pacmanx1

Unfortunately, VA can do anything they want. With that said, when I was issued my CPAP machine, I was told to try to get used to it by using it when I get on the PC or reading or watching a movie. It really helped me. I sometimes fall asleep when watching a movie so that is an added help for when I have to turn it in for checks. Please keep in mind that sleep apnea is a silent killer, every time you fall a sleep your body could stop breathing and could cause major damage. I hate mine but I want to stick around to see my grand kids. I know I only sleep a few hours a night so it will all come out fine. Sorry for the vent, hope this helps

Citation Nr: 1001376 Decision Date: 01/08/10 Archive Date: 01/15/10 DOCKET NO. 07-27 131 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Florida Department of Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD D. Van Wambeke, Counsel INTRODUCTION The Veteran served on active duty from June 1966 to November 1986. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a March 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, which denied the claim. The Veteran presented testimony before the undersigned Veterans Law Judge in June 2008. A transcript of the hearing is of record. The issue was remanded by the Board in December 2008 for additional development and to address due process concerns. The actions directed by the Board have been accomplished and the matter returned for appellate review. FINDING OF FACT The Board resolves reasonable doubt by finding that the Veteran has been diagnosed with PTSD as a result of active service. CONCLUSION OF LAW The criteria for service connection for PTSD have been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2009). REASONS AND BASES FOR FINDING AND CONCLUSION Service connection for PTSD requires (1) medical evidence diagnosing the condition in accordance with the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., 1994 (DSM-IV), see 38 C.F.R. § 4.125(a) (2009); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f) (2009); Cohen v. Brown, 10 Vet. App. 128 (1997). The Veteran contends that he has PTSD as a result of an incident that took place on June 25, 1979 while he was assigned as a driver at the Supreme Headquarters Allied Powers Europe (SHAPE) in Belgium. He reports that he was the driver for General J.R.A. who was the Chief of Staff of SHAPE and for General A.H. The Veteran asserts that on the morning of June 25, 1979, he was driving General J.R.A. to SHAPE headquarters and had planned to use a regular route. He reports that he decided to take another route when he saw there was a truck that he did not want to get stuck behind. The Veteran asserts that he later found out there had been an attempt to blow up the car General A.H. was in, which had taken the route the Veteran normally did. He contends that he could have been killed had the car he was driving taken the normal route, though he acknowledges that no one was killed as a result of the bomb. The Veteran also asserts that he drove under the fear of being bombed and attacked every day that he drove for the Chief of Staff for two years after the attempted assassination on General A.H. He further contends that he suffers real aspects of the events and replays the fear of driving in his everyday activities. See August 2006 VA Form 21-0781; June 2007 VA Form 21-4138; August 2007 VA Form 9; June 2008 hearing transcript. The Veteran's service personnel records reveal that he was a driver for the Supreme Allied Commander, Europe (SACEUR) VIP Platoon for SHAPE in Belgium between July 1978 and November 1978 and a VIP driver for SHAPE between November 1978 and August 1981. See Chronology of Service Assignments; Department of Defense Joint Service Commendation Medal. The Veteran has submitted a November 1993 New York Times article related to the 1979 bomb attack on former NATO commander A.H.'s car on June 25, 1979, as well as an unidentified report entitled the "Haig Assassination Attempt." The Board finds that the Veteran's service personnel records and the articles he has submitted provide corroboration that the claimed in-service stressor did occur while the Veteran was working in the capacity of a SHAPE driver. The Veteran acknowledges that he did not seek any treatment while in service. See June 2008 hearing transcript. As such, it is not necessary to discuss the findings in his service treatment records. The Veteran also acknowledges that his first post-service treatment was not until approximately 2005. See id. Treatment records from the VA Medical Center (VAMC) in Bay Pines have been obtained and reveal that the Veteran has been diagnosed with PTSD in conjunction with a report of his alleged stressor. See e.g., May 2007 STP progress note. They also reveal that the Veteran has received group therapy for PTSD, depressive disorder, not otherwise specified (NOS), and alcohol dependence. At noted in the Board's previous decision, it is unclear whether the diagnosis provided in VA treatment records was made in accordance with the DSM-IV criteria, as required by 38 C.F.R. § 3.304(f). It was for this reason that the Board remanded the claim in order for the Veteran to be afforded an examination. The Veteran underwent a VA compensation and pension (C&P) initial PTSD examination in April 2009. In pertinent part, he denied any direct combat exposure but reported experiencing trauma when he was acting as a driver in service, at which time he reported the stressor detailed above. Following psychiatric examination, Axis I diagnoses of chronic PTSD and depression, NOS, were made. The examiner reported that the Veteran had symptoms of PTSD but prognosis was good. The examiner also reported that the Veteran's depressive symptoms did not meet the criteria for a full depressive episode as they only last hours and may be part of his PTSD. It was the examiner's opinion that the diagnosis of PTSD could be related to the stressor as reported by the Veteran and that it is as least as likely as not caused by or a result of the event of the Veteran changing route and later finding out that the others who had taken the original route had been bombed, as he felt it could have been him. The rationale employed by the examiner was that the Veteran experienced a traumatic event in which there was threat/injury to others and the Veteran experienced fear and a sense of helplessness. He has flashbacks, intrusive thoughts, distressing dreams, avoidance and persistent arousal symptoms. The Appeals Management Center (AMC) subsequently requested another opinion, citing the fact that the April 2009 VA examiner did not indicate that the Veteran's claims folder was reviewed at the time of the examination. In June 2009, a different VA examiner reported that after reviewing the complete claims folder and electronic medical records from the Bay Pines VAMC, he fully concurred with the opinion of the April 2009 VA examiner that it is as likely as not that the Veteran's established diagnosis of PTSD is due to the cited stressor of a near-death experience in which the Veteran and a senior SHAPE general averted a potentially fatal terrorist attack while traveling on a civilian road in Belgium in 1979. The examiner's rationale was that since the Veteran evinced no psychiatric problems prior to enlistment or prior to the cited stressor, since the stressor has been verified, and since the Veteran has had continuous symptoms of PTSD to variable degrees and frequency, then it may be reasonably clinically concluded that the noted stressor as likely as not served as the precipitant for a subsequent anxiety disorder. The examiner further noted that as the Veteran has continuously experienced key target symptoms of PTSD, as outlined in the DSM-IV, then the diagnosis qualifiers are fulfilled. It was also reported that near- death experiences are frequent causes of PTSD, as cited in published scientific studies and case reports. The examiner made some other findings that the Board has determined are not pertinent to the issue on appeal. The Board does note, however, that the VA examiner reported that with regard to the Veteran's additional diagnosis of depressive disorder, NOS, his symptoms of depression have evolved in recent years in consort with the sustained expression of PTSD. Per DSM-IV diagnostic criteria, the current expression of depressive symptoms is consonant with the mood disorder diagnosis that has been the focus of treatment (depressive disorder, NOS) and does not meet the full criteria for another mood disorder diagnosis. After reviewing the cited clinical records and interviewing the Veteran, it was the examiner's opinion that it would be speculative to estimate the causality of the Veteran's post- service depression to his PTSD (anxiety disorder), or to estimate the relative contributions of his depression symptoms and his anxiety condition to his overall limitations in psychosocial functioning and quality of life. In light of the opinions provided by the VA examiners in April 2009 and June 2009, and in light of 38 U.S.C.A. § 1154 (a) (West 2002), which requires consideration of the places, types, and circumstances of the Veteran's service as shown by his service record, the Board resolves all reasonable doubt in the Veteran's favor by finding that service connection for PTSD is warranted. 38 C.F.R. §§ 3.102, 3.303, 3.304. VA's duties to notify and assist claimants in substantiating a claim for VA benefits are found at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2009). As the claim has been granted, the duty to notify and assist has been met to the extent necessary. ORDER Service connection for PTSD is granted. ____________________________________________ P.M. DILORENZO Veterans Law Judge, Board of Veterans' Appeals

