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Jay Johnson
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Posts posted by Jay Johnson
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Jay,
Spending money, I am not afraid of, but doctors yes.
Thanks,
Josephine
That's the beauty of an IMO; you are in charge and you can fire them if they say something you disagree with:-) The wife has been seeing the same civilian psychiatrist for about 1.5 years now and we're about to fire him when we find someone better. During a recent episode of her's the psych completely missed that she was in a psychotic/dissassociative state and completely bought into her "coping mode" as if she had made some miraculous recovery. His utter failure at his own profession means he can find a new patient in my opinion!
Again, psychiatry is voodoo medicine, so find someone you feel best fits your needs/wants....most of them are over-educated idiots anyway.
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Jay,
When a Psychiatrist has to change your medical records to give you a personality disorder, then somewhere there is a RAT.
I am not saying that a Psychiatrist is not more qualified under normal circumstances, but when one has to lie to get what they want, then I haven't anything good to say about them.
At least the Phd Psychologist had the gumption to state the truth and go by the medical records. I can't say that for the other two.
The Psychologist didn't have too much trouble with his diagnosis when a veteran is sitting there with 43 years of treatment records for " Anxiety". Some of these treatment records were from Board Certified Psychiatrist.
How hard can it be to write down what 4 other doctors have written down over a period of 43 years.
I am not counting the two Board Certified Psychiatrist from the United States Navy.
I am only saying, " If a doctor has something to say, for God's sake, at least let it be the truth.
I did not have an abortion in service.
They changed my medical records to make me have three children alive. I do not, I have one dead son and two live daughters age 37 and 41.
At any time, I am ready to contact the AMC and withdraw my claim, for it just isn't worth going to the hospital for.
Josephine
Mental issues are subjective in the eyes of most people in this country and the VA uses that subjective nature to put wholes in every mental disorder they see. This is why I always strongly suggest using civilian care when one has a psychiatric disorder and staying as far away from the VA as possible....mental disorders have highs and lows by nature and although the VA is "supposed" to rate someone based on the lows and how often those lows occur, they do not; rather, they will focus on any shred of evidence that can be used to deny/low-ball a veteran.
So, if you want to fix your claim (and you can) you have to be vigilant and get some very hard evidence to win your case. This means spending some $ for *good* IMOs from highly qualified psychiatrists (IE - if you have PTSD see a psychiatrist that specializes in PTSD/anxiety disorders). The VA is like any civil law suite, you must prove your case by a preponderance of the evidence and shoot holes in their case against you wherever applicable. For you, this means getting more evidence stating that you do not have a personality disorder and having more evidence then they do showing that you have a well-founded nexus.
It may take a year, or more, but you CAN win your case. Perhaps finding a *good* psychiatrist and sticking with him/her for several months+ would be the evidence you need....the VA would be hard pressed to ignore your treating psychiatrist's eval even if there are dissenting opinions because your IMO opinion would be over a lengthy period and the VA opinions would likely be very short interviews with little medical background on your disorder.
It's sad that the VA uses these tactics, but you can beat them at their game if you go about it in the right way and take your time.
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Jan,
I am sure that you are correct and yet there is the point of finding a doctor that will state not just my condition today.
I went for the one IME and gave the Psychiartrist all of my SMR"s. He stated that in his opinion, he could not say with any certainty whether my anxiety began in service.
He did state that the fear of death in the swimming pool could have been the beginning of PTSD.
Axis 1 was Generalized Anxiety
Axis II No Personality Disorder
Axis III
Axis 1V - The veteran is too familiar with names and places and I am certain that this is having an effect on her present conditon.
Axis V - Gaf - 65
This is where is get good. He refused to put into his write up that he had possession of my SMR's or any of my medical records.
This one was no worth sending to anyone.
