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Lflint33
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Hello everyone I got a 100 % letter from the VARO San Diego this week I got C H 35 and medical for my wife and son also this was after they wanted to reduce me to 90 % after a Q T C appt when the Doctor lied on his report and said I got better. I showed my V A doctor his report and he wrote my a letter and said I have not got better and I would not get any better.I sent this letter in and that was all I needed I did not go to a hearing they went by my doctor letter. In 2000 I was 70 in 2002 I went to 80 and in 2004 I went to 100 % and in 2008 I got 100 % P T scheduled. To all you VETs go to the doctor and get to know them and they give you what you want.
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Yes Testvet my back is service connected and my mental health doctor at the V A wrote me a letter saying my back is causing the depression and my Gaf has been 50 for four years.
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Hello everyone has anyone ever had a comp and pen eval dealing with major depression and the Q T C doctor said you got better and then the doctor that treat you at the V A write you a letter for the rating board that states you have not got better and you will not get any better due to the pain in your body( lower back ) do you all think they will go along with the treating doctor or will they go with the Q T C doctor. Also the ortho doctor wrote me a letter saying my back will never get any better.
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Hello my Gaf 50 got me 70% in June 2004 now I had a Q T C exam 29 Nov 2007 and they are trying to lower me to 50% my G A F has been 50 from June 22,2004 to present with my treating doctor at the V A M C L L but the Q T C doctor said I got better. My treating doctor that work for the V A wrote me a letter that said I have not got any better and it is more likely than not I will do you all think San Diego R O will use his letter or the one from Q T C.
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Jay they won't give it to you you will need to FOIA it from your VARO it took me 2 month's for a decision and it took me two month's to get a copy of my exam.
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Yes Testvet I do go to Loma Linda
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Riverside, Ca are you using Loma Linda VA? Or is this a local Riverside Doc? I grew up there my parents are buried at Riverside National....at March AFB last time I was there Riverside didn't have a VA medical office
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Yes betty yhis is the same guy like I said before I plan to put the brakes on him.
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Would this Dr. Abejuela be the same doctor that you saw?
Sorry it is a long BVA case, but his name is mentioned several times.
Betty
Citation Nr: 0312435
Decision Date: 06/10/03 Archive Date: 06/16/03
DOCKET NO. 93-24 281 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Los
Angeles, California
THE ISSUE
Entitlement to service connection for a nervous disorder.
REPRESENTATION
Appellant represented by: The American Legion
WITNESSES AT HEARING ON APPEAL
The veteran and his spouse
ATTORNEY FOR THE BOARD
Nancy S. Kettelle, Counsel
INTRODUCTION
The veteran served on active duty from June 1956 to July
1959.
This matter came to the Board of Veterans' Appeals (Board) on
appeal from a June 1991 rating action of the Department of
Veterans Affairs (VA), Regional Office (RO) in Los Angeles,
California. In that rating decision, the RO denied
entitlement to service connection for a nervous disorder.
The veteran and his wife testified before a hearing officer
at the RO in March 1993, and the Board remanded the case to
the RO for development in October 1995, March 1998, and
December 2000. The case has been returned to the Board and
is ready for appellate review. A January 2003 letter from
the veteran requesting additional time to submit information
was received at the Board in May 2003. In view of the
favorable action taken further delay for submissions from the
veteran is not considered necessary.
FINDINGS OF FACT
1. The RO has notified the veteran of the evidence needed to
substantiate his claim, and has obtained and developed all
evidence necessary for the equitable disposition of the
claim.
2. Competent medical evidence relates the veteran's current
psychiatric disability, variously diagnosed as bipolar
disorder and anxiety disorder, to his military service.
CONCLUSION OF LAW
The veteran's current psychiatric disability, variously
diagnosed as bipolar disorder and anxiety disorder, was
incurred in active service. 38 U.S.C.A. §§ 1131, 5103,
5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303
(2002).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
Veterans Claims Assistance Act
There has been a significant change in the law during the
pendency of this appeal. On November 9, 2000, the President
signed into law the Veterans Claims Assistance Act of 2000
(VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000). Among
other things, this law redefines the obligations of VA with
respect to notice and the duty to assist. This change in the
law is applicable to all claims filed on or after the date of
enactment of the VCAA, or filed before the date of enactment
and not yet final as of that date. 38 U.S.C.A. § 5103A (West
2002); see Karnas v. Derwinski, 1 Vet. App. 308 (1991).
On receipt of a claim for benefits VA will notify the veteran
of the evidence that is necessary to substantiate the claim.
VA will also inform the veteran which information and
evidence, if any, that he is to provide and which information
and evidence, if any, VA will attempt to obtain on his
behalf. VA will also request that the veteran provide any
evidence in his possession that pertains to the claim.
38 C.F.R. § 3.159; Quartuccio v. Principi, 16 Vet. App. 183,
187 (2002). In general, the VCAA provides that VA will make
reasonable efforts to help the veteran obtain evidence
necessary to substantiate the claim, unless no reasonable
possibility exists that such assistance would aid in
substantiating the claim. VA's duty includes making efforts
to obtain his service medical records, if relevant to the
claim; other relevant records pertaining to service; VA
medical records; and any other relevant records held by any
other source. The veteran is also required to provide the
information necessary to obtain this evidence, including
authorizations for the release of medical records. In a
claim for compensation benefits, the duty to assist includes
providing a VA medical examination or obtaining a medical
opinion if VA determines that such an examination or opinion
is necessary to make a decision on the claim. 38 C.F.R.
