Patrick428

Stretch and others,

Unlike many doctors who charge for IMEs or IMHO, I do not charge anything to any veteran who needs help with their claim or assistance in reconstituting mistakes made by VA MH clinicians, private providers who have little or no experience with veterans, or individuals who write IMEs or MHO. I post what I did based on a long term history of redoing messes created by other practitioners, including Dr. Bash. Again, it is only my opinion. All one has to do is research Dr. Bash's record with the BVA. Second, and I will repeat when it comes to Mental Heath diagnoses, ONLY a Clinicall Psychologist or Psychiatrist, or those they sign off on can diagnose or render an opinion pertaining to a claim. This does not include Internal Medicine Specilists, Radiologists, Family Doctors, Surgeons, LPCs, grandma, or a buddy who is a veteran.

Finally, for anyone suggesting I'm here to conduct business would be wrong. I'm retired, but still maintain active licenses to practice Psychology, and have been a certified expert in PTSD clinically and forensically for over 30-years. One may ask why I do what I do for free? I do it because I was helped by a doctor who assisted me in obtaining the ratings I felt I rated free of charge. It follows the old adage, "It was done for me, and I just pass it forward." Nothing more, nothing less. Like many of you, I'm a two tour Vietnam veteran who served in the Matine Corps; wounded twice; 100% P and T with SMC-S. In other words, been there, done that, and have the T-shirt. Just because I'm a Psychologist does not translate into I did not have a life before Psychology.

Patrick428

PTSD/dissociative type will not create a higher rating because of a subtype or specifier. All PTSD diagnoses are coded 309.81 with specifiers like dissociative, depersonalization, delayed expression, etc. What matters is the overall severity of PTSD that will determine its rating. A veteran may be diagnosed with PTSD, dissociative, but only have moderate deficits plus some problems with social and occupational impairment, may receive a rating of 50%. The VA follows percentage levels for rating all mental disorders starting at 0%, 10%, 30%, 50%, 70%, and 100%. So if a veteran was diagnosed with PTSD/dissociative and meets the criteria for 100% including Total Social and Occupational Impairment, along with supporting evidence, the veteran should be rated 100%. If it is severe, then 70%, and so on. The coding for PTSD is 309.81 regardless of the specifier. Acute Stress Disorder does have several codes, but the duration is only 6 months with no delayed onset. However, I always hope any veteran receives the highest rating possible.

Patrick

I do IMHOs for a number of veterans. Clearly understand, this is only my opinion, and it is up to each individual veteran to decide for themselves what is in their best interest. However, I would not suggest using Dr. Bash for an IME. One, he is not well regarded by the VA across the board, and two he charges an exorbinate fee for his services. If your willing to part with $1500 to $7000 for an IME from him, be my guest. Second, he's a radiologist and any opinions concerning PTSD or other mental disorders are moot. The VA has a hard and fast rule that only a Private or VA Psychiatrist or Clinical Psychologist can render an opinion for the VA about Mental Health issues. I can assure you, I have performed IMNOs for veterans who used Dr. Bash, and can with some degree of reliability say, most of his opinions on mental health are denied by the VA. I am not sure of his ability with medical issues, however, when any person, or organization touts they aid or can do wonders for your claim, probably can't. I am currently reviewing a IME from a Dr. Bush of Williamson, GA, who wrote a 20-page report trying to undo what Dr. Bash provided as an IME. My part is writing a mental health opinion, again attempting to undo a Mental Health Evaluation from Dr. Bash. I do not know Dr. Bash, and for all practicle purpsoes may be a very fine physician. I worked for the VA as a Clinical Psychologist and a C and P examiner for several years. I am not tooting my own horn, but I have seen his work. Need I say more?

Here's BVA decision denying a veteran SC for Sleep Apnea secondary to SC Depression, who used Dr. Bash for IME. It's interesting reading and there are many more BVA decisions with similar outcomes referencing Dr. Bash.

http://www.va.gov/vetapp10/files2/1016260.txt


If a veteran is seeking an IME, I suggest going to a Specialist at a University Medical Center and having it done. First, University doctors do not have an agenda, nor are they in it for the bucks. Additionally you will get a credible IME based on current and up-to-date medical information and procedures.

