Mental Health C&P

[jlduty]

I had all of my initial C&P exams about 3 weeks ago.  I was not initially scheduled to see a mental health professional.  At the general exam I was asked if I had ever been seen by a mental health professional during my AD service and whether I had ever been depressed.  I answered yes to both.  The examiner recommended to the VA that I have a mental health exam as well.    I received the appointment letter two days ago.

I have never been diagnosed with depression but I did have an evaluation/interview when I was trying to get my chronic pain diagnosed.  I never heard back from the doctor after the evaluation.  However, I have had suicidal thoughts at three different times in my life.  I also went to a therapist through Military One Source when I was going through my divorce.    Well, onto my question I guess, now that I have given a little background information.  I am just wondering what I should expect at my exam next week?  I am not sure what I should even say.  I am not currently struggling at all, however, I can get dark sometimes.  I would like to have a service connection in case I slide back into a bad place in the future.  I am only hoping for a 0%.  Should I add mental condition or depression to my claim or should I wait until my current claim is settled so as not to send it back to the beginning again? Or will this exam be sufficient?  Any advice or insight would be greatly appreciated.     

[Buck52]

I Copy this from Ms T Bird Military News she puts on hadit

it could help.

DSM 5 or DSM IV For VA Mental Disorders Compensation and Pension Exam

Question presented since we went from version IV to 5 of the Diagnostic and Statistical Manual of Mental Disorders M21-1 MR Part III IV 3 Sec A-1 General Claims Process Which version are being used in VA Compensation Claims.

Click this link for the most recent version Section A. Examination Requests – Veterans Benefits – United States Department of Veterans Affairs

When I went to my PTSD C&P (OTC)...I was just myself  as I set there I answer all her questions but I could not sit still, not from nervousness but my PTSD was turned on  with anxiety   I was trying my best to get through the exam, I made eye contact and not stair at the floor.

Mostly she read things off the computer RO sends them.

'' I understand you been diagnosed by the VA for PTSD'',And mention to me she would not ask me about my stressors  that she had read my records and she didn't want to put me through those horrific memory's 

Thank you Mam.

Most of the questions she ask me was my grade level in High School and about my jobs after military  why I had so many and my social behavior, she said she understands  my movement in being employed, and of course questions about PTSD SI  Ect,,ect,,

Just be honest and never say anything you can't back up.

let your records/evidence speak for you.

jmo

.................Buck

[Mark D Worthen PsyD]

On 5/20/2016 at 11:56 AM, Andyman73 said:

Yeah, guess I fumbled the ball a bit, there.

Mark, I wasn't really saying that everyday is your worst day. However if you give a general answer, then something important gets left out. For example, if you say that when you're having a tough day, SI thoughts dance around in your head. Which is in the 70% rating area. But if you say that you're generally depressed all the time, well, the examiner may opine your depression is of a much lesser % degree.  Or, maybe it doesn't matter because your examiner isn't interested.

Like Gastone said, I certainly am not trying to get anything passed/over on the VA. I just want to be treated fairly and given what's due me.  If I go 2 decades without seeking help, because I believed I wasn't eligible, am I to be punished because of it?  Am I less deserving, or less believable? What if I had succeeded with my suicide attempts? It wouldn't matter what anyone thought about me then, or if they believed me at all.

Talon, if your examiner is not interested in your service, and keeps trying to steer the conversation to the time before service, at what point do you, the Vet get to say enough? 

I agree 100% Andyman73. We are definitely on the same page. 

[Mark D Worthen PsyD]

On 5/20/2016 at 10:31 AM, TALON II FE said:

I agree with the above from Mark and Gastone, with a word of caution:  I would highly recommend avoiding any topic matter PRIOR to your service.  I think this is what Andy was getting at in part of his post.  Even though there is a qualifier which says that a disability made worse by service should be treated the same as one incurred while in service, in MH rating, this does not seemed to be honored as 'frequently'.  I have seen many Vets run into problems when they started going into childhood, adolescence, etc.  It really is NOT pertinent to the rating, or should it be part of the SC

Keep in mind, this is NOT a medical appointment!  It is more of a legal fact-finding inquiry.  In all honesty, you were enlisted or commissioned being of "sound mind and body", excepting anything found during intake thru MEPS, etc.  Unless they noted issues then, you effectively had "no defect" upon entry into service.  Initially, I failed the depth perception test.  I had just switched to glasses from contacts for the MEPS, so that was the cause.  I later switched to a flying gig from busting my knuckles, passed the depth perception test, no problem.  BUT, if I tried to claim a depth perception issue, I would have a steep hill to climb.  Once you open up that Pandora's box at a C&P, well...it could cause issues.

Please keep in mind, a C&P is NOT treatment!  In treatment, I would recommend baring it all.  You have to put it all out there and deal with it to realize the maximum return from your therapy, BUT I don't believe that a C&P is the place for that.  Stick to what happened in service and since you exited, you will be less likely to incur "unexpected" or "unplanned" results, or a lack of results altogether.

