IMEF-Gunny

So, I had the IME done last Friday.....6 hours of testing, interviewing and records review. Very difficult 6 hours to say the least. I will be posting about the Psychologist in the IMO/IME forum. I do not have the exam report yet, but whether it's in my favor or not, the Doc was great, very thorough, genuinely caring guy and a Marine and Vietnam veteran to boot. Should have the results by November 15th or so, then I'll file the NOD paperwork, asking for reconsideration and if not granted DRO review. I will post the IME notes when they come in.

I know that I was sent for what was quoted as a general medical C&P exam because I had multiple contentions related to GWI. (Memory loss, bi-lateral arm/shoulder pain, sleep disturbances & stomch issues).

Yes ma'am, I actually re-opened for reconsideration "short term memory loss from a NOD in 2016 claim that was denied becuase my 87 year old Iranian C&P examiner asked me what all contentions I had, I told him my stomach issues, fecal incontinence (embarrassing so I usually don't mention it), sleep impairment, bi-lateral arm/shoulder pain and memory issues. He simply replied "Memory is mental health" and ended the exam without further questions. They added the short term memory loss to this claim, as I knew was their policy. C&P doc only examined my stomach and sphincter. The VA rated me at 30% for undiagnosed illness on my stomach, combining incontenence with that issue, returned the C&P exam as Inadequate for all other conditions. My good old C&P doctor said in response that "veteran denied all other contentions, he only complained of his stomach and hemmoroids".......so they denied all other contentions.....whether he forgot our convesration, lied to cover his ass.....I don't know.......oh, and I did not claim hemmoroids, nor have I ever had or complained of hemmoroids..... War of words, but VA doctors always win......for example, my primary care VA doc has in her notes that I am an Air Force vet, my wife is an Air Force vet and our daughter is trying to join the Air Force".....this is direct dictation during an exam!!!! I am a Marine Corps vet (as well as IANG), wife has never served in any branch, daughter has never tried to join the ASAF? I did not correct it, because at some point, VA will argue that the notes state this or that and I'm going to point them to this as evidence of how "accurate" their VA docs "notes" are! In my earlier NOD, I filled out the NOD form and noted for them to also see the attached statement and supporting evidence for reconsideration, so I covered my bases in two prongs. My previous NOD is in and verified via ebennies as to status, the memory claim shows combined to the new claim.

Yes, the C&P examiner done such things as discussed my panic episodes, which he asked me to describe the physical reaction to as well (sweating, anxious, etc) he did not mention that convesation, instead listing it as Panic- None......he excluded a lot, re-diagnosed things as due to depression, failed to mention any reference to my friend who died, etc,etc,etc.........Yes she diagnosed me, they accepted it, conceded my stressors but their PHD level psychologist did not support or agree and instead changed my diagnosis to MDD......ststing that I had depression, alcohol abuse and he would have to "speculate" to tie my stressor activity or service to my current symptoms.....he keeps referencing 25 years, "relatively" symptom free.......there is NO evidence to support that notion either. Here is a letter I am drafting to send in, along with my IMO's after they are complete. I believe that an honest, unbias examiner will not only support the PTSD diagnosis, but also the idea that MDD is comorbid and would definitely have been aggrivated beyond normal progression by service outside the wire. NODPTSD.pdf

I was diagnosed with PTSD by a VA psychiatric NP. C&P doc saw my "truth room" admission and labeled it MDD pre-existing then VA denied saying because it read no sx of depression that day.....I was considered sound