Always,
Josephine
Be more up front with your psychiatrists. Tell them what you expect of them in their eval and how to format it. Don't make it sound as if you're paying for a favorable diagnosis either, because that's not what you're seeking; rather, you should tell him/her to be honest in their assessment, but to include items XYZ in their eval and use verbage like "more likely than not". It is best to write up a formal paper on what you're looking for and to include a sample eval that the VA would find acceptable, because you'll never get all your points across in a single eval, nor will the MD remember the finer points of the conversation (time = money).
So, shop around for a good psychiatrist (one psych can vary greatly from another...this field is far from an exact science; in my opinion, it's closer to voodoo medicine) and be prepared with what you're looking for out of them. Also, pay in cash because psychs LOVE cash customers......use insurance and you'll find they're booked for 2 months; say you're paying in cash and you'll be seen this tuesday:-)
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Josephine,
"VA Regulation does not allow the R. O to state: We place out weight with a " Psychiatrist" as they are a " Psychiatrist". VA Regulations - C&P by a Psychologist, Nurse, etc are equal. Credentials do not come into play only the rationale of the decision. Am I not correct?"
Actually, no, that's not correct. The decision maker's job within the VA is to deteremine the weight to be afforded to certain evidence as it applies to disability compensation claims.
I have seen claims where the RVSR or DRO has gone against a C&P examiners opinion in which they stated some medical issue wasn't related to a veteran's service and placed more weight on an IMO provided by an outside doctor and subsequently award the claim based on that outside IMO.
Actually credentials by doctors play a large role in the weight that their IMO's/statments are afforded by the decision maker. Granted, the rational also plays a large role, but for example, if there are two doctors wrangling over how an MRI is read and one of those doctors is a radiologist and the other is say just a general practioner, then the VA will most certainly place more weight with that radiologist's opinion.
Vike 17
Vike is absolutely right here. In fact, SS won't even take the opinion of a psychologist unless a psychiatrist signs off on said opinion. The same goes for the military.....my wife had been seeing a AF psychologist (captain) for about a year before she initially broke down, but he was not allowed to do the eval for her medical boarding; instead, she had to be pawned off to an AF psychiatrist at a neighboring base that knew nothing of her case.
In terms of education, psychologists and psychiatrists are light years apart even though both may hold doctorates. This is why the average psychologist earns around 50K in the US and the average psychiatrist earns about 175K+. A PsyD is nothing more than a LOT of schooling based on outdated psychological data from 40+ years ago and a ton of writing/clinical observation of behavior. A psychiatrist, on the other hand, has a MD and knows EVERYTHING a psychologist knows plus has far more knowledge of the physiological effects of various psychological "issues" on the brain.
As far as most government agencies are concerned, a psychologist cannot even diagnose you, let alone write a formal eval...they simply are not qualified to do so. A psychologist is for therapy, not diagnosis. The only reason the VA gives them any weight is because they cannot afford to send every vet to a psychiatrist for a C&P (would cost 5x more), so they have cheated and used people unqualified to do C&Ps and, therefore, are forced to accept IMO from those under-qualified individuals.
A psychologist/NP/PA should be used only in conjunction with a qualified medical professional (IE - an MD).
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Hoppy,
You wrote, "Your GAF of 49 might not be low enough for them to give you a 70%" - please tell me that the VA cannot use your GAF score alone as the sole determination for your rating. Don't they have to consider the actual words that the examiner writes about your disability?!?
My IMO doc gave me a GAF of 35 so if this is the issue with my rating hopefully the IMO doc's GAF should help.
I have a letter from the CPA who does our taxes stating that I haven't worked since 1998 and then I only earned $4,000. Will send that in as well.
Thanks for the post.
TS
Tss,
I'm sorry I haven't written sooner, but the wife decided to stop taking her meds and subsequently had an episode that landed *ME* in jail on July 4th (not one of my better holiday memories)....long story.....
Anyway, the VA tends to use your GAF against you and not for you. In other words, if your GAF is low, they will ignore it; if it is high they will use it to low-ball you. It's standard stuff for PTSD.
