Emotional Instability Reaction Term

[Josephine]

Emotional Instability Reaction _ code 460 - may not always be a " Personality Disorder"?

[

Citation Nr: 0302710

Decision Date: 02/12/03 Archive Date: 02/19/03

DOCKET NO. 99-19 695 ) DATE

)

)

On appeal from the

Department of Veterans Affairs Regional Office in No. Little

Rock, Arkansas

THE ISSUE

Entitlement to service connection for an anxiety disorder.

REPRESENTATION

Appellant represented by: The American Legion

WITNESSES AT HEARING ON APPEAL

Appellant and spouse

ATTORNEY FOR THE BOARD

J. D. Deane, Associate Counsel

INTRODUCTION

The veteran served on active duty from August 1958 to March

1959.

This case comes before the Board of Veterans' Appeals (Board) from a July 1999 rating decision of the North Little Rock, Arkansas, Regional Office (RO) of the Department of Veterans

Affairs (VA).

The Board remanded the veteran's claim in July 2001 for action consistent with the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000) (codified as amended at 38 U.S.C.A. § 5100 et seq. (West Supp. 2001)). In August 2002, the Board further developed

the claim, ordering a VA examination to evaluate the veteran's disability.

The veteran had a personal hearing before the undersigned

Member of the Board in May 2001.

FINDINGS OF FACT

1. All evidence requisite for equitable disposition of the veteran's claim for service connection has been obtained and examined, and all due process concerns as to the development

of the claim have been addressed.

2. The veteran has a current anxiety disorder, which was diagnosed as an emotional instability reaction during his military service.

CONCLUSION OF LAW

An anxiety disorder was incurred in active service. 38 U.S.C.A. §§ 1101, 1110 (West 1991 & Supp. 2002); 38 C.F.R. §§ 3.303 (2002).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Service connection is granted for a disability resulting from an injury suffered or disease contracted while in active duty or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. See 38 U.S.C.A. §§ 1110, 1131 (West 1991 & Supp. 2002); 38 C.F.R. § 3.303

(2002). In general, establishing service connection for a disability requires the existence of a current disability and a relationship or connection between that disability and a disease or injury incurred in service. See 38 U.S.C.A. § 1110 (West 1991 & Supp. 2002); 38 C.F.R. §§ 3.303, 3.304

(2002); Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992).

I. Entitlement to Service Connection for Anxiety Disorder

The veteran contends that he currently suffers from an anxiety disorder as a result of his active service, and that service connection for his psychiatric disability is appropriate. After a review of the evidence, the Board finds that the record supports his contention, and that service connection for an anxiety disorder is warranted.

Most of the veteran's service medical records are unavailable. The National Personnel Records Center reported that they did not have such records for the veteran, and that they had probably been accidentally destroyed in a 1973 fire at that facility. However, a January 1959 treatment record

states that the veteran complained of chronic anxiety reaction. Another report from January 1959 noted that the veteran was admitted to the hospital in a lethargic state after ingesting an overdose of pills. The February 1959 Medical Evaluation Board report lists a diagnosis of emotional instability reaction including symptoms of lability of emotions, suicidal gesture, lowered tolerance to frustration, difficulty in accepting authority, and somatizations when under stress.

The veteran has also submitted VA outpatient treatment records, statements from his wife, and his own statements to support his claim. VA outpatient records from 1997 to 1999 show treatment for a major depressive order, insomnia, and a history of substance abuse. In the May 2001 hearing

transcript, the veteran as well as his spouse described his symptoms during and after separation from service.

A December 2002 VA examination report lists a diagnosis of anxiety disorder. The examiner noted in his report that the veteran complained of chronic sleep impairment and anxiety during the examination. The examiner also stated that the veteran was casually groomed and cooperative with an anxious mood as well as exhibited limited insight and adequate judgment. No gross memory impairment, hallucinations or delusions were noted in the December 2002 examination report.

The examiner stated that the veteran had received a diagnosis of emotional instability reaction during service, a term that was no longer part of the diagnostic nomenclature. It was noted that the symptoms reported in service appeared to be the same as symptoms described by the veteran in the

examination report. The examiner opined that there appeared to be a nexus between the emotional instability diagnosed in service and the veteran's present symptomatology.

