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tylerb333

Second Class Petty Officers
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Everything posted by tylerb333

  1. Quick question...I had an appeal in thinking it would take years to see through to the end.  I filed another tdiu claim nearly a year later with new evidence.   Then RAMP came out, and I won.  I was awarded tdiu with chapter 35.  Can the later comp claim revisit my tdiu p and t?  Or is it protected?   I file a request to drop the claim, and I sent the ramp decision in.  Do I have anything  to worry about?

  2. PTSD) Disability Benefits Questionnaire Name of patient/Veteran: Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes [ ] No ICD Code: F43.10 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Antisocial personality disorder ICD Code: F60.2 Mental Disorder Diagnosis #2: Opioid use disorder ICD Code: F11.20 Mental Disorder Diagnosis #3: PTSD ICD Code: F43.10 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Deferred to medical 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [X] Yes [ ] No [ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: Antisocial personality disorder is responsible for contentious interpersonal relationships including threats, aggression, assault; failure to accept responsibility; violation of social norms and law; impulsive decisions and behaviors; and affective instability. In the symptom list below antisocial personality disorder is responsible for impaired judgment, disturbance of motivation and mood, difficulty establishing and maintaining effective social/work relationships, difficulty adapting to stressful circumstances, and impaired impulse control. Opioid use disorder has been in institutional remission June 2018, and is not at this time contributing to the symptom picture. Substance use is well known to have deleterious effects on mood, cognition, and behavior. When active, however, these symptoms likely take a predominant role. PTSD is responsible for the remaining symptoms below, which include depressed mood, chronic sleep impairment, and flat affect. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [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 b. For the indicated occupational and social impairment, is it possible to differentiate which impairment is caused by each mental disorder? [X] Yes [ ] No [ ] Not Applicable (N/A) If yes, list which occupational and social impairment is attributable to each diagnosis: As noted above regarding symptoms, Antisocial personality disorder is primary and PTSD is secondary. c. If a diagnosis of TBI exists, is it possible to differentiate which occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] Not Applicable (N/A) SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder [X] CPRS 2. Recent History (since prior exam) ------------------------------------ a. Relevant social/marital/family history: The veteran last completed a PTSD review DBQ 06/20/17, and he reported that since that exam he has moved from Columbus to Marysville. The veteran currently is in residential programming at Chillicothe VA, hoping for placement in the DOM. The veteran denied his family situation since last exam. Socially, the veteran said he is getting along well with other residents here. His girlfriend and mother visited him here. He said he is made some acquaintances in the programming as well as a couple friends. b. Relevant occupational and educational history: The veteran denied changes in education since last exam. He has completed a GED and some college, and has a license to work with fuel and chemicals for shipping. The veteran denied employment since May 2017. He worked in landscaping prior and occasionally for his mother after that. His mother's business is sales of retail and bank machines. He said his mother arranged his hours to suit him. c. Relevant mental health history, to include prescribed medications and family mental health: The veteran denied pre-military and military mental health treatment. Specifically, he denied a history of hospitalization, suicide attempt, outpatient therapy, and prescription of psychotropic medications prior to about 2001. CPRS and VBMS were reviewed with the following relevant mental health entries. 06/20/17: PTSD review DBQ. MSE: Mood and affect depressed, otherwise normal. Examiner opined significant impairment. 06/14/18: Medical certificate. The veteran requested admission due to depression, suicidal ideation, overdose attempt on Seroquel and alcohol last evening, and hearing voices telling him to kill himself every day. UDS was positive for oxycodone, Suboxone, and cannabinoids. DX: Cocaine dependence; alcohol abuse; cannabis dependence; opioid dependence; PTSD. 06/19/18: Medical certificate. Veteran seen for change in programming. MSE: Normal except for dysphoric affect. d. Relevant legal and behavioral histor y: The veteran denied arrest since last exam, however, he has 3 years and 3 months left on parole. As a juvenile, the veteran was arrested for trespassing, DUI, domestic dispute. He denied being remanded to juvenile detention. During military, the veteran was arrested for underage consumption. He also received NJPs for being late to work (up to 10 hours), possession of pornography, disrespect to a commanding officer, and drinking while on duty. After service, the veteran has been arrested for domestic violence 2, aggravated robbery 3, and theft. He served 10 years in ODRC. While in prison, the veteran reported that he ran the inmate "store" providing drugs, contraband items, and running gambling schemes. He received over 50 tickets for institutional rules violations while in prison. He was released in September 2016. e. Relevant substance abuse history: The veteran reported that historically he has rarely used alcohol, perhaps 1-2 times per month and none since June 2018. The veteran denied use of illicit drugs since June 2018. In the period immediately prior he primarily used narcotics and heroin. f. Other, if any: Nothing further. 3. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threatening situations (non- combat related stressors). Do NOT mark symptoms below that are clearly not attributable to the Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined"). [X] Markedly diminished interest or participation in significant activities. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Hypervigilance. [X] Exaggerated startle response. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Chronic sleep impairment [X] Flattened affect [X] Impaired judgment [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Impaired impulse control, such as unprovoked irritability with periods of violence 5. Behavioral observations -------------------------- The veteran presented as guarded. We were able to establish adequate rapport through time. He initiated conversation and elaborated on topics, often to highlight the frequency and severity of symptoms. He was easily re-directed, however. He was cooperative in that he answered all questions asked. The veteran's mood was neutral and stable. His affect was mildly flat and mildly irritable, with limited mobility in range and intensity. The veteran seldom smiled and laughed, and seldom responded to humor. He was not tearful. There was no hopelessness and helplessness evident in his comments. There was no objective evidence of facial flushing, vigilance, arousal, tremor, perspiration, or muscle tension. Speech, thought processes, orientation, attention, and memory all were within expectations. Psychomotor was remarkable for bouncing a leg. Given vocabulary, and educational, employment, and military history, I estimate his IQ in the average range. The veteran denied recent changes in sleep, noting he experiences nightmares about 70% of the time. He appeared alert and rested and did not report functional loss due to sleep problems. He said his appetite is unchanged with some weight increase with abstinence from drugs. Thought content was negative for objective signs of psychosis and the veteran denied same. He also denied suicidal and homicidal ideation, but added "They call it passive SI. I'm getting better at telling people about it." Given several opportunities, the veteran reported current symptoms of: Nightmares; not liking to think about the military event; staying away from crowds; inability to interact with people; increased stress with work; blaming himself for the event happening; being aware of his surroundings; isolating from others; not sleeping well; drug use. The veteran reported abilities indicating that he retains considerable cognitive capacity (physical capacity is not assessed here). When home, he enjoys gardening, growing roses, and mowing his sisters grass. He told that he can drive independently. The veteran said he can perform personal care independently. The veteran told that he can use a calendar, clock, calculator, telephone, and computer. He reported that he can manage money, appointments, and medications, as well as shop and pay bills. For enjoyment he watches TV on his laptop, works out, watches OSU football, and does some light reading. He had good social skills on exam. Socially, the veteran said he is getting along well with other residents here. His girlfriend and mother visited him here. He said he is made some acquaintances in the programming as well as a couple friends. 6. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 8. Remarks, (including any testing results) if any: --------------------------------------------------- ****This forensic report is a legal document intended for the sole use of VBA in determining the veteran's eligibility for compensation and pension. This examination is very different from other psychological examinations, such as for treatment, with considerably different criteria and, thus, often with considerably different diagnoses and outcomes. As such, great caution is needed in interpreting this information and use of this report outside its intended purpose by VHA personnel, VSO, and/or the veteran is STRONGLY discouraged. This examination does not constitute a rating decision. Rating decisions are made solely by the Regional Office after all available data have been reviewed and verified. Note that "The examiner should not express an opinion regarding the merits of any claim or the percentage evaluation that should be assigned for a disability. Determination of service connection and disability ratings for VA benefits is exclusively a function of VBA" (VHA Directive 1046). Thus, any questions or concerns regarding rating decisions should be directed to the Regional Office or an Appeals Board.**** The veteran was seen today for this PTSD Review exam. I verbally provided the usual informed consent regarding: this being a VBA assessment, not treatment; the report becomes a legal document; the forensic role of VBA; the potential outcomes of a review exam; and limits to confidentiality. A written copy of Informed Consent was offered. Throughout the interview the veteran inserted nearly every symptom of PTSD listed in the DSM 5. He noted often that these symptoms are severe and prevent him from interacting with people and working with others. This was not particularly consistent with mental status and functional data. Some patterns of thought developed throughout the interview, such as when the veteran noted that when people try to enforce rules or consequences for his behavior he makes threats and blames them for causing him to use substances. He noted that all his criminal behavior and drug use is due to the military assault, even though he also reported that alcohol and drug use began at an early age, as did arrest. For example, the veteran said that the traumatic event in service caused and or heightened his drug use in response, but he also commented that "I figured out when I was younger that using drugs and alcohol makes problems like that go away." The veteran noted that he was found to have steroids in his jacket while at Bay Pines. He subsequently was discharged from the program. He then interpreted that as "people make me fail. That (being discharged from Bay Pines) put me in a bad place and made me attempt suicide. They deny my individual unemployability because they say I'll get better with treatment, then the treatment kicks me out and I'm worse now." This behavior and thinking is quite consistent with personality disorder. The veteran was diagnosed with PTSD in prior C&P exams, the diagnosis has been carried forward by treatment providers, and by his report continues with sufficient symptoms for the diagnosis. Thus the diagnosis of PTSD continues, as likely as not due to events in military service. Antisocial personality disorder was present well before military service, so it is less likely as not caused by military events, and there is no evidence that this disorder was exaggerated by military events. Also, alcohol and illicit drug use clearly was present prior to enrollment in military, so it is less likely as not caused by military service. There is no evidence that the veteran's substance use was due to events in military service nor has it progressed beyond the normal course for this disorder. Put another way, even if the military event had not occurred it is likely that the resulting pattern of substance use would have been present. Moreover, while there is some equivalence in the literature about the direction of causality when both mental disorder and substance use are present, DSM 5 does not acknowledge any substance use disorder as "due to mental illness," yet there are numerous "substance-induced" mental disorders. INDIVIDUAL UNEMPLOYABILITY The veteran retains considerable residual mental function (physical limitations, if any, are not assessed nor considered here). The veteran can perform personal care independently. He has a driver's license and drives independently. The veteran can use a calendar, clock, calculator, telephone, and computer. He can manage money, appointments, and medications, as well as pay bills. There is no mental disorder that prevents him from attending to, learning, and persisting to complete simple and complex tasks. There is no cognitive dysfunction that would prevent same. His performance on mental status in attention, concentration, memory, abstraction, and thought processes were within expectations for age. The veteran reported limited socialization. Yet, he dated, married, and maintains a current relationship (after divorcing). He maintains some contact with family. Moreover, the veteran was a quite bright, capable, pleasant, cooperative gentleman on exam, and his social skills here were excellent. He reported isolating at home, not liking to be around people, and having difficult relationships through time. The veteran is not a member of any clubs/organizations. Indeed, personality disorder is predictive of contentious interpersonal relationships and the affective instability and impulsive decisionmaking/behavior of the personality disorder may interfere with motivation and concentration.