I just got back home today and I really don't have time to read all of the posts since the 4th, but, with what I have read, I would say that you should get a copy of the VA criteria for mental disorders and use it in conjunction with some good IMOs to get a better, and more fair, rating. In each of my wife's decisions they cited that criteria word for word in their decision, so you need to provide that to your IMO (or IMOs) in order to word your appeal appropriately.
As for the daily function stuff - that seems more like an aid and attendance issue then PTSD. Although the 100% level does mention an inability to care for oneself in terms of basic daily functions, I don't think it's a point of emphasis for the VA raters. In fact, I don't think I've ever heard of the VA awarding A&A based on that criteria.....my wife's A&A was due to the threat she posed to herself and others and made no mention of her inability to bath, feed and take her own meds. It's probably not impossible, but I doubt the VA would give much weight to someone who, in essence, "chooses" not to groom themselves (though I strongly disagree with that statement; it is how most people feel in this country).
Anywho, I'll check back in as I can, but I'm trying to keep the wife out of the mental hospital ATM and dealing with a with a legal system that is completely ignorant about severe mental disorders. BTW, if anyone lives in the state of WA never, EVER call 911 for anything...you're better off letting someone kill you before calling those bastards!
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I tried to point out that it didn't apply to the question in this thread, I just wanted to make sure that people were aware that it could be done. I don't see how it is a shady area if the regulations permit it to be granted and the VA is reinforcing training on this subject. It was listed directly as a FAQ on a PTSD information letter released to the RO's in an effort to help expedite the processing of claims in which they are unnecessarily developing to the service department for verification of stressors when the disability was diagnosed in service.
To help put it into context, two of the more commonly claimed disabilities are hemorrhoids and pseudofolliculitis barbae (razor bumps) which you will see become service-connected because they manifest in service. While each vet may be predisposed to developing the condition, the fact that a chronic disability initially manifest during military service is binding on VA. With any potential pre-existing disability, such as your cancer scenario or the conditions previously mentioned, there must be "clear and convincing evidence" per their regulatory criteria to refute or rebut the presumption of soundness upon a veteran's entry into military service. This is a very high burden of proof for them to reach without concrete evidence of treatment prior to military service (which is not there in the vast majority of claims).
I'll admit that there is no easy answer to any of this as the facts would have to be judged on a case by case basis. I'm just trying to help out anyone that might need it
Well, the difference is that PTSD develops due to a severe stressor, so it's unlikely that someone would develop PTSD while in the military, yet have it non-military related. It's certainly not impossible, but highly improbable:-) I wonder how they would handle PTSd with delayed onset if the stressor was preexisting, yet it did not "mainfest" itself until one entered the service? That would be tricky, in my opinion, because it would depend on whether or not the person technically had preexisting PTSD or not?...when does PTSD technically start in that case?
As you can see, it's not so blac and white with PTSd (or doesn't seem to be to me).
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Actually that is not entirely true, if PTSD manifests in service due to stressor(s) which occurred prior to active duty it will still become service-connected. The key part is that the disability had to manifest in service. I know that it seems strange, but it's really not any different than other disabilities which certain people are predispositioned to develop at some point in time such as Wolff-Parkinson White syndrome. VARO's have been notified of this fact in recent training.
I realize that this does not apply to this specific question, but I just wanted to point out that others may not necessarily be excluded and more and more people are being diagnosed with PTSD prior to their discharge from service.
That's a VERY shady area though, especially in terms of PTSD. Also, isn't there a difference between a condition "manifesting" itself while in service and one that existed prior to service that gets worse for no apparent reason (IE - not the military's fault)? I'm not 100% sure, but I think there's a difference between getting cancer while in the military and having cancer once you get in that is discovered after the fact.
I'm not entirely sure though...seems like a grey area.....
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If you were healthy enough to pass basic plus the rigors of war, than one should assume that your preexisting PTSD was not at a level that was terribly disabling. If, after the fact (due to the war), your PTSD symptoms now rise to the level of being disabling then the military did indeed aggravate your preexisting condition.
