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Here is the denial: 11. Service connection for post traumatic stress disorder. Service connection may be granted for a disability which began in military service or was caused by some event or experience in service. Service connection for post traumatic stress disorder is denied since this condition neither occurred in nor was caused by service. Mental Health progress noted of December 9, 2008, gives an Axis I diagnosis of depression and PTSD related to MVA. A letter from Theresa Mignone-Klostermann, PhD. dated April 10,2009, indicates that you have been in treatment since December 3,2008, under the care of Anna Kusche, MA and Sabrina O'Kennon, and supervised by herself. This is for treatment of PTSD and Traumatic Brain Injury secondary to a motor vehicle accident that occurred while on active duty in the military. These conditions effect your functioning in both occupational and social settings. VA Screening for PTSD on May 29,2008, was negative. You denied PTSD symptoms at Mental Health outpatient treatment on October 14, 2008. Psychology consultation on November 17,2008, indicates symptoms of PTSD related to motor vehicle accident. December 3, 2008, mental health outpatient notes indicate that in 2006, you witnessed a motor vehicle accident in which you saw people in a mini van "being carried out on stretchers." Since this time you have experienced significant increase in anxiety and PTSD symptoms (nightmares of accident 2x/week, mood swings, angry outbursts, fighting with coworkers, physical fatigue, increased isolation/avoidance, needing more "alone time"). Mental health outpatient note of December 9,2008 addressed the PTSD surrounding 2005 car accident: You acknowledged this accident as turning point for decline in functioning. You reported that you were driving with your children in the car and a rock "flew up and cracked the windshield by your son's head." No injuries were sustained, however, you have experienced significant increase in anxiety and decrease in daily functioning since this time. You stated that "before this, you were able to manage your issues. " It is determined that your PTSD is not related to your military service.

Hello All, Got the brown envelope yesterday and to my surpise my PTSD claim was denied. I submitted a very well grounded claim, with a daignosis and dr's letter providing a nexus to the event that happened while I was on active duty. I did not receive a C&P exam just a denial letter. Isn't a C&P required with a well grounded claim? Any advice will be greatly appreciated. Thanks!

I'm still working, and hope to continue for as long as possible. While I have had difficulty working, I have a Federal job, and they have been pretty accomidating.

I'm happy with the 70% for the TBI, but They denied the PTSD w/o a C&P exam. The 70% for the TBI put me at 90%, and I don't think the RO wanted me to get to 100 %. I will appeal the PTSD decision, and will post in the PTSD forum later.

Got the Brown Envelope Today . . . TBI 70%, PTSD deneid. Guess that the examiner only needed 7 mins for the exam.

68mustang, The book is a great tool, good advice on putting the claim together. Also, great advise on avoiding typical pitfalls.

J I've attached the info you requested (It's a pdf): page 1 is the claim page 2 is the chiro's nexus letter page 3 & 4 is the first denial page 5 & 6 are the second denial. Thanks for taking the time to look at this. Thanks! 1995_Claim.pdf

Thanks Time and Wings for the insight! Wings, yes I am working, but having a hard time, I also have PTSD from the accident, and besides haviing a hard time driving, and having issues with remembering how to do my job, I have developed a nasty temper. GAF is normally reported arround 50. I filed the claim for PTSD at the same time as TBI, but for some reason I haven't had the PTSD C&P scheduled yet. Time, thanks for pointing out the poss NOD on the memory issues esp since my memory is the bigest issue with the TBI.

