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

[Josephine]

Free,

I will try to make some sense of this mess. I did fill out the form- 9 as requested as I only had 60 days to turn it in.

Did it make any sense? Probably not!!

I could only say that I did not have a C&P examination.

Emotional Instability can be a " Psychiatric Disorder".

I want 100 % service connection for anxiety with depression from my first filing date of 1978 due to my " Psychiatric Records" never acquired by the VA.

No one addressed the headaches for which I filed a NOD.

What did I think that they did right or wrong. I put I didn't think that they did anything correctly.

I called the BVA and this Form- 9 was sent to them as soon as I turned it back in to the VA.

I then went for my first C&P - Generalized Anxiety Not otherwise Specified with depression. " More Likely than Not this Veteran had a " acquired chronic psychiatric disability in service. "

5 months later. I received a notice of my Office Visit at the VAMC

Two Quack Psychiatrist -

Axis 1 - Anxiety not other wise specified

Axis 2 - Personality Disorder not otherwise specified with borderline, dependent and histrionic traits

AXis 3 - Other illness

Axis 4 None

Axis V GAf - 40

The veterans symptoms are primary consistent with a personality disorder and it does not appear the veteran developed "a chronic psychiatric disability in service."

Ruling - we place our weight with the psychiatrist as they were psychiatrist.

January 2006 went to BVA remanded to AMC April 2006 - finally now to rate.

The most stupid thing that I ever did was to file a claim in 1978 and again in 2002. A lawyer needs to get ahold of this thing and not me.

If the VA had only ask for the " psychiatric records in 1978 and not leave them in the archives for me to locate in 2004. 40 years after the fact.

Always and thanks,

Josephine

Edited August 16, 2007 by Josephine

[free_spirit_etc]

So after they sent you the NON final decision and you sent in the appeal form - they sent you to the two C&P exams?

And they then sent you a finaly decision of denial?

Who sent you the "Ruling - we place our weight with the psychiatrist as they were psychiatrist."

Wow! That is some profound reason and bases based on sound medical rationale. Geez! (and you gotta wonder if they thought they needed a psychiatrist - why they didn't send you to one in the first place)

But was that sent by the Ro - or the AMC?

It says that the AMC handles the remands from the BVA. The website says:

"Development is completed in strict compliance with the wording of the remand order."

Do you know what the remand order says? What was it the BVA asked the AMC to do with your claim.

It does look like the AMC will have to send you a statement of case if they deny your claim. ANd if they do - you will probably need to be ready to move on it pretty quick -- as I think cases that have been remanded by the BVA get shot up the docket when they are returned.

Free

Free,

I will try to make some sense of this mess. I did fill out the form- 9 as requested as I only had 60 days to turn it in.

Did it make any sense? Probably not!!

I could only say that I did not have a C&P examination.

Emotional Instability can be a " Psychiatric Disorder".

I want 100 % service connection for anxiety with depression from my first filing date of 1978 due to my " Psychiatric Records" never acquired by the VA.

No one addressed the headaches for which I filed a NOD.

What did I think that they did right or wrong. I put I didn't think that they did anything correctly.

I called the BVA and this Form- 9 was sent to them as soon as I turned it back in to the VA.

I then went for my first C&P - Generalized Anxiety Not otherwise Specified with depression. " More Likely than Not this Veteran had a " acquired chronic psychiatric disability in service. "

5 months later. I received a notice of my Office Visit at the VAMC

Two Quack Psychiatrist -

Axis 1 - Anxiety not other wise specified

Axis 2 - Personality Disorder not otherwise specified with borderline, dependent and histrionic traits

AXis 3 - Other illness

Axis 4 None

Axis V GAf - 40

The veterans symptoms are primary consistent with a personality disorder and it does not appear the veteran developed "a chronic psychiatric disability in service."

Ruling - we place our weight with the psychiatrist as they were psychiatrist.

January 2006 went to BVA remanded to AMC April 2006 - finally now to rate.

The most stupid thing that I ever did was to file a claim in 1978 and again in 2002. A lawyer needs to get ahold of this thing and not me.

If the VA had only ask for the " psychiatric records in 1978 and not leave them in the archives for me to locate in 2004. 40 years after the fact.

Always and thanks,

Josephine

[free_spirit_etc]

Interesting.. Very interesting...

In my experience - though my son was under the care of a PSYCHIATRIST (who could prescribe medicine) - he would not render an official diagnosis until he sent my son to PSYCHOLOGISTS for psychological testing. He based the diagnosis on their testing and reports.

Notice the word is called PSYCHOLOGICAL testing - NOT psychIARTIC testing.

http://www.guidetopsychology.com/testing.htm

Psychological tests are usually administered and interpreted by a psychologist because studies in psychopathology, along with academic courses and supervision in psychological testing, are an integral part of the doctoral degree in clinical psychology. A counselor who has had the appropriate academic courses and supervision may administer occupational tests or achievement and aptitude tests, but most counselors have not received the training to administer personality tests. Academic courses and supervision in psychological testing are usually not a part of a psychiatrist’s medical training, so most psychiatrists can ethically administer only some specific clinical tests that are straight-forward check-lists of symptoms.