So, you should certainly file a claim, but PTSD is a hard fight these days and I'm sure the RO will use your prior issues to deny your claim. But, in the long run, it sounds like you have a solid claim provided you have a verifiable stressor and you can prove that said stressor led to a worsening of your condition.
If I were you, I would downplay the early PTSD as mild depression (which you admitted to) and/or anxiety, which had a minimal impact on your life. The less you talk about the past, the better in my opinion.
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The VA, like most government agencies, is all about detail and format. It is not enough to get an IMO that states you are unemployable or X amount disabled; you need your psych to write up a formal evaluation that uses VA terminology and VA formatting. It should include a GAF (all 5 axis) and terms like "more likely than not" and other VA catch phrases.
In the end, it's hard for the VA to argue their own language when it's used against them:-)
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PTSD is under the same classification as GAD; they are both anxiety disorders. As for your case specifically, if you feel you deserve a higher rating than file for an increase, but there's no need to change/add a diagnosis simply because a doctor said you have another one. In some cases, it is wise to get additional issues evaluated due to DIC compensation, but PTSD and GAD are the same issue and, coupled with depression, they all fall under the same category, so if you qualify for DIC under GAD/depression it will not change anything if you have PTSD as well.
However, if you can prove a stressor and you feel your condition has worsened then, by all means, file for an increase and put a claim in for PTSD. 30% isn't exactly a big deal...now, if you were 100% P&T with your current diagnosis, then I would probably advise against claiming PTSD.
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What ever happened to a presumption of health when entering the military? The regs are in the veterans' favor; they're just not being applied correctly. Perhaps with a government push they will clear it up.....PD is a very rare issue and not very well understood. There is NO way that many people have PD from the military...NO WAY.
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The VA does not have the right to assume that doctors are being fraudulant. If anything, the VA doctors should be given no weight considering they have a vested interest in the VA and NOT the veteran. Whomever said that needs to be dragged out into the street and...um... talked to??
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SOs tend to be very good at procedural matters, but are fairly useless outside of that. Anyone can read through the regs and the prior BVA/CAVC rulings to compile a good case for THEMSELVES; 99% of the time (some cases are trickier than others). Of the 7 or 8 SOs I had contacted for my wife, 4 of them were completely clueless, 2 were A-holes and the first one, though helpful, did nothing more than staple the evidence *I* collected together and ship it off to the right people with the right forms.
Just keep in mind that SOs are not legal scholars, nor do they have some inside info into the VA system...most of what they know, outside of experience, can be learned via the internet. So, if you feel your SO's are holding you back, then dump them and do it yourself....I got 100% + A&A for PTSD without their help; it's not impossible.
SO's are best for people who are completely new to the system and who don't have the time/ability to learn the ins/outs of the VA (which can take a LONG time). However, the new law concerning the use of lawyers should be helpful to more vets.....it will also likely make SOs obsolete (or for the poor who can't afford lawyers....but that's a class issue and a whole 'nother can of wurms all together).
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2905 sounds high...perhaps you did get some SMC after all.
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At the very least they need to follow the DSM and seperate the different conditions into their general categories. In other words, PTSD, OCD, panic disorder, GAD are ALL under "anxiety disorders" in the DSM. Bipolar is under "mood disorders" as is MDD. Schizophrenia is another category and you should be under "delerium, dementia, amnestic and other cognitive disorders" (yet another category). At least this way, one would get credit for at least having different forms of mental disorders.
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Vike gave the politically correct answer:-), but it's a bit more complicated than that. Some disabilities seem to take social impairment (IE - quality of life) into more consideration than others (IE - mental disorders). In theory, compensation is supposed to ONLY be about lost wages, but their are people who lead relatively normal lives, are 100% disabled and earn good money working.
Personally, I think ALL disabilities should be treated equally and ALL of them should factor in social impairments. Being that it is nearly impossible to sue the military for social impairment (IE - civil litigation), the VA should compensate veterans appropriately.
