Paul Allison

I am just returning from the local VA clinic. It was a terrible experience. I went for an appointment with my assigned primary doctor in order to have prescriptions filled that are connected with my service-connected disabilities. I even went in with prescriptions written by my private doctor. Well, this doctor decides to question why I need these medications AND my disabilities. I just had a couple C&Ps in January and was notified of my increase in rating in March. And this doctor decides that she needs to get her voice in somehow. I'm so pissed that I'm rambling more than usual. Long story short, she won't prescribe any of medications without conducting her own tests, even though these meds were reviewed during my C&P and connected to the service-connected injuries. One of the meds is desmopressin. Folks, I have to have this medication, and I'm about out. So, she approves a couple days' worth. Well, the pharmacy tells me they don't keep it in inventory and that I need to purchase it at the local pharmacy and let them reimburse. Keep in mind, the only reason I'm even at this clinic, because I'm not required to check in for medical or psychological, is that when I went to the local pharmacy to have the prescriptio ns filled from my private doctor, 1 MONTH of desmopressin is about $1000. No way can I afford that. So, I'm pissed and fuming, and wanting to vent.

Just curious what folks think are the friendlist states for disabled veterans and why. Paul

Depression does suck. You might ask your doctor about Cymbalta. It's the latest one for me... It becomes generic in June, so the cost should drop (that is, if you're paying out of pocket). Paul

Thank you for the advice. The Request for Reconsideration went into the mail (certified with return receipt) earlier today. I countered every point I found false or inaccurate. I also stressed my age (31), the impact that the constant voiding (Diabetes Insipidus) has on my quality of life, and their rater's own statements regarding my inability to work (along with select quotations from other doctors). I am hoping the rater will look at my file, my current rating, and this letter, and bump my rating such that I am 100% scheduled. I might be naive in that hope... However, If it does not pan out, then I will file the NOD within the 1-year mark. If I am awarded the 100% scheduled rating, then I am not going to bother with seeking backpay. The time and hassle are not worth it to me. What sort of experience have you had regarding the length of time it takes for a response and decision regarding the Request for Reconsideration? I have read on this forum that it generally does not take as long as a NOD. Again, thank you (everyone) for the advice and guidance. This has been a multi-year process for me given that I tend to have to work in intense spurts. Paul

Another question: Can this be included in a REQUEST for RECONSIDERATION? I request reconsideration for back pay to XXX. According to § 4.129 -- Mental disorders due to traumatic stress: “When a mental disorder that develops in service as a result of a highly stressful event is severe enough to bring about the veteran's release from active military service, the rating agency shall assign an evaluation of not less than 50 percent and schedule an examination within the six month period following the veteran's discharge to determine whether a change in evaluation is warranted.” As my PEB indicates, I was honorably discharged from active military service with a service-connected injury to my brain incurred in XXX. Despite this highly stressful event, I was NOT awarded 50 percent and scheduled an examination within the six month period following discharge. Instead, I was rated with post concussive syndrome with chronic headaches, cognitive disorder and mild dysthymia at 10% disabling AND rated with left upper extremity (minor) weakness due to herniated discs, cervical spine, with radiculitis at 10% disabling. In consequence, given the above evidence documented within my records, I request back pay.

I just re-read the decision letter. You are correct. I only need one or more episodes of dehydration in the past year not requiring parenteral hydration. Thank you. I made the correction in my tentative NOD and REQUEST for RECONSIDERATION letters. However, I still don't have evidence within their one-year frame. The last blood work that indicated severe dehydration was in 2006. Since that time, they have increased my desmopressin (medication) to a very high level. What is the code for the Urinary Frequency you indicated below? Can I include this code in the REQUEST given that the decision letter indicates that I have "polyuria with 3-4 per hour voiding" and their examiner wrote, "ongoing severe poluria or almost continuous epidodes, day and night, of urination."

Interesting. I had NO clue of this rating. Thank you for providing it. I am rated for Diabetes Insipidus (DI) due to damage in my hypothalamus. It causes a variety of problems (e.g., urination, fatigue) AND can lead to congestive heart failure. It might be worth you checking out DI. Anyone, does the DI subsume the Urinary Frequency rating?

