ptsd 100% Schedular Ptsd No Longer Awarded?

[vasolas]

Please forgive my long-windedness but I'd really appreciate your advice, thoughts and opinions also I guess this is letting off steam for me.

I'm a Vietnam infantry vet and I served as a spotter on a sniper team. I've had about 16 years of intermittent private psychotherapy and continuous VA treatment since 2001. My ptsd claim included an '05 "PTSD Evaluation" from a private psychologist that I've seen weekly for almost 9 years. (it was very detailed but I'm only outlining here) It noted that I had chronic suicidal ideation, homocidal thoughts and that I was a risk to do harm to myself or others. It diagnosed ptsd chronic, severe and major depression, recurrent. It noted that I was medically retired due to ptsd and stated that, due to ptsd, I was totally and permanently disabled, unemployable and unlikely to improve. It assigned a GAF of 30. Also I had included supportive reports from a private social worker, psychiatrist, and former employer that documented my treatment for ptsd going back to 1990 as well as more recent progress notes from my VA hospital.

The VA C&P psychiatrist diagnosed chronic ptsd & major depression recurrent and severe. His report described me as a "hermit" who is "severely impaired socially and vocationally". He wrote that "It is unlikely that this man could ever function in any kind of work capacity at this time". He assigned a GAF of 35.

I'd expected to be awarded 100% schedular ptsd but in June 05 I received 70% and IU was deferred. I filed a NOD with a personal narrative that described how my symptoms had worsened and how they approximated the General Rating Formula for Mental Disorder's criteria for 100% schedular disability. Included was a copy of my recent SSD award due to ptsd, a progress note from a VA psychiatrist that stated that I was "considered totally and permanently disabled for gainful employment", 3 more progress notes all with GAF's of 30, plus other supportive documentation.

In late March 07 I received a SOC that continued my 70% and ignored most of my evidence that supported a grant of 100% schedular. It cited 9 pages of VA regs and 1 of reasons and bases. The R&B's described me as having mild to moderate daily dysphoria, moderate social anxiety symptoms (I've been a hermit for years inorder to cope with severe anxiety,depression and to avoid conflict with people), no violence toward people (my personal narrative described one of several such incidents in which I had crawled with loaded weapon to a car that had stopped at night in the boonies where I live - my VA psychiatrist hadn't quoted this incident directly in his report but had referred to it as an example of my "perpetual combat behaviors"). The SOC also stated that I denied suicidal or homocidal ideations (the preponderance of the many documents I'd sent noted chronic suicidal thoughts (w/o intent) and at least 2 of them reported homocidal thoughts). The SOC selectively plucked from the many documents I'd sent any positive reference to myself and ignored the statements that were supportive of a 100% schedular rating. For example, It used against me one sentence from a report that noted that I had helped to care for my terminally ill father but it made no reference to my occupational impairment, my consistenly low GAF scores and I was not offered another C&P.

I would greatly appreciate any advice, thoughts or opinions about my case and how I might best present my appeal for 100% schedular to the Board (my deadline is near). Perhaps I should be satisfied with 70% and the possibility of IU especially since so many deserving vets aren't even awarded that, and I know that it is now very difficult or perhaps impossible to be granted 100% schedular, but it is a matter of principal to me since I believe that my war-related mental disorder has rendered me 100% disabled.

Also is it possible/likely that VARO will deny me IU when I apply or order me to a C&P for IU? If it is awarded would it be retroactive to my original claim date-June 05?

Incidentally, I believe my claim for 100% schedular would have been granted 6-10 years ago despite the requirement of having psychotic symptoms per the General Rating Formula. I'm aware that VA has been criticised for spending so much and awarding so many 100% schedular awards in the past but I'm not aware of any published documents that have directed VA to limit granting such awards. Does anyone know of such directives or of any VA watchdog who has revealed them?

Does anyone know of anyone who has received 100% schedular ptsd in the past year and of the basis for that award?

Has the VA completely stopped awarding 100% schedular for ptsd?

[vasolas]

Thanks to all for your replies - this is very helpful. I hope you will respond further when I answer the questions you've asked.

Pete53 it sure feels good that you understand why I've held out for the 100% scheduler rating. I guess I did it more out of anger/passion than intelligence.

I haven't yet sent the application for IU but will in the next couple of days. I believe I can get an IMO from a psychiatrist that states I'm unemployable (thanks to several of you who suggested that). It will have to be mailed after I've sent the IU application due to fast approaching 60 day deadline since the SOC. Do you see any problem with sending the application for IU at the same time as my Form 9 substantive appeal or in the same envelope? If IU is awarded, I wonder whether it is likely to be granted as of the date of the application or inferred from evidence in my original claim - the C&P psychiatrist had written that I was severly impaired vocationally and stated "It is unlikely that this man could ever function in any kind of work capacity at this time". My paranoid self wonders about the conflict in grammer in that statement. Is the "at this time" part a code, whether intentional or not, that cues the RO to order a C&P to determine my unemployability?

