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Rockhound
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Posts posted by Rockhound
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cowgirl: Since another copy of my C-File would be a bit much for my pocket book. I am thinking of having a look at it at the VARO. I wouldn't mind if I could go over my file with my VSO present so they can be witness to this certification not being their.
The only certification showing in my statement of the case is the VA Adjudicators statement that their had been a diagnosis change. No certification from the VA examiner that states that the original diagnosis was erronious.
Certification must come from a DR., in this case, a Dr. of Psychiatry and not from speculation by the VA Adjudicator that an alternate diagnosis had been made.
Speaking to the choir am I. LoL
Rockhound
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A thought had accord to me. What if you asked to review your C-File at the VARO and while you were doing so, you could not find a particular piece of evidence that the VARO used to deny your original claim. i.e:
1. Certification by Va examiner, that found the oringinal diagnosis on which SC was predicated upon, was erronious.
If they cannot provide this certification, what would you recourse be?
How would you know what evidence you would need, to rebutt their emplied evidence?
Is a difference of opinion, sufficient to change a diagnosis in a VA Claim? If the certification that the original diagnosis was in error, is missing, then that would be all that they had, if that.
;) 
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I am not arguing the need for C&P exams, just their timing and under what conditions one should be demanded.
Sec. 3.326 Examinations.
(a) Where there is a claim for disability compensation or pension
but medical evidence accompanying the claim is not adequate for rating
purposes, a Department of Veterans Affairs examination will be
authorized.
What I am saying that this regulation is to vague. Rating purposes, to me means that SC is not the question, but that rating the percentage of disability is.
A C&P examination to Rebute SC should be a different regulation and their should be a time line to follow by the VA in order for them to deny SC. To buch these together only further complicate the issues.
If SC is in question, then they must first follow specific steps, such as is spelled out in M21-1, but apparently since M21-1 is not a CFR or a USC, then it is not inforceable, nor can the Veteran use it to argue that his due process rights were violated. Nothing backed by Law says the VA has to follow this procedure.
One reason for a C&P exam is that the adjudicator is contimplating denying SC. This is done out of sequence with the Veterans due process rights. Shouldn't the Veteran be given the opportunity first to know that SC might be denied and given time to seek out or provide addition evidence, that would provide the necessary information neccessary for adjudication purposes? Making it unnecceassary for a C&P exam, except to determine the percentage rate of disability.
I could use some direction on how to present this to my Congressman and/or Senator.
Rockhound. :o
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How can one get how and why the VA can demand a C&P exam?
For instance: Veteran was injured and or diagnosed with a disease and/or disorder. Shows where he was examined, tested, and/or observed, then treated clearly in service and/or was medically discharged for said injury, disease, and/or disorder. Why then is the VARO allowed to demand the Veteran to submit to a C&P exam, without first determining whether or not what his claim is predicated upon is Service connected or not, without first allowing the Veteran to provide additional evidence in his favor to support the continuation of his claim for Service connection.
I understand that a C&P examination may be required, if their is some question as to SC, But shouldn't that come only if the Veteran is not able to come up with additional evidence to support his claim? After all this is supposed to be a non adversarial proceding to determine SC, isn't it?
It seems to me, that if you allow a C&P before the Veteran has a chance to prove his claim to SC, then the timing of the C&P exam is paramount to avoid even the suspicion of inpropriety that it is an advasarial procedure and not a nonadvasarial procedure.
If SC is extablished from in-service records, Then it should only be the need of a C&P exam to show or determine the percentage of disability and not go on a fishing expidition for a different diagnosis.
I'd like to see a change in how or when a C&P examination is used and/or required.
That if used to clarify an injury, desease, and/or disorder. That the VARO must show cause reason and basis for why the records of the Veteran's is not sufficiant for rating purposes. Give the Veteran first bite a the apple to prove that it is and/or provide additional evidence to support why it is, before they can issue a demand for a C&P exam.