I agree with larryJ "looks like 100% schedular" Did the PTSD C & P exam say that you were competent to handle your own funds? Did it say that you knew what you disability pay was?

I believe it stands for General Anxiety Disorder. You should get a separate C & P exam for your claim for depression, but VA can rate you without giving you a C & P exam.

All mental health disabilities fall under the General Rating Formula for Mental Disorders except an Eating disorder.

We all know that saying something and doing something are two different things. I could not find the full article even if there is a full article, there may not be a full article and for this to happen will be a miracle but never the less, I will pass it on. If someone can find more information or the full story please post it. I found this on WWW.Veteranstoday.com, it was under the Top 10 Veterans Stories in Today's News and the date is supposed to be 9/23/2010.

Congrats

Gulf War Illness Research Results Published September 22, 2010 posted by Denise Nichols Gulf War agents trigger discrete transcriptional changes in human neuronal cells Authors: G. C. Kayihana; M. Wooda; B. Mouzona; S. Fergusona; E. Margenthalera; V. Mathuraa; M. Mullana; F. Crawforda Abstract Reports on Gulf War illness (GWI) implicated the use of the pesticide permethrin (PER), and the insect repellent N,N-diethyl-m-toluamide (DEET), in its etiology, as well as pyridostigmine bromide (PB), which was given as a prophylactic treatment against nerve agent exposure. Using Affymetrix microarrays the genomic response of human neuronal SHSY-5Y cells to 10 days of exposure to these agents was characterized and profiles of gene modulation unique to each treatment were demonstrated. In particular, a significantly greater impact of PER was observed compared to the other treatments. The Ingenuity Pathway Analysis knowledgebase was used to analyze the genomic datasets and attribute functional consequences to the effects of related genes, which were significantly up- or down-regulated in response to different treatments. Canonical pathways shown to be significantly modulated at the genomic level in response to exposure included cellular mechanisms, which might contribute to the clinical presentation in GWI patients and thus be targeted for further investigation as potential targets for therapeutic intervention. Keywords: Gulf War illness; permethrin; DEET; pyridostigmine bromide Affiliation: a Roskamp Institute, Sarasota, FL, USA DOI: 10.1080/02772241003611946 Published in: Toxicological & Environmental Chemistry, Volume 92, Issue 9 October 2010 , pages 1783 – 1799

Congrats

Try calling the VA National Direct Deposit Center. They can tell you the amount and the day it should be posted to your account; 1-877-838-2778. Keep in mind that your claim must be fully completed and award payment was sent to be paid out.