In brief, the record shows that the veteran's current anxiety disorder is related to his period of active service. The opinion contained in the December 2002 VA examination report establishes a link between the veteran's current anxiety disorder and the symptoms diagnosed as an emotional

instability reaction during his active military service. Service medical records reflect that the veteran suffered from an emotional instability reaction while in service. In the December 2002 VA examination report, the examiner specifically stated that the veteran's current disability is

attributable to his period of active military service. The Board finds that the veteran's claim for service connection of an anxiety order must be granted.

II. VCAA

A change in the law, on November 9, 2000, redefined the obligations of VA with respect to the duty to assist and included an enhanced duty to notify the claimant of the information and evidence necessary to substantiate a claim for VA benefits. See Veterans Claims Assistance Act of 2000

(VCAA), 38 U.S.C.A. §§ 5100 et. seq. (West Supp. 2002). Implementing regulations for VCAA have been published. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2002).

Except for amendments not applicable, the provisions of the regulations merely implement the VCAA and do not provide any rights other than those provided by the VCAA.

As noted above, the Board remanded this appeal to the RO in July 2001 for action consistent with the VCAA. As this decision of the Board is a complete grant of the benefit sought on appeal - i.e., service connection for an anxiety disorder - the Board concludes that sufficient evidence to

decide the claim has been obtained and that any defect in the notice and development requirements of the VCAA that may exist in this instance would not be prejudicial to the

veteran.

ORDER

Service connection for an anxiety disorder is granted.

MARY GALLAGHER

Member, Board of Veterans' Appeals

IMPORTANT NOTICE: We have attached a VA Form 4597 that tells

you what steps you can take if you disagree with our

decision. We are in the process of updating the form to

reflect changes in the law effective on December 27, 2001.

See the Veterans Education and Benefits Expansion Act of

2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the

meanwhile, please note these important

Josephine

[free_spirit_etc]

Here is the Court case I was talking about. The RO is not allowed to prejudice your claim by tainting the evidence - i.e. they can't guide the person issuing the medical opinion as to what to say.

So - it would be interesting if you could get the request the RO wrote to obtain the second C&P.

You can bet that at they sent you for a second one after the first one was favorable - they were looking for something specific.

If they had any questions about the first one - they could have contacted the doctor who wrote it and asked him to clarify or expand on what he had said. They did not WANT his further opinion. They wanted a different one.

So there MIGHT be something in their request to the second examiner that you can show prejudices your claim.

But they also could have just tainted it orally, rather than in writing.

Or as the nurse seemed to confirm that strange things always happened in that room - they might just have known exactly where to send you.

http://www.hadit.com/library/law/971178colayongvtogo.htm

AOAS COLAYONG, APPELLANT, v. TOGO D. WEST, JR., SECRETARY OF VETERANS AFFAIRS, APPELLEE.

12 Vet App 52412 Vet. App. 524; 1999 US App Vet Claims LEXIS 8851999 U.S. App. Vet. Claims LEXIS 885

In an October 1, 1996, memorandum to the Chief Medical Officer (presumably at a VA medical facility in the Philippines), the RO stated:

1. This is a BVA remand. The veteran is service connected for Pott's disease with kyphotic deformity and complete limitation of motion evaluated at 60%. A private physician, not an orthopedic surgeon, has reported that the veteran's spine has complete bony fixation (ankylosis) with unfavorable angle and with marked deformity and involvement of major joints (Marie-Strumpell type) or without other joint involvement (Bechterew type). his description of the veteran's spine is lifted verbatim from the Rating Schedule which would warrant the veteran a 100% evaluation.

2. The veteran was examined on August 21, 1996. Kindly review the claims folder and provide us with an expert opinion as to whether the above description by the private physician matches the veteran's spine condition. You might want to review the January 1973 examination and x-rays to determine if there is a significant increase in the severity compared to the 1993 and current examinations.

3. We will appreciate your resolving the above problem for us. Please feel free to refute the private physician's report as fully as possible for a better argument.

