Symptomatology Is Required, Not Continuity Of Treatment

[Josephine]

Is this stating that he was considered service connected?

It is noted that there is no continuity of psychiatric symptomatology shown by medical records, including the service medical records at discharge from service. However, continuity of symptomatology is required, not continuity of treatment, and the veteran had indicated to a clinician that he had been suffering from anxiety for 20 years. See Wilson v. Derwinski, 2 Vet.App. 16 (1991). Additionally, as noted above, the veteran’s anxiety during service has been determined to be chronic and there is no intercurrent cause for the veteran’s current anxiety disorder shown. Therefore, any later manifestation of the anxiety disorder is considered to be service connected. See 38 C.F.R. § 3.303(;) (1996);

Brannon v. Derwinski, 1 Vet.App. 314 (1991).

Thanks,

Josephine

[Hoppy]

Josephine,

This is a good one to kick around. Don't lose this it might apply to you. This is my take.

Although they discuss the continuity V. treatment issue the real issue in this case is that the condition had been determined to be chronic in-service. They also indicated there was no evidence of intercurrent causes. I have seen service connection awarded on this same type of logic. Remember the argument I told you to use that there is no evidence the in-service condition resolved. This is very similar. I would say this case is stronger because somebody (they don't say who and when) determined that the condition was chronic in-service. My bet is that there was a significant amount of military treatment reports showing the condition in-service.

When it is not shown to be chronic in-service only then the continuity of treatment/symptoms kicks in in. Then you can use the combination of inservice and post service symptoms to show a chronic condition. This is in the M-21. Also keep in my that any condition must be sufficiently chronic post service to be disabling or they will also reject the claim.

A problem occurs if you try to establish post service symptoms without having post service treatment. They require verification of the post symptoms by someone who is qualified to make such a verification. I have read many cases where they do not allow descriptions of symptoms based soley on the veterans claim that there were symptoms and they also reject claims when the person doing the verification is not qualified.

Another interesting point in this case is that they did allow his testimony that the inservice symptoms continued after service. However, my bet is that they will only do this when it has been established that the condition was chronic in service and was verified as chronic in-service by qualified sources.

Edited July 22, 2007 by Hoppy

[Josephine]

Hoppy,

I see your take on this one. I have used all that I have to give to my claim.

When the Personnel Officer offered me the early discharge due to " Unsuitability", and told me that I would be giving up all of my G. I benefits, he was just about correct.

Had the VA did what they should have done in 1978 and secured those " Psychiatric Records" from the Archives and just not pretended that they did, I would not have the battle that I have today.

Medical records 43 years old are hard and next to impossible to locate. I believe the law states 10 years to keep.

When Vike states that I have no Nexus, I guess he is just about correct.

I have went as far as contacting Dr. C. to clarifiy his medical records and to hxxx with what he meant when he wrote.

Vascular v Tension Headaches? Cafergot ineffective - Librium T.I. D.

He has written for the record that any dummy can see that is a concept. He added the Librium for Nervous/ Anxiety.

Sent me to the two Psychiatrist who use the word " Nervous".

I have watched this Medical Term change with the VA. from " Nerousness" to " Anxiety" to "Acquired Psychaitric Disorder".

I can remember a day when in your medical records it stated high blood pressure and now it says hypertension.

Are they not one of the same?

This is my take.

As far as I know the AMC is to have me an answer by the end of August and if it is a denial. I am shoving this junk in the trash can.

Thank God for Dr. C. I came out of that Hxxx alive!

Josephine

Edited July 22, 2007 by Josephine

[Hoppy]

Josephine,

I am aware of a case where the word nexus or more likely than not was never addressed in the medical reports and the veteran was awarded service connection. The veteran had claimed that he was mis-diagnosed in the military and that there was a nexus between the in-service condition and the current condition. Additionally, the veteran argued that diagnostic criteria used prior to the publication of the DSM IV was not adaquate and that a re-evaluation based on the DSM IV was justified. Justification was based on the fact that diagnostic criteria had changed with the publication of the DSM IV.