Carlie did you try calling them or going there and ask due to your condition and the fact that you were excused before to remove you from the jury list completely? It may work, you know the old saying 'It won't hurt if you ask" they can only say you need another doctor's statement or they can say no problem. If they say that you need another doctor's statement, I would make sure the doctor would write something that would get me completely removed from the list. Hope this helps

Good news, your 30% should be protected under the 20 year rule. (Authority: 38 U.S.C. 1155) (b) A disability which has been continuously rated at or above any evaluation of disability for 20 or more years for compensation purposes under laws administered by the Department of Veterans Affairs will not be reduced to less than such evaluation except upon a showing that such rating was based on fraud. Likewise, a rating of permanent total disability for pension purposes which has been in force for 20 or more years will not be reduced except upon a showing that the rating was based on fraud. The 20-year period will be computed from the effective date of the evaluation to the effective date of reduction of evaluation. Bad news, you will most likely not qualify for Voc rehab. (a) Time limit for eligibility to receive vocational rehabilitation. (1) For purposes of §§21.41 through 21.46, the term basic period of eligibility means the 12-year period beginning on the date of a veteran's discharge or release from his or her last period of active military, naval, or air service, and ending on the date that is 12 years from the veteran's discharge or release date, but the beginning date may be deferred or the ending date extended under the sections referred to in paragraph (b) of this section. Other news, you should think about and consider. Voc Rehab is sometimes awarded when a veteran gets an increase in his or her service connected disabilities. Others may chime in.

VAOIG: STERILIZATION OF REUSABLE MEDICAL EQUIPMENT AN ISSUE AT FARGO VA Annual competencies for the colonoscope, the bronchoscope, the cystoscope, and the orthopedic instruments had not been completed. by Larry Scott, VA Watchdog dot Org On September 20, 2010, the VA's Office of Inspector General (VAOIG) released the following report: Combined Assessment Program Review of the Fargo VA Medical Center, Fargo, North Dakota -- Report Number 09-03745-250, 9/20/2010 | Summary | [url=http://www4.va.gov/oig/CAP/VAOIG-09-03745-250.pdf]Report The Executive Summary is posted below. Executive Summary: Combined Assessment Program Review of the Fargo VA Medical Center, Fargo, North Dakota Review Purpose: The purpose was to evaluate selected activities, focusing on patient care administration and quality management. We conducted the review the week of June 28, 2010. Review Results: The review covered eight activities. We made no recommendations in the following activities: Coordination of Care Physician Credentialing and Privileging] Quality Management Suicide Prevention Safety Plans The facility's reported accomplishment was the community living center "Wishes on Wings" program where a veteran on hospice status can request to have a wish granted. Recommendations: We made recommendations in the following four activities: Reusable Medical Equipment: Annual competency assessments and training need to be completed and documented for applicable staff, and all standard operating procedures for reusable medical equipment need to reflect current practice. Environment of Care: Weekly rounds data needs to be consistently tracked, trended, and reported to the oversight committee quarterly. Annual respirator fit testing, training, and medical evaluation need to be completed for all identified staff. The local hand hygiene policy needs to be updated, and clinical staff need to receive feedback. All staff who work on the locked mental health unit and members of the Multidisciplinary Safety Inspection Team need to receive training on environmental hazards that pose a risk to suicidal patients. Magnetic Resonance Imaging Safety: The local magnetic resonance imaging safety policy needs to include emergency procedures unique to the area, and staff need to be aware of how to respond to those emergencies. Medication Management: Community living center clinicians need to document all required influenza vaccine elements. A consistent process for documenting the retrospective review of medication orders placed when the onsite pharmacy is closed needs to be implemented. Comments The Acting Veterans Integrated Service Network and Facility Directors agreed with the Combined Assessment Program review findings and recommendations and provided acceptable improvement plans. We will follow up on the planned actions until they are completed. (original signed by:) JOHN D. DAIGH, JR., M.D. Assistant Inspector General for Healthcare Inspections