§ 3.159.
In this case, the RO provided the veteran a statement of the
case in August 1991 and supplemental statements of the case
in August 1996, August 1997, April 2000, July 2000 and
December 2002. In those documents, the RO informed the
veteran that it had reviewed service medical records, VA
examination reports and VA medical records in conjunction
with his claims. In those documents, the RO also notified
the veteran of the requirements for direct service connection
as well as service connection on a presumptive basis for
psychoses. In a letter dated in October 2001, the RO told
the veteran about the VCAA and notified him that he should
identify the names and addresses of health care providers who
had treated him for his claimed disability and notified him
that VA would attempt to obtain those records but that it was
still his responsibility to make sure the records were
received by VA. In the December 2002 supplemental statement
of the case, the RO outlined the provisions of the VCAA in
detail. In view of the decision in this case, the Board is
satisfied that the veteran has been adequately advised what
evidence he should submit and what evidence VA would obtain
on his behalf, in accordance with Quartuccio v. Principi, 16
Vet. App. 183 (2002).
As to the duty to assist, the RO arranged for psychiatric
examination of the veteran and obtained medical opinions in
conjunction with the claim. In addition, the RO obtained the
veteran's service medial records, VA outpatient records and
some of the private medical records identified by the
veteran. In support of his claim, the veteran has submitted
VA treatment records as well as private treatment records and
statements form private psychiatrists and psychologists. In
addition, the veteran and his wife testified at a hearing at
the RO in March 1993. Further, the veteran and his
representative have provided written argument in conjunction
with his claim.
Based on the foregoing, the Board concludes that the veteran
has received adequate notice and that relevant data has been
obtained for determining the merits of the veteran's claim
and that no further assistance is required to substantiate
his claim.
Law and regulations
Service connection may be established for a disability
resulting from disease or injury incurred in or aggravated by
active service. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. The
mere fact of an in-service injury is not enough; there must
be chronic disability resulting from that injury. For the
showing of chronic disease in service, there is required a
combination of manifestations sufficient to identify the
disease entity and sufficient observation to establish
chronicity at the time. If chronicity in service is not
established, a showing of continuity of symptoms after
discharge is required to support the claim. 38 C.F.R. §
3.303(:P. Service connection may be granted on a presumptive
basis for certain chronic diseases, including psychoses, if
such is shown to have been manifest to a compensable degree
within one year following the date of separation from
service. 38 U.S.C.A. §§ 1101, 1112, 1137; 38 C.F.R.
§§ 3.307, 3.309. Service connection may also be granted for
any disease diagnosed after discharge when all of the
evidence establishes that the disease was incurred in
service. 38 C.F.R. § 3.303(d).
In order to establish service connection, there must be (1)
medical evidence of a current disability; (2) medical, or in
certain circumstances, lay evidence of the in-service
incurrence or aggravation of a disease or injury; and (3)
medical evidence of a nexus between the claimed in-service
disease or injury and the current disability. Hickson v.
West, 12 Vet. App. 247, 253 (1999).
Standard of review
After the evidence has been assembled, it is the Board's
responsibility to evaluate the entire record. See
38 U.S.C.A. § 7104(a) (West 2002). When there is an
approximate balance of evidence regarding the merits of an
issue material to the determination of the matter, the
benefit of the doubt in resolving each such issue shall be
given to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R.
§§ 3.102, 4.3 (2002). In Gilbert v. Derwinski, 1 Vet. App.
49, 53 (1990), the United States Court of Appeals for
Veterans Claims (Court) stated that "a veteran need only
demonstrate that there is 'an approximate balance of positive
and negative evidence' in order to prevail." To deny a
claim on its merits, the preponderance of the evidence must
be against the claim. See Alemany v. Brown, 9 Vet. App. 518,
519 (1996), citing Gilbert, 1 Vet. App. at 54.
Background and analysis
The veteran contends that his current psychiatric disability
started in service, and he has stated and testified that he
often felt depressed and nervous during service. He
testified at the March 1993 hearing that on one occasion in
service he sought treatment at the urging of a friend and was
treated for nervousness. He testified that he was on board
ship at the time and was given medication and was kept in
sickbay for three days. He also testified that although he
received no other treatment for nervousness in service, he
received treatment for physical injuries after three men
assaulted him while he was on liberty. He testified that
ever since that incident he had had nightmares of someone
coming after him with a weapon, like a gun or a knife, and
trying to kill him.
The veteran's service medical records show that at service
entrance in June 1956, he denied a history of nervous trouble
of any sort, and on psychiatric evaluation, he was found to
be clinically normal. Sick call treatment records show that
in April 1957 he complained of nervousness and was treated
with Equanil. The treatment record does not show the
disposition at that time, i.e., whether the veteran was or
was not immediately returned to duty. A later entry, dated
in December 1957 shows that the veteran was treated with
aspirin with codeine and hot soaks for complaints of chest
pain and right and left mandible pain after having been
"jumped" the previous night. At the veteran's separation
examination in June 1956, the veteran was evaluated as
psychiatrically normal.