Everyone- Thank you for the useful advice. I did not intend to exclude by indicating Berta within my last post. Do I send the Reconsideration Letter to the same place as the NOD? And regarding the urinary problems... I actually brought the medical examiner a copy of a "pee" log. If that wasn't enough, the legit 12+ visits to the restroom over the course of my examination probably helped convince him. The psychological examiner verbally indicated that the "pee" log was not relevant to that examination. I disagreed with him and pointed out that it affected my quality of life, but that never made it into the decision letter either... Paul

Thank you for your response to my thread, Berta. Warning: long message. The entire appeal process (filing to deposit of money in my bank account) took less than six months. I think my case was expedited because I am (just) 31, incurred a service-connected mild traumatic brain injury, and had evidence from many doctors. The decision included: 1) Evaluation of dysthymic disorder due to post-concussive syndrome/cognitive disorder at 50%; 2) Entitlement to a separate evaluation for migraine headaches at 50%; 3) Evaluation of degenerative disc disaese and cervical spondylosis C4-C7 at 10%; 4) Evaluation of plantar fasciitis, right foot, at 10%; 5) Evaluation of neuralgia, right sural nerve, at 10%; 6) Evaluation of left upper extremity (minor) weakness due to herniated discs, cervical spine, with radiculitis at 10%; 7) Diabetes insipidus (DI) at 20%; 8) Entitlement to individual unemployability is denied. This totals 90%. I do not currently receive SSA disability. The rater didn't attempt to rebutt anything in my claim. It appears I was not awarded TDIU because the C&P "mental" evaluator reported I was employed, which was (and is) not the case. He spent maybe 15 minutes with me. This is in contrast to the C&P "physical" evaluator who spent over 3 hours with me. He was a specialist in TBIs (or at least presented himself that way). He asked very specific questions that none of my very good private doctors ever thought to ask about. He took notes nonstop. I've requested a copy of my "C" file. I don't know what to do regarding TDIU. Since their evaluator recommended me for it (essentially), I think I have a strong case to appeal. However, given my age I am conflicted. Healthwise, I have mangeable days and VERY bad, dark days. If I take TDIU at 31, then I am capped at ~14 grand/annually in part-time work. I can make twice that in such work at this time in the 2-3 mangeable days/week. The ideal situation for me is to be rated at 100% and retain the ability to hold full-time employment, thus no cap in earning potential, while leaving the door open for unemployability given that all my doctors think as I grow older, it's only going to get much worse. So, in some ways, the VA's mistake might not be so bad for me if I can get the scheduled rating up to 100%. I just don't know how to do it. As you know, that last ten percent is very difficult to achieve. I think the areas I can argue include diabetes insipidus and dysthymic disorder. The DI was rated at 20% because the blood work records I submitted proving two separate periods of dehydration without parenteral hydration were outside of the one year required for the 40%. And since my endocrinologist has placed me on desmopressin, my BUN/Creatine ratio (used to gauge dehydration) is within the (high) acceptable range. The DI is awful though... I urinate (on medication) 3-4 times/hour. I am quite sure it contributes to my low quality of life. I don't know how to argue to have this rating increased given the lack of medical evidence. The dysthmic disorder is a different story. The decision letter contai ns several egregious errors. I just don't know how to get this rating increased; thus, why I inquired about secondary or comorbid conditions to investigate that might lead to a higher rating. If this rating could be increased to a 70%, and the DI to a 40%, I would be at a scheduled 100%, I believe. Not sure. The better option would be to somehow argue for an increase of the dysthymia to 100%. Not sure if this is possible, despite the MMPI-2 scores that reflect I am suicidal, homicidal, etc. My psychologist and psychistrist had my GAF between 45-55. The VA examiner put it at 60, I believe. So, below is my tentative NOD; rather, the one I will ask the VSO to write and send. It is: Department of Veteran Affairs Attention: XXX – In reply to: XXX Dear Sir or Madam, I received a rating decision dated XXX. Consider this letter to be an official “Notice of Disagreement” (NOD) regarding the following disability: 1) Evaluation of dysthymic disorder due to post-concussive syndrome/cognitive disorder. I disagree with the examination from VA Medical Center XXX, which showed that I denied current suicidal ideation or any past attempts. I did NOT deny current suicidal ideation. I did deny homicidal ideation. At the time of the examination, I DID (and still do) have obsessive suicidal ideation and stated as much to the examiner. Suicidal ideation is corroborated by the results of the MMPI-2. Also, I did NOT report having five friends. I reported having less than five friends (<2) and difficulty in establishing and maintaining relationships. These inaccuracies must be amended within my record. Further, as indicated in the neuropsychological testing conducted XXX by XXX (included in the original PEB disposition), resulting in an Axis II diagnosis of Obsessive-Compulsive Personality Traits, XXX stated: “Mr. Allison is seen as a highly obsessive individual who does present with some obsessive-compulsive personality characteristics.” Further, there ARE deficiencies in most areas, such as work, school, family relations, thinking and mood that interfere with routine activities, as indicated in a letter from XXX dated XXX: • “Paul faces lifelong limitations due to this traumatic brain injury”; • “The memory deficit has created a lack of confidence and profoundly effects inter-personal relationships”; • “Paul is unable to drink coffee, tea, colas, and any number of beverages that have a diuretic effect. He is restricted to carefully chosen dietary items, as he has found a large number of foods ‘not worth it’ since symptoms can be very disruptive in a social, work, or classroom setting. Restaurant choices must be made very carefully”; • “Paul’s career choices will be limited …” • “Since the XXX accident created a traumatic brain injury it is as likely as not there will be a continued decline in function and working memory which will impact Paul’s way of life, potential livelihood and inter-personal relationships.” Further, it is the VA medical “examiner’s opinion that you are not a candidate to work because of your service connected disabilities.” In consequence, I disagree with the VA decision to award only 50 percent for the service connected dysthymia. The higher evaluation of 70 percent IS warranted given the documented occupational and social impairment, with deficiencies in work, family relations, thinking and mood. (should I push for 100%? -- I'm not sure what that requires) I am requesting a “De Novo Review” by a new Decision Review Officer. 2) I disagree with the examination from VA Medical Center XXX, which showed that I am currently employed part-time with XXX. I am NOT (nor was I at the time of the examination) employed by XXX. My last month of employment was XXX, as indicated in my federal tax records. This inaccuracy must be amended in my record. I am unemployed and have been unemployed since XXX. I will be awaiting your reply. Sincerely, Paul Allison 24 March 2008 Thank you for reading this Berta. Suggestions are welcomed. I've been piecing my claim together for several years from the threads on this forum and with the help of a loved one. Paul

