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Mark D Worthen PsyD

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Everything posted by Mark D Worthen PsyD

  1. It is definitely confusing! I suggest that in almost all instances you communicate via U.S. Postal Service mail, sending all correspondence via Certified Mail, Return Receipt requested: Certified Mail - Prove you sent it. See when it was delivered or that a delivery attempt was made, and get the signature of the person who accepts the mailing when combined with Return Receipt. $3.55 Return Receipt - Get an electronic or hardcopy delivery record showing the recipient’s signature. $2.85 for mail receipt. $1.70 for email receipt. Detailed info on this USPS web page - Insuranc
  2. Information from a non-VA clinician (physician, psychologist, audiologist, etc.) supporting a veteran's disability claim can be divided into two types: (1) A report of diagnosis, treatment, prognosis, progress notes, etc. from a treating clinician, without an opinion regarding causation (nexus). For PTSD and other mental disorder claims, which is what I know best, medical records from treating clinicians are very important. VBA—and a VA examiner—should have access to your VHA (Veterans Health Administration) medical records. They should also have access to your STRs (service treatmen
  3. 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 fu
  4. 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 (
  5. 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."
  6. 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
  7. 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
  8. 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 apprec
  9. 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
  10. 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.
  11. 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 alo
  12. 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
  13. 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 unl
  14. 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
  15. 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.)
  16. Wow, this is a great thread. Nothing like the voices of experience to get a good sense of what's available in terms of an IMO/IME/Nexus Opinion. I don't know any of the physicians personally, but similar to what y'all have written, I have been impressed with Drs. Bash and Anise with regard to their breadth and depth of knowledge and ability to communicate effectively in writing. I have also enjoyed listening to Dr. Bash on the HadIt radio hour. I don't know as much about Dr. Ellis but I have read numerous positive reports here and on other forums. I have never read anything negativ
  17. Usually the endorsed symptoms make the rating higher. In the General Rating Formula for Mental Disorders (38 C.F.R. § 4.130) the endorsed symptoms are associated with the following disability impairment levels (ratings): anxiety, suspiciousness, chronic sleep impairment > 30% difficulty in establishing and maintaining effective work and social relationships > 50% difficulty adapting to stressful circumstances (including work or a worklike setting) > 70% The VBA RSVR ("rater") considers all reliable evidence, although the endorsed symptoms carry more weight, al
  18. Complex PTSD usually results from sustained, awful childhood abuse - sexual, physical, or mental/emotional - often all three. I've diagnosed Complex PTSD several times, usually with female MST survivors. A crucial point for C&P psychologists: Either opine that military sexual trauma aggravated the pre-existing mental disorder beyond its normal course and progression; or explain how adult trauma can, in a sense, "reawaken" dormant or subthreshold trauma-related symptomatology. It's rare these days for VBA to claim a disorder pre-dated military service, but the last thi
  19. I tried to connect my social media accounts--Twitter, Google+, and LinkedIn--but for each of them I received an error message, like this: You need to pass the "client_id" parameter Missing required parameter: client_id Is there something I need to do on my end that I'm too dense to figure out? Thanks! P.S. Teresa - Thank you for regularly publishing your newsletter. I haven't worked the past two years while I received medical treatment, and I wasn't keeping up with veterans disability news as much as in the past. But as my recovery progressed (all better now thank g
  20. The odds are exceptionally low that it would change anything. A few facts to know: * If VA used ICD-11, a vet could theoretically be diagnosed with Complex PTSD due to childhood trauma and due to combat trauma. * Complex PTSD is an ICD-11 diagnosis, but the VA uses DSM-5/ICD-10-CM, which does not have Complex PTSD as a diagnosis. * I'm neither a veterans law attorney, nor an expert on the regulations, but I think you fall under 38 C.F.R. § 3.951(b), which states in part: "A disability which has been continuously rated at or above any evaluation of disability for 20 or more
  21. That should get you a C&P exam for sure. I wish you all the best! Mark
  22. If he hasn't had an Agent Orange Registry Health Exam for Veterans, it's a good thing to do for medical (treatment) reasons. It is completely separate from the disability compensation process, but the doctor can alert the veteran to conditions that might be related to Agent Orange exposure, for which he could then receive treatment. (If he does not have an earned income, and for other reasons, he is probably eligible for free medical treatment at the VA.)
  23. IMHO Secretary Bob is the real deal - he really gives a f**k. He is trying to drastically change the entrenched, fear-based, authoritarian management style that emanates from 810 Varmint Ave. (Can you tell whose blog I read?) Of course the Entrenched are resisting tooth and nail. I hope whomever is Prez come next January will reappoint him, although that doesn't happen often.
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