Further, should the VA C&P exam show evidence against the Veterans claim for SC, then once again the Veteran should be allowed to provide evidence to rebute the VA C&P examination report, prior to any decision being made on the claim for which SC is predicated upon.
Also. concerning DSM IV AXIS I and II. If SC connection is predicated on AXIS I, and their is also a AXIS II condition. Then only the AXIS one can be used to determine SC, since SC was not predicated on II, it should have no consideration.
Sorry if this is no more than a rant. but how does one pose such question of Law to the VA to show how advasarial the VA procedures are and how predudicial they can be when not properly applied in a proper sequence when applying them.
Rockhound :o
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Come on people, surely someone has information on this matter???
Rockhound :o
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I guess I have three questions, not one.
How much weight should a Veterans Statement, as to personal and medical history be accorded in a claim for a mental disorder, when their are no direct facts to tell if the statements are true, under stated, overstated, or just an imaginary tell as the result of a mental disorder or even possibly a false belief given, even after a minor TBI with concussion and short period of unconsciousness?
Is this why it is important for psychological tests, exams, and observation be noted and given to a Veteran when a mental disorder is claimed or more importantly when a diagnosis is changed from a mental disorder to a developmental disorder?
How can it be that a single, time limited, examination by a VA examinor, which is only supported by the Veterans own recollection of events prior to service, during service, and after service or as stated as the history and his time limited observations, be more probative than a conferance of both Medical and Psychatric Dr's, whose findings are supported by not only tests and exams, but daily observations, over a much longer period of time, be given more weight, when a mental disorder is what the claim is predicated upon?
Rockhound :o
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rentalguy: That's been my problem with being treated by the VA. Their only concern is treating my current symptoms and/or diagnosis. They have no concern as to what happened to me as a child or in the USN. I've asked till I am blue in the face as to whether their is nay corrolation between my symptoms and diagnosises now and what happened in service or if as a result of what happened in service. I get no where. I am hoping that an appointment in Feb. will turn over a new leaf in this respect, but I am not holding my breath at this time.
Rockhound :o
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Thanks Josephine: Best information for my psychiatrist to have thus far.
Rockhound :o
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When you file your appeal or a claim for increase, and as you say, your personal relationships with family and friends is suffering. Ask them to write out statements as to their personal observations of your condition and to then sign it. I certify that to the best of my knowledge all that I have stated in this letter is true and accurate. Having it notorised wouldn't hurt. Of course having it notorized will cost a few dollars, unless you are friends with a notory.
Of course an IMO/Independent Medical Opinion as to your condition being so severe that it would be impossible for you to seek substantial gainfull employment would also help your claim. You could use that also to file with Social Security for SSDI, if you do not already have it.
Good luck, and yes 10% is a joke. :o
Rockhound B)
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I have pretty much read everything I can find, on this subject till my eyes, at times, become blurred, due to dry eye syndrome, as a result of my Sarcoidosis and Glaucoma conditions.
I'd say that (99.9 %) ninety-nine point nine percent of what I read, deals with a diagnostic change after SC has already been awarded and not enough of the (.01%) point zero one percent, dealing with a change of a diagnosis at the VARO, AOJ in an original claim where SC has yet to be determined, to be of any use.
Does anyone have any cases, or know of any, that deal with the VARO, AOJ, in an original claim, not following the statutory and/or regulatory procedures, when they assert that a previously diagnosed disorder/disease, for which SC was predicated on, was wrong and that their C&P Examiner opinioned a different diagnosis. Using that diagnosis, without the proper certification, that the original diagnosis was clear and unmistakenly erronious, to then deny the claim, since the new diagnosis led one to believe that it predated service and/or was a defect and not a disorder and/or disease, for which SC could be assigned?
I maybe asking the wrong question in the search engines, but no matter what I ask, I end up with everything but cases on this subject matter. Even the M21-1, CFR and USC seem to be written in a manner that SC has already been decided upon.
I've got to find something to help support an independent medical opinion, besides what the Dr might provide. I do not want to give the VARO room to wiggle out, when next I file my claim.