The veteran asserts that he has current psychiatric
disability related to his feelings of being depressed and
nervous in service as well as his nightmares in service. On
review of the entire record, the Board concludes that the
weight of the evidence is at least in equipoise on this
matter, warranting a grant of service connection for the
veteran's current psychiatric disability, variously diagnosed
as bipolar disorder and anxiety disorder. In this regard,
the veteran's service medical records do document treatment
of nervousness on one occasion and although they do not
confirm that the veteran remained in sickbay for three days,
they are not inconsistent with such a finding as the record
entry does not indicate that the disposition was immediate
return to duty. The records further confirm that the veteran
was assaulted while in service as the veteran was treated for
physical complaints after he was "jumped." Further, they
indicate that the injuries were of sufficient severity to
warrant skull X-rays in January 1958.
A November 1992 notarized statement from the veteran's former
brother-in-law corroborates the veteran's assertions
pertaining to the onset of his feelings of depression and
nervousness in service. The brother-in-law, who knew the
veteran before, during and after service stated that before
service the veteran was a fun-loving and free-spirited type
of person, but that during service he and other family
members noticed a big difference in the veteran's attitude
when they saw him while he was on leave. The brother-in-law
said that the veteran had become depressed and moody and not
the same person. The Board further notes that the veteran's
current contentions regarding his feelings in service are
consistent with history he provided at a psychiatric
evaluation by Donald S. Patterson, M.D., in May 1975 in
conjunction with his application for Social Security
disability benefits. At that time the veteran reported that
he was depressed quite often during service, but was not seen
by a military psychiatrist and did not mention the feelings
of depression to a chaplain. He also reported that three men
assaulted him while he was on liberty and that he believed
his depressions had been more severe since then.
The earliest available post-service medical records
pertaining to the veteran's claim are clinical records from
Palo Alto-Stanford Medical Center showing that in October
1966 the veteran was diagnosed as having psychoneurosis,
chronic anxiety state with conversion reaction. In a
November 1966 entry, the physician noted that the veteran had
a long-standing history of neurotic behavior and that his
present symptoms represented a continuation of that behavior.
Valium was prescribed, and further psychiatric consultation
was recommended.
The Board notes that the veteran has referred to earlier
post-service psychiatric treatment beginning with having been
seen by a neuropsychiatrist, Dr. Henry Colony, in 1960 and
1961. At the March 1993 hearing the veteran testified that
Dr. Colony had died, but that at VA's request he had provided
Dr. Colony's name and address in 1975 in conjunction with
another claim, but VA had made no attempt to obtain Dr.
Colony's records at that time when they more likely would
have been available. In any event, reports and clinical
records from other physicians show that the veteran has for
many years, including in records long-predating the current
claim, given a history of treatment by Dr. Colony in the 1960
- 1961 period, and having received a diagnosis of
schizophrenia and treatment with Thorazine at that time. At
the March 1993 hearing, the veteran testified that he had to
be off work at that time and when he returned to work Dr.
Colony wrote a note that he had schizophrenia. The veteran
testified that at that time he did not know what that meant
and that when he found out, he was very embarrassed to take
that note back to work.
Additionally, although the veteran has reported other medical
treatment for his psychiatric symptoms between the time he
saw Dr. Colony and the time he was seen at the Palo Alto-
Stanford Medical Center, there are no records in the file
that document this. The Palo Alto-Stanford Medical Center
records do state that the veteran's complaints had responded
transiently to Librium, Vitamin B12 and Valium, only to
recur, which, in the Board's judgment, indicates at least
some treatment between the time the veteran was reportedly
treated with Thorazine and late 1966.
In Dr. Patterson's May 1975 letter, he noted that the veteran
had been referred to a psychiatrist in 1971 because of having
taken an overdose of Valium or Librium, which had been
prescribed for him. Further, from January to March 1973 he
had been in a day care program following a 2 to 3 week
hospitalization during which he was placed on antidepressant
medication. Records from Santa Barbara Cottage Hospital show
the veteran was admitted on an emergent basis due to an acute
suicidal state in September 1975. He was noted to have a
fairly long history of major psychiatric difficulties and to
be in treatment with a Dr. Anthony Lapolla. He was
discharged in October 1975 with a diagnosis of depressive
neurosis. At a psychiatric evaluation conducted by Jesse R.
Freeland, M.D., in March 1976, the veteran described frequent
bouts of depression and suicide attempts as well as 'spells'
for many years, with prodromal scotomata and evident
unconsciousness. The veteran recalled feeling very depressed
as a child and said his mother was a very nervous person. He
said he was discharged from the navy because of depression.
The veteran also reported that 15 years before the March 1976
examination he saw Dr. Colony in Oakland and was given
Thorazine. After examination, Dr. Freeland stated that a
speculative diagnosis would be that of an affective type of
schizophrenia with an ictal and possibly a psychomotor
component.
In various letters, Anthony Lapolla, M.D., has stated that he
first treated the veteran in 1972 or 1973 through the Santa
Barbara Mental Health Service and that the veteran came with
a diagnosis of schizophrenia. In an April 1991 letter, Dr.
Lapolla outlined the history of his treatment of the veteran
since the early 1970s. He described the veteran's symptoms
and explained his rationale for diagnosing the veteran as
having manic-depressive illness. He noted that family
history indicated that several members of the veteran's
family, on his mother's side, suffered from depression of a
severe type. Dr. Lapolla noted that the veteran's adjustment
to military service was poor and that the veteran claimed he
was frequently depressed and could not adjust to the
"controlled" life of the Navy. In the April 1991 letter
Dr. Lapolla said it was his opinion that since an early age
the veteran had a mental illness, which became worse before
joining the Navy. Dr. Lapolla said it culminated during the
veteran's enlistment so that he was unable to make an
adjustment.