Moreover, in light of the objective medical evidence as to pain (R. at 28, 38-39, 80, 89-90, 107, 179, 135), which could cause functional impairment under DC 5286-5295, the Court will remand this claim for a new examination that adequately evaluates the functional impairment due to pain, followed by a decision that specifically addresses the pain issue, supported by an adequate statement of reasons or bases. See _CFR_4.40 38 C.F.R. § 4.40 , 4.45 (1998); DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995); see also Smallwood v. Brown, 10 Vet. App. 93, 99 (1997); Green, 1 Vet. App. at 124 ("fulfillment of the statutory duty to assist . . . includes the conduct of a thorough and contemporaneous medical examination, one which takes into account the records of the prior medical treatment, so that the evaluation of the claimed disability will be a fully informed one"). Also, "in regard to cases affected by change of medical findings or diagnosis", VA agencies are charged with handling such cases "so as to produce the greatest degree of stability of disability evaluations consistent with the law and [VA] regulations", and the Secretary's regulation provides: "It is essential that the entire record of examinations and the medical-industrial history be reviewed to ascertain whether the recent examination is full and complete, including all special examinations indicated as a result of general examination and the entire case history." _CFR_3.344 38 C.F.R. § 3.344(a) (1998). On remand, the Board must ensure that this regulation is heeded.

b. BVA Reliance on Medical Opinion Obtained by Tainted Process:

The Court notes that, in reaching the above conclusion, the Board relied on the October 1996 orthopedic medical opinion by the VA specialist that was solicited by the RO. R. at 6-7. Although the Board also said that "even without the doctor's opinion" it had concluded that DC 5286 applied only to conditions that affect "the entire spine", the Board was obviously influenced by the conclusion in the October 1996 medical opinion by the specialist that DC 5286 was not applicable to Pott's disease, even if the entire spine had been involved (R. at 191). The RO, in its October 1996 engagement memorandum that led to the October 1996 opinion, alleged that Dr. Lloren's October 1994 diagnosis as to the veteran's back disability was "lifted verbatim from the Rating Schedule", sought a resolution to that "problem", and then proposed that the specialist "feel free to refute the private physician's report as fully as possible for a better argument." R. at 255. That language suggested and, in effect, requested that the orthopedic specialist refute Dr. Lloren's opinion that the veteran's condition was ratable under DC 5286. In addition, the RO limited the inquiry to two narrow issues -- whether the previous report was accurate and whether the veteran's disability had recently worsened -- and left to the specialist's discretion whether he would {12 Vet. App. 535} review certain prior examination and x-ray reports ("you might want to review the 1973 examination and x-rays", R. at 255).

The Court holds that the questions that the RO presented to that orthopedic specialist in the engagement memorandum were fatally flawed in that a "question may not suggest an answer or limit the field of inquiry by the expert." Bielby v. Brown, 7 Vet. App. 260, 268-69 (1994); see also Austin v. Brown, 6 Vet. App. 547, 552 (1994). The Secretary has conceded the impropriety of that memorandum. Under _CFR_4.23 38 C.F.R. § 4.23 (1998), "rating officers must not allow their personal feelings to intrude . . . and fairness and courtesy must at all times be shown to applicants". That regulation was violated by the engagement memorandum prepared here. Moreover, the memorandum also violated a requirement in _CFR_4.1 38 C.F.R. § 4.1 ("it is thus essential, both in the examination and in the evaluation of disability, that each disability be reviewed in relation to its history" (emphasis added)), because it gave the examiner discretion as to whether to review certain prior medical records. See Green (Victor), supra ("thorough and contemporaneous medical examination" is one that "takes into account the records of the prior medical treatment, so that the evaluation of the claimed disability will be a fully informed one").

[free_spirit_etc]

Here is something else to add to your stash. Librium, which I think you said you were prescribed for anxiety, is not only not used to treat BPD, but is actually not recommended for use with people with BPD.

http://psyweb.com/Drughtm/jsp/librium.jsp

Librium has been known to interact undesirably with certain medical conditions. Tell your doctor if you have, or have a history of, any of the following conditions:

· Borderline personality disorder or a history of violent behavior.

Just another tidbit of info

Free

[free_spirit_etc]

http://www.magellanassist.com/mem/library/...mp;CategoryId=2

Borderline Personality Disorder

Treatment

Medication

In addition to psychotherapy, mental health professionals may use medication to help provide stability during treatment. Frequently used medications include mood stabilizers, such as lithium and carbamazepine; anti-depressants; and low-dose neuroleptics when manic or psychotic features (very distorted thoughts or beliefs) are present.