Also I wonder why some believe IU is better than 100% scheduler? Is it because you think IU is more convincing for SSD or for other reasons?

J.J. you're right that my strongest evidence was from my psychologist's IMO and I've come to agree with you that their reports are ignored by VA. This must also be true of non-VA social workers and counselors? I can understand that they also ignore personal statements especially when not supported by or contradicted by VA treatment personnel.

As John999 pointed out, it is more about documented symptoms and inability to work than diagnosis. I don't present my symptoms well to the VA treatment providers (and that is on me). I am by nature stoic and quiet and don't want to appear to be a crybaby. I know this is not practical when applying for a claim but I've had trouble overcoming my own nature. I am able to present my issues in writing. As to work, I began working at the legal age while in highschool and worked my way through college prior to the war. Since the war I've worked fulltime only 10 of the 36 years. There have been 9 years with no employment but most of the rest I managed to work part-time. A psychiatrist's 1990 IMO documented that I'd only worked F/T 4 years since the war at that point. It was submitted with my '05 claim. I stressed poor work history in the narrative of my NOD, and it was firmly stated in my psychologist's IMO - for what that was worth. Should I submit a SSA statement of earnings? It would show earnings but wouldn't directly indicate how many years were part-time.

I'm realizing that my claim had some major shortcomings. While the VA hospital reports gave me a solid diagnosis and consistent GAF scores of 30 & 31, they were inconsistent in describing my symptoms, and their Mental Status Exams were always identical and with no indication of disorietation etc. No doubt their MSE's were preprogrammed so the psychiatrist could knock out a quick report. In fact, after leaving his office and walking to the release of information building his reports are always already there. I know that writing a good report is time consuming and stressful especially with a large caseload but am still disappointed, to put it mildly, that I was unable to consistenly assert the severity of my symptoms and they weren't able to consistently discern them. The first hospital report was more of a comprehensive evaluation. It did strongly assert my ptsd symptoms and gave a GAF of 30. It was done by a physicians assistant who is a Vietnam vet. Another of his reports noted that I'd carried a pistol to a Christmas dinner and it assigned a GAF of 25. But the following progress notes from the psychiatrist were not as detailed and thereby may have given the impression that my symptoms were no longer as severe as they once were. I do believe that rating specialists may now tend to give more weight to MSE's than to low GAF's.

Thanks Vike17 for your thoughtful analysis of my case. My NOD did request a DRO and I assume the SOC was done by or under the supervision of the DRO. I didn't request a hearing as I tend to lockup and become stoic under pressure and I wasn't confident that that would go well for me, also I had no reason to believe my service officer was very interested in my case. In hindsight It would have been better if I was able to establish a relationship with a better VSO. You are right to take me to task for not applying 6-10 years ago. My "incidentally ... " comment was speculative and referred to water over the dam, but I am fascinated by the internal workings of the VA and how it can be influenced by public or governmental scrutiny. For example, Mobie16r had quoted a "letter sent to VA rating officials". In fact his quote was taken from a transcript of a satellite broadcast, "PTSD: Improving the C&P Process to Better Serve Our Veterans - February 26, 2001. Presented by VHA and Employee Education System". It's target audience was "raters, examiners, Mental Health/Readjustment Counseling Service providers, VBA and VHA Networks and Facility Directors". It was accompanied by a 50 page booklet that highly encouraged the above people to more fairly interpret and judge ptsd claims. It covered diagnosis, assessment, gaf's, C&P initial ptsd evaluations, review exams for ptsd, the General Rating Formula for Mental Disorders (to more fairly interpret the extremly strict criteria for 100% scheduler) etc. No question this very comprehensive guideline was intended to better serve veterans. Subsequent to it in the years after 2001, there was the enormous increase in grants of 100% schedular ptsd and IU. I'm just saying that there may have been a causal relationship and I assume that as more and more vets received awards that more and more applied. I'm also assuming that this generosity came to a screeching halt at some point. Perhaps I'm only projecting from the relative lack of success of my own claim - does anyone know of any evidence that grants of 100% schedular and/or IU are decreasing? If they have decreased significantly, I think it would be reasonable to wonder whether there was some directive or more likely some broadcast, conference call or internal guidelines that encourage the above mentioned people to tighten up their interpretation and judgement of ptsd claims.

Also I'm still interested whether anyone knows of an incidence in the past year where a grant of 100% scheduler ptsd was awarded and the basis for it?

I better quit speculating and get to work on my IU application and on completing my substantive appeal for 100% scheduler ptsd.

I'd greatly appreciate any further advice, thoughts or opinions that you have.