The record shows that in November 1991,with release from the
veteran, Dr. Lapolla requested copies of the veteran's
service medical records. Later, in a letter dated in
February 1993, Dr. Lapolla stated that the veteran's manic-
depressive illness became manifest after he enlisted in the
Navy, while aboard ship. Dr. Lapolla stated that much of the
veteran's behavior was part of this and his emotional
reaction to incidents he encountered.
VA outpatient records document treatment of the veteran at
mental health clinics from the early 1980s. Treatment
records show complaints of depression, paranoid delusions,
hallucinations, ideas of reference and bad dreams and include
diagnoses of manic-depressive illness and schizophrenia at
various times. Medication was prescribed on a continuing
basis.
Following Dr. Lapolla's retirement in 1993, the veteran
received treatment from private psychiatrists, T. Tice, M.D.,
and Richard M. Deamer, M.D, with continuing follow-up for
psychiatric medications from a VA clinic. At a VA mental
health clinic evaluation in May 1993, the veteran stated that
he had high and low mood swings, with the low moods
predominating. He also said that he had had auditory
hallucinations with his depressive episodes. He reported
that his mood swings started when he was 18 to 19 years old.
Various clinical records over the period from 1993 to 1999
show that the veteran's complaints included tenseness,
wanting to withdraw, panic attacks and anxiety dreams about 4
times a week in which he said he seemed to be chased and was
scared. He also complained of periods of feeling depressed
and periods of feeling anxious. Medications continued to be
prescribed and the diagnosis was bipolar disorder.
Clinical records from Dr. Tice show that in May 1995 he
described the veteran as a manic depressive since age 18 who
wanted psychiatric therapy and possibly medication. At that
time the veteran reported that he was on an aircraft carrier
in service and would feel depressed for about 2 weeks
followed by mania for 4 to 7 days. He also gave a history of
having been unconscious for a few minutes when he was mugged
at age 19 years. After examination, the impression was rule
out bipolar disorder with rapid cycling and rule out
schizoaffective disorder. In July 1995, the Dr. Tice's
assessment was schizoaffective disorder, bipolar type with
rapid cycling.
In multiple letters dated from 1993 to 2001, Eva A. Turner,
M.A., has reported that she worked with Dr. Lapolla from the
early 1970s until his retirement in 1993 and that she was
part of the team that handled the veteran's case when he
received treatment from Santa Barbara County Mental Health
Services and continued seeing the veteran after she and Dr.
Lapolla started in private practice together by 1976. In a
November 1999 letter, she stated that the veteran's diagnosis
was clearly post-traumatic stress syndrome superimposed on a
bipolar disorder, which she said meant that his depressive
periods were often gravely aggravated by extreme anxiety.
She said that the veteran continued to suffer flashbacks from
his navy experience and had periods when his depression
became morbidly severe. In other letters she stated that the
veteran had long, broad mood swings tending toward the
"down-side" of the spectrum and that these were accompanied
by agitated anxiety. She said that in therapy the veteran
had associated these feelings with his experiences in the
navy. Ms. Turner noted there were familial and personal
features in the veteran's history that represented tendencies
toward this kind of symptomology, but she said his first
manifestations apparently occurred while he was in the navy.
In her most recent letter, which is dated in December 2001,
Ms. Turner emphasized the veteran's personal experience in
the navy, mostly his feeling singled out, ganged up on,
teased and tormented by his shipmates, elicited his first
major psychiatric breakdown and had a lasting traumatic
effect on him.
Others who have treated the veteran have also associated the
veteran's psychiatric disability with his military service.
For example, records from the psychiatrist, Dr. Deamer, show
that he treated the veteran during the period from November
1996 to August 2001. In March 1997, Dr. Deamer noted that
the veteran reported the he first experience pressured
speech, euphoric/grandiose mood and racing thoughts while he
was on an aircraft carrier in the navy, and it was at this
time that he was given Equanil, which the veteran said gave
him some relief. He reported recurrent episodes of rapidly
fluctuating mood status ever since. Dr. Deamer's diagnostic
impression reported in March 1997 was bipolar disorder,
mixed. In a clinical entry dated in October 1999, Dr. Deamer
noted that the veteran told him about a beating he received
in service while on shore duty and about some sort of
physical altercation he had with one of his buddies while on
a ship. In a letter dated in October 1999, Dr. Deamer stated
that the veteran continued to suffer from bipolar disorder
and there were features of his clinical situation consistent
with PTSD. Dr. Deamer said it was a condition the veteran
experienced on active duty with the navy, and from which he
continued to suffer.
In addition to treatment from various psychiatrists, another
psychologist, Kent L. Coleman, Ph.D., also saw the veteran,
starting in 1995. In a letter dated in November 1999, Dr.
Coleman said that based on clinical information garnered from
interview, it appeared likely that the veteran's manic-
depressive disorder, chronic bipolar disorder, developed
during his enlistment in the navy and that he had suffered
from that condition ever since.
