Mark D Worthen PsyD

I have 3-4 diagnoses over the years. VA ratings can only cover one of them for ratig purposes. I don't stress about that too much what they call it, its the effects on you and your daily living that are important. You can manifest certain conditions over time like, I started out as Major depression, Severe, and that has morphed into also autism spectrum disorder and OCD tendencies. The Depression is still there, but its all layered together. 

You can be diagnosed with PTSD but in order to file a claim for PTSD service connected is the diagnose for one, TWO that the PTSD occurred in service, and Three you are getting the treatment for it.
The mere fact that you get diagnosed with PTSD doesn't warrant a VA claim for S/C.  You have to prove it is related to while you were in the service.  A lot of Vet's think just because they have PTSD they are automatically s/c for it.  Not so fast now.....
Just go to the appointment and see how it goes.

This time, I agree with VSO, at least sort of.   The earlier you apply, the earlier your effective date.  The longer you wait to apply, the more it costs you in retro.  
I dont see anything wrong with applying for "PTSD and any other diagnosed  applicable mental disoreder".  You do not have to be an expert at  classifying mental health disroders to get VA benefits.  Let the docs diagnose you and treat you.   
To delay filing because you are worried about which mental health disorder diagnosis makes no sense.  They are all rated the same, once service connected, based upon symptoms.  

Thank you so much @Andyman73. 
Although PTSD garners most of the attention these days, the fact remains that almost as many veterans receive SC for other mental disorders. [The proportion is 59% PTSD and 41% other mental disorders.]
If you haven't already, definitely tell your VA doc what you want and need and how you feel. The more direct you are with your psychologist or psychiatrist, the more you will get out of it. 
All the Best,
Mark

This is one reason why veterans should be granted electronic (Internet) access to their claims file on VBMS. 
VSOs have access. Contract examiners have access. The IME companies (QTC, VES, etc.) have access. C&P clinics have access. Why not the vet?
Is this need on the agenda of any of the influential veterans service organizations?

This is one reason why veterans should be granted electronic (Internet) access to their claims file on VBMS. 
VSOs have access. Contract examiners have access. The IME companies (QTC, VES, etc.) have access. C&P clinics have access. Why not the vet?
Is this need on the agenda of any of the influential veterans service organizations?

VBA routinely asks C&P examiners to examine for both IU factors and current symptom severity & functional impairment (which is what the disability is rating is based on). So it's standard policy, nothing you did wrong. 
Personally I think that if the veteran does not ask for an increased rating, then VA should ask the examiner to address IU only. That would save everybody some time, and save the taxpayers some cash too. But, alas, VA did not ask for my opinion on the matter.  [Although when I worked for VA I gave them all sorts of unsolicited opinions about how things should be done! ... I suspect the big wigs are glad I left. ;^]
~~~
Yes, definitely call the C&P Clinic (or contract company) to see if it's appropriate and safe to have the C&P exams! You might want to ask your OB/GYN about it too. 
~~~
What did you want to know about the IU process? 
~~~
I hope you and your baby are peachy keen throughout the birth process and afterwards, and that you and yours enjoy your new precious miracle. :O)
All the Best,
Mark

That is an excellent point. Many, many vets do not know that they need to request Vet Center records separately from any other VA medical records. 
I recently wrote a long detailed page on how to request veterans military records and medical records, and I put the Vet Center info in red with arrows pointing at it because it is so often overlooked! 
http://ptsdexams.com/veterans-military-records/#vet-center-records
All the best,
Mark

That might have been true in the past, but since the advent of the DBQs, the Raters focus on the items checked off on the 'Symptoms' list (Section II, Number 5 of the Initial PTSD DBQ). The reason for this focus is that those symptoms come directly, verbatim, from the General Rating Formula for Mental Disorders.
I cannot remember the last time I saw a rating consistent with the summary statement of social and occupational impairment (Section I, Number 4a) when the symptoms endorsed corresponded with a significantly higher rating. 
Plus, Raters now use an automated Evaluation Builder, which uses the items in the Symptoms List to determine the rating. 