Rockhound. :o
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Thanks Josephune: That explains "deferred", but it doesn't explain why every one of my AXIS II findings are deferred. Either I have a personality disorder or I don't and not one on my Psychiatric evaluations before the VA Examiners report, state, say, or otherwis insinuate that I had a personality disorder and not once have these types of evaluations since then.
Can you understand how this has left me in a state of perpetuating anxiety, that just because the VA examiner said I had a personality disorder, and the VA adjudicator says that my original diagnosis was wrong. Why I worry so much about having another psychotic break and end up hurting someone this time?
I've asked, begged, and pleaded for some sort of closure on this matter, for so long, that now everytime I become too stressed out with everyday life, my anxiety levels climb through the roof and my depression drops to the deepest pits of Hell.
I'm hoping that in Feb. this closer will begin. Otherwise I am not sure I want to go on treating something I am told is a personality disorder with Drugs ment to treat mood disorders and schizophrenia. Heck, I can't even afford the meds for my physical problems as it is. Two less would mean money enough to pay for two and half trips into town each month.
;) 
:o :P B) -
AXIS I is used to show the primary diagnosis, AXIS II shows the personality traits I believe???
What is ment by AXIS II.........Deferred???
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Question: Is it required of the VARO AOG, under the Duty to assist Veteran in proving his claim, to state what evidence is required to rebut their use of an alternate diagnosis, that is used to deny Veteran claim?
If I have continuelly applied for SC of a psychiatric disorder, and they claim it is a personality disorder, must they state as to what evidence would be necessary to rebut the personality disorder as wrong or since it has been some time since last C&P exam, provide you with one?
If a C&P exam is conducted and the C&P examiner relies on the prior C&P examiners report, can I then if they deny, appeal that the C&P exams failed to meet the statuatory and regulatory requirement for adjudication purposes, since their is no certification by the prior VA Examiner, that clearly and unmistakably finds the original psychiatric disorder erronious and that the personality disorder is being made to correct it?
Rockhound :o
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It's not that I want her to change it, I just want to make sure that once my psychiatrist reads the actual records about my prior psychotic episode, that she writes something that shows that during this most recent visit, my statements should not be used as facts of trueth, but as an idicator of how mixed up my thought processes were that day.
After reading this most recent report, I can not even remember saying most of what she had written down.
I'll just have to see that she gets the records to pre-view and make sure I write down some questions I need answered when my appointment in Feb. come around.
Rockhound :o
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Last week I sort of lost it, nearly ended up on the fifth floor of our VA Hospital, which is our psych ward.
A week later I picked up a copy of my psychiatrists report of that visit and boy is the information on it all messed up, none of it makes any seance compaired to what has already been recorded of past events that I tried to relay to my psychiatrist concerning what happened to me during service, that led to my medical discharge.
I wanted to take the report and ask her how she could have written what she did, then I thought as to how I must have really been messed up, if this is the what she preceived what I was saying.
I'm wondering if I should wait until the later part of Feb. when my next appointment is, to talk to her, since I will be providing her with my medical records of that time in service, for her to look over, for a IME/IMO.
After reading the report of the actual events and such, she will be able to see where my thought patterns were not conhesive that day last week. For the two reports seem as if they were of two different people, for two different events in their lives. Very little of which would lead one to think that they came from the same person.
Should I wait, or should I make an earlier appointment?
Rockhound :o
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Sorry for the late follow up. Had a bad horse to deal with and problems accessing the forum.
When I asked the SSA clerk, how am I to tell if any of the coded reasons they gave me, in determining my claim for SSDI were for psychological problems and she said that it was. But now that I have the Codes deciphered. There is no mention on my psychological problem, that made up for at least half of why I cannot work.
I'm totally confused why it is not mentioned as part of the reason for my SSDI award. Especially when you consider that Sarcoidosis, an Auto-immune desease can go into remission, sometimes permenently or at least long term, which would then eliminate several problems that prevent me from seeking substantial gainful employment.