I've been a long-time lurker on this site. Thank you all for your wonderful service to disabled veterans. I recently received a decision on my claim for service-connected compensation. My old rating was 20%. My new rating is 90%. I feel fortunate (though it is deserved) given the experiences of many of the veterans and their struggle with the Va. But there are inaccuracies within the decision letter. So, I'm hoping that several of you will offer me some guidance on how to proceed. 1) I was rated 50% for Dysthymic Disorder. What is needed to be rated 100%? 2) I disagree with the examination from VA Medical Center XXX, 2008, which showed that I denied current suicidal ideation or any past attempts. I did NOT deny current suicidal ideation. I did deny homicidal ideation. At the time of the examination, I DID have suicidal ideation and stated as much to the examiner. Suicidal ideation is corroborated by the results of the MMPI-2. Further, I did NOT report having five friends. I reported having less than five friends. There is also documentation supporting deficiencies in work, family relations, thinking and mood. This is important because my medical evidence (i.e., letter from medical doctor, letter from psych iatrist, letter from psychologist, and MMPI-2 results) support (at minimum) a 70% rating. How do I get this corrected within my record? Can this be accomplished within the NOD? 4) What are comorbid or secondary conditions that I should be exploring given the Dysthymic Disorder? 5) I disagree with the examination from VA Medical Center XXX, 2008, which showed that I am currently employed part-time with XXX. I am NOT (nor was I at the time of the examination) employed by XXX. My last month with XXX was XXX, as indicated in my federal tax records. This is an error that must be amended in my C-file. I am unemployed and have been unemployed since XXX. This is important because I filed for individual unemployability. It was denied. However, the decision letter states, "It is the examiner's opinion that you are not a candidate to work because of your service connected disabilities." It is also supported by an evaluation of 50% for Migraine Headaches, which indicates "very frequent, completely prostrating, and prolonged attacks productive of severe economic inadaptability", and a letter from my medical doctor indicating life-long difficulties regarding acquiring and maintaining a job. How do I get this corrected within my record? Can this be accomplished in the NOD? If you've made it this far, thank you. Paul