I agree that there is no need for the veteran to bring up problems they had prior to military service. At the same time, the C&P psychologist might ask some questions about a veteran's "developmental history." As others have wisely advised, just answer such questions matter-of-factly. Don't be vague or evasive, but you don't have to go into a lot of detail. 

I know that some C&P examiners seem to go out of their way to pin a vet's current problems on an (allegedly) pre-existing mental disorder. I have seen such C&P exam reports. Occasionally, the examiner is accurate, but more often than not it's clear they went on a fishing expedition, which is infuriating to me, so I can only imagine how frustrating and demoralizing it must be for a veteran who receives such a bad exam. Fortunately, I have seen less of those types of biased exams in recent years. But, as TALON said, it can happen. 

If VBA denies a claim based on an allegedly pre-existing mental disorder, and the vet believes it's a mistake, then definitely ask for a reconsideration or appeal the decision. Also as TALON said, service members are presumed to be fit for duty, or one might say, "of sound mind and body", when they are accepted into service. This "presumption of soundness" means that if VA later says, "Wait, no, he really wasn't of sound mind and body", then VA must present "clear and unmistakable evidence" proving that the veteran's current mental disorder (or other medical disorder/injury) pre-existed service, and was not aggravated by service. That's a high burden to prove, although sometimes it takes a judge to ask the hard questions and to conclude that VA's 'evidence' is not clear and unmistakable. In the mental health realm I have seen VBA issuing fewer denials based on pre-existing mental disorders over time, although it certainly still happens. 

The most common problems I've seen are the usually ludicrous, but unfortunately ubiquitous, personality disorder diagnoses made by Army, Navy, or Air Force docs. My advice to interns and new C&P psychologists has been to be highly skeptical of such diagnoses, i.e., assume they are inaccurate unless the military psychologist or psychiatrist presented a compelling case for the diagnosis in MEB/PEB proceedings or otherwise. Such compelling evidence is very uncommon in my experience. 

Edited May 21, 2016 by Mark D Worthen PsyD
improve clarity of expression; typos

[Mark D Worthen PsyD]

Btw, I consulted Mr. Google to make sure I was wording things correctly - I searched for "presumption of soundness" - and one of the first results was from a veterans law attorney's blog. Check out what this lawyer did for the vet he represented.

Quote

 

Our client kept insisting that his pre-service injury was to the lumbar spine and not the thoracic spine. The VA didn't buy it.

So here's what we did. We tracked down the orthopedic surgeon who treated him in 1967. Although his records from that era were no longer available, he indicated that based on the treatment he provided to the veteran, the injury did not likely involve the thoracic spine. The now retired surgeon wrote two very detailed reports.

We also tracked down the nurse who treated him for the pre-service injury. She provided a sworn affidavit that the veteran presented to the hospital in 1967 with complaints to the lumbar spine.

[Source: http://veteransdisabilityinfo.com/blog/recent-win-using-presumption-soundness ]

I do not know this attorney or his firm, I just thought it was pretty cool that they tracked down a surgeon and nurse who treated the veteran almost 50 years ago. 

~ Mark

Edited May 21, 2016 by Mark D Worthen PsyD
added URL to blog post

[Andyman73]

jlduty,

I apologize for hijacking your thread.  I deleted my post to prevent further hijacking.

Edited May 26, 2016 by Andyman73

[jlduty]

Thanks to all of you for your input.  I am really grateful.  As an update, I had my C&P yesterday.  The Dr had a copy of my evaluation that I had when I was seeking a diagnosis for my chronic pain.  The Dr back in 2012 did tell me that she did not think my pain was all in my head.  What she failed to tell me was that "the patient is suffering from depression and anxiety and should begin treatment.  Will follow up with her in 2 weeks".  I was never told to schedule an appointment or that I was suffering (in the clinical sense) from anxiety or depression.  I never went back to Mental Health and I definitely would have if I had been told.  I guess that is neither here nor there, but, I suppose that is my service connection right there.  The Examiner also told me that I should seek therapy which indicates to me that he thinks I am still having some difficulty with life, etc.  

As far as his questions go, there was a pretty in depth framework he was required to follow with specific questions.  He was really open and empathetic.  He stated up front that it wasn't a therapy session and that I might feel rushed.  He also said that he would move on the next question once he felt he had enough info to answer one.  He also said he wanted me to feel heard, so if I had more to add that I needed to assert myself and make sure I told him.  He did start at birth and moved forward from there.  Asked about my family unit growing up. If I suffered any abuse?  If I could maintain social relationships?  He asked how school was for me both socially and academically.  He asked about my deployments and about my current family situation.  He asked how many children I have and what # marriage I am on.  It was a rather in depth interview.  At the end, he asked if I had any other symptoms or information to add. He also gave me the opportunity to ask him questions about the exam.