As to your last line - Concurrent receipt is supposed to change that disparity between government employees and disabled vets, but it's being phased in slowly and only covers a fraction of the vets at the moment. There has been legislation introduced that should cover most, if not all vets, for both disability and retirement, but who knows whether or not it will pass:-(
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Well, the printer/scanner you have acts like the USB cord for the camera, thus eliminating the need for it. Also, most of the newer printer/scanners are very compatible with the newer cameras, thus eliminating the need for the camera software.
As for photo shop - You'll learn to love it (or other picture software). Some websites are very picky about how large the pic can be and what format it needs to be in (jpeg, bit, etc), and those software programs allow you to convert things. Also, you can do some really neat things with some of the pic software out there like set your pics to music via slideshows, crop people in and out of photos, change the background, etc. I'm sure you'll get the hang of all that stuff eventually; it's basically a trial and error thing:-)
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I hate to say it, but that led me to a sigh of relief:-) It's still wrong on the RO's part, but knowing that they weren't just randomly selecting a 100% P&T PTSD vet for "review" is FAR different than being pricks over a reopened claim with new and material evidence. BTW, I think this is seattle's MO....they seem to completely ignore ALL of the prior evidence in a given PTSD case while focusing ONLY on the newest evidence and, more specifically, ONLY the portions of the new evidence which are against the veteran (IE - a report can give a 20 GAF, say the person is all but bedridden, but if the word "better" is anywhere in the document, they decrease the rating). It's almost word for word what they did to the wife (or tried to do at least).
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Breaking congressional law isn't "trickery" in my opinion and it should be taken quite seriously. If you don't, you run the risk of it becoming a standard practice. We don't know the particulars of the case, so it's hard to say exactly what happened here, but if it is a witch hunt (as the OP suggested), then we should all be outraged. I know many folks on here are P&T and if the VA is going to randomly start pulling files for C&Ps we should stop it before it starts.
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"SO DOES P&T REALLY MEAN NO FURTHER EXAMS. I HAVE POSTED MANY TIMES THAT JUST BECUASE YOU ARE P&T DOES NOT MEAN THE VA WILL CALL YOU BACK FOR ANOTHER EXAM IF THEY FEEL YOU ARE IMPROVING"
As Calnight said this is SO true-
one of my friends was in quite a state because he got a letter for a C & P- he had been 100% P & T with SMC for 11 years. I know the dates exactly as I got him this award.But then his SMC was dropped due to improvement in his cancer-(I think that decision was erroneaous but he didnt want to fight it-
WHat appeared to happen is that-after years of denying PTSD he went to my new rep and the rep got him 50% PTSD.Added with something else SC in VA Math (maybe 40% for GSW)he then got SMC again-It seemed the VA was questioning that award -the PTSD award-to see if he had improved.
I told him to write back to the RO and ask them how a disability(PTSD) due to a severe gun shot wound could possibly improve.A GSW is an obvious lifelong stressor,and his GSW is clearly corroborated from the annuals of Blackhorse and his med records from Hoi An- not only that this vet had TWO GSWs on his DD 214-forget how they say 2 Purple Hearts on the DD 214-I saw his Purple Hearts many times-
it made no sense what they were doing.
In about 3 weeks the VA concured with the vet- no further exams at all.For anything.
But in your example here there was "something" the RO could point to for justifying a C&P with P&T. My guess is that the veteran in question (from the original poster) had done "something" to trigger the inquiry. If not, it is a whole 'nother ball game, because it amounts to a witch hunt....I mean, did the RO just randomly select a P&T PTSD case for review?
I don't want to pass judgement, but even in my wife's case there was "some" reason for them ordering her to a C&P with P&T.....she *was* in the fiduciary program and when we moved out here the fiduciary folks felt that she didn't need to be in the program anymore. This, of course, was the "improvement" they needed to justify reopening her case. So, as wrong as I think it was, they still covered their butts in ordering her into a new C&P with P&T. To just order a P&T vet into a C&P for absolutely NO reason seems to be against the law in my opinion...the regs clearly state that "new" evidence must be brought to light in order to start their witch hunt.