In a letter dated in June 2000, Dr. Coleman said that at the
veteran's request he had done a chart review and reviewed
prior medical records, including the veteran's service
medical records. Dr. Coleman stated that at his initial
meeting with the veteran in mid-1995 the veteran described
having highs and lows since the 1950s but said he did not
know what they were for a long period of time. Dr. Coleman
said the veteran described the onset as being prior to his
visit to sickbay in April 1957 where the sick call treatment
record described the complaint of nervousness and the veteran
was given Equanil. Dr. Coleman noted that Equanil is the
brand name for meprobamate, which is indicated for the
management of anxiety disorders or for the short-term relief
of the symptoms of anxiety. Dr. Coleman indicated that he
also reviewed post-service clinical records and professional
opinions of several clinicians and stated that he felt
comfortable in noting that the veteran's mental illness had
been long-standing, with all likelihood being manifested
during his years of military service. In support of his
opinion, Dr. Coleman noted the mean age of onset for a first
manic episode was in the early 20s and Dr. Lapolla's mention
of prodromal signs prior to enlistment, which Dr. Coleman
said was supportive of the view that the veteran's manic
depressive illness symptoms became manifest during his
military service.
Evidence against the veteran's claims comes from opinions by
two psychiatrists, Albert Shnaider, M.D., and Reynaldo
Abejuela, M.D. In a report dated in February 2000, Dr.
Shnaider stated that he interviewed the veteran and reviewed
medical records, including the veteran's service medical
records, provided by VA. After examination, the Axis I
diagnoses were bipolar disorder, depressed, and panic attack
disorder with agoraphobia. Dr. Shnaider stated that medical
logs from the navy do not contain any mental health
complaints or treatment records and that the medical records
do not reveal any significant psychiatric impairments or
complaints prior to the late 1960s. He said he thus believed
that the date of onset of the veteran's emotional instability
was in the late 1960s to early 1970s. He stated that he
believed it less likely [than not] that the veteran's
psychiatric disorders were related to his military service.
Dr. Shnaider said he based this conclusion on the fact that
there were no significant psychiatric treatments rendered or
complaints documented while the veteran was in the service.
Dr. Shnaider noted that he had been requested to consider
reports by Ms. Eva Turner and Dr. Lapolla. Dr. Shnaider said
he found no report from Ms. Turner. Dr. Shnaider referred to
an April 1991 letter from Dr. Lapolla, but he did not mention
Dr. Lapolla's February 1993 letter in which he stated that
the veteran's illness became manifest in service. Further,
the Board notes that in his report Dr. Shnaider stated that
records he reviewed included treatment records from Santa
Barbara County Mental Health dated between 1983 and 1987 and
an evaluation from Santa Barbara County Mental Health dated
October 31, 1986. The Board observes that while the record
includes VA outpatient records dated between 1982 and 1987,
including the report of an October 31, 1986, VA mental health
clinic diagnostic and disposition conference, the Board finds
no indication of the existence of records from Santa Barbara
County Mental Health for the same period.
In a report dated in March 2003, Dr. Abejuela stated that he
had not seen the veteran, but that his report was a review of
records to reconcile the findings and provide an opinion.
Dr. Abejuela referred to Dr. Shnaider's February 2000 report.
As did Dr. Shnaider, Dr. Abejuela referred to Santa Barbara
County Mental Health treatment records and an evaluation
report dated in the 1980s. Dr. Abejuela said that he
concurred with Dr. Shnaider that the etiology or nature of
the veteran's mental illness was idiopathic, which he said
meant they did not know what caused the veteran's bipolar
disorder. Dr. Abejuela also said that he concurred with Dr.
Shnaider that based on medical records and pertinent medical
evidence, they could only provide a range from the late 1960s
to the early 1970s regarding the date of onset for the
veteran's emotional instability. Dr. Abejuela said that
based on the medical evidence and records he had reviewed,
including Dr. Shnaider's report, he concurred with Dr.
Shnaider that it is less likely [than not] that the veteran's
psychiatric disorders are related to his military service.
He said the justification for this conclusion was that there
was no significant psychiatric treatment rendered nor were
there documented complaints while the veteran was in the
navy.
In a follow-up report dated in July 2002, Dr. Shnaider said
he had been asked to review his previous report and the prior
report prepared by Dr. Abejuela and render an opinion as to
the etiology and date of onset of the veteran's diagnosed
psychiatric disorders, whether it is as likely as not that
his diagnosed disorder is related to his military service.
In his July 2002 report, Dr. Shnaider noted that he had
earlier opined that there was insufficient evidence to
conclude that the veteran's current psychiatric diagnoses
began or were caused by military service.
In his July 2002 report, Dr. Shnaider provided a discussion
and then stated that he continued to believe that the
veteran's current bipolar disorder and panic attack disorder
was unlikely related to his military service. In the
discussion, Dr. Shnaider stated that he had reviewed Dr.
Coleman's June 2000 report. Dr. Shnaider stated that Dr.
Coleman mentioned that the patient has been experiencing
"depressive symptoms" since the fifties, but other than by
the veteran's own reporting of the timing of his symptoms did
not cite any specific medical records to substantiate the
veteran's complaints. In this regard, the Board's review of
Dr. Coleman's report shows that he stated "[a]t the initial
session, we discussed how he had been manifesting "manic
depressive" symptoms since the 1950s, however he did not
know what they were for a long period of time. He described
these highs and lows and just not being able to cope or
function (being super depressed for extended periods of time
and then having relatively short periods of manic activity).
