What Is The Va Definition Of " Ability To Function Independently" ? ..

[tssnave]

I am starting to work on my NOD and need some help trying to figure out just what the VA means by the words they use. Pete, John, Josephine, 1968VV, Betrayed, Vike17, Berta, elders, advocates, or anyone that has experience with the mental disorders rating and VA rigamarole, please chime in.

According to the VA Decision, my claim (mental disorder rating schedule), which was rated 50%, was not rated higher because:

"this does not affect your ability to function independently"

However, the CP Exam shows the following:

IS THERE PROBLEM WITH ACTIVITIES OF DAILY LIVING: Yes

HOUSEHOLD CHORES, GROOMING, BATHING, DRIVING OTHER RECREATION ACTIVITIES: MODERATE

The Virginia Dept of Rehabilitative Services states:

DEFINITION: Independent Living is the ability to carry out basic Activities of Daily Living.

So I'm confused on what, exactly, the VA uses as their definition of indepentdent functioning. The generally accepted rehab definition is the ability to take care of your activities of daily living but apparently the VA has some other definition. If you know what that would be, please enlighten me (with the location in the VA reg, if possible so I can quote their own regs back to them in my NOD).

The 70% rating criteria for Mental Disorders lists "....near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively.....neglect of personal appearance and hygiene...."

The 100% rating criteria lists "... intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene)......."

It seems to me that the C&P exam has covered the issue of how my disability affects my ability to function independently and since this is the sole reason cited for not giving me a higher rating, I'm confused on how to approach this in my NOD.

From my understanding the VA is either saying:

1. we don't recognize the standard definition of independent living so we're keeping your rating at 50%

2. we do recognize the stanard definition but even though the CP Exam says "Yes" we don't acknowledge that affirmative answer because you are only affected "MODERATE"

3. we are denying you 70% because you don't have the right wording based on the VA criteria in your C&P exam for 70% and we'll just ignore the fact that you do have the correct wording for 100%

4. we see that you have a valid claim for 70% (and IU, but that's another story) but we want to see if YOU see that you have a valid claim for 70% (ok, just ignore that one, I know we're not supposed to bash the VA but I have been in an emotional basement for months now over this mess and am just now crawling out to try to get this NOD done and get frustrated and depressed everytime I sit down to work on it).

Could someone please give me a VA reference that explains what they mean by function independently?

I would appreciate any suggestions on how to approach this in the NOD. At this point, I have simply quoted the C&P exam back to them. I have also gotten an IMO that is very strong on this point but feel like I need to address the C&P since I want the effective date to be the date of my original claim.

Thanks,

TS Snave

Edited July 11, 2007 by tssnave

[Berta]

I think you have to read the regs for higher rating in the whole context.

this is only one part of the criteria-

I am making this point because my husband was meticulous in his personal habits for as long as I knew him.If the VA laundry didn't have his work uniforms starched-he would take a few we had here and iron them himself.

He was rated 30% for 8 years and went to 100% SC PTSD.

IL -Independent Living ' is not the same as what this part of the C & P is all about.

A PTSD rating or any other mental disorder involves the entire clinical record.

Some vets I know had a saying around the VAMC-years ago- dont tie your shoes and you will get PTSD comp-

They based this on a severely mentally disturbed Vietnam veteran always on the grounds of the VAMC and in therapy there-who could not tie his shoes.

What they failed to consider-and I knew this vet very well- is that, although he was in Vietnam, he did NOT have PTSD or any SC at all.

He had a NSC mental disorder.

[tssnave]

Berta,

Thanks for the reply. One of the ways in my NOD I've approached the whole "does not affect your ability to live independently" reason for denying me 70% is to point out that my C&P Exam states that I am unable to hold down a job due to my sc disabiilty therefore I am unable to be self supporting and live indepedently.

The whole "does not affect your ability to live independently" is the only thing the VA cited as a reason for not giving me a higher rating and I'm trying to figure out how to counter it in my NOD.

I've gotten a very good independent phsychological evaluation that addressess all the things my spouse has to do for me that clearly states I am unable to live independently because of my sc mental disorder so perhaps that will be enough. But the shrink took it from the whole activities of daily living aspect (which he says is the only determining factors for independent living - however, he doesn't realize the VA makes up its own rules) and since the VA didn't seem to count problems with activities of daily living as an indicator that I am unable to live independently I am not sure just what it is they are looking for.

