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Mark D Worthen PsyD
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Posts posted by Mark D Worthen PsyD
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What diagnosis does his current treating psychiatrist list? How about mental health treatment in the past--did they diagnose schizophrenia? PTSD?
When did he first manifest symptoms of schizophrenia? When did he first receive treatment for schizophrenia?
Sorry to ask so many questions, but that information will help me and others to give you more specific advice.
I agree with @Berta - you have a right to receive a copy of the C&P exam reports from VBA after the Rating Decision. Use VA FORM 3288 and either mail or fax it to the VBA Centralized Intake Center. If you mail it, do so in a way that gives you proof that it was received, e.g., U.S. Postal Service Signature Confirmation. If you fax the form, you will receive a fax receipt from the VBA centralized intake center.
I attached a copy of VA FORM 3288 with some tips for how to fill it out.
You can complete the form by printing it and then filling it out with a pen, or you can type your answers into the form, and then print it. Be sure to sign and date the form in ink. VA FORM 3288 is online at:
http://www.va.gov/vaforms/va/pdf/VA3288.pdf
All the Best,
Mark
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This descriptor is at the 30% level, from the General Rating Formula for Mental Disorders (38 C.F.R. § 4.130):
[X] Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation
However, these items, from Section II, Number 3 of the Mental Disorders DBQ, are at generally higher levels:
30%
[X] Depressed mood
[X] Anxiety
[X] Suspiciousness
[X] Chronic sleep impairment50%
[X] Disturbances of motivation and mood
[X] Difficulty in establishing and maintaining effective work and social relationships70%
[X] Difficulty in adapting to stressful circumstances, including work or a worklike setting
[X] Inability to establish and maintain effective relationships
[X] Neglect of personal appearance and hygiene
[X] Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygieneYou can find the signs, descriptions of functional impairment, and symptoms associated with each disability rating level in the General Rating Formula for Mental Disorders. I attached a Word doc, whcih contains the Rating Formula.
Of course, the RVSR (VBA 'rater') determines your disability rating, but as I understand it, if they assign a rating lower than 70%, in your case, then they need to provide a rationale. It partly depends on your medical records, particularly mental health treatment records, but if they are not dramatically different, in terms of the symptoms and associated problems noted, then I would anticipate an increased disability rating for depression.
I noticed that she (the C&P psychologist) did not say anything about IU (Individual Unemployability). If the VBA requested information about employability on VA FORM 2507 (the referral form VBA uses to request a C&P from a VA medical center or contractor), then VBA will probably send your exam report back as insufficient and instruct the examiner to answer their question(s) about employability.
Her diagnosis for ICD-10 code F32.9 is wrong. She listed Depressive Disorder NOS (Not Otherwise Specified), which is a DSM-IV diagnosis. VA instructed C&P psychologists to use DSM-5 beginning on 1 December 2013. The ICD-10 code F32.9 is for Major Depressive Disorder, Single Episode, Unspecified.
Although the C&P psychologist's report is not a good one, it looks like the end result will be positive for you.
Thank you for your service and sacrifice for our country @dolfanbls.
All the Best,
Mark
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I list the following resources on my website (PTSDexams.com). The first two links are articles (posts) I wrote, published on my site:
Advice for Veterans – VA PTSD Compensation and Pension Exam – Advice for veterans who have filed a VA disability benefits claim for posttraumatic stress disorder (PTSD), and have been scheduled for a Compensation and Pension examination (C&P exam).
Advice for Veterans – PTSD Military Sexual Trauma (MST) C&P Exams – Suggestions for MST survivors to file a successful claim for VA disability compensation benefits, although much of the information applies to veterans disability benefits claims in general.
What to Expect at Your C&P Exam – Well-written article for veterans that explains what you can expect at your C&P exam and how to prepare.
What to Expect at Your C&P Exam (Video) – A 5-minute video produced by the Department of Veterans Affairs that describes what veterans can expect at their C&P exam.
Exam Tips from a Veterans Law Attorney – Check out lawyer Chris Attig’s 10 Tips to Help You Keep the C&P Exam in Perspective. He offers excellent advice from a legal perspective, which is entirely consistent with the suggestions I provide from a psychologist’s perspective.
