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  1. This is a reply to @Cliche Magnet's post - PTSD's long term effects. Did you win a decision? For some reason I was not able to reply the usual way (I could not type into the box). Incurrence and Continuity When did you discharge from military service, and when did you first seek mental health treatment? If you began to manifest symptoms of a psych disorder during service, and you sought treatment soon after discharge, and you have suffered from that same (or similar) disorder since that time, i.e., you have shown continuity of symptoms, then it is possible that VBA could find that the disorder was incurred during your military service and you are entitled to VA disability benefits. [See: 38 C.F.R. §3.303(a) and (b)]. This principle would apply whether or not your diagnosis is PTSD. In other words, if you manifested some posttraumatic stress symptoms, but not enough to satisfy the DSM-5 diagnostic criteria for the disorder, but all your psych symptoms considered collectively, for example, posttraumatic stress symptoms + depression sx + anxiety sx, do meet diagnostic criteria for another mental disorder, then that mental disorder could be service-connected, Service connection for a psych disorder under these incurrence and continuity principles poses some challenges, but I evaluated several veterans over the years who received disability compensation for such conditions. Usually the biggest challenge is that the veteran did not seek treatment until many years after discharge. In those cases, one of the fundamental questions the C&P examiner and the VBA adjudicator have to consider is, "If he had a mental disorder that caused functional disability for all those years, why didn't he seek help?" Of course, there are some very legitimate answers to that question, e.g., socialization causing men to avoid seeking help due to the narrow, rigid masculine role identity our society has historically imposed on boys and men; plus an ethos in the military to eschew mental health treatment because others will likely perceive it as a sign of weakness and incompetence. As an aside, I should mention that if a veteran suffers from psychoses during or shortly after military service, and he or she still has disabling symptoms from the same or similar psychotic disorder, then service connection is covered under a different regulation concerning chronic conditions. [See: C.F.R. 38 §3.307 and §3.309(a)]. PTSD If you have PTSD due to watching your friend burn to death, and your friend's tragic demise is documented, and your presence on the scene can also be demonstrated via documentation and/or lay testimony, then yes, the PTSD can be service connected. And in that case, a letter from your commander and others would be helpful. You could certainly seek an IME (I use the term, IPE, since I am a psychologist ;-), and that is something I do in my private practice, but frankly it costs $1000 or more and you can get a C&P exam for free. If the C&P exam ends up being inadequate and VBA denies service connection, then an IME/IPE would make more sense. Of course, that's just my opinion. You should also see what other knowledgeable people think. Dual Role Conflict In general, treating psychologists should not write 'nexus letters' or complete DBQs because doing so constitutes a dual role conflict. A C&P exam is a forensic mental health evaluation, where the 'client' is VBA, the 'referral questions' are directly related to legal issues, and the goal is to conduct an independent, objective, unbiased evaluation. In terms of the C&P psychologist, he or she is an expert witness, providing expert witness testimony in a federal legal proceeding. Psychotherapy is a treatment/helping relationship, where you are the client, the referral questions relate to helping you, and the objective is to help you achieve your recovery goals. In terms of the treating psychologist, he or she is providing a healthcare service. As you can see, the professional relationship between the psychologist and the veteran in these two scenarios are very different. In situations like the one you mentioned, i.e., asking a treating psychologist to write a nexus letter, it's helpful to know that such treating psychologists must be very careful about being in two very different roles at the same time with the same person. Usually it is not a good idea. (See: American Psychological Association's (APA) Ethical Principles of Psychologists and Code of Conduct, Ethical Standards 3.06 and 3.07. All the Best, Mark
  2. This morning I noticed that the upgrades the VA performed on ePeggy this weekend added a "What Did We Not Receive?" section on my compensation claim status screen. I'm glad that they added this, but wish they were clear as to exactly what requested information was not received. For instance, one line says, "Medical evidence from private provider", but I have no idea what piece of paper, examination, lab result, doctor, date or anything that they are talking about. Anybody else notice this new screen? Or has it been there all along, and I just never received it before? Have a great morning everyone. Mark
  3. From time to time I see that buddy letters are used to help develop the continuity and nexus of a claim. I also see recommendations for letters from a spouse, children or other family members. Does the VA really consider this strong probationer lay evidence? I hadn't thought about having my wife write a letter, but if it will put another nail in the claim, maybe I should. Any thoughts or past experiences? Happy Labor Day! Mark
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