Sorry to say, that after four years now, it is still with me, but thankfullly it hasn't progressed to my heart and lungs or other organs of my body like some people I know. At least not significantly enough to note at this time.
Rockhound :o
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What happened to me in service was an Acute Schizophrenic Episode, In Remission. At the time of my medical discharge their was no active psychosis and as far as I know and/or can show, is that I contiue not to have any active psychosis. If I did, I would probably be locked up for killing someone this time. Or if I went into remission would have been on some heavy anti psychotic drugs, stronger than or at a heavier dosage I currently take.
What I am wanting to SC is the Adjustment disorder with major chronic depression and anxiety that I feel is as a result of that psychotic epidsode, since the medical board said that I demonstrated moderate impairment to social and industrial adaptability, which possibly would be permenent, but severely impaired for future service in the military.
The Medical board also stated that I suffered from depression and anxiety due to this psychotic episode.
My latest 72 hr self admit Dec. 2005, DSM IV Axis states:
AXIS I Dysthymia with MDE and anxiety
r/o adjustment disorder with mixed anxiety and depressed mood
AXIS II deferred
AXIS III Adjustment disorder with anxiety
Sacrcoidosis
Obstructive Sleep Apnea, mild, mostly sleep hypoxia for which he is
on nightime oxygen
Chronic sinusitis
Restrictive lung disease
Osteoarthritis of knees
Hypothyroidism
DM II
Hypertension
Morbid Obesity
Mild pulmonary hypertension.
AXIS IV Limited mobility, unemployable
Axis V GAF at admission 30, GAF at discharge 55
Mr. XXXXXXX's MMPI-2 profile is consistant with the following diagnoses: Paranoid or Disorganized schizophrenia; schizotypal personality disorder; and bipolar disorder. However, given that Mr.XXXXXXX was referring to the psychotic episode in his distant past when he endorsed items suggesting psychotic symptoms, and that his clinical presentation di not include typical psychotic symtoms, Mr. XXXXXXX is likely suffering from Major Depressive Disorder wit atypical and/or psychotic features.
When I was accessed for admissionmy
AXIS I Schixophrenia by hx
Depression NOS
AXIS II Deferred
AXIS III See problem list
AXIS IV Step father ill - per Dr. SXXXXX note
SC problem - per Dr. SXXXXX Dr. Stoll's note
AXIS V GAF 30
I have no idea what was in that note, not part of the medical file. Is their some way I can access that note with a FOIA request. This Dr. is on a leave of absence, may return in six months.
Time for pills. They seemed to be working agian.
Rockhound :)
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testvet: you misunderstand what I said. The TDIU I got from the VA was for NSC Pension and not for SC Disability & Compensation. Since my SSDI award is more than my NSC Pensio, it went by,by. You cannot collet both unless your SSDI is less than you NSC Pension. Then the VA will pay the difference.
I am and have been fighting to SC my mental disorders to that, what happend in service or at least as a result of the psychotic episode I had in service. but the VA keeps refering to a diagnosis change that was not supported by statutory or regulatory procedure or by the evidence in the VA Examiners report.
Just suffice that a Pension is not the same as SC disability compensation.
Rockhound :)
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Thanks everyone, thanks CG for the list. There has to be something missing in this determination. even though I am obese is size and have osteoarthritis and other problems, it just doesn't seem like enough to award me disability, at least not on my first try. I filed my papers and they awarded me disability, no argument, no fuss. Even the VA didn't consider my weight and other problems were worth mentioning in their pension award. I was given 30% Sarcoidosis and 50% for a adjustment disorder with depression and anxiety with TDIU.
It just doesn't make since to me that SSA would not list the Adjustment disorder with Depression and Anxiety. listing it with a Diagnostic number.
