing the same thing.

Edited January 10, 2014 by 63SIERRA

[63SIERRA]

A little more abt the COLOSSUS system that insurance companies are try to institute. they require that you fill out a long detailed questionaire, that will inevitably used to screw you by your own admissions thru alot of trick type questions. so if your confronted with this system, be careful.

[NavyWife]

Just got off the phone with my DAV POA, in which he informed me I was denied. He explained they looked at it as a single traumatic event or diagnoses from the military, not as a secondary to my TBI, in which my mental health practitioner clearly stated and which I have 45 pages of supporting evidence stating exactly that. The rep from the DAV told me it was written up wrong. He is talking with the rater as we speak to change it. I'm pretty upset.

Phil-

Your claim should have been filed as "depression secondary to TBI"

Correct me if I'm wrong, but it sounds like the claim was written as "direct service connection for depression".

Look at your copy of your claim and check how it was filed.

Depression is one of the "presumptives" of TBI if it is diagnosed in a certain time frame, either 1 or 3 years after the TBI.

"Depression if manifest within 3 years of moderate or severe TBI, or within 12 months of mild TBI."

Was your depression diagnosed within 3 years after the TBI?

http://www.gpo.gov/fdsys/pkg/FR-2013-12-17/pdf/2013-29911.pdf

http://www.stripes.com/news/va-eases-rules-for-claims-on-some-tbi-related-health-problems-1.257939

The law making it presumptive is new, but even without that new law, things like depression, PTSD and anxiety are well-known to be caused by TBI.

http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayProduct&productID=647

They should be filed as "secondary to TBI" and have a current diagnosis and a nexus statement (if not meeting the presumptive criteria).

FYI, there is a long list of physical problems caused by TBI that can be linked as secondary. Have you looked on the internet to see if any of those other problems are affecting you?

I hope your rep can get this fixed for you!!!!

Edited January 11, 2014 by NavyWife

[Scout Swimmer]

Ok, talked to my VSO. I plain out asked him how the hell did this happen? How in the hell did you not see every bit of my evidence was directed secondary to TBI, yet you allowed it be rated a direct connection claim? I asked him if he was new, overworked, underpaid, and if he was just to plain busy to actually represent me. He managed to utter two words. "I'm sorry" I hate the VA. No treatment or records in military service? Really? Do they really xxxxxxx think grunts pull their platoon Sergeants aside and say: "I'm feeling depressed. Can I bail out on you guys today? I would gladly give up every dollar I've ever been sent with compensation just for a chance, A CHANCE for these raters to be brought up on criminal charges. What a crock. I'm one of the LUCKY ones. I hold gainful employment. My wife makes decent money, we do ok, but Jesus, I feel so bad for those who actually depend on these corrupt assholes. Apologies for the obscenities.

Edited January 11, 2014 by Philgrenier

[Scout Swimmer]

Navy wife, the VA head shrink also diagnosed me for PTSD, but it's only mentioned once, I was denied on depression with 47 pages of documentation stating it was caused by my TBI, so I figure what's the point?