I attached a copy of the General Rating Formula for Mental Disorders.
Mark
General Rating Formula for Mental Disorders.docx

Then another Lay opinion, the C & P Dr stating "medium to severe," might go a 70. At the 50 or 70, good chance of getting an "Inferred IU Claim."
Be prepared to file the IU FDC on E-Ben, the same day you get your Actual Award or see the Award on your E-Ben site. Not a bad idea to get educated regarding VA IU and Chapter 31 benefits, again, just a lay opinion.
There is a certain segment of the Vet population that believes the VA Rater's take every possible opportunity, to "Low Ball," SC Awards. I personally haven't seen it, but again that's just my Lay opinion.
You just had your PTSD C & P, was it from an FDC or Reg AXX Claim? With an FDC, you should have a Decision with in 3 -4 months. Reg AXX Claim, could be waiting 9 -14 months or so.
Semper Fi

That might have been true in the past, but since the advent of the DBQs, the Raters focus on the items checked off on the 'Symptoms' list (Section II, Number 5 of the Initial PTSD DBQ). The reason for this focus is that those symptoms come directly, verbatim, from the General Rating Formula for Mental Disorders.
I cannot remember the last time I saw a rating consistent with the summary statement of social and occupational impairment (Section I, Number 4a) when the symptoms endorsed corresponded with a significantly higher rating. 
Plus, Raters now use an automated Evaluation Builder, which uses the items in the Symptoms List to determine the rating. 
I attached a copy of the General Rating Formula for Mental Disorders.
Mark
General Rating Formula for Mental Disorders.docx

I had a C&P exam for my PTSD/MST for an increase back in February and I was currently at 30% at that time.  After reading the C&P and going to the "Occupational and Social Impairment" I was sure I was going to be reduced.  But I was awarded 50%!!!
The occupational and social impairment has some weight with the rater but the overall exam is what they are looking at plus any medical records prior to the C&P exam.
Your exam indicates that you will be awarded PTSD with MST.  More importantly, are you in treatment?
I ask, because I too was assaulted and I suffer with an ED and BDD.  I am in therapy weekly!

Folks:
Ordered my C-file as soon as I sent in my first claim almost a year ago and am trying to finish a NOD. Basically, I've come to the realization now that although it would have a major impact on my NOD outcome, there's no way that I'm not going to see it before the NOD goes out? 
Also, after hearing a speech by President Obama yesterday about NASA's proposed timeline for landing an American on Mars around 2030 - 2035, I told my wife I at least wanted to live long enough to see that event ..and realized that I may even see my C-File by then as well. :)
Godspeed, Rootbeer22
 

I have filed NODs and attended in-person hearings with both the BVA and a DRO, but keep in mind that the BVA and DRO work at different speeds.
My BVA experience was at the hands of a local VSO who knew much more than I did back when I barely knew anything about the BVA in the 1990's. He filled out the Form 9, I signed it, then I went in front of the board and simply pleaded my case. I won about half of my claims in the end, but if I had known then what I knew now, I would have had better results.
I went in front of the VARO DRO a few years ago after filing a NOD with a request for an in-person meeting with them. I filed the NOD right away to protect my effective date and also stated I would provide more evidence. I made sure all relevant evidence in my favor which I had at the time was submitted. It took a while before my DRO meeting happened and I accumulated more evidence, buddy letters, and nexus/IMO letters from various physicians (specialists). I submitted those as I obtained them. When it came time for my DRO review, I had my evidence organized by disability into separate folders and subdivided into sections where I submitted each set of new evidence along with proof showing they received it. Because some of the medical evidence was from non-VA physicians, to save time, I also included release of information documents (otherwise the VA would mail them to me and it would cause more delays). I talked with the DRO. Showed them evidence for each disability, how I met the rating criteria, the nexus/IMO letters, etc... We compared my evidence vs. what the VA had and I left them with copies of what the VA didn't have. I practiced this in advance, too, to limit the focus to what was important and had a list of questions for the DRO about each. It was a very productive meeting and I had good results, but all DRO's are not created equally.