  3. Can I site law in a letter submitted as evidence? The veteran was diagnosed with PTSD in prior C&P exams, the diagnosis has been carried forward by treatment providers, and by his report continues with sufficient symptoms for the diagnosis. Thus the diagnosis of PTSD continues, as likely as not due to events in military service. Antisocial personality disorder was present well before military service, so it is less likely as not caused by military events, and there is no evidence that this disorder was exaggerated by military events. Also, alcohol and illicit drug use clearly was present prior to enrollment in military, so it is less likely as not caused by military service. There is no evidence that the veteran's substance use was due to events in military service nor has it progressed beyond the normal course for this disorder. Put another way, even if the military event had not occurred it is likely that the resulting pattern of substance use would have been present. Moreover, while there is some equivalence in the literature about the direction of causality when both mental disorder and substance use are present, DSM 5 does not acknowledge any substance use disorder as "due to mental illness," yet there are numerous "substance-induced" mental disorders. LAW: pay attention to examples not to use....and c an p doc uses likely, less likely as not....
  4. Gaston, it's been a while... I have a vocal rehab not feasible letter.  Pretty much the soc said can do sedentary work and will likely get better with treatment.   Well I went to said treatment, and I was discharged early for behavior.  They left me in Florida 1000 miles away from home they didn't help me find shelter I slept on the beach in on the streets for 8 days and I tried to commit suicide while is down there.  I'm currently in treatment now after another suicide attempt and I'm going to be going to a generic mental health treatment facility in a substance abuse facility, VA.

    Your thoughts!

  5. Yes I'm 70 percent with secondary substance use disorder. I have a total rating of 80 percent. The soc said I was able to follow direction, etc. And I would likely get better with treatment.
  6. Mt first c and p was favorable.  the subsequent one for tdiu was completed by a tyrant!  this lady acted like it was her money being handed out.  The clarification requested by the examiner was favorable(see thread)  also the 2nd examiner checked the in-person box.  She is in Maryland, and I am in Ohio.  Is this grounds for an appeal?  And what do you think about ramp?

  7. this was the clarfacation the BVA asked for, and the subsequent opinion: The veteran's use of opiates, cannabis, and alcohol began prior to service, thus current/recent use/abuse is not caused by an in-service related event. Given the veteran's consistent diagnosis and treatment of PTSD, and the frequency of relapse of substance use, it is as least as likely as not that his substance use (to include opioid use disorder) is aggravated beyond its natural progression by his PTSD symptoms. (this is in my favor) Per 3/15/2017 initial PTSD exam the veteran was diagnosed with PTSD, alcohol use disorder, cannabis use disorder, and opioid use disorder, all of which were in early remission. The 3/15/2017 medical opinion, the examiner opined that the veteran's opioid use disorder, and substance use in general, was made worse by his MST. The 6/20/2017 review PTSD examination indicates that symptoms present at that time were due to PTSD and not substance use as he had been abstinent from drug use with the exception of his opioid maintenance therapy. The veteran is service connected for the combination of PTSD and substance use disorders however per 11/20/2017 medical opinion regarding unemployability, the examiner noted that the veteran was service-connected only for PTSD and not substance use which is incorrect. Per rating decisions 3/27/2017 and 10/11/2017, the veteran was service connected for "PTSD with secondary alcohol use disorder, cannabis use disorder, and opioid use disorder." They are separate disorders, and not all symptoms are present all of the time. The examiner commented specifically on the veteran's PTSD symptoms and separated the veteran's substance abuse disorder symptoms. The veteran's substance use predated his military service;(sic) thus it was not caused by his reported assault. It was, however, likely aggravated by the residuals of his assault as described in treatment notes which indicate that with worsening PTSD symptoms, the veteran has reported relapsing on substances, particularly heroin. (again, in my favor)
  8. except, I was denied. You think I'd win in ramp? Ive got additional evidence...I've been hospitalized three times,. Once, in a lockdown ward/
  9. Denial...really? The veteran's use of opiates, cannabis, and alcohol began prior to service, thus current/recent use/abuse is not caused by an in-service related event. Given the veteran's consistent diagnosis and treatment of PTSD, and the frequency of relapse of substance use, it is as least as likely as not that his substance use (to include opioid use disorder) is aggravated beyond its natural progression by his PTSD symptoms. Per 3/15/2017 initial PTSD exam the veteran was diagnosed with PTSD, alcohol use disorder, cannabis use disorder, and opioid use disorder, all of which were in early remission. The 3/15/2017 medical opinion, the examiner opined that the veteran's opioid use disorder, and substance use in general, was made worse by his MST. The 6/20/2017 review PTSD examination indicates that symptoms present at that time were due to PTSD and not substance use as he had been abstinent from drug use with the exception of his opioid maintenance therapy. The veteran is service connected for the combination of PTSD and substance use disorders however per 11/20/2017 medical opinion regarding unemployability, the examiner noted that the veteran was service-connected only for PTSD and not substance use which is incorrect. Per rating decisions 3/27/2017 and 10/11/2017, the veteran was service connected for "PTSD with secondary alcohol use disorder, cannabis use disorder, and opioid use disorder." They are separate disorders, and not all symptoms are present all of the time. The examiner commented specifically on the veteran's PTSD symptoms and separated the veteran's substance abuse disorder symptoms. The veteran's substance use predated his military service, thus it was not caused by his reported assault. It was, however, likely aggravated by the residuals of his assault as described in treatment notes which indicate that with worsening PTSD symptoms, the veteran has reported relapsing on substances, particularly heroin.