JMHO,

Patrick428

I do IMHOs for a number of veterans. Clearly understand, this is only my opinion, and it is up to each individual veteran to decide for themselves what is in their best interest. However, I would not suggest using Dr. Bash for an IME. One, he is not well regarded by the VA across the board, and two he charges an exorbinate fee for his services. If your willing to part with $1500 to $7000 for an IME from him, be my guest. Second, he's a radiologist and any opinions concerning PTSD or other mental disorders are moot. The VA has a hard and fast rule that only a Private or VA Psychiatrist or Clinical Psychologist can render an opinion for the VA about Mental Health issues. I can assure you, I have performed IMNOs for veterans who used Dr. Bash, and can with some degree of reliability say, most of his opinions on mental health are denied by the VA. I am not sure of his ability with medical issues, however, when any person, or organization touts they aid or can do wonders for your claim, probably can't. I am currently reviewing a IME from a Dr. Bush of Williamson, GA, who wrote a 20-page report trying to undo what Dr. Bash provided as an IME. My part is writing a mental health opinion, again attempting to undo a Mental Health Evaluation from Dr. Bash. I do not know Dr. Bash, and for all practicle purpsoes may be a very fine physician. I worked for the VA as a Clinical Psychologist and a C and P examiner for several years. I am not tooting my own horn, but I have seen his work. Need I say more?

Here's BVA decision denying a veteran SC for Sleep Apnea secondary to SC Depression, who used Dr. Bash for IME. It's interesting reading and there are many more BVA decisions with similar outcomes referencing Dr. Bash.

http://www.va.gov/vetapp10/files2/1016260.txt


If a veteran is seeking an IME, I suggest going to a Specialist at a University Medical Center and having it done. First, University doctors do not have an agenda, nor are they in it for the bucks. Additionally you will get a credible IME based on current and up-to-date medical information and procedures.

JMHO,

Patrick428

Stretch and others,

Unlike many doctors who charge for IMEs or IMHO, I do not charge anything to any veteran who needs help with their claim or assistance in reconstituting mistakes made by VA MH clinicians, private providers who have little or no experience with veterans, or individuals who write IMEs or MHO. I post what I did based on a long term history of redoing messes created by other practitioners, including Dr. Bash. Again, it is only my opinion. All one has to do is research Dr. Bash's record with the BVA. Second, and I will repeat when it comes to Mental Heath diagnoses, ONLY a Clinicall Psychologist or Psychiatrist, or those they sign off on can diagnose or render an opinion pertaining to a claim. This does not include Internal Medicine Specilists, Radiologists, Family Doctors, Surgeons, LPCs, grandma, or a buddy who is a veteran.

Finally, for anyone suggesting I'm here to conduct business would be wrong. I'm retired, but still maintain active licenses to practice Psychology, and have been a certified expert in PTSD clinically and forensically for over 30-years. One may ask why I do what I do for free? I do it because I was helped by a doctor who assisted me in obtaining the ratings I felt I rated free of charge. It follows the old adage, "It was done for me, and I just pass it forward." Nothing more, nothing less. Like many of you, I'm a two tour Vietnam veteran who served in the Matine Corps; wounded twice; 100% P and T with SMC-S. In other words, been there, done that, and have the T-shirt. Just because I'm a Psychologist does not translate into I did not have a life before Psychology.

Patrick428

Stretch and others,

Unlike many doctors who charge for IMEs or IMHO, I do not charge anything to any veteran who needs help with their claim or assistance in reconstituting mistakes made by VA MH clinicians, private providers who have little or no experience with veterans, or individuals who write IMEs or MHO. I post what I did based on a long term history of redoing messes created by other practitioners, including Dr. Bash. Again, it is only my opinion. All one has to do is research Dr. Bash's record with the BVA. Second, and I will repeat when it comes to Mental Heath diagnoses, ONLY a Clinicall Psychologist or Psychiatrist, or those they sign off on can diagnose or render an opinion pertaining to a claim. This does not include Internal Medicine Specilists, Radiologists, Family Doctors, Surgeons, LPCs, grandma, or a buddy who is a veteran.

Finally, for anyone suggesting I'm here to conduct business would be wrong. I'm retired, but still maintain active licenses to practice Psychology, and have been a certified expert in PTSD clinically and forensically for over 30-years. One may ask why I do what I do for free? I do it because I was helped by a doctor who assisted me in obtaining the ratings I felt I rated free of charge. It follows the old adage, "It was done for me, and I just pass it forward." Nothing more, nothing less. Like many of you, I'm a two tour Vietnam veteran who served in the Matine Corps; wounded twice; 100% P and T with SMC-S. In other words, been there, done that, and have the T-shirt. Just because I'm a Psychologist does not translate into I did not have a life before Psychology.