RedactedAggravation.tif RedactedDenial.tif RedactedPTSDExam.tif

I will attach it here now, as well as the denial letter

So, I recieved my denial from VA, as expected. I have an IMO scheduled for November, but I'm not sure which way to go with my NOD.....thankfully, I have a couple of options here. So, VA C&P doctor said that he did not agree with my diagnosis of PTSD, he asked about stressors one time in his interview and instead focussed on history. He diagnosed MDD, based on notes from bootcamp from MH (Not exams from MEPS, but rather lay admission in the "moment of truth" room seconds before swearing in). He based the entire C&P on the notion of "pre-existing" Depression, alcohol abuse and suicidal ideation. What is interesting here is the "depression/alcohol was not noted in my MEPS physical. It was "investigated" during 3rd week of bootcamp based on "moment of truth" admission. So, in investigating this, I find the following: "What this all means for the Veteran is that he or she can point to an entrance examination in which a condition is not noted in order to cancel most VA arguments that his or her condition was a preexisting condition. This also means that if a Veteran signs a statement that he or she had issues prior to joining the military during a moment of truth prior to basic training, the VA cannot use that statement to show a preexisting condition". Also, the "notes" from bootcamp, because they were based on my lay statements/ admission, cannot be considered during my C&P examination and must be treated as though it was never said: § 3.304 Direct service connection; wartime and peacetime. (a)General. The basic considerations relating to service connection are stated in § 3.303. The criteria in this section apply only to disabilities which may have resulted from service in a period of war or service rendered on or after January 1, 1947. (b)Presumption of soundness. The veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service. Only such conditions as are recorded in examination reports are to be considered as noted. (Authority: 38 U.S.C. 1111) (1) History of preservice existence of conditions recorded at the time of examination does not constitute a notation of such conditions but will be considered together with all other material evidence in determinations as to inception. Determinations should not be based on medical judgment alone as distinguished from accepted medical principles, or on history alone without regard to clinical factors pertinent to the basic character, origin and development of such injury or disease. They should be based on thorough analysis of the evidentiary showing and careful correlation of all material facts, with due regard to accepted medical principles pertaining to the history, manifestations, clinical course, and character of the particular injury or disease or residuals thereof. (2) History conforming to accepted medical principles should be given due consideration, in conjunction with basic clinical data, and be accorded probative value consistent with accepted medical and evidentiary principles in relation to value consistent with accepted medical evidence relating to incurrence, symptoms and course of the injury or disease, including official and other records made prior to, during or subsequent to service, together with all other lay and medical evidence concerning the inception, development and manifestations of the particular condition will be taken into full account. (3) Signed statements of veterans relating to the origin, or incurrence of any disease or injury made in service if against his or her own interest is of no force and effect if other data do not establish the fact. Other evidence will be considered as though such statement were not of record. So, do I ask that the C&P be thrown out, a new PTSD C&P be ordered and also that I get a different examiner as this one's opinion would now be bias given the notes he recieved which were supposed to be treated as though they were not of record, because it was based on the premise of a Pre-existing condition from a "moment of truth" admission, and therfor should not have been considered at the C&P exam to begin with? Also, note that because of his language, such as "speculation, likely, etc" VSO says the C&P should already be thrown out. OR, should I argue that both VA and the examiner stated that depression was "Clearly and unmistakably present prior to service" and put VA in the position of having to prove that aggrivation could/did not take place? The VA currently states that I am presumed to have been in "sound condition" because it was noted in bootcamp that I had no sx depression the day I talked to MH, even though the notes indicated "Guarded modd and affect" and I was made to sign a "No harm contract" to return to training..........However, at the same time VA is saying I had "clear and unmistakable pre-existing depression in the same breath that could/would not be aggrivated by service! Do I file to have the C&P thrown out, requesting a new C&P exam and different examiner.....pursuing PTSD diagnosis to be SC or Do I argue that VA has already conceded "pre-existing" depression and force them to prove no aggrivation (knowing that they cannot measure pre-service %, in service aggrivation or post service % and that an IMO is likely to support both PTSD diagnosis as well as MDD aggrivation due to service?

The woman who made the PTSD diagnosis was a Psychiatric Nurse Practicioner. VA denial letter states I meet criterion A based on his report, but I must meet all criterion A thru H . I'm guessing MDD, aggravated is my only hope. Guy at AL said the C&P is crap because the Dr used the terminology that it would be speculation to determine any % of aggravation.....

I was diagnosed by my primary VA MH therapist, she is a Psychiatric NP. Unfortunately, her notes are brief and do not include discussions we've had about panic episodes, hypervigilence, etc. My stressors have been verified by VA and have been conceded by VA. If you read the C&P exam, he states that no criteria is met, yet in other areas of the report, he lists symptoms that would meet the criteria. He also states that I have a pre-existing depression but that he cannot determine agrivation % as it would be speculation......then wouldn't it also be speculation to say it didn't become aggrivated by service? The whole exam was a sham....VA says denied because no criteria met, pre-existing depression....but declared fit for duty, so no connection for pre-existing condition.....Huh? I'd really like to hear what Berta's advice would be......I'm hoping she will chime in at some point. Called American Legion......they acted like they could give a shit less.....told me to just get the IMO (Which is going to cost me $1500 out of pocket), file to re-open the claim for a re-consideration, if that don't work, file a NOD and ask for DRO review......current appeal wait time average is 5 years per their data.