You heard the old saying, "chance favors the prepared mind", but I wanted to take "chance" out of it.

I was successful with getting 100% P&T at the RO level by requesting a De Novo review.
Below is a summary of how this was done:
1- I filled a claim and was denied at the RO level.
2- Sent NOD with two Nexus letters. The RO cued themselves and granted 40%.
3- Sent NOD with three Nexus letters and requested a De Novo review. The DRO at the RO cued themselves again and granted 100% P&T. The second NOD took 15 months and 7 days to get 100% P&T.
Nexus letters are the most important key to winning a claim. All this was accomplished at the RO level.

My understanding is that de novo reviews by a Decision Review Officer (DRO) take place much faster than an appeal to the Board of Veterans Appeals. Is that correct?

This is a reply to @Cliche Magnet's post -  PTSD's long term effects. Did you win a decision? For some reason I was not able to reply the usual way (I could not type into the box). 
Incurrence and Continuity
When did you discharge from military service, and when did you first seek mental health treatment? 
If you began to manifest symptoms of a psych disorder during service, and you sought treatment soon after discharge, and you have suffered from that same (or similar) disorder since that time, i.e., you have shown continuity of symptoms, then it is possible that VBA could find that the disorder was incurred during your military service and you are entitled to VA disability benefits. [See: 38 C.F.R. §3.303(a) and (b)].
This principle would apply whether or not your diagnosis is PTSD. In other words, if you manifested some posttraumatic stress symptoms, but not enough to satisfy the DSM-5 diagnostic criteria for the disorder, but all your psych symptoms considered collectively, for example, posttraumatic stress symptoms + depression sx + anxiety sx, do meet diagnostic criteria for another mental disorder, then that mental disorder could be service-connected, 
Service connection for a psych disorder under these incurrence and continuity principles poses some challenges, but I evaluated several veterans over the years who received disability compensation for such conditions. Usually the biggest challenge is that the veteran did not seek treatment until many years after discharge. In those cases, one of the fundamental questions the C&P examiner and the VBA adjudicator have to consider is, "If he had a mental disorder that caused functional disability for all those years, why didn't he seek help?" 
Of course, there are some very legitimate answers to that question, e.g., socialization causing men to avoid seeking help due to the narrow, rigid masculine role identity our society has historically imposed on boys and men; plus an ethos in the military to eschew mental health treatment because others will likely perceive it as a sign of weakness and incompetence.
As an aside, I should mention that if a veteran suffers from psychoses during or shortly after military service, and he or she still has disabling symptoms from the same or similar psychotic disorder, then service connection is covered under a different regulation concerning chronic conditions. [See: C.F.R. 38 §3.307 and §3.309(a)].
PTSD
If you have PTSD due to watching your friend burn to death, and your friend's tragic demise is documented, and your presence on the scene can also be demonstrated via documentation and/or lay testimony, then yes, the PTSD can be service connected. And in that case, a letter from your commander and others would be helpful. 
You could certainly seek an IME (I use the term, IPE, since I am a psychologist ;-), and that is something I do in my private practice, but frankly it costs $1000 or more and you can get a C&P exam for free. If the C&P exam ends up being inadequate and VBA denies service connection, then an IME/IPE would make more sense. Of course, that's just my opinion. You should also see what other knowledgeable people think.
Dual Role Conflict
In general, treating psychologists should not write 'nexus letters' or complete DBQs because doing so constitutes a dual role conflict.
A C&P exam is a forensic mental health evaluation, where the 'client' is VBA, the 'referral questions' are directly related to legal issues, and the goal is to conduct an independent, objective, unbiased evaluation. In terms of the C&P psychologist, he or she is an expert witness, providing expert witness testimony in a federal legal proceeding.
Psychotherapy is a treatment/helping relationship, where you are the client, the referral questions relate to helping you, and the objective is to help you achieve your recovery goals. In terms of the treating psychologist, he or she is providing a healthcare service.