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Hi Rita,
I recently wrote a blog post with detailed suggestions for filing a PTSD due to MST claim, including several links to additional online resources:
Advice for Veterans – PTSD Military Sexual Trauma (MST) C&P Exams
Feel free to ask any questions about the information in that post, either in a response (comment) to the post, or here on HadIt.com :O)
The good news is that, as @GuaymasJim said, you can indeed receive disability benefits for PTSD/MST even the horrible crime against you occurred many years ago.
All the Best,
Mark
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Quote
Question 1) Is this normal? Are they splitting up the disability into two things?
My understanding is that eating disorders are considered to be a separate disability from all other mental disorders. See this post:
QuoteQuestion 2) Can you lose service connected? She didn't really ask a lot about my time in the military. This was previously established, however.
Extremely unlikely.
I hope it goes well for you. :O)
All the Best,
Mark
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On 5/7/2016 at 1:11 AM, jfrei said:
In the exam they said I had no TBI will the fact that I have proven SC for one help my PTSD claim?
VBA service connected you for TBI, but then said you do not have TBI?
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On 5/8/2016 at 11:10 PM, obj1970 said:
I was denied PTSD...
In the VBA Decision Letter you received, they provide reasons for denying a claim. What reasons did they give you for denying your PTSD claim?
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On 5/11/2016 at 2:31 PM, Navy8081 said:
I was diagnosed with PTSD by full fledge mental health doctor who worked for the VA and he also ended up being my C&P Examiner after he had treated me for 10 years of mental health therapy . I was diagnosed in 2009 and increased to 70 percent PTSD in 2013 and was given Permanent and Total as well at the time.
I then counseled with a social worker for years after that and never diagnosed with Borderline Personality Disorder.
Now I have a new social worker who says that my symptoms are BPD and not so much PTSD because I felt abandoned because my parents husband and brother passed away.
I am really upset over this.
DIAGNOSIS
Per DSM-5, the diagnostic manual published by the American Psychiatric Association, Borderline Personality Disorder (BPD) is:Quote“a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early adulthood and present in a variety of contexts..."
The key part for your situation is "beginning in early adulthood". By definition, symptoms that began after the multiple tragic losses you suffered cannot be BPD because you were well into adulthood by that time.
Also, note this paragraph from the NAMI website:
QuoteDiagnosis: There is no single medical test to diagnose BPD, and a diagnosis is not based on one sign or symptom. BPD is diagnosed by a mental health professional following a comprehensive psychiatric interview that may include talking with previous clinicians, medical evaluations and, when appropriate, interviews with friends and family. | Source: https://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder
Did your psychotherapist (the social worker) talk with your previous doctors and therapists, or at least read their notes? Did you complete any medical or psychological testing/evaluations? Did she interview a friend or family member or two?
BE ASSERTIVE - TAKE CARE OF YOURSELF
Have you talked with your therapist about your concerns? That's usually the best first step. If she listens carefully and responds empathically, and rethinks the diagnosis, then it could turn out to be a good learning experience for her, and therapeutic for you. Or, maybe you have some BPD characteristics (I tend to doubt it, but it's best to consider the possibilities). If that is the case and she explains why she thinks you have some BPD characteristics, and how she can help you (and you can help yourself), then that too would probably be therapeutic.Keep in mind that BPD, or some BPD traits without having the full-blown disorder, does not make the individual a 'bad' person, or 'crazy', or anything along those lines. BPD usually results from significant emotional, sexual, and/or physical abuse during childhood or adolescence, and represents the child's best attempts to try to cope with an overwhelmingly painful, difficult, no-win environment. People can develop borderline-like symptoms in adulthood, although that is much less common (and they would not be diagnosed with BPD because of the diagnostic criteria I mentioned earlier).
If your therapist does not seem to understand why this new diagnosis bothers you, and she does not respond with warmth and empathy, I would suggest asking for a second opinion from a psychologist or psychiatrist with a lot of experience helping people with PTSD due to sexual trauma. And ask for a new psychotherapist--you have that right.
All the Best,
Mark
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14 hours ago, Prettypantha said:
To answer your question about the female sexual arousal...that was all of it. It didn't have neither a section of yes or no, nor to write a summary. As you can see, it was a full page with no break.
Hmmm. That's a pretty glaring error for the examiner to make IMHO.