VA OFFICIAL CALLED OUT ON $74,000 IN BENEFITS The VA's VISN 4 director intervened and pressured subordinates to gain approval of an unusual dual-track education payment program for a family friend. NOTE from Larry Scott, VA Watchdog dot Org ... Use our search engine for more about Michael Moreland ... here ... Veterans Affairs official called out on $74K in benefits By Walter F. Roche Jr. PITTSBURGH TRIBUNE-REVIEW The Department of Veterans Affairs' top regional official intervened and pressured subordinates to gain approval of an unusual dual-track education payment program for a family friend. Records the Tribune-Review obtained show that Michael Moreland, director of the VA's Region 4, pushed for approval of two tuition payment programs worth a combined $74,000 for Megan Sartore, 27, of Cranberry, a pharmacist employed at the VA's Highland Drive facility since 2009. Moreland refused a request for an interview and would not answer questions submitted to his press office about his efforts on Sartore's behalf. E-mails the Trib reviewed show an increasingly impatient Moreland questioned a VA human resources officer about the approvals. In a July 12 e-mail to human resources director Marie Colosimo, Moreland wrote: "I have been told multiple times this has been fixed, it is fixed ... it has been over a year. See if it is being paid." Additionally, VA sources said Moreland called Colosimo late on a Sunday evening, demanding to know the status of the loan requests and why they weren't approved. Moreland, through a spokesman, denied making such a phone call. A month earlier, Sartore herself questioned Colosimo about the holdup in an e-mail. "Am I enrolled in both programs yet?" she wrote June 15. "Please advise at earliest convenience." Colosimo replied in an e-mail that VA administrators requested "additional justification from me, because of the unusual request for dual compensation from both programs at the same time." Asked about Moreland's intervention on her behalf, Sartore said: "No one was listening. I went through the chain of command. If someone is not doing their job, you go to the next step up. Do you have any idea of all the problems I went through?" She said she was merely trying to get benefits promised to her when she was hired. VA Region 4 spokesman David E. Cowgill issued a two-paragraph response stating that it was typical for Moreland to receive inquiries from VA employees in the region. "In his capacity as the director and chief executive officer of VISN 4, Mr. Moreland often makes inquiries about these concerns to medical center leadership or department level supervisors at each of the 10 medical centers in our network," Cowgill wrote. Records show Sartore simultaneously applied for two tuition programs, raising questions among VA officials. Nonetheless, VA administrators approved Sartore's applications for the Education Debt Reduction Program and the Student Loan Repayment Program in late July. To justify the unusual request, Colosimo wrote in a June 4 memo to Sylvia Delsa with the VA's Healthcare Retention & Recruitment Office in New Orleans that "clinical pharmacists are historically difficult to recruit in the Pittsburgh area," and that "it is very difficult to find applicants with extensive clinical pharmacy experience." Yet, records the Trib obtained show that Sartore is classified as a "staff pharmacist" and not a "clinical pharmacist," which requires different training. In a written response to questions, Colosimo acknowledged that Sartore is not a clinical pharmacist but wrote that the "quoted statement refers to experience, not title." Colosimo said she is "not personally aware of a relationship" between Sartore and the Morelands. Asked whether she considered Moreland's inquiries on Sartore's behalf unusual, Colosimo wrote: "I often receive specific inquiries from Mr. Moreland on a variety of topics." She said Sartore is not the only employee to benefit from both tuition assistance programs. Cowgill said he could not provide data on how many other agency employees, in Pittsburgh or nationally, were benefiting from both programs siimultaneously. Records show the Education Debt Reduction Program could provide $44,000 to Sartore to pay off her college loans through 2014, provided she remains a VA employee during that time. Under the Student Loan Repayment Program, she is eligible for up to $30,000 more, in yearly payouts of $10,000. Under that program, the annual payments go directly to a lender and not an employee. In his July 12 e-mail, Moreland did ask about the status of applications by other pharmacists for educational assistance. "How about the other pharncist (sic) ... are they receiving payment yet???" he wrote. State records show Sartore was granted a pharmacist intern license on Oct. 31, 2005. The state issued her a full pharmacist license Nov. 4, 2008. Michael Moreland's wife, Barbara, sponsored Sartore this year for a Western Pennsylvania Dressage Association event. Barbara Moreland is active in the association, an equestrian organization in which Sartore competed. Sartore declined to discuss her relationship with the Moreland family, calling it a personal matter. "My relationship outside the VA is private," she said.

I got one several years ago and I sent them a nice letter asking to be excuse from duty and told them due to my mental and physical conditions, I could not be of any good service to them. In my letter I included a list of the medications I was taking and told them there was no way I could really concentrate. I got a letter back saying I was excused. After I got the letter excusing me, I never heard from them again. I know it has been at least seven years. I did not get my PCP to do anything and at that time my SSDI was just pending. Hope this helps

Urodynamic testing. These tests measure pressure in your bladder when it's at rest and when it's filling. A doctor or nurse inserts a catheter into your urethra and bladder to fill your bladder with water. Meanwhile, a pressure monitor measures and records the pressure within your bladder. This test helps measure your bladder strength and urinary sphincter health. http://www.vba.va.gov/bln/21/benefits/exams/disexm24.htm

You need to file the TDIU form. I am not sure of your condition and you may or may not get awarded TDIU but you still need to file the form. Put your claim in writing and let VA make their decision. If VA awards your TDIU claim then great but if they deny your claim let them put it in writing. Since you have already been awarded service connection for your back and PTSD, these claims can be increased. This maybe a fight but keep in mind when you file a TDIU claim , VA should give you new C & P exams to determine if your back and your PTSD has gotten worst. In reference to your PTSD claim, when you have your C & P exam, Just spill your guts, tell them everything that deals with your PTSD and deal with what ever you have to deal with after the exam. The examiner does not know you and can't write in the records that you are having major problems if you don't tell him/her. Also the same with any mental health appointment, the appointments are to help you so VA needs to know what is going on with you to really help. Filing a TDIU claim is the same as asking for an Increase in your disabilities. You may not meet the regulation to be awarded TDIU right now but if VA increases your PTSD and/or Back disability ratings, you may reach that magical percentage of the regulation, so again file the claim. Here is the form: http://www.vba.va.go...21-8940-ARE.pdf