I guess I shouldn't rock the boat, trying to get SSA to acknowledge my mental problems. I got half my battle won getting SSDI so All I need now is the VA to step up and do the right thing, even if I half to twist wome arms to get it. LoL
Rockhound :)
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Went to Social Security Admin. Office today and asked for a copy of my award letter and reasons for my award of SSDI. The letter stated when and how much I was getting, but the reasons for their decision to award me SSDI is only listed with a DIG & SDIG code number.
DIG 2780 and SDIG 7150.
When I told them how am I supposed to know what these codes ment, or how I was to let my Dr or Psychiatrist or even the VARO on a claim I was working on. The clerk told me that the VARO would know what the Codes mean.
Why wouldn't they tell me? Are these Codes so imflamitory as to my mental statis that they must keep me from directly knowing what they mean?
Will a FOIA do me any good to get this information. I could possibly even be probative to my claim to refute the PD I have been saddle with. How am I to tell?
Rockhound :)
p.s. Am I paranoid if the Government is really out to do me harm?
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I stopped by the SSA office today to pick up a copy of my award and reasons given for the award. To my surprise they handed me a letter with no more than Code numbers on it and would not tell me what they ment.
I asked how is my Dr. or psychiatrist or even the VA to know what these Codes mean. They told me that the VARO would know what they ment. I asked them why they used the Code, my Dr and/or psychiatrist needs to know what they mean and they will have no clue.
As it turns out, I was right, the VA hospital has no idea, nor the Social Worker I talked to. I went by my VSO and even they didn't know what the Codes stood for.
Don't I have a right to know what these Codes mean? What must I do if the VARO will not tell me what the Codes mean? Can I submit a FOIA request, will SSA be forced to tell me what these Codes mean? Will a similiar request to the VARO make them tell me what these Codes mean?
The Codes are DIG 2780 and SDIG 7150
This has me so upset and my paranoia that the Government is out to get me is really beginning to scare me. It's things like this that gets my idealation screeming at me to do something. Time for Meds. I hate taking them, makes me feel like a Zomby.
Any help is appreciated
Rockhound :)
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Quick not: I am not saying to lie. But I would refraise my wording about when most of his migraines would come to him after work and on his days off.
I would say something like my mirgraines would come on after a hard day at work, and at times at the end of a siminly long week, I would then spend my time away from work suffering from and recouperating from the migraine. Had it been a work a work day I would have been force to miss work and spend more time having a physician document these episodes for the benefit of my employer. As it is, with the medication I am currently on I am able to mitigate the number of times these migraine episodes interfere with my employment. Even though I am able to be home for the most part and able to treat my migraines, I still must spend these times in bed at rest, since I am unable to do anything else during these times.
Something like that. Don't point out that they only happen after work, it should make it sound that they come on during or at the end of a work day or week.
Rockhound :)
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Even though a Veteran is over weight, even obese. You can ask for an opinion as to how much the broken Nasal bone contrilbutes to his Sleep Apnea. If it is sufficiant to say that even without the Veteran being over weight, the Broken Nasal bone, with deviated septum would still pose a contributing factor to the Sleep Apnea, then he could get at least a 10% rating.
I have a constricting/restricting lung disorder, with a contributing factor of morbid obesity. It is only surmised at this point that the C/R lung disorders is the result of the obesity, since I have a autoimmune disease called Sarcoidosis which can also cause these types of disorders. I also have a Nasal Fracture with a deviated septum. It requires daily nasal spray of a corticosteroid at the highest recommended dosage to maintain an open passage through the Nasal passages.
During my sleep study that was recommended by my ENT and PCP Dr's. I was diagnosed with minor obstructive sleep apnea with Nocturnal Hypoxia, which requires treatment with oxygen when I sleep.
So as you can see, it is tantamount that you get a proper medical opinion and diagnosis of your sleep apnea and a determination of how much your Broken Nasal Bone and possible Deviated Septum and/or should you be over weight, might be contributory factors.
I wish you good luck, but it is apparent you will need more than one opinion and the multiple opinions must take into account any contributory factors, to overcome the VA logic that if your over weight, then that is why you have sleep apnea and not your fractured Nasal bone.