QuoteMy VSO initiated my claims, but after filing...I am basically on my own! He never return my calls, or texts. I make copies of documents to drop off to him while at the hospital and he's never in his office. So, for the most part, I'll either mail him a copy or place underneath his door/dropbox. Which he still doesn't contact me about nothing! Basically, I feel at this point...if there's a denial, all I can do to help my situation would be to hire an attorney. Still quite clueless to everything, but I'm trying my best to absorb as much as I can.
I agree with @Gastone that you might not need to retain legal counsel, and that waiting to see what VBA says is probably your best course of action.
And definitely find a new service officer! You need someone you can count on. The National Association of County Veterans Service Officers provides an easy-to-use Find a Service Officer Tool on their website.Also ask vets in your area if they have a good service officer that you might be able to see.
Quote.there was a question on the 7th screenshot top portion asking, "was an opinion requested for the condition (internal VA only)? She answered, Yes! This leads me to think that she had to get another opinion, right?
I don't know. I've never filled out that DBQ.
- Seriously though, I have no idea what the "internal VA only" part means--I've not seen anything like that before.
QuoteIf the rater is confused, will they get back in contact with her to clarify her statements?
Yes, they should. I would imagine the exam will be returned as "insufficient", with questions for the examiner. You know, something like, "WTF?! Were you on crack when you wrote this?!"
All the Best @Prettypantha,
~ Mark
- Prettypantha, TALON II FE and flores97
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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.
QuoteOur 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
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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.
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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.
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On 5/18/2016 at 0:06 PM, Andyman73 said:
...when you go to the C&P exam for MH, describe everything from your worst day ever. They will downplay your level of MH rating if they can.
I don't make a habit of disagreeing with Marines, as I value my life and limbs
, but I would suggest caution about focusing only on your worst day ever.
I understand where you're coming from Andyman73, as there are some biased, prejudiced, disrespectful C&P psychologists or psychiatrists who tend to discount or minimize a veteran's symptoms and associated functional impairment. IMHO those types should immediately get the boot, and it really pisses me off that they are even allowed near a DBQ.
On the other hand, if you get a decent examiner, you don't want him or her to think you're exaggerating. Of course, if they ask you to "describe one of your worst days", definitely do so--tell it like it is.
Otherwise, it is usually best to answer the examiner's questions as asked. This will usually mean describing both your history of depression, which will include the worst times, and your current symptoms.
Keeping a daily symptom diary can really help with providing vivid descriptions of your symptoms and how they limit your life. I write about such a diary on my blog (URL in my signature, below), along with a lot of other advice for PTSD and mental disorder C&P exams. (There is no advertising on my blog, and I do not sell anything.)
All the Best,
Mark
- Andyman73 and TALON II FE
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On 5/18/2016 at 9:34 AM, jlduty said:
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.
I would check with your veterans service officer, but if VBA requested a Mental Disorders C&P exam, that means they will issue a disability determination regarding depression, so it does not seem like you would need to file a Mental Disorders claim. Again, check with your service officer as there may be details or intricacies in your case that would dictate a difference course of action.
Your goal of establishing SC, even if it is only 0%, is smart. Hopefully you will not suffer from depressive illness in the future. But as the old saying goes, "An ounce of prevention is worth a pound of cure."
All the Best,
Mark
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I'm not a gynecologist, but I agree that as written the examiner's Opinion and Rationale do not seem to make sense.
I wonder if the examiner checked the wrong box on the DBQ? The Opinion part is basically a 'Yes or No' checkbox, i.e., the examiner does not actually type, "The condition claimed was less likely than not...". The examiner does type the rationale, which is what makes me wonder if she checked the wrong box for the Opinion.
Did the examiner answer the question about female sexual arousal disorder? I did not see it, but I could have missed it.
Looks like the VSR (VBA employee who prepares the 2507--the request for exam) did a good job highlighting the pages of your service medical records (SMRs, also known as service treatment records or STRs).
I wonder if requesting a reconsideration--and pointing out the possibility of a simply clerical error, i.e., checking the wrong box on the DBQ--would be the best course of action. What does your veterans service officer think?
- flores97 and TALON II FE
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On 4/30/2016 at 7:16 PM, SLY said:
Hi all, I'm new here. I was just wondering if raters usually pay more attention to the "description" or the "symptoms"
Symptoms.