So the VA placed their weight with the opinion of someone who is not the most qualified to administer or interpret psychological tests.

Was the first C&P done by a Psycholgist?

By the way - did they actually GIVE you any psychological tests? Or was the psychiatrist so brilliant that he could determine that all your problems stemmed from your 'personality disorder not otherwise specified'(i.e "we don't know WHAT kind it is because it doesn FIT any of them") (with traits of three kinds) and NOT from your diagnosed and treated anxiety without having to do any testing (which they aren't qualified to do anyway)?

Free

Ruling - we place our weight with the psychiatrist as they were psychiatrist.

[Josephine]

Free,

Yes the first C&P was done by a PHD Psychologist. I am sorry that I have looked at that darn C&P so many times that I didn't even see that she had stuck that " Not Otherwise Specified in there.

I find it strange that after I picked up the first copy of that C&P and placed a complaint against it with the Patient Advocate and the Regional Office that 30 days later, she went in and placed that

PRIVACY ACT AMENDMENT NOTE

You may not VIEW THIS COMPLETED PRIVACY ACT AMENDEMENT NOTE.

Date of note May 16, 2005

I have a copy with the AMENDMENT and a copy of the C&P without that note.

There was absolutely no psychological tests

I didn't know that Psychiatrist weren't qualifed to do those test. This must be why when I called a Psychiatrist last week, he refused.

Thanks so much,

Josephine

[Josephine]

Free,

I called Virginia Tech and spoke with one of their PHD Psychologist and what you have posted is correct.

Psychiatrist are not trained to administer or interpret any of the testing. They can take the written results of the Psychologist and administer meds if needed for the P.D.

You are also correct, they would never administer Librium, Valium or any of those class of drugs for a PD. Disorder either.

I ask him about that Personality Disorder not otherwise specified with bordeline, dependent , histrionic traits and he said that meant that I did not have a Personality Disorder, not even to the extent that it needed to be mentioned.

He said that the Psychaitrist were qualifed to write that down and that is why they placed the not otherwise specified, as they knew no testing had been done to make any firm diagnosis.

He did state that the Anxiety not Otherwise Specified was a DSM Coded diagnosis.

My said that he knew DR. P and that he was more than Qualified to Treat my Anxiety and sure as heck would know after 30 years, if I had a Personality Disorder.

Thanks so much for your time,

Josephine

Edited August 16, 2007 by Josephine

[free_spirit_etc]

Actually, I didn't know that either. But I know they usually refer to it as psychOLOGICAL testing and psychOLOGICAL evaluations. And I remembered when my son was under the care of a psychiatrist - he had discussed his SUSPECTED diagnosis with me - but said he would not CONFIRM them UNTIL he sent my son to a PSYCHOLOGIST for the testing.

So I looked up some info to check it out.

So I think that will be an important part of your argument in an appeal if you need to do one.

They sent you to a psychologist, who is qualified to do psychological evaluations. The psychologist confirmed your diagnosis you already had of anxiety - and was favorable to your claim.

Then they sent you to a PSYCHIATRIST for an evaluation. The psychiatrist actually confirmed your diagnosis of Anxiety on Axis I, but also gave you and NEW diagnosis of Personality Disorder on Axis II, and opinioned that your problems stemmed from the Personality Disorder.

There are a lot of weak areas in that.

The VA SENT you to someone who it is not standard medical practice for them to even DO psychological testing.

The psychiatrist gave you a NEW diagnois WITHOUT even doing any psychological testing.

The NEW diagnosis wasn't even specific. They tagged you with a Not Otherwise Specified DIAGNOSIS (as there was not evidence that you met the criteria for any of the specific disorders) and then assigned traits from several of the disorders.

The VA gave more weight to the psychiatrist just because they were a psychiatrist even though standard medical practice does not involve psychiatrists doing PSYCHOLOGICAL evaluations - and that they did no testing to confirm the NEW diagnosis they gave you.

They probably gave more weight to the psychiatrist because 30 years of total disability is expensive and they could pay several people's bonuses out of those funds.

Free

Free,

Yes the first C&P was done by a PHD Psychologist. I am sorry that I have looked at that darn C&P so many times that I didn't even see that she had stuck that " Not Otherwise Specified in there.

I find it strange that after I picked up the first copy of that C&P and placed a complaint against it with the Patient Advocate and the Regional Office that 30 days later, she went in and placed that

PRIVACY ACT AMENDMENT NOTE

You may not VIEW THIS COMPLETED PRIVACY ACT AMENDEMENT NOTE.

Date of note May 16, 2005

I have a copy with the AMENDMENT and a copy of the C&P without that note.

There was absolutely no psychological tests

I didn't know that Psychiatrist weren't qualifed to do those test. This must be why when I called a Psychiatrist last week, he refused.

Thanks so much,

Josephine