I just noticed JJ's recent post and Testvet's. I assume Testvet that your 100% P&T is not an IU award but schedular? JJ your rightous post expresses remarkable empathy with the frustration, resignation and discouragement that I've been feeling. I appreciate your insights into the waxing and waning of symptoms, the relapses etc. I've been dealing with depression since the war. I'm at a low point now in part due to my father's recent death. I'd stayed nights with him sleeping with one eye open, as we once did, to respond to his cries for help. The VA psychiatrist and PA have documented this as a "normal grief reaction" and prior to that they had begun to diagnose dysphoria instead of depression. Sometimes even discribing it as "mild to moderate". It is discouraging that they do not recognize complex ptsd when they see it. Perhaps I've been too apologetic in this post. Thanks

[Pete53]

Your on the right track. Sending in the TDIU with your Form 9 is fine. Be sure and comment on the Form 9 how long it has been since you last worked and earned a regualr amount. Part time work usually does not count.

You are not alone. Many here have taken the journey you are on and if you don't panic and don't give up you have a winner.

Your Hospitalization is going to make you win your claim.

[Vike17]

vasolas,

I wasn't trying to take to task with not filing 6-10 years ago or anything of that nature. It just struck me at that time because you lost 6-10 years of monetary benefits that you were due!

The problem I see with your claim, and you mentioned it in your previous post, is

"I don't present my symptoms well to the VA treatment providers (and that is on me). I am by nature stoic and quiet and don't want to appear to be a crybaby...I'm realizing that my claim had some major shortcomings. While the VA hospital reports gave me a solid diagnosis and consistent GAF scores of 30 & 31, they were inconsistent in describing my symptoms, and their Mental Status Exams were always identical and with no indication of disorietation etc"

This tells me that the VA proabaly made the correct decision based on the symptoms you presented to the examiner. I also say this because, first, the RVSR (possibly a Coach also) looked at your claim, and second, a DRO and possibly the Coach at the Appeals Team took a look at your case and decided the same thing. One other thing to keep in mind is that a GAF score alone does not dictate a rating. This is a claissic example of where the GAF score doesn't match up with the symptoms presented and the subsequent write-up. The decision maker must ultimately assign an evaluations based on the symptoms of the veteran, not a GAF socre. For what its worth, I've seen veterans receive a 50% evluation for mental disorders with a GAF of 65. The evaluation is based is based on the overall symptoms. Also, keep in mind, the 70% evaluation criteria has "severe occupational and social impairment" as does the 100% evaluation.

As far as the letter you mentioned from Feb. 2001, even though I haven't read it, I suspect the intent of it was to have the treating physicians more accurately document the symptoms and progress of PTSD and maybe all mental health patients so the Regional Offices could make a more accurate evalution based on their write-ups. If I'm not mistaken this was brought upon in part by the large increase of 100% evlautions being awarded from 1999 onwards (same goes for the IU veterans). This pamphlet wasn't meant to set any agenda or anything.

One other thing to keep in mind is that a 100% evalution due to PTSD, or any mental health disability for that matter, is actually more rare than one thinks. The 100% evaluation borders with being institutionalized or in the constant company of another person for care. Just look at some of the symptoms and you'll see what I mean. I'm not saying by any means that you do not meet the criteria for the 100% evlaution or anything along those lines, I can't say one way or another because I haven't seen your C-file and I'm noy a shrink, but keep in prespective that the 100% evlaution is a rare bird when asking if someone has recently been awarded it. In the whole population of disabled veterans, which is at about 2.8 million, only about 70,000-75,000 have a 100% schedular evaluation based soley on PTSD, not because of some conspiracy by VA to "low-ball" veterans evlautions, but because those symptoms are actually rare.

If I were you I would as Pete said submit the IU form along with the Form 9. By doing so, your appeal will be held up until the RO decideds your IU claim.

Vike 17

[Jay Johnson]

GAF is one's "overall" symtpoms and speaks directly to social and occupational impairment. It is also a method used around the world by the most respected psychiatrists on the planet. In short, it is *the* standard for psychological evaluations, but the VA likes to ignore it because psychiatrists tend to call it the way they see it. ALL of the symtpoms listed are conducive of a GAF below 40 and 25-31 sounds dead on by DSM standards (according to the symptoms you've listed).

[Jay Johnson]

By the way, 100% PTSD is rare, because the VA has ridiculous standards. Vike is right in that one must be practically institutionalized in order to qualify for that rating, which is blatant discrimination against vets with mental disabilities. A physically disabled vet can be 100% disabled while living a, relatively, normal life.

[sixthscents]

Army,

The VA cannot rate each individual mood disorder. By CFR 38 it would be pyramiding, so they can rate you for PTSD, and take into consideration the other diagnosis while making the rating but thats it. PTSD is classed as an anxiety disorder - but I'm no shrink so who knows. The VA is SUPPOSED to consider the highest rated disorder, and thats what they actually compensate you for.

Further - They have stereotyped and lumped combat mental problems into PTSD

Well, it is Post Traumatic Stress Syndrome..... combat mental problems are obviously traumatic, and post apllies, so what would you have them do? Honestly, its a rational system if used correctly. I am not stating that it is or is not used correctly, but how it is laid out makes perfect sense. In fact, I can think of no other way to do it.

I am not trying to score points here off of you but I dont understand what you would prefer happen. The pyramiding rule applies to all injuries, not just mental, s its not unfair in that aspect. So, help me out here I dont understand.