Anti-anxiety medications, such as Valium (diazepam), Xanax (alprazolam) or Librium (benzodiazepine), generally aren't good for BPD patients. These medications reduce inhibitions, which is fine for an otherwise anxious patient who's uptight yet in control, but potentially hazardous for people who are impulsive, extremely sensitive and reactive and prone to abuse alcohol or drugs.

Here is something else to add to your stash. Librium, which I think you said you were prescribed for anxiety, is not only not used to treat BPD, but is actually not recommended for use with people with BPD.

http://psyweb.com/Drughtm/jsp/librium.jsp

Librium has been known to interact undesirably with certain medical conditions. Tell your doctor if you have, or have a history of, any of the following conditions:

· Borderline personality disorder or a history of violent behavior.

Just another tidbit of info

Free

[Josephine]

Yes. The case shows that it doesn't always mean personality disorder. I also notice the BVA judge was a female.


I would think that the change in the diagnostic nomenclature might work to your advantage in this one. 


It would be interesting to find why they stopped using that as a diagnosis - and what diagnosis branched off of that. I imagine the DSM changed it.


I was also interested in your letters from your minister. They talked about how active you were in the church, etc. BEFORE you went into the service.


Were you also active in school organizations? Service groups?


I know usually the big deal is proving something occured in the service - and the nexus.


However, I think the broader picture you could create of how "normal" you were BEFORE the service - the odder the "personality disorder" diagnosis would look.


So - if you have to appeal - even a couple of statements from someone in the past may help. They wouldn't even have to be someone who knew you after and noticed the marked change in you. In fact someone who says things about you before the service but says they did not see you much after - and can't remark on it much - still add credibility to your other statements from those who DID see the change. and the statements should be pretty credible, as they are not testifying to things they don't have knowledge of.


For example - a statement I wrote for my husband's claim - there were places where I stated - I cannot discuss that period, as I did not know him at that time, but I can discuss what I DO know.


Sometimes such statements can be more supportive tha ones that have something to say about everything. They can back the other statements.


I wouldn't overwhelm them with 100 statements. But you could ask 100 people - so you will get 7 - 2 of which will be good to use.


Anyway - just MY idea. If I were looking at the case...And one doctor said it was personality disorder and the other doctor said it was anxiety - and both connected it to my service. And then I saw a few statements about how you were involved in this, that, and the other right before you went into the service - the personality disorder theory would start looking more questionable to me.


Then I would start looking more closely at the personality disorder C&P. What tests did they do to determine that? Where did they get their information about the incidents they describe? If they state the patient reported them, why didn't she ever report the same things to someone else? Or why did no one else mention them in their reports.


How do they know she is a "cutter" Did they take pictures of, or describe any scars?


So a couple of statements might be helpful. At least the probably wouldn't hurt. Again, if they can describe how you changed - that is nice. But even a statement along the lines of I was surprised to hear that Josephine had so many problems after the service - because I knew her right before that and she was ______. If they don't know for sure how you were after - and state that they don't know - that can be okay - and even add credibility to their statements.


They won't replace a strong medical opinion - But they can help support a positive opinion and help debunk a negative one. At least where the anxiety vs. personality disroder comes into play.


I would think a rational person would start thinking - hmmm - she was normal going in - and was emotionally unstable going out - I wonder what happened in between.


Free

Free,

I notice that I also have a Lady Judge working my claim.

I didn't want to hog up the site with my claim, but will post the two letters by my Pastor.

Letter One

April 17, 2005

To whom it may concern:

I was Pastor for the XXXXXX Church located in xxxxxxx until my retirement.

I am writing a letter to you concerning xxxxxxx.

I have known xxxx , from the age of 15, as she was an active member of the xxxxx Church.

She was a quiet and confident young lady heavily involved in church activities and she worked with so much enthusiasm.

xxxx played the piano for each of our services for several years and also for our young peoples fellowship group, and attended all of our young people's church outings and enjoyed so much being with the other young people in the church.

She enlisted in the United states Navy in 1963.

xxxx came back to church after discharge in 1964, but only came a few times and never came back.

She came approximately three times.