Dr. Coleman went on to state "[h]e described the onset of
his manic depressive disorder as being prior to the visits to
sick bay on 4/28/57 where the Sick Call Treatment record
describes the complaint as nervousness and he was given
Equanil, brand name for meprobamate which is indicated for
the management of anxiety disorders or for the short-term
relief of the symptoms of anxiety." The Board observes that
Dr. Coleman spoke of the veteran discussing not only
depressive but also manic symptoms, and that Dr. Coleman
cited to the April 1957 entry in the veteran's service
medical record as objective evidence of treatment for anxiety
in service.
In his July 2002 report Dr. Shnaider stated that he observed
an inconsistency in the veteran's statements in that during
his interview with the veteran, the veteran reported that his
symptoms began in 1959 but in contrast he reported to Dr.
Coleman that his symptoms began in the sixties. Based on
this, Dr. Shnaider stated that the accuracy of the veteran's
memory with respect to his symptomatology was highly
questionable. Dr. Shnaider said that he did not believe this
lent any credence to the notion that the patient's
psychiatric illness began in earnest prior or during military
service. On review of the record, the Board can confirm that
in his February 2000 report Dr. Shnaider said " . . . he
reports that in 1959 he began experiencing significant mood
instability. . .." However, nowhere in Dr. Coleman's June
2000 report does he state that the veteran reported that his
symptoms began in the 1960s. The Board therefore finds that
Dr. Shnaider's conclusion as to the veteran's credibility is
without support in the record.
On further review of Dr. Shnaider's July 2002 report, the
Board finds Dr. Shnaider's reasoning and conclusions to be
equivocal, and therefore not dispositive of the issue at
hand. Dr. Shnaider stated, "[t]here are no medical records
available to substantiate the patient's symptomatology prior
to the sixties and seventies. Thus, my his best estimate
[is] that the veteran's current psychiatric disorders had
their onset in earnest in the early sixties." (Emphasis
added.) Dr. Shnaider went on to say that particularly due to
lack of evidence of significant psychiatric impairment as
documented in the veteran's service record as well as lack of
documentation of significant impairment until the sixties, he
believed it was not likely that the veteran's current
psychiatric diagnosis were related to his military service.
Dr. Shnaider ended that paragraph with the statement that
"t is just as likely as not that his complaints with
respect to depression and anxiety while in military service
are independent of and are not related to the patient's
current psychiatric diagnosis." In the paragraph that
followed, Dr. Shnaider again stated that upon reviewing all
medical records available, he did not find sufficient
evidence to indicate that the onset of the veteran's current
psychiatric diagnoses was prior to 1960. He stated that he
continued to believe that the veteran's current bipolar
disorder and panic attack disorder were unlikely to be
related to his military service.
The Board is unable to reconcile Dr. Shnaider's statements.
Had he said it was more likely than not that the veteran's
complaints with respect to depression and anxiety while in
military service are independent of and are not related to
the veteran's current psychiatric diagnosis, the Board could
find consistency in his Dr. Shnaider's position. Considering
Dr. Shnaider's statements as made, along the with
inaccuracies and other ambiguities in his reports, leads the
Board to conclude that it can place only limited weight of
probative value on his reports.
Turning to Dr. Abejuela's second report, which is dated in
August 2002, inaccuracies and misstatements in that document
lead the Board to the conclusion that it, and his prior
report, also have only limited weight of probative value. In
this regard, in the August 2002 report Dr. Abejuela states
repeatedly that the veteran was in service from June 1966 to
August 1969, while the veteran actually had active service
from June 1956 to August 1959.This puts in doubt the
conclusions reached by Dr. Abejuela. For example, referring
to his own March 2000 report Dr. Abejuela states "t was
concluded in March of 2000 that there was no significant
psychiatric treatment rendered, nor were there documented
complaints while the veteran was in the navy. The veteran
was in the navy between 1966 and 1969. All of the treatment
and symptoms in the records were after that. It was
concluded that the etiology was not military-related, but a
condition the veteran had while in the service."
Dr. Abejuela states that according to Dr. Lapolla, the
veteran began treatment in early 1970. Dr. Abejuela went on
to say that this, again, helped the conclusion that the
veteran's bipolar disorder and psychiatric illness did not
start in the military. The Board has reviewed the multiple
letters from Dr. Lapolla that are in the file. They state
not that the veteran first received psychiatric treatment in
the 1970, rather they state that Dr. Lapolla started treating
the veteran in the early 1970s. The Board notes, in
addition, that in his April 1991 letter, Dr. Lapolla reported
that the veteran came to him with a diagnosis of
schizophrenia.
An additional example of questionable interpretation by Dr.
Abejuela is his summary of information from the May 1975
report from Donald S. Patterson, M.D. Referring to Dr.
Patterson's report, Dr. Abejuela said, "the veteran had
problems from an early age. The veteran had a cruel parent
and there was a divorce of the parents when the veteran was
age 7 or 8. His mother died after that, and he had problems
with a very difficult childhood history." Examination of
Dr. Patterson's report shows that he did say that the
veteran's father was an extremely cruel parent and that there
was a divorce of the parents when the veteran was at the age
of 7 or 8. Dr. Patterson then said that the veteran's mother
died three years ago. He followed this with the statement
that at age 12, the veteran was placed away from his mother
to live with his older brother. Though not crucial to the
substance of the veteran's claim, the Board views Dr.
Abejuela's statement as suggesting that Dr. Patterson
reported that the veteran's mother died when the veteran was
a child, while Dr. Patterson in fact was reporting that the
veteran's mother died 3 years prior to his examination of the
veteran in May 1975.
