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Mark D Worthen PsyD

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Mark D Worthen PsyD last won the day on April 3 2019

Mark D Worthen PsyD had the most liked content!

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About Mark D Worthen PsyD

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    E-4 Petty Officer 3rd Class

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  • Location
    Park City, Utah
  • Interests
    Improving the reliability and validity of C&P exams for PTSD and other mental disorders.

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  1. Were you diagnosed with a thyroid condition in service? If not, did you display hypothyroidism symptoms during your military service, in addition to the weight issue? If you have all your military medical records ("STRs" or service treatment records), ask a Registered Nurse, physician, or other knowledgeable medical professional to review your labs for any indicators of hypothyroidism (or any thyroid problem). I am not a physician. These are simply ideas based on my knowledge of the VA disability program in general. Both of my brothers have hypothyroidism so I know it's no fun, to say the least! Both of them did eventually start to feel better when, as you discussed, their docs were able to fine-tune the Synthroid (levothyroxine) dosage. I hope you get to feeling better quickly! ~ Mark
  2. That looks like very sound advice, dajoker12. I have not yet seen scientific evidence that PTSD causes obstructive sleep apnea (I have read all the articles you posted), but: (1) scientific evidence and legal evidence are not the same; and (2) it could be that there is such a causal relationship but research has simply not identified it yet. There is also the question of aggravation, as you (dajoker12) discuss in your post. I think aggravation is more likely than causation. There has not been much research on the aggravation question, but a sleep medicine physician might (and I know some do) conclude that there can be such a relationship, i.e., that PTSD aggravates (exacerbates) Obstructive Sleep Apnea. I wrote an article (blog post) a while back about mental disorders that are secondary to service-connected medical disorders and I emphasized the importance of specifically asking VBA to consider secondary service connection, and I offered some suggested language for veterans service officers. In my experience, sometimes VBA did not ask a C&P examiner to consider the aggravation question and the examiner did not think of it either (even though they should). Consequently, veterans who might have received disability benefits for a secondary condition did not. That's why I believe it's important to clearly and specifically ask VBA to consider secondary service connection when you file the claim. I adjusted the wording of suggested language for veterans service officers to consider to fit the current topic, i.e., the PTSD ==> Obstructive Sleep Apnea relationship. This is a claim for obstructive sleep apnea that is proximately due to, or aggravated by, the veteran's service-connected posttraumatic stress disorder (PTSD). Please note that the veteran asks the Veteran Benefits Administration to: 1) First consider if the veteran's obstructive sleep apnea is proximately due to, or a result of, the veteran's service-connected PTSD. 2) If not, the veteran then asks VBA to consider if the veteran's service-connected PTSD has aggravated (increased the severity of) the veteran's obstructive sleep apnea beyond its normal course or progression. Allen v. Brown, 7 Vet. App. 439 (1995); Aggravation of nonservice-connected disabilities, 38 C.F.R. § 3.310(b). Note that you should ask a veterans service officer, VA-accredited claims agent, or veterans law attorney about how to phrase questions since they know more about the topic than I do. What I wrote above is simply a suggestion to consider. ~ Mark
  3. Just to make sure I understand correctly, you are currently receiving disability compensation for PTSD at the 70% level. Is that correct? If so, I am wondering if the letter asking you for more details on your stressors might be a mistake. Verifying stressors is something that happens before a veteran is service connected for PTSD. Once you are service connected why would they go back to the service connection question? It's like them saying, "You are service connected for PTSD, so we want to confirm that you have PTSD." As Spock would say, "that does not compute."