Committee Examines Progress of VBA Efforts to Improve Training for Claims Processors September 20, 2010 posted by Michael Leon Stakeholders acknowledge gains from increased staff funding, yet cite need for improved training and management to help VBA tackle benefits backlog - Washington D.C., – On September 16, 2010, John Hall (D-NY), Chair of the Subcommittee on Disability Assistance and Memorial Affairs, conducted a hearing on the effectiveness of personnel training within the Veteran Benefits Administration (VBA) to address the backlog of unresolved veteran benefits claims. Representatives of the Department of Veterans Affairs (VA) reported improvements in both the quantity and quality of VBA's training model, and were confident that overtime, with continued focus, pending benefit claims will begin to dramatically decrease. "Today's hearing is designed to examine the impact of landmark legislation passed by Congress in recent years targeted at expanding the number of and training for veterans' benefits claims processers," said Chairman Hall. "It is indisputable that VBA's staff and the training they receive have increased due to recent Congressional action, however additional efforts are needed to ensure that veterans, their families, and survivors receive their just benefits in a timely and accurate manner." Since 2007, Congress has appropriated more than $750 million to VA to hire over 10,000 new VBA claims processers on an expedited hiring timetable. Recognizing that the claims backlog cannot be solved by brute force alone, Congress passed legislation in 2008 to equip VBA claims personnel with the training and other resources needed to perform their duties. As a result, VA recently expanded the training requirements for claims processing personnel. According to Chairman Hall, while improvements have been made, more work is needed. "Twenty percent of the 1 million-plus disability claims processed by VA in 2009 were erroneous. The same year, 200,000 VA disability claims were delayed for four months or more before being fully processed. The VA must do a better job ensuring that its claims processors receive the right kind of training to decide veterans' cases correctly the first time. At this point in time, it is failing to meet that standard."" To address this issue, Congress directed the Government Accountability Office (GAO) to examine VBA's claims processing training program. GAO confirmed VA's reports that the agency's training had improved, yet suggested that VA could do a better job in linking its quality-control and training resources to ensure that VBA claims processers get the right training needed in a timely manner. GAO also found significant quality improvements could be made by more closely monitoring the developmental stages in the claims process, and targeting additional training to remedy persistent staff processing errors. These critiques were echoed during the hearing by veterans stakeholders such as the American Federation of Government Employees, which represents the interests of claims processers and other VA employees. Veterans Affairs Secretary Eric Shinseki has set an ambitious goal to erase the VBA claims backlog erased by 2015 and reduce the claims process to less than 125 days. Chairman of the House Committee on Veterans' Affairs Committee Bob Filner (D-CA) said, "I am encouraged by the training improvements and other reforms underway at VBA and I remain optimistic that VA, assisted by Congress, can achieve the benchmark set by Secretary Shinseki. Adjudicating claims for wounded warriors is complicated and can be extremely technical. This is why it is critical to properly train and manage claims personnel. If we continue to concentrate on these efforts, I am confident that we can fix the broken claims system so that our veterans, their families, and survivors receive the 21st Century, world-class benefits and services they deserve."