  10. is this in my favor? The veteran's use of opiates, cannabis, and alcohol began prior to service, thus current/recent use/abuse is not caused by an in-service related event. Given the veteran's consistent diagnosis and treatment of PTSD, and the frequency of relapse of substance use, it is as least as likely as not that his substance use (to include opioid use disorder) is aggravated beyond its natural progression by his PTSD symptoms.
  11. If a c and p examiner checked the box stating it was an in-person exam, and it was not. Is this good enough for appeal for remand or reversal?
  12. The last C and P examiner said this: The veteran's use of opiates, cannabis, and alcohol began prior to service, thus current/recent use/abuse is not caused by an in-service related event. Given the veteran's consistent diagnosis and treatment of PTSD, and the frequency of relapse of substance use, it is as least as likely as not that his substance use (to include opioid use disorder) is aggravated beyond its natural progression by his PTSD symptoms. The examiner was mistaken when they said I had used opiates prior to service. That is factually untrue. I had tried marijuana and alcohol, what teenager hasn't. Additionally, I had gotten waivers prior to enlisting for marijuana. Also, the examiner checked the box stating it was an in-person exam. It was not.
  13. Note Title: SUICIDE BEHAVIOR REPORT Location: Chillicothe OH VAMC Signed By: HINES,JEENEE M Co-signed By: HINES,JEENEE M Date/Time Signed: 18 Jun 2018 @ 1007 ------------------------------------------------------------------------- LOCAL TITLE: SUICIDE BEHAVIOR REPORT STANDARD TITLE: SUICIDE RISK ASSESSMENT NOTE DATE OF NOTE: JUN 18, 2018@10:03 ENTRY DATE: JUN 18, 2018@10:04:06 AUTHOR: HINES,JEENEE M EXP COSIGNER: URGENCY: STATUS: COMPLETED DOB: JUL 22,1980 (37) -- Date/Time of event: Jun 13,2018@22:00 (Time is approximate) Location of event: Off station Patient status at time of event: Outpatient Outcome of event: remained outpt, hospitalized: indicate where in the box below voluntarily came to UC day after -- Source of information: Written, Patient self-report Name & Phone # of source: veteran -- Patient's stated: Level of INTENT of this event was: High Staff assessment: Level of INTENT of this event was: High Staff assessment: Level of LETHALITY of this event was: Low Last Pain Score Before Event: 6 Did the patient have access to firearms? Unknown Description of event: struggling with depression and positive for suicidal ideation, made an attempt at overdose on quetiapine and alcohol Past 10 Clinic Visits: 06/17/2018 12:40 CHI MH INPT PSY 21-45MIN UNSCHEDULED 06/16/2018 14:31 CHI MH INPT PSY 21-45MIN UNSCHEDULED 06/15/2018 13:00 CHI RECREATION GROUP 2 UNSCHEDULED 06/15/2018 12:46 CHI PHARM INPT MH UNSCHEDULED 06/15/2018 09:03 CHI MH INPT PSY 21-45MIN UNSCHEDULED 06/15/2018 09:00 CHI TCM CARE MANAGEMENT R UNSCHEDULED 06/14/2018 12:37 CHI MH URGENT CARE 8-4 1 01/03/2018 15:30 CHI TELE MHRRTP UNSCHEDULED 12/20/2017 15:55 CHI PRRTP NP UNSCHEDULED 12/20/2017 13:30 CHI PM&RS PHYSICIAN INPAT CANCELLED BY CLINIC -- Patient is currently receiving treatment in the following areas: Ambulatory Care Primary Care Provider: COPC Case Manager/Therapist: COPC Name of Provider prescribing psychiatric medications:COPC Active problems - Computerized Problem List is the source for the following: 1. Cocaine dependence (SNOMED CT 31956009) 2. AA - Alcohol abuse (SNOMED CT 15167005) 3. Cannabis dependence (SNOMED CT 85005007) 4. Low back pain (SNOMED CT 279039007) 5. Chronic post-traumatic stress disorder 6. Opioid dependence -- BRIEF PLAN/DISPOSITION: Developed crisis management plan, Medication management, Refer for Mental Health treatment, Assure followup appointment is made /es/ JEENEE M HINES, LISW-S CLINICAL SOCIAL WORKER Signed: 06/18/2018 10:07 From the service...even then I had work, social, and legal problems.