  4. People that exploit veterans directly or indirectly deserve harsh punishment. Theresa - I love what you told the reporter: “Your service to your country shouldn’t be shilled by some carnival barker on the corner.” Amen. ~ Mark P.S. I used to do a lot of forensic psych evaluations in North Carolina (criminal cases) so I'm pretty familiar with the judicial system there and how to obtain (publicly-available) information. The perp in this case, Daniel D. James was on the docket for 1 Apr 2019 as the article indicated. For these initial arraignment hearings there usually isn't much info, and that's true for his case. It does list his file number though, which makes it a little easier to research down the road when he finally agrees to a plea bargain (presumably - he'd be stupid to plead his case before a jury). He's charged with a felony, Obtaining Property Under False Pretense, and a misdemeanor, violating a solicitation ordinance. His file number is 19CR 204599. The Public Defender's office is representing him. Here's a link to the docket printout: DISTRICT Court Calendar: 04/01/19, AM Session in court Room 0301 for DISTRICT_CRIMINAL_COURT_ (PDF) or text version. He is #15 on the docket.
  5. Congratulations SwiftSig! I admire your hard work, willingness to ask for help (which takes guts in my book), and discipline to do your part, like organizing everything per your service officer's suggestion. Not an easy task when you are, after all, having to cope with several disabilities and the added stress of the arduous claims process. And it is heartening to hear that 83% of the VA examiners you saw did their homework and treated you with the respect you deserve. Of course, 83% means there's room for improvement, but really that's not too bad for a huge bureaucracy like the VA, and considering that being a C&P examiner is one of the more difficult jobs at VHA. ~ Mark P.S. Lest anyone think I am an apologist for the VA, you should know (and many of you already know) that I am not shy about criticizing the Department of Veterans Affairs. Case in point is a 97-page "white paper", Psych C&P Exams Are Unfair to Veterans, which I submitted to the federal Advisory Committee on Disability Compensation and posted online for anyone to read (or scan, it is a bit dense ;-).
  6. This isn't a crucial point as I'm sure Dr. Valette is up to date on VBA regulations and policies. But just as an FYI for everyone, see this part of the M21-1: M21-1 Adjudicative Procedures Manual, III.iv.3.D.2.c. Telehealth and Telemental Health Examinations ... A mental health DBQ submitted by a private provider and based on a telephone interview with a Veteran is not acceptable or actionable for rating purposes under any circumstances. VHA has determined that, in order to assess a Veteran’s mental health via telemental protocol, examiners must be able to see clearly, and fully appreciate all non-verbal cues, mannerisms, and manifestations displayed by the Veteran in a manner on par with an in-person examination.
  7. Bluebonnie - I feel sad and angry (toward VA) reading your denial letter. You have serious, painful psychological disorders caused by sexual assault which occurred when you were serving our country. A VA psychologist even said so! But because your painful, debilitating symptom do not match with the precise diagnostic criteria for the one-and-only diagnosis that counts, oh gosh sorry you're horrific experience and resulting years and years of suffering don't count. The problem here is not the VA examiner, or the VBA rater, or any of the front-line VA staff who work in the disability claims arena. Most of them like and respect veterans, want to help veterans if they legally can, and many of them are veterans. The problem is VA upper management who apparently did not consult with sexual assault experts, and did not read the scientific literature on this topic. If they had, they would know that sexual assault, particularly when compared to combat trauma (where PTSD is far and away the most common diagnosis), causes a variety of psychological maladies (disorders). VA could have done it right in 2010 when they added 38 C.F.R. § 3.304(f)(5) and they have had 8 + years since then to update the regulation so that any mental disorder caused (or aggravated) by MST is compensable. --- I agree with others who have recommended an Independent Psychological Exam (IPE) or Independent Medical Exam (if it is a psychiatrist). I don't know Dr. Valette but if other vets recommend him, that sounds like a good plan to me! There are definitely legitimate ways to respond to this denial from the psychology perspective. Plus, there are probably legal issues to consider, so I highly recommending retaining an attorney. Of course, all professionals have to earn a living so you need to pay them, but you can pay veterans law attorneys based on a contingency agreement where they receive 20% (or thereabouts) of your back pay if you win your case.
  8. Excellent points broncovet & JKWilliamsSr. I've studied mental health C&P exam issues intensively for 8 years, and I continue to learn important details by reading this forum. Y'all are awesome.
  9. Mark D Worthen. I had a question concerning the new Ketamine drug Johnson and Johnson is coming out with. If you can find the time please email me @ Haasume@yahoo.com.  I don't know how to work private chat "if there even is one" .   Thank You.  J