latimes.com/news/local/la-me-veterans-invisible-wounds-20100920,0,7812729.story latimes.com Many veterans with PTSD struggle to find supportive employment Experts say simple accommodations can greatly improve their success in the workplace, but many employers are still wary of hiring those with mental disabilities. By Alexandra Zavis, Los Angeles Times September 19, 2010 Michael Butcher has applied for at least 25 jobs since injuries he suffered in Iraq forced him to leave the Army three years ago. "I was even turned down by McDonald's," said the 29-year-old San Diego native. The military is known for developing leadership, adaptability, loyalty and teamwork. But Butcher said when he tells employers he needs time off to see therapists for post-traumatic stress disorder and a brain injury, they don't call back. "They think you are mental," he said. After nearly a decade of war, many U.S. military veterans have lived through extended periods of combat stress and the trauma of losing colleagues. Nearly a third of the troops returning from Iraq and Afghanistan report symptoms of PTSD, severe depression or traumatic brain injury, according to a 2008 study by the Rand Corp. Many of these new veterans struggle to find and retain civilian jobs. Not only are they returning to the worst economy in decades, advocates say, but many employers do not know how to accommodate these invisible wounds and worry that they might "go postal." "If you are a person with a lost limb, it's a little more straightforward what you might need," said John Wilson, assistant legislative director for Disabled American Veterans. "You might need a different kind of keyboard or voice-recognition software to do the typing." But employers may not know what to expect from a person with PTSD or a brain injury. The symptoms can include severe headaches, memory lapses, poor concentration, slurred speech, loss of balance, a short temper and anxiety in a crowd. "These elements can make it a challenge to do everyday activities in the workplace," said Raymond Jefferson, assistant secretary for the Veterans' Employment and Training Service in the U.S. Department of Labor. "But there are very reasonable accommodations employers can make to allow wounded warriors with PTSD and [brain injuries] to be high-contributing, high-performing members on the team." When the Society for Human Resource Management surveyed its members in June, 46% said they believed post-traumatic stress and other mental health issues posed a hiring challenge. Just 22% said the same about combat-related physical disabilities. Although media attention has helped make the diagnosis and treatment of PTSD and traumatic brain injury a government priority, veterans say it has also contributed to the stigma associated with these wounds. "They hear so many stories on the news — this soldier got back from Iraq and killed his wife — which makes people a little reluctant to hire you," Butcher said. Butcher deployed to Iraq in 2003 as part of a tank crew that repeatedly came under fire. One hot day he left a hatch open and the force of a grenade blast slammed his head against an iron shield. Many veterans are using education benefits to improve their qualifications. But when Butcher enrolled in community college, the sight of Muslim students kneeling to pray triggered terrifying flashbacks. He left after one semester. A friend helped arrange an internship at a computer manufacturing company, but Butcher said he got into frequent arguments with co-workers. After four days, he was asked to leave. Butcher said he has since learned to walk away when he gets angry and uses weekly counseling sessions to relieve stress. But he said the flexibility he would need from an employer puts him at a disadvantage compared to job seekers who don't have special needs. Officials with the U.S. departments of Veterans Affairs, Labor and Defense have worked to assure potential employers that the mental and cognitive disabilities of many veterans can be accommodated with little expense and minimum disruption. Short rest periods — no longer than a smoking break — can make a big difference, said Ruth Fanning, who heads the VA's Vocational Rehabilitation and Employment Service. The department also pays for adaptive technology, such as electronic organizers to help keep track of appointments and white-noise machines to reduce distractions. Denita Hartfield, a veteran now working from home, takes a digital recorder into every meeting, writes lists in color-coded notebooks and covers her workspace with Post-it note reminders. A striking woman, fashionably attired, with a master's degree in criminal justice and weapons of mass destruction, Hartfield struggled as dean of students at a business school because her disabilities were not immediately apparent. "I'd get ridiculed every time I had to go to a medical appointment," she said. "I'm not what people think a disabled veteran should look like." Hartfield's 17-year Army career was cut short by a 2005 ambush in Iraq. She spent the next two years in and out of the hospital to repair three crushed ribs and drain fluid from around her heart. She is now home in Bakersfield, but commutes several times a week to medical centers in Sepulveda and West Los Angeles to treat a brain injury and PTSD. To compensate, she would work 13-hour days, which caused more stress. But she said her supervisor would still complain when she had to leave for an appointment. When she was asked to delay surgery to remove shrapnel from her back, she resigned. "I need my appointments to live," she said. Hartfield now wants to set up her own business advising veterans and employers how to work together. She says more open communication would have helped in her case, but at first she did not want to acknowledge her disabilities. "One of the problems is so many folks aren't even talking about their invisible wounds," said Tim Embree, legislative associate for Iraq and Afghanistan Veterans of America. "The issues are different with every individual, so what I think matters is that the individual understands what's going on as well as the employer." To help employers better accommodate the mental health issues veterans face, the Department of Labor has set up a web site, America's Heroes at Work. Many veterans find civilian work with the U.S. government, which is one of the largest employers of former military personnel; they make up a quarter of the federal workforce. About 40% of the staff at VA medical call centers in Northern California are disabled veterans, many of them with PTSD or brain injuries, according to Project Hired, the nonprofit contracted to run them. Los Angeles Habilitation House is training 18 veterans with invisible wounds to provide contract management services to the government. They include Ronta Foster, a 49-year-old father of two who has cycled between the Army and low-paying civilian jobs for years. He was diagnosed with PTSD and traumatic brain injury after deploying to Iraq in 2003 but traces the symptoms back to a beating he received outside a German nightclub in 1982. "The opportunities have been far and few for me," Foster said. "This here is going to give me an opportunity to start another career and take care of me and my family. That's all I have been wanting to do for 30 years." Some companies also seek out veterans. Joshua Stout is one of 80 people recruited through Northrop Grumman's hiring program for severely wounded veterans from Iraq and Afghanistan. A former Marine who served in both wars, he now works as a project manager at a plant in San Diego that is developing an unmanned surveillance plane for the Navy. The company consulted occupational nurses on how to help the 27-year-old manage PTSD and a brain injury. They showed him how to set reminders on his computer and arranged his cubicle so co-workers could not come up from behind and startle him. Stout said he struggled to learn how to manage databases, but his supervisor worked with him until he could remember the steps. "I get a lot of self pride out of working for this company," he said. "I'm still supporting the troops and I'm still defending freedom." Although accommodations have to be made, Karen Stang, who manages the hiring program, said managers appreciate what veterans like Stout bring to the company. "They bring loyalty, a great work ethic, commitment," she said. "It's been a real win-win." alexandra.zavis@latimes.com