As you can see, the professional relationship between the psychologist and the veteran in these two scenarios are very different. In situations like the one you mentioned, i.e., asking a treating psychologist to write a nexus letter, it's helpful to know that such treating psychologists must be very careful about being in two very different roles at the same time with the same person. Usually it is not a good idea. (See: American Psychological Association's (APA) Ethical Principles of Psychologists and Code of Conduct, Ethical Standards 3.06 and 3.07.
All the Best,
Mark

. The VA "interpreted" "Thou Shall not Steal" to mean "Stealing is not recommended 12% of the time".   Remember, this is where VA is spending our benefit/health care dollars...on US Supreme Court lawyers to fight Vets.  I thought VA was supposed to care for Vets, not fight them??  My solution is to fire 75% of the  lawyers who work for VA and hire doctors to cut the wait time, instead.  
The Veterans Affairs Department lost a Supreme Court battle in a controversial lawsuit that accused it of denying federal contracts to veteran-owned businesses. The high court ruled that the VA failed to comply with the law. On Thursday, the Supreme Court unanimously agreed that the federal government had violated the so-called “Rule of Two” when the VA awarded a contract for an emergency notification system to a company not owned by a veteran.
Read more ‘Systemic failures’ at Wisconsin Veterans Affairs hospital – Senate report The provision is part of the Veterans Benefits, Health Care, and Information Technology Act of 2006, which stipulates that only small veteran-owned businesses “shall be” considered when two or more are likely to submit reasonable bids for a major contract.
“The surrounding subsections of §8127 [section of the law] confirm that Congress used the word ‘shall’ in §8127(d) as a command,” the Supreme Court ruled. “The word ‘shall’ usually connotes a requirement, unlike the word ‘may,’ which implies discretion,” Justice Clarence Thomas wrote.
The VA’s decision to award the contract to an outsider was challenged in a 2012 lawsuit, Kingdomware Technologies v. US, which was filed by a permanently disabled US Army veteran. The complaint accused the government of thwarting the law, as the VA did not restrict competition using the “Rule of Two.”
The veteran petitioner had lost twice before, when two lower courts, the Court of Federal Claims and the US Court of Appeals for the Federal Circuit, ruled in favor of the VA.
In both cases, the judges ruled that the department was not required to use the “Rule of Two” in all contracting. The federal appeals court said that the VA did not have to comply with the rule if it awarded between 7 and 12 percent of all contracts to companies owned by disabled veterans.
READ MORE: Over 125,000 veterans denied benefits by the VA – report
The Supreme Court weighed in and reversed the decision.
“The Act does not allow the Department to evade the Rule of Two on the ground that it has already met its contracting goals or on the ground that the Department has placed an order through the FSS [federal supply schedule],” Justice Thomas wrote.
The Supreme Court noted that Congress provided two exceptions to the “Rule of Two,” both of which allow the department to use non-competitive and sole-source contracts for contracts below specific dollar thresholds, but ruled that neither of them applied in this case.
It has also rejected the department’s argument that requiring it to apply the “Rule of Two” whenever it buys anything would “hamper mundane purchases like ‘griddles or food slicers.’”

Then even less likely that they will do anything related to you current 70% rating for PTSD, i.e., I would be shocked if they don't just keep it the same. Your claim is mainly about TDIU anyway, so, as you know, that will be the focus. 
Btw, I very much respect and honor you for your service to our nation. My kids get to grow up in a free country because of brave men like you. 
Mark

This is a reply to @Cliche Magnet's post -  PTSD's long term effects. Did you win a decision? For some reason I was not able to reply the usual way (I could not type into the box). 
Incurrence and Continuity
When did you discharge from military service, and when did you first seek mental health treatment? 
If you began to manifest symptoms of a psych disorder during service, and you sought treatment soon after discharge, and you have suffered from that same (or similar) disorder since that time, i.e., you have shown continuity of symptoms, then it is possible that VBA could find that the disorder was incurred during your military service and you are entitled to VA disability benefits. [See: 38 C.F.R. §3.303(a) and (b)].