Patrick428

It is true that an Initial DBQ for PTSD must be completed by a VA Psychologist or Psychiatrist, however, if the veterans has been already diagnosed with PTSD by his VA or private Psychologist or psychiatrist, then an Initial DBQ is moot. The Initial DBQ is used for veterans who are first time patients in a VA clinic and have never been diagnosed with PTSD. There have been many cases when a veteran simply files a claim for PTSD and is given a C and P, whereupon the examiner will do the Initial DBQ for PTSD. Any Clinical Psychologist or Psychiatrist, or those under their supervision can do a Review DBQ for PTSD or other Mental Disorders can be completed by a private practitioner. I do them all the time, and was formerly and C and P examiner for the VA. There are exceptions to who can and cannot fill out certain DBQs:

http://www.benefits.va.gov/compensation/dbq_FAQs.asp
Which DBQs are not available for use by private providers? A: There are no DBQs for the following medical examinations:
Initial Examination for Post-Traumatic Stress Disorder Hearing Loss and Tinnitus Residuals of Traumatic Brain Injury Cold Injury Residuals Prisoner of War Examination Protocol Gulf War Medical Examination General Medical Examination for Compensation Purposes General Medical Examination for Pension Purposes Patrick428

Hedgy,

Don't be discouraged, as a C and P exam is only one part of many parts in rendering a decision. If your examner was not a specialist in Gastroenterology, and your treatment specialist is, the VA will generally takes the conclusions of your treating specialist. I had the similar problem with Parkinson's Disease. My Neurologist wrote what I consider an fabulous DBQ. However, the VA sent me to a C and P with an Internal Medcine Specialist. He tried to undercut my Neurologist at every step. When the decision came, the raters determined that one, I should have never sent to a C and P, as they took my Neurologist's information and treatment records over that of the C and P examiner. The decisions basically said, "since your Neurologist is your treating specialist and has been treating you for Parkinson's Disease, the C and P was not considered and we established service connection based on your treatment specialists DBQ and treatment notes. I was granted 70% for Presumptve Parkinson's due to Agent Orange.

On a side note, I did my stint as a MH C and P examiner for the VA. Often as is the case, the C and P examiner may not have read your C-file and based his/her conclusions on simply what he/she had on hand. Let the raters do their job. If they feel the C and P was inadequate, they will no doubt give greater weight to your treatment specialist.

Patrick428

Take your C and P, and sit down and find all errors you feel are not correct. Then one-by-one quote the error and then provide evidence to correct the errors. Understand you are not a medical doctor, and generally their opinions hold hard and fast. However, if you have medical evidence contrary to the examiners findings, list this in your letter of corrections and then attach this medical evidence to your letter of corrections. Do not send it the C and P unit, but send it to the RO handling your claim. If they have a Claims Coach see that this information gets to this individual, then request once the CC has gone over it, to send it to the Supervisor over all the DROs in your Regional Office.

Here are three options you can also do:

Complain to the Patient Advocate at your VAMC (if they are good)
Send a complaint: via iris.va.gov
or send it to:

If your location of residence is:

AL, CT, DE, DC, FL, GA, IN, KY, ME, MA, MI, MS, NH, NJ, NY, NC, OH, PA, RI, SC, TN, VT, VA, WV

DVA, Evidence Intake Ctr, POB 4444, Newnan GA 30271-0020 or

fax toll free to 844-531-7818

or

All other States:
DVA, Evidence Intake Ctr, POB 4444, Janesville, WI, 53547-4444 or
Fax toll free to 844-822-5246

Patrick428

Take your C and P, and sit down and find all errors you feel are not correct. Then one-by-one quote the error and then provide evidence to correct the errors. Understand you are not a medical doctor, and generally their opinions hold hard and fast. However, if you have medical evidence contrary to the examiners findings, list this in your letter of corrections and then attach this medical evidence to your letter of corrections. Do not send it the C and P unit, but send it to the RO handling your claim. If they have a Claims Coach see that this information gets to this individual, then request once the CC has gone over it, to send it to the Supervisor over all the DROs in your Regional Office.

Here are three options you can also do:

Complain to the Patient Advocate at your VAMC (if they are good)
Send a complaint: via iris.va.gov
or send it to:

If your location of residence is:

AL, CT, DE, DC, FL, GA, IN, KY, ME, MA, MI, MS, NH, NJ, NY, NC, OH, PA, RI, SC, TN, VT, VA, WV

DVA, Evidence Intake Ctr, POB 4444, Newnan GA 30271-0020 or

fax toll free to 844-531-7818

or

All other States:
DVA, Evidence Intake Ctr, POB 4444, Janesville, WI, 53547-4444 or
Fax toll free to 844-822-5246

Patrick428

Be a little leary of an examiner who makes these kinds of statements. Especially to walk away from your job. It's not that you will not be service connected, but the examiner was out of bounds in making a comment of this type. This suggests that your condition is so bad, a reasonable person may walk away from a C and P feeling they have a slam-dunk for a claim. A C and P is just one part of about 20 different processes a claim must go through for a rating. I spent some of my career as a psychologist in a VA Mental Health clinic and as a C and P examiner. We were told to be courteous and polite, and treat veterans with dignity (which seems to have disappeared recently), and not make statements that would leave the impression you were "good to go." In some cases, a good word from the examiner sometimes ends up with a low rating or a denial, This is why an examiner does not want to elude to the idea you will get service connection because this is not their job. Examiners verifies the diagnosis is correct and then determines the severity of the contention being examined. Tada!!

Patrick428