In general, the RVSR ('Rater') must justify, with a well-written rationale, why they assigned a lower disability rating than the rating reflected in the symptoms the examiner endorsed on the DBQ.
In your case, the examiner endorsed four symptoms at the 30% level; two at 50%; and four at 70%. Therefore, if the RVSR assigns a 50% disability rating (unlikely), he or she would need to explain why, given that you have four symptoms representative of a 70% rating.
There are exceptions to this general rule, which an experienced VBA staffer, veterans service officer, or veterans law attorney can explain better than I could, but in my experience those exceptions are rare.
As you said, hopefully you will receive your Rating Decision soon and you can breathe a sigh of relief.
All the Best,
Mark
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On 5/14/2016 at 5:44 PM, Corpsman8404 said:
Good info in the blog, Doc.
Thanks man! Much appreciated.
QuoteI think I've seen quite a lot of posters here that were successful with their Dr's using the word "aggravates" in their IMO's. I know when I had a private board certified sleep specialist/pulmonologist do one for me, he used that wording. He added this in his IMO: 'in my opinion it is more than likely as not that his sleep apnea is related to and aggravated by his other service connected related condition, PTSD' (He underlined the more than part). // He also did a DBQ for me, and in part of that he also stated, '..he has a diagnosis for both OSA and PTSD. Based on his history and medical literature it is more likely than not there is a relationship between the diagnoses which contribute to and aggravate one another'.
Nice. Looks like a smart, well-written opinion with rationale. Good doc for your fellow veterans to know about for an IME (Independent Medical Examination).
All the Best,
Mark
- flores97 and Corpsman8404
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On 5/14/2016 at 4:45 PM, Buck52 said:
I apologize Dr Mark Worthen
No problem at all.
Although I earned a Doctor of Psychology (PsyD) degree, when it comes right down to it, I see myself as just another guy. Like most folks, it's a man's (or woman's) character that means the most. Having said that, I do appreciate your courtesy and kind words.
And I wish you the absolute best in your healing and in receiving the benefits you have earned!
~ Mark
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It's not easy to find, but there is a BVA Customer Service page, which contains the following info:
QuoteOur mailing address is:
Board of Veterans’ Appeals
810 Vermont Avenue, North West
Washington, DC 20420
For your convenience the Board of Veterans' Appeals has a FAX line. FAX: 1 202 495 6803
We may be reached by our phone number 1-800-923-8387 Monday-Friday 9:00am-4:30pm (Eastern time zone).
For an Email status report on your claim before the Board of Veterans’ Appeals, please state your name, file number and request, click here Ask a Question
Note that the "Ask a Question" link takes you to a generic form on the VA's Inquiry Routing & Information System (IRIS). So it is really important to include your full name, file number, and specific request on the form. Also, here are the categories you want to select from the drop-down menu in the Topic, Sub-topic, and Inquiry Type section:
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On 5/12/2016 at 10:17 AM, Buck52 said:
Anybody know if this would be pyermiding?
and what all would I need for evidence?
No, it would not be pyramiding. It would be a 'secondary' disorder, which is a “…disability which is proximately due to or the result of a service-connected disease or injury…” (38 C.F.R § 3.310).
In terms of evidence, I would definitely talk with a Veterans Service Officer about it. There are a couple of options:
- You could file a claim for OSA (Obstructive Sleep Apnea) secondary to PTSD, and then go to the C&P exam and see what happens. --> If this is not successful, you could then try the next option and ask for a reconsideration.
- You could pay for an Independent Medical Examination (IME) and then file the claim. --> Downside here is that you might be successful with the first option, and you would not have needed to spend the money on an IME.
- You could ask your sleep medicine doctor and/or psychiatrist for a 'nexus letter'. --> Unless the doctor knows what's involved and how to write it (which takes a lot of time, btw), this is not likely to succeed.
I know that many veterans have received SC for sleep apnea secondary to PTSD. However, there is not any scientific evidence at this time that shows a causal link (nexus) between PTSD and OSA. Vets usually get SC because the C&P examiner does not read the scientific literature and they simply give an opinion. The VBA must accept such opinions as valid unless there is some obvious error.