Thank you for the input. The worst part of this is now I'm going to have to spend a fortune out of pocket and endure 8-10 more hours of psychological testing and questioning. Hell, I can't make it thru a 30 minute psych appointment at my local VA without a breakdown. Just sad that the system is this way. Going to a psychologist employed by the VA is aiken to going to the other guys insurance company to see if they'll pay for the wreck out of the kindness of their heart.....

Thank you for the input thus far. I have sent all of my documents associated with this claim to two seperate PHD level psychologist that are within 4 hours of me. Neither knows me personally, so no hired guns. Dr Val***e requires $2500 flat fee for IMO, but I've heard that he is well known amongst the VA and his IMO could actually not be beneficial for my claim.....don't know how true that is and nothing against him. They say clear & unmistakable pre-existing depression, "purely speculation" to say what % aggravation might be due to service.......but in the same breath say I was deemed fit for service and do not meet but 1 of the criteria for PTSD.......due to crappy C&P.....however, if you pain your way thru the C&P his notes actually list several items that would meet said criteria! Frustrating!

That's the odd thing here. VA says I had pre-existing depression that "clearly and unmistakibly" existed prior to service, but then in the same breath says that I was deemed fit for duty. The C&P doc says I have only one criteria for PTSD and therefor do not qualify.....mostly because he excluded much of it, but his report is riddled with things that show I would meet criteria. So, I'm denied PTSD and also Denied aggravation for depression because he says it would be "purely speculation to say what % of aggrivation might have been due to service". No, no PH was awarded to anyone for the shrapnel incidents. They have conceded all stressors, but because this doctor says I was "25 years relatively symptom free" they claim deployment and stressors could not attribute to my current state........though, nowhere does anything say I went 25 years symptom free....or "relatively". He states depression as very mild.....that based on the MMPI.....not the fact that I break down everytime I have to talk about this shit, not suicidal ideation, not friends being killed......not anxiety because my stomach's been xxxxxx up for 26 years and I never know when I'll shit my pants at my kid's recital.......frustrating!

So, I have my denial letter. I have posted my redacted exam, follow up from same C&P psychologist where he answers the question of aggrivation of pre-existing condition and copy of denial letter. Bear in mind that he failed to include things like our discussion about frequent panic attacks, where he asked me to describe the physical attributes of such but then chose to list it as "none", he made no mention of my friend who died in the Gulf, he handpicked excerpts from my VAMC notes not including the bad, but only snippets of the better comments by my attending psych dr.....standard VA employed C&P examiner tactics. I currently have two seperate PHD level Psychologist reviewing my entire file to evaluate the Dr's opinion give me their independent medical opinion. One of those Dr's has performed C&P exams for VA as a contracted Psychologist. My questiona are: 1. What do you think my chances are of getting this remedied and/or getting this SC? 2. Should I file to re-open the claim with IMO's or simply file the NOD, include IMO's and request DRO review? 3. Should I approach this from the pre-existing (Aggravation) aspect or PTSD (considering it would require a VA employed C&P examiner to opine and agree with a PTSD diagnosis, essentially going against the first VA Dr's opinion) My VSO has been useless, no contact and I'm considering, if I opt to re-open and get shot down again, hiring a law firm to assist. Any advice from seasoned vets is appreciated. RedactedAggravation.tif RedactedDenial.tif RedactedPTSDExam.tif

If only the VA's logic followed yours......I was denied....because they said I had a pre-existing condition, not aggrivated by service....but I was also found fit for duty and don't meet all criteria for PTSD......although they did concede all of my stressors........Hmm?