  10. Have you had your C&P exam for PTSD yet? Folks with ADHD, which is a disorder with an onset during childhood (although it can continue into adulthood), are probably more likely to develop PTSD. I can certainly see PTSD aggravating pre-existing ADHD beyond its normal course and progression. From a VA disability benefits perspective, this is the most important relationship between the disorders. If an examiner concludes, and VBA agrees, that PTSD exacerbated your ADHD, and that this exacerbation (aggravation) led to even more social & occupational impairment than the PTSD alone would cause, the combined effects of PTSD and ADHD are compensable.
  11. In addition to the excellent advice you've received from your fellow vets, I'll briefly share from an examiner's perspective. I learned from my friends who are veterans and from the many veterans I evaluated over the years that the "rules of the game" change dramatically when services members leave the military and enter the world of being a veteran. In the military, seeing the doc for anything that's serious or chronic will likely hurt your career and you'll go from "Awesome member of the team" to "Potential liability". Then, when you enter the world of being a veteran all of a sudden everyone is exclaims, "What?! You haven't sought treatment? You gotta do that man." I don't mean in any way to discount the advice you've received here--I totally agree with it. I'm simply highlighting the stark contrast between life in the military vs. life as a veteran. My main point is that decent C&P examiners know that there are many possible reasons why a veteran hasn't sought treatment before. When and if it seems appropriate (trust your gut) tell your examiners in a brief, matter-of-fact way (like you did here) why you put off treatment for so long. Don't belabor the point. Finally, as others have said, when you go for treatment appointments, try to put your disability claim out of your head. Ask yourself, "If I didn't have a pending claim, what would I say? How would I act?" I've had severe allergies since I was a teenager and they're awful. People who don't have them really don't understand (unless they're medical folks.) But over the years my doctors have found treatments that work for me and now the allergies are a nuisance, but tolerable. Allergies are just one of the ailments you're dealing with, but my point is that treatment is often quite helpful. All the best, Mark
  12. As a C&P examiner, I took letters from spouses seriously. And, if a vet was accompanied by his or her spouse and asked me to speak with him or her, I would always do so as it often helped me to better understand the frequency, intensity, and duration of mental disorder symptoms and associated functional impairment. Unfortunately, VA does not require examiners to interview family members, and there are not any specific requirements for examiners about how to regard letters from family members. Nonetheless, letters from "lay witnesses" could help, even help a lot, and they're unlikely to hurt a veteran's claim. Veterans law attorney Chris Attig recommends submitting lay witness statements as a "Declaration", which he explains in a blog post. Note that Mr. Attig calls it a "sworn declaration" whereas other legal websites, and the relevant U.S. Code, call it either an "unsworn declaration" or simply a "declaration". In my experience reading Mr. Attig's blog over the years, he offers well-written, important, accurate information for veterans and their representatives. I don't know Chris Attig personally, but I respect him and value his opinion. Although they don't mention using a Declaration, the law firm Chisholm, Chisholm, & Kilpatrick has a good article, accompanied by a question & answer video titled, How to Use Lay Evidence for VA Disability Claims. There's an easy-to-understand, informative article on the Martindale (legal publisher) website that discusses Declarations in general, i.e, the article is not specific to veterans law: When to Swear and When to Declare: Affidavit or Declaration? by Matthew J. Bakota (21 May 2012). Finally, here is the statute itself: 28 U.S. Code § 1746 - Unsworn declarations under penalty of per­jury. I'm not an attorney, but it looks pretty straightforward. If it were me I would write exactly what the law specifies at the bottom of a family member's letter, and ask them to date and sign it: Note this part: "... under penalty of perjury ...." Chris Attig offers important advice in the blog post I mentioned above: I hope all your exams go well SwiftSig! ~ Mark
  13. My guess would be that yours is not a difficult claim to adjudicate so they were able to get it (almost) finished faster than expected. Based on the info you shared, there's no way they'll reduce your rating. Regarding the term "moderate to severe", it's important to put it in perspective. 90% to 95% of the country is not suffering from two serious debilitating mental disorders at the same time. Here's Dr. Mark's off-the-cuff, unscientific, for-illustrative-purposes only, 11-point "severity scale" that I just typed out as a "thought experiment" to give you a sense of where "moderate to severe" fits on the continuum. Rating - Description 0 - No symptoms, no history of disorder. 2 - Mild symptoms but frequency, intensity, & duration insufficient for DSM-5 diagnosis of disorder. 4 - Mild symptoms that satisfy DSM-5 diagnosis for the disorder. Experiencing symptoms more often and with more intensity - harder for him to say "it's just a bad week" or similar. Wife said he seems dejected, less energy, motivation flags. He'll bounce back for days or even a week or two but that's becoming less often. Calling in sick to work more often. Supervisor said management has commented on his declined productivity. 6 - Moderate symptoms that cause noticeable and significant social and occupational impairment; frequent distress, dispirited; interpersonal relationships strained, even with her children; school functioning has clearly declined. Got a "C" in one course and two Incomplete grades. Decided to hold off on continuing college coursework, even though she is close to earning all credits for bachelor's degree. 8 - Moderate to Severe - frequent painful symptoms much of the time despite assiduously seeking treatment and following his doctors' advice; significant social & occupational dysfunction; probably will need to seek medical leave, reduce work hours, or may end up not being able to work. Psychiatrist has discussed options for "treatment-resistant depression", e.g., ECT (electroconvulsive therapy); the new ketamine-like medication; Lithium; Abilify; etc.; psychologist recommended VA's 6-week residential treatment program for PTSD in Sheridan, WY. 10 - Severe - very frequent, soul-crushing painful symptoms most of the time despite assiduously seeking treatment and following his doctors' advice; substantial suffering is obvious; significant social impairment, and no longer able to work, at least for the next several months or longer. [The above is not an official, unofficial, actual, or real mental health scale. It's just a way to put symptom severity and functional impairment in perspective for illustrative purposes only.]
  14. If that is literally what they wrote, with nothing about other mental health professionals, it's flat out wrong. Most VBA staff would never write such nonsense. Maybe he or she was brand new? (Not that being new is an excuse.)
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