Respiratory Studies re 1-Treatment and 1-Diagnostic Biomarker Gulf War Illness September 18, 2010 posted by Denise Nichols · Two positive studies but not a real surprise to the Gulf War Veterans who are ill. Sleep Breath. 2010 Aug 19. [Epub ahead of print] The effect of nasal continuous positive airway pressure on the symptoms of Gulf War illness. Amin MM, Gold MS, Broderick JE, Gold AR. Division of Pulmonary/Critical Care/Sleep Medicine, (111D), DVA Medical Center, Northport, NY, 11768, USA, mohammad.amin2@va.gov. Abstract PURPOSE: We performed a pilot study to determine whether nasal continuous positive airway pressure (CPAP) alleviates the symptoms of veterans with Gulf War illness (GWI) and sleep disordered breathing (SDB). METHODS: Eighteen male veterans with GWI and SDB recruited by advertisement, participated in a randomized, single-masked, sham-controlled treatment trial. Participants received 3 weeks of treatment during sleep with either therapeutic nasal CPAP or sham nasal CPAP. Using validated questionnaires, pain, fatigue, cognitive function, sleep disturbance, and general health were assessed by self-report before and after treatment. One of the participants assigned to therapeutic CPAP was excluded from the trial before starting treatment, leaving 17 participants. RESULTS: Compared to the nine sham nasal CPAP recipients, the eight participants receiving therapeutic nasal CPAP experienced improvements in pain (34%; p = 0.0008), fatigue (38%; p = 0.0002), cognitive function (33%; p = 0.004), sleep quality (41%; p = 0.0003), physical health (34%; p = 0.0003), and mental health (16%; p = 0.03). CONCLUSIONS: Our findings in this pilot study suggest that nasal CPAP may greatly improve symptoms in veterans with GWI and SDB. Sleep Breath. 2010 Aug 12. [Epub ahead of print] Inspiratory airflow dynamics during sleep in veterans with Gulf War illness: a controlled study. Amin MM, Belisova Z, Hossain S, Gold MS, Broderick JE, Gold AR. Division of Pulmonary/Critical Care/Sleep Medicine, DVA Medical Center, Northport, NY, 11768, USA, mohammad.amin2@va.gov. Abstract PURPOSE: To determine whether veterans with Gulf War Illness (GWI) are distinguished by sleep-disordered breathing, we compared inspiratory airflow dynamics during sleep between veterans with GWI and asymptomatic veterans of the first Gulf War. METHODS: We recruited 18 male veterans with GWI and 11 asymptomatic male veterans of the first Gulf War by advertisement. The two samples were matched for age and body mass index. Each participant underwent a first full-night polysomnogram (PSG) while sleeping supine using standard clinical monitoring of sleep and breathing. A second PSG was performed measuring airflow with a pneumotachograph in series with a nasal mask and respiratory effort with a supraglottic pressure (Psg) catheter to assess the presence of inspiratory airflow limitation during supine N2 sleep. We determined the prevalence of flow-limited breaths by sampling continuous N2 sleep and plotting inspiratory flow against Psg for each breath in the sample. We expressed the prevalence of flow-limited breaths as their percentage in the sample. RESULTS: Compared to controls, veterans with GWI had an increased frequency of arousals related to apneas, hypopneas, and mild inspiratory airflow limitation. During supine N2 sleep, veterans with GWI had 96 +/- 5% (mean +/- SD) of their breaths flow-limited while controls had 36 +/- 25% of their breaths flow limited (p < 0.0001). CONCLUSIONS: Veterans with GWI experience sleep-disordered breathing that may distinguish them from asymptomatic veterans of the first Gulf War.