So, I have my denial letter. I have posted my redacted exam, follow up from same C&P psychologist where he answers the question of aggrivation of pre-existing condition and copy of denial letter. Bear in mind that he failed to include things like our discussion about frequent panic attacks, where he asked me to describe the physical attributes of such but then chose to list it as "none", he made no mention of my friend who died in the Gulf, he handpicked excerpts from my VAMC notes not including the bad, but only snippets of the better comments by my attending psych dr.....standard VA employed C&P examiner tactics. I currently have two seperate PHD level Psychologist reviewing my entire file to evaluate the Dr's opinion give me their independent medical opinion. One of those Dr's has performed C&P exams for VA as a contracted Psychologist. My questiona are: 1. What do you think my chances are of getting this remedied and/or getting this SC? 2. Should I file to re-open the claim with IMO's or simply file the NOD, include IMO's and request DRO review? 3. Should I approach this from the pre-existing (Aggravation) aspect or PTSD (considering it would require a VA employed C&P examiner to opine and agree with a PTSD diagnosis, essentially going against the first VA Dr's opinion) My VSO has been useless, no contact and I'm considering, if I opt to re-open and get shot down again, hiring a law firm to assist. Any advice from seasoned vets is appreciated. RedactedAggravation.tif RedactedDenial.tif RedactedPTSDExam.tif

No....the doc clearly states his opinion and rationale supporting PTSD due to Iraq stressors. I would say you will be awarded....but, it is after all the VA.....so, until that envelope comes, anything is possible! Good luck!

Good advice from John.....VA docs, especially mental heath C&P examiners, seem to latch onto pre-military issues and especially alcohol/substance issues, no matter how trivial or minor.....then everything is because of alcohol/drugs, therfor not service connected. Be honest but do not overshare, volunteer or overstate.

30% PTSD

He based the "mild" on the MMPI results soley. Psychologist.....There is nothing, anywhere in my files that support the idea of mild depression. Quite the opposite really. He also, cut & pasted parts of VAMC notes.....only the ones that said "doing better on the meds" type appointment notes. He also neglected to mention things that happened in service, like my friend being killed in the Gulf, although he used it to essentially say.....see, depression, not PTSD....it was a sham all the way around. I also made mistakes.....I let him lead the questioning. He never mentioned stressors.....instead querying me about my friends death, my hatred for Islam, etc. We had discussion of panic attacks when I don a SCBA, like a gas mask, at work and get panic attacks.....he excluded that and marked it "no panic attacks", etc, etc

Waiting on the official letter, but I'd say......C&P doctor's oppinion that MDD not aggrivated by service. I'll know more in the next 10 days. His latest aggrivation notes are riddled with contradiction. MEDICAL OPINION SUMMARY ----------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: TYPE OF MEDICAL OPINION REQUESTED: Aggravation of a pre-existing condition. OPINION REQUESTED: Aggravation of a pre-existing condition. The examiner diagnosed major depressive disorder and stated the condition existed prior to service. We need an aggravation medical opinion. Was the Veteran's major depressive disorder (which clearly and unmistakably existed prior to service) aggravated beyond its natural progression by the Veteran's service? The Veteran served in Southwest Asia during the Gulf War and has submitted stressor statements on VA Forms 21-0781, Statements in Support for Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD), received June 29 and August 10, 2017. The service treatment records on file show a history of depression and alcohol use prior to service:************* (2 incidents at age 14 and 16 of minor consumption) - 12/01/1989, depression and alcohol use - 12/01/1988, alcohol abuse Active duty dates are from 11/30/1990 to 04/29/1991. Rationale must be provided in the appropriate section. If more than one mental disorder is diagnosed please comment on their relationship to one another and, if possible, please state which symptoms are attributed to each disorder. If your examination determines that the Veteran does not have diagnosis of PTSD and you diagnose another mental disorder, please provide an opinion as to whether it is at least as likely as not that the Veteran's diagnosed mental disorder is a result of an in-service stressor related event. b. Indicate type of exam for which opinion has been requested: DBQ PTSD Initial TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR AGGRAVATION OF A CONDITION THAT EXISTED PRIOR TO SERVICE ] b. The claimed condition, which clearly and unmistakably existed prior to service, was not aggravated beyond its natural progression by an in-service CONFIDENTIAL Page 7 of 8 event, injury or illness. c. Rationale: It would be speculation to determine the presence of aggravation due to any trauma occurring during veteran's military service. **********so, wouldn't it be speculation to say it wasn't?????? This conclusion is based on the following: 1) Veteran has multiple established factors increasing the likelihood of depression including relationship difficulties, early family risk factors********parents divorced at 8 years old, and alcohol abuse. ************(2 incidents at age 14 & 16) These established factors are likely associated with significant aspects of veteran's depression. Separating out the portion of depression attributable to trauma in the presence of these other larger factors would be a questionable exercise at best. **********Again, if you cannot seperate them then how can you rule that it didn't? 2) The literature to establish a connection between trauma and depression does not exist in a way that allows application in this situation. **********so, no literature to disprove aggrivation???? PTSD and Major Depression likely have some level of concordance (having one diagnosis increases the likelihood of having the other diagnosis); however, even this literature has not established firm levels of concordance depending on the severity of trauma, family history, and other risk factors not to mention the more than 25 years between the trauma and current functioning such as exists for the veteran. *********NO WHERE in my files, history does anyone or anything say I went 25 years, in the doctor's words "relatively problem free"!! In addition, this literature is about diagnosed PTSD, not just a trauma having occurred. Similarly, there is literature on connection between general stresses and depression but again not in a manner that allows the assessment of a 25 year lapse between stress and current depression.********No evidence to 25 years trouble free.....buddy statements from family, friends, work say very differently!!!! 3) Veteran's depression is very mild. *********VAMC notes and C&P contradict this sharply.....he bases this on the fact that my MMPI showed lower depressive signs and no malingering The mildness of the depression suggests that any portion of depression attributable to aggravation would be very small. Smaller than the accuracy of current psychological strategies to measure.*********I have yet to make it thru a VA appointment or C&P without breaking down hard! *************************************************************************