  14. The aforementioned C and P examiner was a nightmare! There are horror stories about this woman. She acted like the benefits were coming out of her pocket. My initial C and P examiner's opinion was closer to the truth.
  15. Note Title: SUICIDE BEHAVIOR REPORT Location: Chillicothe OH VAMC Signed By: HINES,JEENEE M Co-signed By: HINES,JEENEE M Date/Time Signed: 18 Jun 2018 @ 1007 ------------------------------------------------------------------------- LOCAL TITLE: SUICIDE BEHAVIOR REPORT STANDARD TITLE: SUICIDE RISK ASSESSMENT NOTE DATE OF NOTE: JUN 18, 2018@10:03 ENTRY DATE: JUN 18, 2018@10:04:06 AUTHOR: HINES,JEENEE M EXP COSIGNER: URGENCY: STATUS: COMPLETED DOB: JUL 22,1980 (37) -- Date/Time of event: Jun 13,2018@22:00 (Time is approximate) Location of event: Off station Patient status at time of event: Outpatient Outcome of event: remained outpt, hospitalized: indicate where in the box below voluntarily came to UC day after -- Source of information: Written, Patient self-report Name & Phone # of source: veteran -- Patient's stated: Level of INTENT of this event was: High Staff assessment: Level of INTENT of this event was: High Staff assessment: Level of LETHALITY of this event was: Low Last Pain Score Before Event: 6 Did the patient have access to firearms? Unknown Description of event: struggling with depression and positive for suicidal ideation, made an attempt at overdose on quetiapine and alcohol Past 10 Clinic Visits: 06/17/2018 12:40 CHI MH INPT PSY 21-45MIN UNSCHEDULED 06/16/2018 14:31 CHI MH INPT PSY 21-45MIN UNSCHEDULED 06/15/2018 13:00 CHI RECREATION GROUP 2 UNSCHEDULED 06/15/2018 12:46 CHI PHARM INPT MH UNSCHEDULED 06/15/2018 09:03 CHI MH INPT PSY 21-45MIN UNSCHEDULED 06/15/2018 09:00 CHI TCM CARE MANAGEMENT R UNSCHEDULED 06/14/2018 12:37 CHI MH URGENT CARE 8-4 1 01/03/2018 15:30 CHI TELE MHRRTP UNSCHEDULED 12/20/2017 15:55 CHI PRRTP NP UNSCHEDULED 12/20/2017 13:30 CHI PM&RS PHYSICIAN INPAT CANCELLED BY CLINIC -- Patient is currently receiving treatment in the following areas: Ambulatory Care Primary Care Provider: COPC Case Manager/Therapist: COPC Name of Provider prescribing psychiatric medications:COPC Active problems - Computerized Problem List is the source for the following: 1. Cocaine dependence (SNOMED CT 31956009) 2. AA - Alcohol abuse (SNOMED CT 15167005) 3. Cannabis dependence (SNOMED CT 85005007) 4. Low back pain (SNOMED CT 279039007) 5. Chronic post-traumatic stress disorder 6. Opioid dependence -- BRIEF PLAN/DISPOSITION: Developed crisis management plan, Medication management, Refer for Mental Health treatment, Assure followup appointment is made /es/ JEENEE M HINES, LISW-S CLINICAL SOCIAL WORKER Signed: 06/18/2018 10:07 From the service...even then I had work, social, and legal problems.
  16. Note Title: SUICIDE BEHAVIOR REPORT Location: Chillicothe OH VAMC Signed By: HINES,JEENEE M Co-signed By: HINES,JEENEE M Date/Time Signed: 18 Jun 2018 @ 1007 ------------------------------------------------------------------------- LOCAL TITLE: SUICIDE BEHAVIOR REPORT STANDARD TITLE: SUICIDE RISK ASSESSMENT NOTE DATE OF NOTE: JUN 18, 2018@10:03 ENTRY DATE: JUN 18, 2018@10:04:06 AUTHOR: HINES,JEENEE M EXP COSIGNER: URGENCY: STATUS: COMPLETED DOB: JUL 22,1980 (37) -- Date/Time of event: Jun 13,2018@22:00 (Time is approximate) Location of event: Off station Patient status at time of event: Outpatient Outcome of event: remained outpt, hospitalized: indicate where in the box below voluntarily came to UC day after -- Source of information: Written, Patient self-report Name & Phone # of source: veteran -- Patient's stated: Level of INTENT of this event was: High Staff assessment: Level of INTENT of this event was: High Staff assessment: Level of LETHALITY of this event was: Low Last Pain Score Before Event: 6 Did the patient have access to firearms? Unknown Description of event: struggling with depression and positive for suicidal ideation, made an attempt at overdose on quetiapine and alcohol Past 10 Clinic Visits: 06/17/2018 12:40 CHI MH INPT PSY 21-45MIN UNSCHEDULED 06/16/2018 14:31 CHI MH INPT PSY 21-45MIN UNSCHEDULED 06/15/2018 13:00 CHI RECREATION GROUP 2 UNSCHEDULED 06/15/2018 12:46 CHI PHARM INPT MH UNSCHEDULED 06/15/2018 09:03 CHI MH INPT PSY 21-45MIN UNSCHEDULED 06/15/2018 09:00 CHI TCM CARE MANAGEMENT R UNSCHEDULED 06/14/2018 12:37 CHI MH URGENT CARE 8-4 1 01/03/2018 15:30 CHI TELE MHRRTP UNSCHEDULED 12/20/2017 15:55 CHI PRRTP NP UNSCHEDULED 12/20/2017 13:30 CHI PM&RS PHYSICIAN INPAT CANCELLED BY CLINIC -- Patient is currently receiving treatment in the following areas: Ambulatory Care Primary Care Provider: COPC Case Manager/Therapist: COPC Name of Provider prescribing psychiatric medications:COPC Active problems - Computerized Problem List is the source for the following: 1. Cocaine dependence (SNOMED CT 31956009) 2. AA - Alcohol abuse (SNOMED CT 15167005) 3. Cannabis dependence (SNOMED CT 85005007) 4. Low back pain (SNOMED CT 279039007) 5. Chronic post-traumatic stress disorder 6. Opioid dependence -- BRIEF PLAN/DISPOSITION: Developed crisis management plan, Medication management, Refer for Mental Health treatment, Assure followup appointment is made /es/ JEENEE M HINES, LISW-S CLINICAL SOCIAL WORKER Signed: 06/18/2018 10:07 -------------------------------------------------------------------------