When I saw her at church, after her time in service, in 1964, xxxx was unsure of herself and was very introverted and stayed within herself. She was not the confident young lady that I had known before her entrance into the United States Navy in 1963.

We spoke of her medications and all of the physicians and psychiatrist that she was seeing and the abuse that she endured from the physicians while at the Navy Disp. and her drowning incidents in boot camp . I spoke with xxxx concerning my training in Psychology and believe that I was able to place some insight into her mental problems.

I counseled xxx between the years of 1965 - 1978.

Regards

Reverend

xxxxx

--------------------------------------------------------------------------------------------

Letter Two

April 22, 2006

To the Board of Veterans Appeals

I appreciate your consideration of my dedication as Pastor of the xxxxxx Church, located in xxxxx until my retirement.

I have had the privilege to write two letters to you concerning the spiritual relationship I shared with xxxxx .

xxxx was an active member of the church and an inspiration to all that met her before service.

Upon her return from military service in the United States Navy in 1964, she attended church a few times.

During my visits to members of my congregation, I would stop by and visit with xxxx and talk to her and offer her guidance and support revealing to her the truths in the Word of God.

She confined in me the events of striving to pass the required swimming classes and the physical abuse she endured in service, which she felt was the reason for her discontentment with with life and her feelings of nervousness and depression.

I counseled xxxxx as a Pastor and not as a paid per visit Counselor and thus kept not written records of these visits.

I have been a friend to all church members and have kept in contact with each as much as possible.

As per the request of The Veterans Affairs, I have dated my visits with xxxx as closely to date as possible.

I believe that a person's future is more important than ones past and must be considered above the present, for without a future the past and the present become unimportant.

Regards,

Reverend

Here goes and also a letter from a friend.

Name

address

telephone number

July 7, 2006

To the Appeals Management Center:

I don't know why xxxx felt that she would be imposing on me, by asking me to write a letter upon her behalf, as to our life as a child and a teenager and her demeanor before and after service.

Having grown up with xxxx and being her friend for 50 plus years, I can tell you of her life before service and how she was after service.

Her parents were always calm, as her mother baby-sit my two daughters. there was definitely a change in xxxx after service, in that , to my knowledge, she did not take any medication of any kind before service, and I do know that she has taken nerve medication most of her life since her discharge.

I have known xxxx and her family since we were young girls.

I met xxx and her two sisters and one brother and parents when we were about 9 years of age. I have one sister and one brother. My brother was married to her sister.

I lived just a couple of houses below their home for our childhood. xxx was a year younger than me, but we were always were the closest of friends, even though her sister, xxxx was the same age as me, but she was the more daring type and her sister xxxxx was the more serious one, with her head always in a book.

We would walk across the hill, about 1 and a half miles to school each day and have so much fun climbing over the snow drifts and singing as we went. In the summer we would go down into the woods behind her house and play in the apple trees and as we became older, we joined the Girl Scouts together.

We would go camping at Little River and spend the night and walk across the swinging bridge across the river with never a fear on our minds.

I remember xxx taking piano lessons from xxxx xxxx and she would walk out the road once a week for them . She did this for several years. xxxx played the piano for our church and I loved to sing in the choir.

We loved to have our Friday night wiener roast with our church group at the xxx church . We would go to all the Young People's outings and always accompanied by Pastor B. and his wife Jackie. We would go to the amusement park and to Mrs. Radford's home by the river.

xxxx seemed to be as normal as a child and teenager as I was. I graduated one year ahead of xxxx , but we still saw each other, as I worked at the local drug store and she continued on with school. We were always walking to town on Saturdays and going to the Sunday movie. There wasn't much to do in a small town, but we had fun.

xxxx and I would see all the posters outside of the post officer and xxxx talked many times of joining the service, but didn't think that she would ever do it.

When xxxxx graduated from high school she worked a few months in a sewing factory and the next thing that I knew, she had joined the Navy. She was so full of joy and happiness to be making something of her life. xxx had joined the service, and I had began my first year of college.

xxx's dream was to be a Nurse and mind was to be a School teacher.

I taught kindergarten until my retirement in 2004. My dream was to inspire the younger child to be the most that they could be. xxxx tried different jobs, but her nerves got the best of her.

It was my brother that told xxxxx to go the R. O and file for benefits for this nervous condition.