From what my shrink has told me, if they truly looked at the whole picture, as you suggest, even without his eval and just looked at the C&P exam, then we wouldn't be here in the first place because they should have awarded me 70% from the get go and then evaluated me for IU. I think it boils down to one of two things:

1. they didn't want to give me 70% since I raised an IU claim by stating that I had lost every job since I was in the service over 20 years ago due to my sc mental disorder

2. there is some other definition or marker or symptom that the VA is looking for that they are considering to be living independently.

It is the possibility that the VA has some other definition of living independently than the rest of the medical community that I just don't know about that has me posting on the board. I am hoping somebody can enlighten me on just what it is the VA is looking for when they talk about living independently so I can try to CYA in my NOD.

Suggestions, anyone?

Thanks,

TS

Edited July 11, 2007 by tssnave

[Josephine]

tssnave,

Just signed on.

Here is my take on your situation. I will give you an example of my last C&P by the Board of Two Psychiatrist.

Here is segments from their write up.

The veteran is afraid to drive a car and only goes to the stores about once a month and refuses to go alone. She will not write checks in public or except change as she is afraid that others will see her wet hands. She throws food all over the floor, she tears up her home, beats up her husband, slapped her oldest daughter when she was two weeks old, because she spit all over her clothes. The veteran denies any self inflicted injuries or eating disorder, " according to her". She has never been able to hold gainful employment due to high levels of anxiety. One medical records states she is a gravida 3 para 2, but " she claims to have only two children". When asked what she does when she runs out of Valium, she states, " I never run out".

The veterans functions well by herself.

Axis 1 Anxiety

GAf 40

This BS goes on and on and not one darn thing in my medical records of 43 years to back up one shred of this Sxxx.

My point is if I can't do xxxx without the help of others, why do they think that I function so well on my own.

With that GAF?

I hope that you can see through this HOG WASH!

( By the way for my first C&P the Doctor saw a completely different person.

Nicely dressed, excellent eye contact and I hope you see my point.

Diagnosis of Anxiety with Depression

" More likely than not the veterans anxiety began in service. )

Always,

Josephine

Edited July 12, 2007 by Josephine

[Hoppy]

TS,

At this point in time I am going with the VA's intrepretation of the doctors reports as not justifying the rating of 70%. Base your appeal on adjudications errors. This might help keep the effective date if you win. However, In addition to your appeal based on adjudication error. Get an assessment that is clearly written by the doctor to show that you cannot work, or for some other reason the Iu is justifiable. If you can get the doctor to say the original report should have been intrepreted in a manner that would justify IU and, or 70%. This would then definately cause a situation where the rater rebutted the doctors original report.

I think your assesment that the VA has aproblem with the dostors report is on the right track.

STRONG MEDICAL EVIDENCE WINS CLAIMS< THATS IT.

Edited July 12, 2007 by Hoppy

[Josephine]

Tssnave,

You are on the right track. Your doctors report appears to be ignored.

Good Luck,

Josephine

Edited July 12, 2007 by Josephine

[tssnave]

Josephine - thanks for chiming in and for the support.

Hoppy - thanks for the reply. I may not have been clear in my post (I have been depressed for over a month and for the last several days have been ramping up with mania so I may not be very coherent from the lack of sleep right now).

While I do have an IMO that states clearly I am unable to function independently, I have not sent that in yet. I'm going to send it in with my NOD if I can every get it written.

When you wrote "If you can get the doctor to say the original report should have been intrepreted in a manner that would justify IU and, or 70%. This would then definately cause a situation where the rater rebutted the doctors original report." do you mean to get the IMO doc to write that the C&P Exam was not interpreted correctly or to try to get the VA C&P doc who wrote the report to say it was misinterpreted?

Some other interesting facts about the VA awarding me 50% -- The C&P Exam states:

IS THERE TOTAL OCCUPATIONAL AND SOCIAL IMPAIRMENT DUE TO MENTAL DISORDER SIGNS AND SYMPTOMS: Yes

However, the Decision letter awarded me 50% because it "doesn't affect my ability to live independently" even though the C&P states I have total occupational and social impairment and can't hold down a job due to my sc bipolar disorder. My GAF was 49 so I don't know where they got 50% as an accurate rating. I just know the whole shooting match is causing me some wicked rapid cycling which is making it impossible for me to get the NOD done.

Any advice or suggestions are appreciated.