I hope I have made some since. I'm on quite a few medication right now, some are for psychatric problems and may interfere with my logic and cognitive functioning at this time.
Rockhound :)
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John999: I'd be more than willing to spend time as an in-patient, but I have two pets, a cat and a dog. They both mean as much to me as if they were my children. Silly, irrational, or just crazy some may say. But they have been their for me without question or demanding no more than a soft word of praise, a treat now and agian, food, water and to lay down next to me and keep me company.
Physically speeking, I am alone, spiritially and mentally, there are those like you here at Hadit, who give me incouragement, advice, and well wishes. My cat and dog only have me to depend on and I do not have the resources to have them looked after by others, whether it be a neighbor, or a paid person or kennel.
Even my last stay of 72 hr self admit, I had the forethought to fill up their self feeders and put down extra water, to carry them through that trying time. But any longer or for an indefinite stay, I would have to make other arrangements. Giving them up is not an option I am not prepared to consider at this time.
I live out away from town about 25 miles, which puts me at odds with programs that would otherwise be available to me, Volunteers from the local SPCA are of no help because of this distance also and bording them at their Kennel is not with out a financial cost to me either.
Sorry for the rant, it hasn't been a very good day, The weather has me shut in once again and I am supposed to go into town tomorrow, Thursday. If it snows more than a few inches, I may not be able to get my chair to the road to be picked up and once in town, I may be limited in where and what business I will be able to complete.
Not to worry, the Sun has to come out sooner or later and it will put me in a better frame of mind and better alble to cope with what is happening and what is needed to be done.
As always, working on my claim has had profound effects on my mental stability and psychy. I am now forced to step back for a time to regroup and get a better grip on things once again.
I will be seeing my VA Psychiatrist this time in Feb. so until then I must collect what I can to support my claim for them to look over and hope they will help me in my effort for an IME. If this fails, I may not have a choice of a self admit.
Thanks everyone for you thoughts, advice, and just being their for Veterans like me.
Rockhound. :)
:o :P B)
Tbi & The Need For Neuropsychological Tests
in VA Disability Claims Research
Posted
c. Need for neuropsychologic tests. Most test procedures used in routine clinical assessment are relatively insensitive, detecting only major or obvious degrees of impairment. They are poorly quantifiable at best and have seldom been standardized. These deficiencies render them poorly suited for rating purposes. Standard, quantifiable neuropsychologic test batteries can overcome most of these limitations. Their use is desirable in all cases, except the most classical or severe, and is mandatory whenever the picture is not clear or easily defined. No single psychometric test is adequate for the purpose of diagnosing or grading severity of the loss of integrity of the “higher brain functions.” Rather, a coordinated battery of tests is needed, preferably administered and interpreted by an experienced neuropsychologist.
What I assume I am reading, is that the examiner cannot rely on just routine clinical assessments or not present on last exam, unless that exam used a battery of standard and quantifiable neuropsychological tests to make the prior assesment.
To simply state, not present at this time or not present at last exam, is insufficiant for rating purposes. Expecially if the last exam was also based on a routine clinical assessment and not a battery of standardized and quantifiable neuropsychological tests.
On the only quatifiable NP testing I ever recieved after a minor TBI. A electroencephlagraph showed a slow wave form tracing of the frontal lobe of the brain. This test was conducted at least two more times of record and even after being off medication for a time, the results were the same. These results can not be seen nor assessed by mear routine clinical assessments. Yet the VA thinks it can be by state that since it was not noted on last examination, they didn't even consider it for SC. Even though it was one of the injuries that I was specifically seeking SC for.
Even with a minor TBI, associated with an untreated or assessed slow wave form of the frontal lobe of the brain, it is as likely as not to cause personality changes, and/or adjustment problems and/or mood disorders such as depression and/or anxiety. I don't need to be a Doctor to know and read how this is true.
Anyone know how much a consult and an electroencephlagraph test would cost these days?
Rockhound