If you do file a claim, be sure to request not only SC based on OSA being "proximately due to or the result of" PTSD, but also SC based on OSA being aggravated by PTSD. I wrote about this point in a blog post regarding secondary mental disorder claims, although the same principle applies to a PTSD-->OSA claim. There is not yet any definitive research regarding PTSD exacerbating OSA, but it seems to be a more plausible connection than direct causation.
All the Best,
Mark
P.S. Central Sleep Apnea is a different animal--I am referring only to OSA. I would never give an opinion regarding PTSD-->CSA secondary claim because there is so little known about the possible relationship, but some physicians, e.g., neurologists, psychiatrists, and others, are more comfortable with such claims because they have more knowledge about possible physiological processes that could theoretically lead a person with PTSD to develop CSA (or PTSD aggravating CSA). Thus, the couple of times I was scheduled for a C&P exam regarding a PTSD-->CSA claim, I would have the exam transferred to an MD.
P.P.S. I highly recommend working with a Veterans Service Officer for a PTSD-->OSA claim.
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C&P exam reports, or 'nexus letters' are more probative, i.e., carry more weight, if the report or letter...
- cites relevant medical research literature
- provides a cogent rationale, i.e., clearly explains why the condition was or was not incurred during military service
- makes it clear that the examiner reviewed all the ‘evidence of record’ (“all procurable and assembled data”) — military records, treatment records, statements by the veteran or others, etc.
- conforms to expectations the Court of Appeals for Veterans Claims (CAVC) set for an examiner’s expert witness testimony (the exam report), as enunciated by the Nieves decision:1
(1) The testimony is based upon sufficient facts or data;
(2) the testimony is the product of reliable principles and methods; and
(3) the expert witness has applied the principles and methods reliably to the facts of the case.
All the Best,
Mark
P.S. Note that the federal courts, including the CAVC, use traditional legal terminology, whereas the VA has created its own terminology. Here is a ‘translation guide’:
Testimony = C&P examiner’s report.
Expert Witness = C&P examiner.
Expert Witness Opinion = Conclusions or opinions reached by the examiner that help to answer a legal question, e.g., diagnoses and the etiology of those diagnoses.Footnote
1. Nieves-Rodriguez v. Peake, 22 Vet.App. 295 (2009) -
21 hours ago, hotrod351 said:
also, shouldnt i wait until they send me there findings stating whether, in there opinion, im competent or not. or should i bring a letter with me. they might think thats kind of strange seeing as they didnt really go into any detail about what the hearing was going to be about, other than it was a competency hearing.
I agree with you, although it's always good to run questions like this by your Veterans Service Officer since he or she is most familiar with all the details of your situation.
Mark
Note: Nothing I write here should be construed as representing the views or policies of the U.S. Department of Veterans Affairs or the federal government. I contribute here as a private citizen who cares about the men and women who risk their lives to protect the rest of us.
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14 hours ago, hotrod351 said:
competency evaluation coming up the 30th of this month. only guessing what this is about. if there going to find in my favor then they want to make sure im competent in handling what ever money they give me.
That probably means the psychiatrist checked off a box in his report (using the DBQ form) saying he thought you were not competent to manage your financial affairs.
If VBA concludes that you are not competent to manage your financial affairs, they will assign a fiduciary who will receive your compensation funds and dole it out for you.
Also, your right to own a firearm will be revoked. See the one-page Word doc I attached to this post for more info.
If you believe you are capable of managing your own finances, I suggest that you:
1) Talk with your Veterans Service Officer about the issue;
2) Ask your treating psychologist or physician (or both) to write a brief letter stating they have not seen any evidence that you cannot manage your own finances - they may or may not be able to write such a letter - don't be offended if they say they can't; and
3) Also ask a family member and/or friend--someone who knows you well--to write a letter indicating that they have seen you manage your finances well, with an example or two of your ability.
Mail or fax the letters to one of VBA's two centralized mail processing centers for disability compensation claims--which one depends on where you live--click here to see the chart on the VA website.
If you fax your request, wait to receive a confirmation fax from them. The confirmation will be faxed to you immediately after they receive your fax. If you mail your request, do so in a way that gives you proof that it was received, e.g., U.S. Postal Service Signature Confirmation, or a similar service via FedEx or UPS.