Exercise for Gulf War Veterans with Chronic Musculoskeletal PainSeptember 19, 2010 posted by Denise Nichols · Exercise for Gulf War Veterans with Chronic Musculoskeletal Pain Below is the news article about this finding followed by the information taken concerning the study itself. We need to hear from the gulf war veterans that are ill that did not participate in this study in the comments section following this article. Questions to address how are you dealing with exercise now since the war? Are you able to exercise? What is the result for you? What diet have you found that helps? Have you had trouble with weight gain or loss? What have you found as ill gulf war veterans that has helped? What research studies have you participated in that helped you? Long-Term Exercise Can Reduce Vets' Muscle Pain A bout of exercise can worsen the aches of American military veterans suffering from chronic musculoskeletal pain, a small new study shows, But researchers say that it's only temporary. Long-term exercise, they stress, can help reduce veterans' chronic pain. About 100,000 veterans from the first Gulf War war have reported chronic musculoskeletal pain (CMP) similar to fibromyalgia. The researchers used heat to test the pain sensitivity of 15 Gulf War veterans with CMP and 17 healthy veterans of that war after a workout. Compared to the healthy participants, veterans with CMP found the heat stimuli to be more intense and unpleasant. The vets with CMP also reported more intense leg pain during exercise and were more sensitive to the heat stimuli after the bout of exercise than they were before it. However, there were no significant differences in the pain threshold between vets with CMP and healthy vets. Previous research has found that chronic (long-term) exercise can help reduce chronic muscle pain, noted the researchers, who worked at Middleton Memorial Hospital in Madison, Wisconsin and the University of Wisconsin. Doctors need to encourage regular exercise for patients with chronic musculoskeletal pain in order to prevent disability, even though the early stages of an exercise program may cause increased pain for a short time, according to the researchers. The study appears in the current issue of the Journal of Pain. Copyright © 2010 HealthDay. All rights reserved. J Pain. 2010 Aug;11(8):764-72. Epub 2010 Mar 24. Exercise alters pain sensitivity in Gulf War veterans with chronic musculoskeletal pain. Cook DB, Stegner AJ, Ellingson LD. New Jersey War Related Injury and Illness Study Center, Veterans Affairs Medical Center, East Orange, New Jersey, USA. dcook@education.wisc.edu Abstract Since returning from the Persian Gulf, nearly 100,000 veterans of the first Gulf War (GVs) have reported numerous symptoms with no apparent medical explanation. A primary complaint of these individuals is chronic musculoskeletal pain (CMP). CMP symptoms in GVs are similar to those reported by patients with fibromyalgia (FM), but have not received equivalent scientific attention. Exercise research in CMP patients suggests that acute exercise may exacerbate pain while chronic exercise can reduce pain and improve other symptoms. However, the influence of exercise on GVs with CMP is largely unexplored. This study examined the impact of an acute bout of exercise on pain sensitivity in GVs with CMP. Thirty-two GVs (CMP, n = 15; Control, n = 17) were recruited to complete a series of psychophysical assessments to determine pain sensitivity to heat and pressure stimuli before and after exercise. In response to heat-pain stimuli, GVs with CMP reported higher pain intensity and affect ratings than healthy GVs and exhibited a significant increase in ratings following exercise. GVs with CMP rated exercise as more painful and effortful and were generally more sensitive to heat-pain stimuli than healthy GVs. These results are similar to what has been reported for acute exercise in patients with FM. PERSPECTIVE: Gulf War veterans with CMP perceive exercise as more painful and effortful than healthy GVs and experience increased pain sensitivity following exercise. These results suggest that similar abnormalities in central nervous system processing of nociceptive information documented in FM may also be occurring in GVs with CMP. PMID: 20338824 [PubMed - in process]

VETERANS' ATTORNEYS CHALLENGE VA'S NEW PTSD RULE IN FEDERAL COURT Suit claims VA Secretary Shinseki has no authority to promulgate a rule that excludes a PTSD diagnosis from a non-VA practitioner. by Larry Scott, VA Watchdog dot Org ------------------------- In July of this year the VA published a new PTSD rule ... one that, in theory, made it easier for a veteran to have a PTSD claim approved. That story here: AS VA PUBLISHES NEW PTSD RULE, SOME SAY IT DOESN'T GO FAR ENOUGH -- "You can't assume these veterans are going to get sympathetic and accurate exams" from the government. "For that reason, I don't see this helping anything." http://www.vawatchdog.org/10/nf10/nfjul10/nf071410-4.htm Many questioned why the final PTSD diagnosis had to be made by a VA practitioner. From an article in The New York Times by James Dao: In a news conference announcing the new rule on Monday, Dr. Robert A. Petzel, the department’s under secretary for health, said the department rejected requests to allow private clinicians to make final diagnoses because, “We’ve got 20,000 professionals who are excellent in handling this.” The assertion that federal clinicians “would create barriers doesn’t ring true to me,” Dr. Petzel added. “Our people are very desirous to get these benefits to the people that deserve them.” The complete NYT article is here: http://www.nytimes.com/2010/07 /13/us/13vets.html?_r=1 For more about the new PTSD rule, use our search engine ... here ... http://www.yourvabenefits.org/sessearch.p hp?q=new+ptsd+rule&op=ph Now, we have a lawsuit challenging the VA's new PTSD rule. The suit was filed in the United States Court of Appeals for the Federal Circuit and was filed by the National Organization for Veterans' Advocates (NOVA). NOVA is an organization made up of attorneys who handle veterans' claims. Their web site is here ... http://www.vetadvocates.com/ Here is an excerpt from NOVA's petition: NOVA petitions the Court because the rule, as revised, established an arbitrary requirement that under certain conditions only Department of Veterans Affairs ("VA") examiners can corroborate a stressor which a veteran claims caused his or her Post-Traumatic Stress Disorder ("PTSD"). Contrary to law, the Secretary failed to provide any basis for such a fundamental change to the longstanding acceptance of diagnoses from qualified private examiners, and indeed there is no such basis. The Secretary thus exceeded his authority and promulgated an arbitrary rule elevating the opinion of a VA examiner over a private examiner. This action threatens to harm vulnerable claimants who are being privately treated for PTSD but who are unable to persuade a VA-appointed examiner of the merits of their claim. The entire petition is available here for viewing or download.

I posted this to another thread but the bottom line is this; Get a medical specialist opinion (IMO) prior to filing a claim or at least prior to your C & P exam and get it in your records. DO NOT let the C & P examiner's medical opinion be the only medical opinion in your file. Get treated and get the evidence that you need to win your claim, try to get enough evidence in your file to support your claim that VA has to grant it the first time.

I guess my medication was kicking in because I posted this in the success stories and it should have been posted in social chat or somewhere else. Moderators can you please move Thanks