  17. The Psychologists opinion is correct: I am able to follow directions and complete simple tasks. But she errs in her judgement in three regards: 1) I am only able to keep and hold a job for a brief period before my PTSD symptoms present as is evidenced in my medical records with respect to my attending groups and hospitalizations. When my symptoms present I am unable to sleep. I become erratic, and hear voices, become paranoid, sometimes attempting suicide. This in and of itself lends itself more times than not to my being dismissed or fired. I eventually relapse to get relief from my symptoms. This leads to sustained use and dependence. 2) I can respond appropriately to coworkers as Dr. Houle suggests, but as I previously mentioned, the PTSD symptoms present, and I am unable to sleep, I become erratic, and I hear voices, I become paranoid, and to suggest I can maintain relationships at work while exhibiting these behaviors is asinine. 3) Dr. Houle suggests that drugs are my problem and that I am not service connected for drug use is just false. I am service connected for drug abuse disorder, a secondary condition to my PTSD (Military Sexual Trauma). Additionally, she states my inability to hold a job is due to that very thing, opioid use disorder. Additionally, I attended said treatment and was dx'd for behavior. That VA left me 1000 miles away without shelter or a plane ride home. I ended up in their VA hospital as a result of a suicide attempt... Since that time I've attempted suicide one other time, that is, twice in 3 mos, and I am currently hospitalized. Do you think in light of these circumstances I would have a shot at IU in the ramp program?
  18. Does this sound or look right to anyone? Denied TDIU... ========================================================================= Date/Time: 20 Jun 2017 @ 0800 Note Title: C&P MENTAL DISORDER Location: Chalmers P Wylie VA Outpatnt Signed By: HOULE,ALLISON C Co-signed By: HOULE,ALLISON C Date/Time Signed: 20 Jun 2017 @ 1641 ------------------------------------------------------------------------- LOCAL TITLE: C&P MENTAL DISORDER STANDARD TITLE: MENTAL HEALTH C & P EXAMINATION CONSULT DATE OF NOTE: JUN 20, 2017@08:00 ENTRY DATE: JUN 20, 2017@16:41:06 AUTHOR: HOULE,ALLISON C EXP COSIGNER: URGENCY: STATUS: COMPLETED *** C&P MENTAL DISORDER Has ADDENDA *** Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire Name of patient/Veteran: xxxxxxx Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes [ ] No 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Posttraumatic Stress Disorder ICD Code: F43.10 Mental Disorder Diagnosis #2: Opioid Use Disorder, Severe, In early remission, on maintenance therapy ICD Code: F11.20 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [X] Yes [ ] No [ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: The veteran's symptoms are primarily related to his PTSD since he has not used substances in more than six months. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with reduced reliability and productivity b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [X] Yes [ ] No [ ] No other mental disorder has been diagnosed If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: The veteran's impairment is related to his PTSD. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS Evidence Comments: The veteran's electronic medical records (CPRS & VistAWeb) and military records (VBMS) were reviewed. The veteran was referred for a compensation and pension examination. The veteran was informed verbally of the nature and purpose of the examination and confidentiality limits. He appeared to have a basic understanding of the purpose of the examination and confidentiality limits. He was provided with a chance to ask questions about the evaluation procedures. All questions were answered to reasonable satisfaction or referred to other resources. He was informed that this examiner is not his treating clinician or the legal determiner of compensation or pension benefits. Instead, he was informed that this examiner is an independent provider of clinical information and expertise to assist those who review and make legal compensation and pension claim decisions and would not be participating in her healthcare. He was given information about the Veteran's 24-hour Crisis Line. The veteran indicated understanding of these terms and explicitly and freely consented to the evaluation. The judgments of symptoms and opinions in this evaluation report are offered to a reasonable degree of psychological certainty and are only based upon the information available at the time of the evaluation. This report was dictated using Dragon Naturally Speaking dictation software. The report has been proofread; however, there still may be some typographical errors due to the nature of the dictation software. The veteran began participating in recovery services at the VA in May 2017. His last group note was dated 5/31/17. A note dated 2/26/17, by Dr. Laurie Berger, indicates that the veteran began therapy at the Vet Center in October 2016. He attends therapy on a weekly basis. He attended six sessions with Dr. Berger when this note was written. The veteran was initially evaluated for a C&P exam by Dr. Janine Schroeder on 3/22/17. 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: The veteran was born and raised in xxxx. He was raised by his mother and father until they divorced when he was 7 years old. The veteran then lived with his mother until he was 14 years old. The veteran's mother remarried when he was 11 years old and he reported that he did not get along well with his stepfather. He went to live with his father at 14 years of age due to being disrespectful towards his stepfather. The veteran has one older sister and one younger brother. The veteran's father did not remarry, but he was in a relationship with the same woman for 20 years. He reported physical abuse by his father throughout his adolescent years. He recalled one incident where he got a black eye after his father hit him. He denied any Child Protective Services involvement. The veteran describes his father as emotionally absent. His father died in 2007 from a heart attack. The veteran is a 36-year-old, divorced male. He was married in 2001 for five years and divorced in 2006. The veteran reported that they divorced due to his drug use. They have a 1X-year-old daughter together. His ex-wife and daughter live in xxxxx. He maintained some contact with his daughter, but has not seen her in several years. The veteran reported that he was involved in a relationship for a few years following his divorce. They are no longer in a relationship, but are close friends. The veteran reported that he has