All the Best,
Mark
Veteran Financial Incompetency and the Brady Act _Info-for-Veterans.docx
Note: Nothing I write here should be construed as representing the views or policies of the U.S. Department of Veterans Affairs or the federal government. I contribute here as a private citizen who cares about the men and women who risk their lives to protect the rest of us.
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It should not be a problem because of the presumption of soundness doctrine.
Quote38 C.F.R. § 3.304(b) Presumption of soundness. The veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service.
Thus, the burden of proof is on VA to prove, with clear and unmistakable evidence, that you suffered from PTSD prior to your military service, and that military service did not aggravate the pre-existing PTSD.
If your entrance physical does not say anything about mental health problems, and if you were never diagnosed with PTSD prior to service, it is not easy for VA to provide "clear and unmistakable" evidence that can refute the presumption of soundness. Even if the C&P psychiatrist (I'm assuming this was a C&P exam) says you had PTSD before service, unless he wrote a detailed and compelling rationale for that opinion, VBA may very well not accept his opinion as "clear and unmistakable" evidence. If they do, I would definitely appeal.
Unless your stepfather's spankings were particularly harsh and abusive, or accompanied by threats, intimidation, and verbal terrorizing, it would be unusual for such an experience to cause PTSD.
Keep us posted.
~ Mark
Note: Nothing I write here should be construed as representing the views or policies of the U.S. Department of Veterans Affairs or the federal government. I contribute here as a private citizen who cares about the men and women who risk their lives to protect the rest of us.
- Seriously though, I have no idea what the "internal VA only" part means--I've not seen anything like that before.
, but I would suggest caution about focusing only on your worst day ever. 
Although I earned a Doctor of Psychology (PsyD) degree, when it comes right down to it, I see myself as just another guy. Like most folks, it's a man's (or woman's) character that means the most. Having said that, I do appreciate your courtesy and kind words.
PTSD Denied NSC - Schizophrenia NSC
in PTSD Post Traumatic Stress Disorder Claims
Posted · Edited by Mark D Worthen PsyD
added 'free' so it's now 'free treatment'
You are most welcome. :o)
Does he refuse psych treatment? Schizophrenia is a serious illness, but patients can often enjoy substantial improvement with treatment. With the NSC 50% rating for schizophrenia, he can receive free treatment at a VAMC or VA outpatient clinic.
When was he discharged? @THOMAS89031's point about continuity of symptoms is an important one. I've done several C&P exams with vets who were not diagnosed with schizophrenia in service but who began to manifest symptoms shortly after service. Schizophrenia usually starts with prodromal symptoms before progressing to the full-blown disorder, so if those symptoms can be identified as beginning during military service, and then continuity of symptoms can be demonstrated, then the veteran should be service-connected. (Of course, the ultimate decision is up to VBA or the BVA, as you know.)
He might very well also suffer from PTSD, but it will help to see what the C&P examiner said about that. Yes, being wounded by an explosive booby trap is certainly a traumatic stressor. It sounds like they are not disputing that fact, but are instead saying that he is not displaying PTSD symptoms (or not many) currently.
You really need a psychiatrist or psychologist with experience conducting C&P exams, otherwise they won't know what kind of information VBA needs to determine service connection. Also, keep in mind that when a doctor completes a DBQ, he or she is declaring him or herself to be an expert witness, offering an expert witness opinion in a federal legal proceeding. Consequently, psychologists and psychiatrists who know what they are doing will devote sufficient time to conduct a thorough, evidence-based evaluation, and write a cogent report to support their diagnosis and opinion(s). So, you're talking at least 5, and as many as 10 hours for a good evaluation and report. At anywhere from $150 to $300 per hour (psychiatrists usually charge more), you're looking at $750 to $3000 for a well-written, persuasive report.
A potentially effective, but less expensive option is a "report critique", in which the psychologist or psychiatrist reviews all the relevant records, and then critiques the C&P exam report, pointing out deficiencies particularly with regard to following established VA guidance for C&P exams, and professional standards for such evaluations. Such a critique can support a request for reconsideration and a new C&P exam. If granted, the critique puts the new C&P examiner on notice that they better conduct a thorough, evidence-based evaluation consistent with VA guidance and relevant professional standards ... because you (and your experts) are watching.
Keep us posted!
All the Best,
Mark