Denied......big shocker. I will re-open with IMO as new & material evidence. If denied again after IMO, I will hire an attorney who specializes in VA appeals. the VA never ceases to amaze me......they seem to work so hard at denying, even when their doctors perform C&P exams and contradict their own statements. I know that my statements mean jack & shit to the VA, but it makes me feel better and it is better than the alternative. None of this is about money to me. I have been quite blessed in terms of career and make a good living......better than their VA shrink in fact. I don't need their money......I need these cock suckers to acknowledge that we paid and continue to pay. We served willingly and honorably and they have a f**king obligation to atleast acknowledge us and quit treating us like f**ing liars and thieves. Anyway.........I will not go away. That I can assure them!

I have the IMO already positioned in case of denial for NOD and DRO review request.....or a re-open with N&M evidence. I understand that IMO is needed to medically refute a piss poor C&P and/or mis-diagnosis. I'm just curious as to the language of "Secondary Action Required" Wednesday - went to Pending Decision Approval with a tentative close date of 9/25/2017.

C&P exam performed, unfavorable, but many contradictions, claim went to prep for decision. I rebutted and shot holes in the Dr's opinion/rationale by quoting/ stating regulations/ laws and bringing up the fact that he changed my diagnosis from that of my local VAMC, said it was pre-existing, but did not address whether it was aggrivated by service. Claim went back to gathering evidence.request 2 came out, which was a request to the same Dr for an opinion as to aggrivation. Again Dr stood his ground, but clearly contradicted himself. Claim immediately went back to prep for decision. Again, I rebutted and shot holes in his response, quoting regulations/ laws and quoting past appeals findings in regard to similar cases. Claim went back to gathering evidence. Monday, still gathering evidence, but reading requested docs past due. called Peggy, no information needed. Tuesday my claim moved to prep for decision again and showing new Request 3 - No longer needed, under which it reads Secondary Action Required. Now, I will assume that this , although under the header "Required from You", is an internal request requesting additional oversight from someone.....likely because I'm a pain in the ass that keeps throwing wrenches into the C&P docs babble, quoting regs/ excerpts from VA training manuals and past appeals decisions, and their the Dr clearly (even to a complete idiot like myself) destroys his own arguments with contradictory statements. So, my question is, from the much more experienced folks here that have spent time in the VA's offices......is the "Secondary Action Needed" likely an internal request for close scrutiny? Peggy said it was saying it needed a second signature, but I'm assuming not for retro , but for dotting I's and T's? As always, any input is appreciated!

My primary care, wrote in my notes that I am an Air Force Veteran, my wife is an Air Force Veteran and my daughter is trying to get into the Air Force. I am a Marine, wife has never served in any branch, nor has my daughter ever tried to join the Air Force. I never corrected her on this, because at some point in all of this fighting with VA over records......that little tidbit will be indicative of the "accuracy" of their medical reports.