spends time with three friends from high school. The veteran stated that he enjoys gardening. b. Relevant Occupational and Educational history: The veteran reported that he did not enjoy school and did not want to do the work. He frequently skipped school to go skating. He stated that he would "have a few beers and smoked pot" when he skipped school. He reported being suspended several times for truancy, fighting, and disrespect towards teachers. He was never held back a grade. He was expelled his junior year of high school due to nonattendance. He earned his GED in 1997. The veteran worked for his father from 1997 until 1999 doing ironwork. The veteran enlisted in the Navy in October 1999. He reported several disciplinary issues while in the service related to going AWOL, being late, and underage drinking. He reported that the sexual assault occurred in the summer of 2001. The veteran received a general under honorable conditions discharge in September 2001 for misconduct. The veteran worked in Virginia Beach beginning in September 2001 doing ironwork. He worked at a company for one year and was fired due to not showing up for work and using alcohol and drugs. He then worked for Roofing Services Incorporated from September 2002 until August 2003. The veteran then earned his tanker men certification, z card, and AB certification to work on tugboats. He worked on boats from September 2003 until March 2005. At that time his wife left him and he moved back to Ohio to be closer to his family. The veteran continued working on boats in Ohio until the summer of 2005 when he got fired. The veteran was incarcerated from 2006 until 2016. After his release from prison, he worked with friends doing landscaping and painting. He began working at ABS Money Systems in January 2017, a company that his mother owns. The veteran reported that he was working 30-40 hours per week for the first two months. He stated that his hours have declined significantly since March and he is currently working 5-6 hours per week. He stated that his work has declined due to his mental health symptoms. However, according to the initial C & P exam, "he is unable to do a lot for her because she works serving ATM machines in banks and with his record he isn't allowed to work in banks." He also reported that his employment since the military has been "short-lived due to his drug and alcohol use." c. Relevant Mental Health history, to include prescribed medications and family mental health: The veteran reported that he was diagnosed with ADHD during childhood and received treatment. The veteran reported a suicide attempt in 2001 after he was discharged from the military. He began attending treatment at the Vet Center in October 2016. He reported that he attends individual therapy twice per week with Dr. Berger. The veteran described his mood as "anxious, paranoid, and depressed." He stated that he feels as though he "can't get a break." He reported having passive thoughts of suicide, but stated that he does not have a plan or intention to kill himself. He stated "I couldn't do that to my family." He stated that he has had difficulty dealing with his emotions since he is no longer using substances and does not have an escape. He stated "I don't have the coping skills." He described having difficulty sleeping and stated that he does not sleep every night. He stated that he is not feel safe in his bed. d. Relevant Legal and Behavioral history: The veteran reported that he had several misdemeanor offenses as a juvenile, including truancy, driving without a license, and theft. He reported that he was arrested for selling drugs at 18 years of age and was placed on probation for one year. According to the previous exam, he was arrested numerous times from June 1998 to September 1999. The veteran was convicted of armed robbery for robbing three pharmacies with a weapon. He served a 10-year prison sentence beginning in October 2006 and was released in September 2016. He is currently on parole for five years. e. Relevant Substance abuse history: The veteran reported that he first drank alcohol at 10 years of age. He began regularly drinking alcohol during high school. He began smoking marijuana at 15 years of age on the weekends. He also experimented with mushrooms and pain/anxiety medication that he took from his father. The veteran's alcohol use increased significantly while in the military. He denied using any drugs while in the service. After his discharge from the service, he continued using alcohol and marijuana. In 2002, he began using narcotic pain medication. He also began using heroin and reported that he eventually used heroin intravenously. The veteran reported using substances throughout his time in prison. He reported that he has been clean from drugs and alcohol since October 2016. He has maintained sobriety using Suboxone. He currently attends AA meetings approximately once per week. He attends substance abuse groups at the VA twice per month. f. Other, if any: No response provided. 3. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threatening situations (non-combat related stressors). Do NOT mark symptoms below that are clearly not attributable to the Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Exaggerated startle response. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships 5. Behavioral observations -------------------------- The veteran arrived 10 minutes late for his appointment and was pleasant upon meeting. The veteran was oriented to person, place, situation, and time. His grooming and hygiene were adequate. He made appropriate eye contact and presented with a depressed mood with a congruent affect. His speech was within normal limits for tone, volume, and rate. His thoughts were logical, linear, and goal-directed. He did not evidence any psychotic symptoms, including responding to auditory or visual hallucinations and delusional beliefs. On a brief mental status exam he was able to freely recall two of three words presented after a brief delay. He was able to recall six digits forward and three digits backward. He was able to complete a serial seven subtraction task with no errors to seven places. He was able to spell the word WORLD forwards and backwards. He was able to complete a two-digit addition and subtraction tasks. He was able to compare an apple and banana and was able to reason abstractly when comparing a poem and a statue. His response to the proverb "don't cry over spilled milk" was good. He was not able to provide a response to the proverb "people in glass houses should not throw stones." 6. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 8. Remarks, (including any testing results) if any: --------------------------------------------------- The veteran was administered a psychological measurement that is useful for interpreting the veracity of other data provided by an examinee during a psychological or neuropsychological examination. This assessment can assist in evaluating and making a clinical opinion regarding the veracity of an examinee's purported symptoms. Research has determined that this tool is a useful instrument to administer in order to screen for possible feigning of PTSD symptoms. The following results should be interpreted in light of the fact that the measurement that was chosen is a screening tool and not designed as a definitive measure of whether or not an individual is feigning mental illness. The Veteran's total score was not elevated beyond the cut-off score. Therefore, his PTSD symptoms are considered to be credible. The veteran was administered the Minnesota Multiphasic Personality Instrument-2-Restructred Form (MMPI-2-RF), which is a self-report psychological assessment used to identify a variety of psychological syndromes. The veteran was provided a quiet, private room to complete the testing. It appears the veteran understood the items and responded to the items in a consistent manner. The veteran over-reported psychological dysfunction, which is evidenced by a considerably larger than average number of infrequent responses. The veteran also possibly overreported symptoms associated with non-credible memory complaints. Although there is evidence of over reporting of symptoms, the profile is considered valid and will be interpreted. Overall, the veteran endorsed considerable emotional distress that is likely perceived as a crisis. The veteran reported feeling sad and dissatisfied with his currently circumstances. He reported a lack of positive emotional experiences, a lack of energy, and a lack of interest in activities. He also reported experiencing various negative emotional experiences including anxiety, anger, and fear. The veteran also reported a significant history of antisocial behavior. This behavior includes involvement with the criminal justice system, difficulty with authority figures, conflictual interpersonal relationships, impulsivity, juvenile delinquency, and substance abuse. The veteran also endorsed various unusual thought and perceptual processes. The veteran endorsed a diffuse pattern of cognitive difficulties including memory complaints. He also reported past suicidal ideation and feelings of helplessness. The veteran endorsed feelings of anxiety, being anger prone, and experiencing multiple fears that restrict his activity inside and outside of the home. He also reported being unassertive and shy. The veteran endorsed not enjoying social events and avoiding social situations. He also reported disliking being around people. On a scale of personality pathology, the veteran endorsed being self-critical and guilt-prone. He also endorsed being pessimistic and feeling depressed. The veteran is currently diagnosed with Posttraumatic Stress Disorder and Opioid Use Disorder, Severe, In early remission, on maintenance therapy. The veteran currently lives alone and is not involved in a romantic relationship. He maintains phone contact with his daughter. He has a close relationship with his mother, sister, and two friends. He is currently working for his mother's company. He reported experiencing symptoms of PTSD. He is attempting to cope with his emotions without the use of drugs. The veteran has been employed numerous times and has been fired for tardiness or alcohol and drug use. He is currently working 5-6 hours per week for his mother's company. According to the previous C&P exam, he is not able to work many hours due to not being permitted to work inside of a bank due to his felony record. The veteran reported that he was "working" during his 10 years in prison selling drugs. He denied having any difficulties while in prison. The veteran is capable of following instructions and performing simple tasks. He is able to concentrate on a simple task and respond appropriately to coworkers and supervisors. /es/ ALLISON C HOULE, PHD C&P Psychologist Signed: 06/20/2017 16:41 06/20/2017 ADDENDUM STATUS: COMPLETED The veteran presented for his appointment. The report from the C&P Exam was completed in Capri by Allison Houle, PhD; procedure code 99456 and 96101. /es/ ALLISON C HOULE, PHD C&P Psychologist Signed: 06/20/2017 16:42
  19. How can the RO deny IU when Voc rehab found me unfeasible?
  20. should left side radiculopathy 10% and right side rad. 10%   be rated having bilateral factor?

     

    1. Berta

      Berta

      I suggest you ask this at our main forum.....I dont know.

  21. one more quick question. About a month ago I saw a request for information from the VA medical facility. Doesn't the BVA have access to that information? And can the BVA see my mental health records?
  22. I have all my evidence in, all C and P's completed, submitted all evidence RO asked for. Should I hit the button asking for the BVA to proceed with deciding my claim?
  23. will the VA rate a 20% lumbosacral strain higher if the C & P mentions radiculopathy and flare ups occurring at least weekly and often more? is the radiculopathy a secondary condition?
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