ptsd Continuity-in Treatment

[Berta]

Continuity in treatment as mentioned in the previous post can be critical to a claim.

As Hoppy mentioned in the previous post-

continuity is a strong factor for service connection.

http://www.va.gov/vetapp07/files1/0702177.txt

The veteran claimed back disability due to service.

"The veteran's medical records indicate continuity of

symptomatology since 1982 and the veteran's current

disability has been linked to service"

The veterans discharge was in 1992.

"Although an August 2004 VA examiner opined that the veteran's

current disability was not related to service, the

examination record does not indicate that the examiner

reviewed the claims file, to include the service medical

records or the above opinion. In light of the records

indicating continuity of symptomatology since service and the

June 2004 physician's opinion, the preponderance of the

evidence is not against the veteran's claim; consequently,

service connection is warranted. "

This next vet did not fair so well as to the continuity factor:

"The first clinical evidence of a complaint of headaches is

dated in August 2001, more than 42 years after his

separation from service. Given the length of time between

his separation from service and the initial record of

complaint, the veteran is not entitled to service connection

for a nervous disorder manifested by post-traumatic headaches

on a presumptive basis. Additionally, in view of the lengthy

period without treatment, there is no evidence of a

continuity of treatment, and this weighs heavily against the

claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000)."

from:http://www.va.gov/vetapp07/files1/0705197.txt

The VA denied headaches and dizziness as related to the inservice documented injury

the veteran had due to the lack of continuity of treatment and symptomalogy.

However the veteran also raised the issue of hearing loss from the inservice injury (he was injured in a football game) and the C & P examiner gave him wrong C & P-

this part of his claim was remanded to determine if the football inservice injury could have caused the hearing loss.

Continuity of treatment and/or symptomalogy is certainly a very important aspect that Hoppy has reminded us of regarding claims-

Years ago there was a vet on TV who pulled out boxes of VA meds he never took and also told the interviewer he did not particiapte in any PTSD therapy.

I would imagine if any VA claims employee saw this show- they would have proposed to reduce this vet's comp.

The VA rationale is-if you have a SC disability- then you get continuous treatment for it and you do cannot determine whether meds should be taken or not.

[sixthscents]

I agree, continuity in a claim as well as CONSISTENT SYMPTOLOGY is very important to a claim. Essentially it can make or break a claim, and I have seen many denial based upon a lack of continuity, combined with other small factors.

[Ricky]

Good point "CONSISTENT SYMPTOLOGY". Also make sure you symptology is recorded. For example I use Tricare at a military facility. There new medical records are computerized and have areas for things such as decression, neurological conditions, back exams etc......and they all defaut to "none present" or no deficits. When I go in for headaches, colds, sight problems etc..... the printed copy of my records says I have no neurological deficits (loss of use of foot and hand due to neurological condition) no back problems etc....... Now I know what is going on for these areas were not examined during the visit. However, when I submit these records to support things like my back claim etc.... they hurt my claim for stroke disorder etc..... VA rater quoted some of them in the denial of my stroke/loss of use claim.

I spoke with the Doc and he said VA should realize that if I go in for a back issue then the neurological area is not looked at....... Well they do not realize this as they quoted them in the denial - said on such and such date treatment records provide that no neurological problems were present!!!!! Now these guys took medical records I sent in to claim a back issue in which I was providing continuity of treatment and used it to deny another claim. He said the computer program can not be changed and he can not conduct a physical each time I go in.

[Hoppy]

YES & NO

I did mention in that post that without a diagnosis or xray that would jump of the page and slap the rater in the face a long gap in treatment is a problem. I think it varies case by case. Additionally, continuity can only be determined by a doctor. Back strains without any hard diagnoses supported by xray or MRI is a weak case. However, if you have a more significant injury of the back supported by inservice xrays or MRI's, I have seen degradations service connected becuase a doctor thought it was likely that a significant disc injury would continue to degrade even if there was a lenghtly time period without treatment.

To paraphrase the M21. It basically says that if chronicity is not established in service then continuity must be established. Chronicity is a medical determination and if the doctor says that condition would be expected to degrade then the actuall time frame can get lengthly.

Edited May 23, 2007 by Hoppy (see edit history)

[free_spirit_etc]

Ricky -- My husband got treatment at a military facility too - and ran into the same problem.

Well - not EXACTLY the same problem -- but he went to get a record of his medical files -- and got a bunch of computer generated check off lists with a FEW brief notes "digitally" jotted on them.

I could not believe that he had a SURGERY -- and it was reduced to a few lines in his medical records.

So he went out to base - and said "What is THIS??" I surgey requiring several days of hospitalization is reduced to a few lines in my medical records??"

They said -- Oh -- we have OTHER records -- like the doctor's notes and things -- but you only asked for your MEDICAL records..." THESE are your medical records.."

So he asked for the OTHER records..

It took him about a week to get them - as they had to get them from somewhere..

But we found a WEALTH of information in them.

Like for his claim for Cancer..

The oncologist on the Initial Report stated that he had been exposed to asbestos while working as an electrician in the Air Force.

The pulmonologist had noted several times his increased risk of cancer from asbestos exposure.

Now - the RO had denied the claim stating that there was no evidence that he was exposed to asbestos as his records did not show he was part of any occupational screening programs (the Air Force did not implement those types of programs until AFTER he cross trained into another field - and once they started the program -- the electricians WERE included in the occupational screenings because of asbestos exposure -- but he spent 13 years with NO safety precautions).

And we don't even know if the "OTHER" records were ever sent to the VA -- before WE sent them last year. He had assumed his medical records were his medical records -- and the VA said they had his medical records...

But if the VA is aware of the fact that the MTF have OTHER medical records - and they allow them to just send that digital stuff -- and lead the veteran to believe they have all of the records - when they don't -- and deny their claims -that is totally ethically wrong!

But you might want to see if you can get your hands on any "other" records they have on you..

Free

Good point "CONSISTENT SYMPTOLOGY". Also make sure you symptology is recorded. For example I use Tricare at a military facility. There new medical records are computerized and have areas for things such as decression, neurological conditions, back exams etc......and they all defaut to "none present" or no deficits. When I go in for headaches, colds, sight problems etc..... the printed copy of my records says I have no neurological deficits (loss of use of foot and hand due to neurological condition) no back problems etc....... Now I know what is going on for these areas were not examined during the visit. However, when I submit these records to support things like my back claim etc.... they hurt my claim for stroke disorder etc..... VA rater quoted some of them in the denial of my stroke/loss of use claim.

I spoke with the Doc and he said VA should realize that if I go in for a back issue then the neurological area is not looked at....... Well they do not realize this as they quoted them in the denial - said on such and such date treatment records provide that no neurological problems were present!!!!! Now these guys took medical records I sent in to claim a back issue in which I was providing continuity of treatment and used it to deny another claim. He said the computer program can not be changed and he can not conduct a physical each time I go in.

[betrayed]

then you get continuous treatment for it and you do cannot determine whether meds should be taken or not.

I disagree in part to this statement, per the patients rights posted by the VA, the patient has a right to make decisions in his or her treatment, I have refused to take several medications as recommended by VA doctors and it has not hurt my case