Got the Exam back, and I'm not sure how it reads: Printed for data from 04/08/2009 to 10/05/2009 *********************** CONFIDENTIAL SUMMARY********************** -------------------------- CP - Compo & Pen. Exams --------------------------- 09/29/2009 TRAUMATIC BRAIN INJURY (TBI) Priority of Exam: INCREASE Examining provider: Approved By: Examination results: EXAM TYPE: Traumatic brain injury. The Veteran is a 42-year-old male. He was in the military from 1985-1991. His service file was provided and it was reviewed. He had two motor vehicle accidents that both occurred in 1989. In the first motor vehicle accident, he has no memory of the events. He said he had loss of consciousness. He said he was seen in the emergency room. He said in the second motor vehicle accident he lost consciousness for three hours. He said he had a three-day stay in the hospital. He says he has no memory of this accident either. The severity rating of the traumatic brain injury at the time of the injury is mild for the first one and moderate for the second incident. The condition has stabilized. He complains of headaches. The headaches occur about 15 times per month. They are moderate to severe in nature. They last all day. About three times a month he is unable to function because of the headache. He currently takes Excedrin Migraine. They resemble migraines. He denies dizziness, vertigo, weakness, or paralysis. He says he has difficulty falling asleep. He has insomnia. He has taken medications in the past with minimal benefit. This occurs on a nightly basis. He complains of daytime fatigue and malaise. He complains of mobility and balance problems. He described mild to moderate memory impairment. He describes short-term memory problems. He says he has decreased attention and concentration. He denies any problems with executive functioning. He has no speech or swallowing difficulties, pain, bowel problems, or bladder problems. He complained of anxiety and depression. He denied erectile dysfunction, sensory changes, vision problems, hearing problems, decreased sense of taste or smell, or seizures. He described hypersensitivity to both sound and light. He complained of irritability and restlessness. He has no signs of autonomic dysfunction, endocrine dysfunction, or cranial nerve dysfunction. His symptoms are stable. His current treatment includes Excedrin Migraine. He says that his daily activities are affected because of his frequent headaches that lead to time off from work. PHYSICAL EXAMINATION: MOTOR: Power, tone, and bulk (5/5) is normal in the deltoids, biceps, triceps, wrist extensor, flexors, small muscles of the hand, iliopsoas, hamstring, quadriceps, gluteal, foot dorsi flexors and plantar flexors. His reflexes are +2. Sensory exam was normal. Gait was normal. There was no spasticity or abnormal cerebellar signs. Autonomic nervous system was normal. CRANIAL NERVES: Visual fields full. Extraocular movements intact. Pupils equal, round, and reactive to light. Funduscopic exam normal. Sensation of the face normal. Tongue and uvula normal. Trapezius and sternocleidomastoid normal. Normal swallowing. Normal hearing. MINI MENTAL STATUS: 28/30. Psychiatric screening was normal. Vision and hearing screening normal. SKIN: Normal. ENDOCRINE/AUTONOMIC: Normal. No other abnormal physical findings. He underwent neuropsychological evaluation on 10/10/08. He was found to have difficulties with impairment of working memory, visual and motor scanning, sequencing, and verbal and visual memory. He also has symptoms of PTSD and depression. I. Memory, attention, concentration, and executive functions; see objective evidence of memory impairment. II: Judgement. A. Normal. III: Social interaction. A. Appropriate. IV: Orientation. A. Always oriented. V: Motor activity. A. Normal. VI: Visual and spacial orientation. C. Moderate impaired. VII: Subjective symptoms. B. Three or more. VIII: Neurobehavioral affects. B. One or more. IX: Communication. A. Able to communicate. X: Consciousness. A. Normal. IMPRESSION: The Veteran with traumatic brain injury. He has the capacity to handle his VA benefit payments:

Now thats the rub, I am not SC for any of the conditions, Here is my history: - In 1989, while on active duty I was involved in 2 separate car accidents, both involving injuries to my back, neck & head. - The second accident was considered poly-traumatic; I was unconscious for several hours, lost 3 days of memories, sever whip-lash, broken rib, clavicle, fractured shoulder blades ect. - The accident and all my injuries were well documented in my SMR's, including 2 years of pt for my back and neck. - Unknowingly I was suffering from TBI & PTSD, and did not re-enlist after 6 years. - I was granted 10% in 1991 for week foot condition, and during the VA examination - I brought up the car accident to the examiners attention, and was advised that since it didn’t happen during work it was not covered. - Within a year of separation I started seeing a chiropractor for back & neck pain. - In 1995, I filed an unassisted claim for back, neck, poor memory, and sever fatigue. (I do not even remember filing this claim until I got my C-file) - The claim was denied without a C& P being performed; they had the evidence of the accidents in my claim file& documentation from my chiropractor. What they didn’t have in my file was a nexus letter sent by my chiro to the RO. I happened to find a copy of the letter in my records. So could the exam for an Increase be due the claim being "reopened" or bacause the RO made a mistake when they denied me 10 years ago?

All, I got the results from my C&Pexams for TBI, Back & Neck,and noticed that the PRIORITY OF EXAM: is for an Incease. Why would Increase be the priority if these are initial exams. Any input would be appreciated.

Congrats on your win. . . I think!

Just wondering if this would apply to me? Here is my history: - In 1989, while on active duty I was involved in 2 separate car accidents, both involving injuries to my back, neck & head. - The second accident was considered poly-traumatic; I was unconscious for several hours, lost 3 days of memories, sever whip-lash, broken rib, clavicle, fractured shoulder blades ect. - The accident and all my injuries were well documented in my SMR's, including 2 years of pt for my back and neck. - Unknowingly I was suffering from TBI & PTSD, and did not re-enlist after 6 years. - I was granted 10% in 1991 for week foot condition, and during the VA examination - I brought up the car accident to the examiners attention, and was advised that since it didn’t happen during work it was not covered. - Within a year of separation I started seeing a chiropractor for back & neck pain. - In 1995, I filed an unassisted claim for back, neck, poor memory, and sever fatigue. (I do not even remember filing this claim until I got my C-file) - The claim was denied without a C& P being performed; they had the evidence of the accidents in my claim file& documentation from my chiropractor. What they didn’t have in my file was a nexus letter sent by my chiro to the RO. I happened to find a copy of the letter in my records. I have not been SC for any of these issues yet, but I have had C&P exams for back , neck & TBI; for the back & neck the examiner stated more likely than not, and the TBI examiner stated is directly caused by accident. Now once I get SC for these conditions, do you think that this thread would apply to me as well? Thanks in advance!