This principle would apply whether or not your diagnosis is PTSD. In other words, if you manifested some posttraumatic stress symptoms, but not enough to satisfy the DSM-5 diagnostic criteria for the disorder, but all your psych symptoms considered collectively, for example, posttraumatic stress symptoms + depression sx + anxiety sx, do meet diagnostic criteria for another mental disorder, then that mental disorder could be service-connected, 
Service connection for a psych disorder under these incurrence and continuity principles poses some challenges, but I evaluated several veterans over the years who received disability compensation for such conditions. Usually the biggest challenge is that the veteran did not seek treatment until many years after discharge. In those cases, one of the fundamental questions the C&P examiner and the VBA adjudicator have to consider is, "If he had a mental disorder that caused functional disability for all those years, why didn't he seek help?" 
Of course, there are some very legitimate answers to that question, e.g., socialization causing men to avoid seeking help due to the narrow, rigid masculine role identity our society has historically imposed on boys and men; plus an ethos in the military to eschew mental health treatment because others will likely perceive it as a sign of weakness and incompetence.
As an aside, I should mention that if a veteran suffers from psychoses during or shortly after military service, and he or she still has disabling symptoms from the same or similar psychotic disorder, then service connection is covered under a different regulation concerning chronic conditions. [See: C.F.R. 38 §3.307 and §3.309(a)].
PTSD
If you have PTSD due to watching your friend burn to death, and your friend's tragic demise is documented, and your presence on the scene can also be demonstrated via documentation and/or lay testimony, then yes, the PTSD can be service connected. And in that case, a letter from your commander and others would be helpful. 
You could certainly seek an IME (I use the term, IPE, since I am a psychologist ;-), and that is something I do in my private practice, but frankly it costs $1000 or more and you can get a C&P exam for free. If the C&P exam ends up being inadequate and VBA denies service connection, then an IME/IPE would make more sense. Of course, that's just my opinion. You should also see what other knowledgeable people think.
Dual Role Conflict
In general, treating psychologists should not write 'nexus letters' or complete DBQs because doing so constitutes a dual role conflict.
A C&P exam is a forensic mental health evaluation, where the 'client' is VBA, the 'referral questions' are directly related to legal issues, and the goal is to conduct an independent, objective, unbiased evaluation. In terms of the C&P psychologist, he or she is an expert witness, providing expert witness testimony in a federal legal proceeding.
Psychotherapy is a treatment/helping relationship, where you are the client, the referral questions relate to helping you, and the objective is to help you achieve your recovery goals. In terms of the treating psychologist, he or she is providing a healthcare service.
As you can see, the professional relationship between the psychologist and the veteran in these two scenarios are very different. In situations like the one you mentioned, i.e., asking a treating psychologist to write a nexus letter, it's helpful to know that such treating psychologists must be very careful about being in two very different roles at the same time with the same person. Usually it is not a good idea. (See: American Psychological Association's (APA) Ethical Principles of Psychologists and Code of Conduct, Ethical Standards 3.06 and 3.07.
All the Best,
Mark

There appears to be a problem with your attachment. When I clicked on the link I got this error message:
Sorry, there is a problem
We could not locate the item you are trying to view. Error code: 2S328/1

I wouldn't worry to much about the ptsd diagnosis and would be happy with the mdd opinion the examiner opined.  You can only be rated for one mental disorder and if it's mdd instead of ptsd you will still get treatment for your problems.  I was diagnosed as mdd even though i am a combat veteran and would have thought i had ptsd.  I do have several stressors but the c&p doc said it was easier to get it rated as mdd because i had depression noted in my service medical records.  Either way i was rated at 50% for mdd.  It looks like you have the same  DSM-V diagnosis that i did. I guess if you aren't getting the right treatment then you could try to get it switched to ptsd.  JMHO!!  

FINAL UPDATE!!!!
Checked e-bennies about an hour ago
OUTCOME: 70% SC
 
In such disbelief right now, I don't even know what to think!!
Thank you everyone for your input && TIME
Hopefully this thread helps future vets!

Hmmm. That's a pretty glaring error for the examiner to make IMHO. 
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. 
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. 
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

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?