Xxx called me from her her youngest daughters homes xxxxx after the examination with the two psychiatrist and she told me that she thought that she was in some kind of a trance. She said that she could remember a little better than she could earlier in the day.

She has read me the examination and I do know that she had a miscarriage between her two daughters as I was present.

I have two wonderful daughters, one being a year younger than her youngest daughter and one being a year older.

I was present at xxxx's home when she brought her oldest daughter home from the hospital and the same for her youngest.

I believe, as someone that has known xxxx most of her life, I can state that she does not like to be the center of attention. She is quiet and is very fearful of driving a car. I have been to xxxx'x home several times, and I have never seen her home torn up, I have never known her to be violent and she has always been married to xxxx.

xxxxx has been good to her family and is very proud of her daughters and eight grandchildren.

This letter is written entirely as from a friend that has known xxxxx for the last 50 plus years. I am not making any medical opinion, as I am not qualified.

I will not receive any financial gain from this letter.

I only wish that she had ask me sooner.

xxxxxxxx

Edited August 15, 2007 by Josephine

[tssnave]

Free - Great insight and input - thanks!

Jo - Hang in there and keep fighting the fight until you win. My hope is with the current spotlight on PD use to screw new vets out of benefits that the court will look favorably towards the old vets who have been screwed for years.

In the court case it states: ...alleged that Dr. Lloren's October 1994 diagnosis as to the veteran's back disability was "lifted verbatim from the Rating Schedule"

This surprised me since my DAV rep sent me a memo w/ a DAV letterhead that had the rating critera (verbatim) for 70% and 100% with yes/no to check off for my PCP and IMO shrink to fill out. I hope this (using the rating critera verbatim) is not a flag for the VA to send you to another C&P exam.

It's like a catch 22 - if you don't list everything in your IMO that's in the rating critera then they can say you don't have symptom X but if you do list everything then they claim there's a problem because you have covered everything "verbatim" in the rating schedule - it's as if they don't realize that you may, in fact, HAVE all the problems in the rating schedule and didn't get it all covered in the C&P exam.

Comments? Anyone else use one of the DAV memos that has the rating criteria listed for the docs to sign?

Thanks,

TS

[free_spirit_etc]

I haven't ever had that experience - but I would think the rating schedule criteria would be a very good idea. In fact - you wonder why the VA doesn't use the checklist.

If the doctor used a checklist of the criteria - then it would seem less likely that the VA would misinterpret their reports. It would be very clear what level of impairment the doctor was talking about.

Of course, you would also want the doctor to write a narrative to discuss the results - along with the checklist.

It would seem like the VA would also like the checklists - as it could speed up the processing of claims...and actually make claims processing more accurate.

The only reason they wouldn't like them - is it gives them less ability to take what the doctor said and put their own interpretation on what it meant.

But as they are lay people, and therefore not competent to issue medical opinions - checklists would be to their advantage.

I think in the claim in question - the VA was just out to deny the increase and other issues. The court also reversed some other decisions of the BVA in the case.

Personally, I think the checklist - which shows the level of impairment - along with a narrative to justify the rating would be very good.

But again, I have no personal experience with it.

Free

Free - Great insight and input - thanks!

Jo - Hang in there and keep fighting the fight until you win. My hope is with the current spotlight on PD use to screw new vets out of benefits that the court will look favorably towards the old vets who have been screwed for years.

In the court case it states: ...alleged that Dr. Lloren's October 1994 diagnosis as to the veteran's back disability was "lifted verbatim from the Rating Schedule"

This surprised me since my DAV rep sent me a memo w/ a DAV letterhead that had the rating critera (verbatim) for 70% and 100% with yes/no to check off for my PCP and IMO shrink to fill out. I hope this (using the rating critera verbatim) is not a flag for the VA to send you to another C&P exam.

It's like a catch 22 - if you don't list everything in your IMO that's in the rating critera then they can say you don't have symptom X but if you do list everything then they claim there's a problem because you have covered everything "verbatim" in the rating schedule - it's as if they don't realize that you may, in fact, HAVE all the problems in the rating schedule and didn't get it all covered in the C&P exam.

Comments? Anyone else use one of the DAV memos that has the rating criteria listed for the docs to sign?

Thanks,

TS