I agree that she's very nice, so I don't mess with her, I have her get of the counslors and mess with them. I've asked why they removed the date stamper, and the only reply I've gotten is that they don't date stamp any more, all the records are eletronic now. LOL

I live and work near the Buffalo VARO, so I normally hand deliver my records, and get a copy date stamped as evidence that I've submitted the claims. Recently the RO removed the date stamper from the receptionist. I asked for a receipt, but was told they don't issue receipts. Not to be beaten by these people, I went out and bought a RECEIVED stamp, and make them sign and date every page. Ha, they really hate me now!!!

Thank you all for your insight, I'm feeling a lot better! I guess I'll just have to wait for the C&P results. Thanks!

Thanks to all who answered! I've taken the following tests: Tests administered: Neuropsychological Screening Exam, Beck Depression Inventory-2 (BDI), Beck Anxiety Index (BAI), PTSD Checklist (PCL-M), Minnesota Multiphasic Personality Interview - 2 (MMPI-2), Clinical interview, Collateral report, Chart review. Here are the results: Average skills were noted in confrontation naming, letter and categoryfluency, reading (post high school level), repetition, digit repetition, serial subtraction (three and seven), design copy and clock drawing and setting. Digit reversal, delayed recall of a story, and visual incidental recall and new learning were mildly impaired but within normal limits. Moderate deficiency was noted in visuomotor scanning, story learning, visual delayed recall and verbal absurdities. Visuomotor sequencing and 12-word list learning and delayed recall and recognition were severely compromised. Responses on the BDI-2 were indicative of severe depression (33/63). Mr. endorsed the severe symptoms of crying, changes in sleeping patterns, and irritability. He also identified nine moderate and five mild symptoms of depression. On the BAI, the patient scored in the moderate to severe range of anxiety (24/63). He endorsed seven moderate symptoms of anxiety. Responses on the PCL-M met criteria B, C and D for a DSM-IV diagnosis of PTSD. MMPI-2: Test-Taking Behaviors: Items were endorsed consistently and accurately. There are no indications of either a very positive or negative self-description that would impact the interpretation of the MMPI-2. Moods: He reported experiencing a moderate level of emotional distress characterized by dysphoric mood, guilt and anxiety. He is often irritable and grouchy, experiences little pleasure from life, is a chronic worrier, and broods and ruminates about himself and his problems. He is likely to overreact to minor stress with agitation, guilt, and self-punishment. His feelings are easily hurt. He easily becomes impatient with other people and he gets angry with himself for giving in to others so much. He has become so angry he does not know what to do with himself and feels he will explode at times. Cognitions: He reported a number of problems with attention, concentration and memory. He is lacking in self-confidence and believes he is not as good as other people. He has a hard time making decisions and usually has to stop and think before acting even in small matters. He thinks often about his perceived personal deficiencies. His inertia and lack of drive reflect his depressive cognitions and negative expectations. Interpersonal Relations:He reported that he is introverted and easily embarrassed. He is passive and dependent and unlikely to be assertive. He is feeling alienated from himself and members of his family.

Just had my C&P for TBI due to MVA 20 years ago. The examiner stated she read my c-file, and thanked me for putting together such a "great" claims package. She asked a few questions about the accident itself, memory, headaches, ect. Then checked my reflexes, vision, and asked about my sense of smell. On my way out the door, she stated that I was SC for TBI, and the RO willl decide my %. All totaled the exam was 7:36. Does this sound right?

The accident even though it happened while you were on shore leave is a stressor for PTSD, and it sounds like it's been documented, so you should have the basis for a good PTSD claim.

I asked for a Sleep Study . . . and allI got was this lousey CPAP <G> All kidding aside. I was diagnosed with SA in 2000 by a civilian doc, and lately I wasn't sleeping well. Since I am now receiving care at the VA, I asked for a Sleep Study, and instead, they issued me an auto CPAP, which adjusts pressure as needed. I was instructed to bring the smart card back. A tech looked at the results, and said allbetter now, and that was it. I have to admit that I sleep better with the new machine, but waould have felt better with a new sleep study.

I received my $716 for knee braces. I also received a denial letter for "additional" clothing allowance for foot/ankle braces. I talked to the person who denied the second allowance, and she stated that I should file a nod as she was informed that the va would only pay 1 clothing allowance, even though a federal appeals court ruled otherwise. She also sugested that I contact my congress critter if the nod dosen't do anything.

I received my denial today for multiple clothing allowances even after including the decision Sursely v Peake, The denial letter only stated that the VA will only pay one clothing allowance. I am service connected for bi-lateral plantair faciitis for which I wear orthotics w/ braces, and bi-lateral arthriitis in the knees for which I wear hinged braces. I have recieved the clothing allowannce in the past for the knee braces. Looks like I'll just have to file a NOD, and ask for a hearing.

I am "static" to recieve a clothing allowance for hinged knee braces, in July I applied for a clothing allowance for the ankle braces I am required to wear for SC FEET & ANKLES. I cited Sursely v Peake and included the case. We'll see what happens.

Whats the catch? I was expecting to have to submit reams of paperwork <g> Thanks for the reply!

Had SC knee scoped last week and will be missing 4-6 weeks from work convalesing. Does anyone know what info from the surgen is required to file under Sec 30? Any advise would be appreciated. Thanks!