The Board also notes that Dr. Abejuela referred to a
"psychiatric report by Dr. Freeland which is also reviewed
and dated 1999." On review of the record, the Board finds
only one report from a Dr. Freeland, and it is a report dated
in 1976, described earlier in this decision. Dr. Abejuela
also stated that he reviewed several handwritten notes from
"Dr. Allen" who was with VA. Review of the record reveals
no VA treatment records from a Dr. Allen, but does show
treatment records signed by a VA physician whose first name
is Allan.
Finally, the Board observes that Dr. Abejuela's discussion
contains ambiguous and conflicting statements. For example,
Dr. Abejuela stated that after reviewing all of the available
additional records, including Dr. Shnaider's February 2000
report, he still agreed with Dr. Shnaider that the etiology
and nature of the veteran's mental illness was idiopathic and
his bipolar disorder started at an early age, as indicated by
Dr. Lapolla. Later in the discussion, he said the onset was
"between 1960s to the early 1970s." In the following
paragraph, he stated that he still concluded "it is less
likely that the veteran's psychiatric disorder is related to
his military service because "there has been no significant
psychiatric treatment rendered nor were there any documented
complaints while the veteran was in the navy." He next said
the veteran's bipolar disorder could have been related to his
problems and childhood history as well as a lot of other
things other than his military service, and ended the
paragraph by saying "t is just that the condition may
have coincided or occurred when the veteran was in the
service." In the final paragraph, Dr, Abejuela said "The
etiology is idiopathic and the onset in the late 1960s to
1970s."
Based on the foregoing, the Board finds that the reports from
Drs. Shnaider and Dr. Abejuela are of limited weight of
probative value because of inaccuracies, ambiguities and
equivocal statements detailed above. The Board interprets
the statements to express the opinions that the veteran's
current disorder did not have its onset in service and is not
causally related to service, though it may have temporally
coincided with service. It is the Board's judgment that the
totality of the other evidence of record is at least in
equipoise with those opinions. In this regard, the Board
notes that after he reviewed the veteran's service medical
records, Dr. Lapolla, in 1993, stated that the veteran's
illness became manifest, after enlisting in the navy, aboard
ship. He said that much of the veteran's behavior was part
of this and his emotional reaction to incidents he
encountered. While the service medical records document only
one complaint of nervousness, they also confirm that the
veteran was assaulted in service. The history of the onset
of mood swings in service reported by the veteran over the
years since service is corroborated by the notarized
statement of his former brother-in-law who, unlike any
medical professional, not only had direct contact with the
veteran after service, but also knew and saw him before and
during service.
The Board further observes that the record strongly suggests
continuity of symptoms, particularly mood swings, including
periods of anxiety as well as depression, from the year
following service to the present. In this regard, the
veteran has reported treatment for nervousness and a
diagnosis of schizophrenia from a neuropsychiatrist, Dr.
Colony, in 1960 and 1961. The Board recognizes that the
Court has held the veteran's lay testimony concerning what
doctors purportedly told him is not competent medical
evidence. This is because the connection between what a
physician said and the layman's account of what the physician
purportedly said, filtered as it was through a layman's
sensibilities, is simply too attenuated and inherently
unreliable to constitute medical evidence. Robinette v.
Brown, 8 Vet. App. 69, 74 (1995). The Board observes,
however, that the veteran is competent to say that he
experienced nervousness at that time and to report that he
took Thorazine prescribed by that physician. In this regard,
the Board notes that Thorazine is a psychotropic drug used
for the management of manifestations of psychotic disorders.
Baker v. West, 11 Vet. App. 163, 164 (1998); Shockley v.
West, 11 Vet. App. 208, 211 (1998); Ashley v. Brown, 6 Vet.
App. 52, 54 (1998).
The record further includes medical evidence of the diagnosis
of chronic anxiety state with conversion reaction in October
1966. In a November 1966 entry, the physician noted that the
veteran had a long-standing history of neurotic behavior and
that his present symptoms represented a continuation of that
behavior. Valium was prescribed, and further psychiatric
consultation was recommended. Reference at that time to
prior treatment with Librium, Vitamin B12 and Valium
indicates at least some treatment between the time the
veteran was reportedly treated with Thorazine in 1960 and
1961 and documented treatment in late 1966. In this regard,
the Board notes that Librium is indicated in the management
of anxiety disorder. Shockley, 11 Vet. App. at 210.
Later medical records show continuing treatment of the
veteran's symptoms throughout the 1970s, 1980s, 1990s and
through to the most recent available treatment records dated
from 2000 to 2002. The terminology associated with the
diagnoses related to these symptoms has varied, including
schizoaffective disorder, manic-depressive disorder, and
bipolar disorder with PTSD and most recently bipolar disorder
with anxiety disorder. The symptoms reportedly associated
with these diagnoses, primarily mood swings with depression
and anxiety, have remained essentially the same over the
decades starting with the nervousness documented in service
and mood swings reported by the veteran to have occurred in
service and confirmed by a lay witness. Further, medical
professionals, including Ms. Turner, Dr. Coleman and Dr.
Deamer have specifically related the veteran's current
psychiatric disability to the symptoms that were manifest in
service and which have been shown to be present since then.
Resolving all doubt in favor of the veteran, the Board finds
that competent medical evidence relates the veteran's current
psychiatric disability, variously diagnosed as bipolar
disorder and anxiety disorder, to his military service
warranting the conclusion that his bipolar disorder and
anxiety disorder were incurred in service.