The veteran submitted five different current psychiatric diagnoses made by doctors. The veteran claimed that all five could exist at the same time and that the symptoms were entwined. The veteran had been treated in the military for a period of 18 months for; anxiety, somatization, nervousness, sleep disorder, tension etc. The veteran was discharged with a personality disorder. Key markers cited in the DSM IV for distinguishing a personality disorder from an anxiety disorder were noted in the SMR. These markers indicated an anxiety disorder. Twenty five years later the veteran contested the diagnosis as being incorrect. Both a PHD in clinical and a psychiatrist reviewed the SMR and determined that the veteran had been mis-diagnosed by military psychiatrists and at the time of discharge the veteran had an chronic anxiety disorder.

This is similar to the case you posted yesterday in that it had been determined that a chronic condition existed while on active duty. Service connection was awarded. The avenue for service connection could be "post service initial diagnosis", or "re-diagnosis" as described in the M-21. All I know is that service connection was awarded based on a review of the SMR.

Originally, I had tried to find out how much time went by between you first visit to a military doctor and the time you were discharged. I thought that this could be a tactic in your case if there was a lengthly time of symptoms noted in your SMR. The problem in your case will in fact require a re-diagnosis. You were discharged for a condition that the VA views as developmental and not the result of service. The first step is a re-diagnosis. Then nexus may or may not be an issue depending on whether or not you can get a diagnosis of a chronic anxiety disorder at the time of discharge.

I also suggested that you look into using an argument that there is no evidence the in-service symptoms resolved after discharge as shown with continuity of treatment and symptoms post service. I have seen BVA decisions awarded by adjudicators using this type of logic when the veteran did not even suggest it

in their statement of facts.

Now that I think about it the good report you got from the PHD did not attempt to make a re-diagnosis of the condition in the military. At some point you either need to get a rediagnosis or a nexus. Argue both and let the VA figure it out.

[Josephine]

Hoppy,

When things became more than I could handle at this duty station, the first thing that I did was put in for a Transfer. I finally after 43 years have a copy of this. Buried in the archives. I waited and waited for the transfer and couldn't hold on any longer and I ask Dr. C. to help me with the discharge and he did.

I saw Dr.C in February and he wrote" Vascular v Tension Headaches? Has had headaches since being in the hospital for the German Measles. Cafergot ineffective Librium T. I D. It was two weeks later that I saw the first Board Psychiarist that noted.

( Dr. C. letter is only to state that he read his medical records and that the Cafergot was for headaches and that he added the Librium to the Cafergot for Anxiety. )

On consulation for nervousness, headaches and irratability. Dissatisifed with working conditons and living in the barracks. Has not liked the Navy since boot Camp.

She feels better just discussing her situation.

Two weeks after that I saw the other Psychiarrist with same complaints. Recommends discharge of " Unsuitability"

It is recommended that xxxxx be separated from the U. S Navy with an Honorable discharge by reasons of unsuitability.

The Commanding Officer letter.

April 7, 1064

xxxxxx is an emotionally immature 19 year of who despises the Navy way of life and who has let her emotions interfere with her ability to perform her duties in a constructive manner. She has been counseled on various occasions by the wave representative and personnel officer of this command and more recently by a chaplain before being referred to the psychiatric services. xxxx feels that the Navy Recruiter lied to her when she enlisted in the Navy, that her superiors expect more of her than she is psychically able to contribute, and that her moral values have been vitiated by her contact with women who are foul - mouthed and crude.

After the first psychiatric consultation, it was believed that xxxxxxxx might be able to resolve some of her personal problems and mature to the extent where she could expend effort constructively. However, after she returned to the command, she vented her feelings to everyone who would listen to her; she felt that the psychiatrist refused to listen to her and failed to help her; and she refused to cooperated with and assist her peers in performance of their duties. Accordingly, a second consultation was arranged with a Board Certified Psychiatrist, and he recommended that she be separated from the service in accordance with article C- 10310, BuPers Manual.

From all indications, it is apparent that xxxxx has a very immature approach to life, is unable to adjust to a Navy environment and refuses, to accept any responsibility whatsoever. She cannot be relied upon to do the most menial task and it is questionable if she will ever be of any value to the service.

Post Medical record start in 1966 Nervousness.

Thanks,

Josephine

Edited July 23, 2007 by Josephine