What worries me most about this case is that it *could* be that the RO singled this guy out to test his disability BEFORE the 20 year mark....if that's the case, we need congressional inquiry.
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By the way, the VA's regs state that a 100% vets needs to have "material" improvement without the need of aid. In other words, if the vet has "gotten better", but said improvement is due to ongoing meds and not working then that is not basis for reduction. In order to lower him they would need to show that he is not on meds and that he is "choosing" not to work, which seems like a long shot to me. Get senators involved and everyone else you can...hell, call the local press and get the media on your side.
One more note, what prompted the C&P? Had he asked for an increase? Does he have another disability? Is he routinely seeing a VA psych and that psych noted improvement in a regular appointment? If the VA did this without ANY cause I think this needs to be fought HARD.
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The Seattle RO pulled the same stuff with the wife. They tried to drop her from 100% P&T (found just 8 months prior to moving to this region by Philly RO) to 50%, then to 70% with TDIU and, eventually, back to 100% with P&T again, but it took phone calls to the acting director and a personal phone call from the review officer to the wife to get it done.
The way I read the VA regs is that the VA cannot subject a P&T vet to a comp exam unless they have new and material evidence to warrant it. However, a veteran also doesn't have the right to refuse a C&P exam, so it becomes a catch 22.....if you don't go they can immediately drop you to 0%, but in order not to go legally, you need legal intervention which isn't afforded to vets. On top of that, once you've gone to the exam the VA now has "new and material evidence" so they can do whatever they want at that point.
I really think this person's case needs to have some money and effort thrown behind it and it needs some public attention. P&T means P&T, not "likely P&T, but we'll check later". Either the VA needs to be less liberal with handing out P&T or they need to do away with it all together, but they can't award it and then ignore the award.
Also, a 100% rating means "total occupational impairment", so the VA should not be able to lower him without awarding TDIU unless there is clear evidence of employment or that the VA has strong evidence that the veteran is being fraudulent and not working on purpose (a really hard claim to prove mind you).
Unfortunately, this seems to be status quo for the Seattle RO, but despite their fishing expeditions they still need to follow the regs in the end.
By the way, I can probably dig up some contact info I used in my wife's case (if I can find it all), so PM me if you want it.
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Insurance in this country is quickly becoming a joke. At 30, I cannot qualify for any life insurance because I'm overweight. Despite the fact that I jog 6 miles per day and bench 350 and have very little body fat (non-smoker, rarely drink, etc); I am a risk because I weigh 225 @ 6'1".
So, being denied for a preexisting condition like PTSD really doesn't surprise me at all.
Now-a-days, if your work doesn't subsidize your insurance, it's not worth getting any. I think they want something like $150/mnth from me for a 30K policy (privately obtained of course). It's madness.......
BTW, the wife is a 100% disabled vet and has been since she left the service and she has no life insurance policy and can't get one (of any real value)....thus is life....
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The bill of rights does not apply to people in the military, so I can understand the DoD's policies on drug screening. However, you are all civilians now and have full rights under our laws and the VA shouldn't be able to screen someone without permission or a court order. I'm betting this issue needs a lawsuit filed in order to fix it.....it may seem trivial to some, but when you give up one civil liberty you can bet they'll go after another soon enough.
Imo Per Dept Of Va
in VA Disability Claims Research
Posted
Many psychologists/NPs/PAs work under the direct supervision of an MD (be it general practice MD or a psychiatrist). SS did accept my wife's NP's eval for SSD, but the NP had to have her residing psychiatrist sign off on the eval in order for SS to accept it. This was about 5 years ago and it was for her initial award (not a continuance), so maybe things have changed or you are refering to maintaining SS rather than being awarded SS. I know my wife's last eval for SSD consisted of a self-reporting statement saying she hasn't improved....nothing more.