ORDER
Entitlement to service connection for bipolar disorder and
anxiety disorder is granted.
____________________________________________
STEVEN L. COHN
Veterans Law Judge, Board of Veterans' Appeals
IMPORTANT NOTICE: We have attached a VA Form 4597 that tells
you what steps you can take if you disagree with our
decision. We are in the process of updating the form to
reflect changes in the law effective on December 27, 2001.
See the Veterans Education and Benefits Expansion Act of
2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the
meanwhile, please note these important corrections to the
advice in the form:
? These changes apply to the section entitled "Appeal to
the United States Court of Appeals for Veterans
Claims." (1) A "Notice of Disagreement filed on or
after November 18, 1988" is no longer required to
appeal to the Court. (2) You are no longer required to
file a copy of your Notice of Appeal with VA's General
Counsel.
? In the section entitled "Representation before VA,"
filing a "Notice of Disagreement with respect to the
claim on or after November 18, 1988" is no longer a
condition for an attorney-at-law or a VA accredited
agent to charge you a fee for representing you.
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Yes Berta this is the same doctor I have also checked him out and as for now he is good to go but I plan to have the V A stop him from doing evals if I can.
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"Dr. Abejuela, who has been working as a nurse's aide to support his family, said he had been unable to enter a hospital residency training program because of the medical association's new policies. He said he had high grades on qualifying tests, and had sent letters to 380 hospitals seeking admission to graduate training programs, but was granted only one interview."
I wonder if he got his MD certification by now-dont know if it is the same doc- but maybe-is he from the Phillipines?
You might want to check this guy out on Healthgrades.com
and see if he is qualified doctor-
and even try to get another C & P by complaining to the director of this VAMC.
http://query.nytimes.com/gst/fullpage.html...mp;pagewanted=3
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Hello everyone I would like to say I received my doctor report from my 11-29-07 exam and I would like to let everyone know the doctor lied on me through out the entire report. He had to be talking about someone else because I did nothing he stated in his report. This is a few things he said I was calling the V A names using foul language he said I said I had a problem with my doctor at the V A and he said I was calling him names.He said I showed up early and was demanding to be seen he also said I wanted him to exam me for my back and not the depression he said I wanted to structure the interview he said I was very un-cooperative and hostile he said I hates talking about the miltary he said I occasional have difficulty performing activities of daily living. He used my old G A F of 51 dated 2004 and it was 2003 and it was used on my last rating decision of 2004 also he used a 61 GAF he gave me in June 2004 which was used on my last rating decision. From my last rating decision my doctor at the V A has given my a GAF of 50 13 times. Could this fool use my scores from my last rating decision. I have already asked for a hearing I also plan to try and have this doctor removed from doing C% P exams His name is Dr. Reynaldo Abejuela out of Riverside Ca.
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Hey Spike could you please e-mail me at lflint33@hotmail.com so we could hook up.
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Thank you all I will be at the VARO San Diego today with a letter requesting a personal hearing because I have not got any better. My back is 60 % and under 5293 that is as high as it could go. I go to all my DR. Appt and yes I do have on going treatment for my back and the depression and also my ortho Dr. at the V A put in his notes my back has progressivly got worse since 1986 when I hurt it and he said he anticipate it will relentlessly progressive affliction. Also I'm service connected for my lungs and now this is getting worse but they can't find out why and this is causing me a great deal of depression I told the Q T C Dr.Yes the Q T C Dr. was a real shrink. Like I said before my shrink at the V A has my gaf at 50 since June 4 2004 and he has had me on all kind of sike med from the start and I still take them and they don't work. He has told me time after that until they can control my back pain what he is treating me for will never get better. I don't understand I go see this clown one time and he give me a 51-55 gaf score. John 999 I am 41.I don't think they looked at my entire medical history because if my back is causing the problem and it hurt all the time and I can't sleep and do all the thing's I use to then how did I get any better. Berta yes my 100 is extraschedular and yes I get consistent treatment and medication for my back and for depression, also my back rating can't go any higher and yes he did note I have occasional difficulty performing daily living and I told him I have problems daily and my pain is always 8-9-10. I would like to add this to the DR. did not understand me that well and I did not understand him either. He told me on the way out don't worrie I agree with your treating Dr.
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Hello everyone I need to find out the best way to deal with a letter to reduce my rating from 100 % to 90 % . I was 70 % for Depressive disorder secondary to chronic low back pain and now they want to drop it to 50 % . My back hurt me all the time it has not got better and my Dr at the Va has my gaf a 50 since 2004 and I go to Q T C and he give me a 51 gaf and said I was not cooperative and he noted I occasional difficulty have problems performing daily living and this is not true.
Tell Us How You Have Been Treated By Varo
in VA Disability Claims Research
Posted
Hello all I use San Diego VARO and I must say they have been really good to me I got out the Navy in June of 1995. I put my first claim in in May 2000 and in Nov 2000 I got 70 % then I put in my second claim in June 2002 and in Sept 2002 I got 80 % then in Oct 2004 I put in another claim and they gave me 100 % in Jan 2005. AUG 2007 I called and asked about CH-35 they opened me back up and sent me to a comp and pen doctor with Q T C and that doctor said I got better and they sent me a letter to reduce so I got a letter from my doctor at V A Loma Linda and sent it to them and just last week they gave me everything 100 % P T SCHD. I will give them a A +.