Remand From Bva To Amc To Denial

[Josephine]

After receiving the denial from the AMC it appears it was one way to get rid of Dr. Mxxxx, VAMC, my first C&P doctor with the " More Likely than Not Decision"?

The Board notes the available record includes both positive

and negative evidence as to service incurrence.

The record clearly reflects that the veteran has received extensive

medical treatment for a variety of disorders since the late

1960s.

During this time, she was prescribed medication for anxiety.

In correspondence dated in April 2004 the veteran's private Internist, M.P. M.D., stated his opinion that the veteran's

anxiety/depression had their origin during her military

service.

However, none of Dr. P.'s treatment records, compiled over many years, reflect any references whatsoever to military service, or events which the veteran asserts occurred therein, which she claims led to the development of her psychiatric disability.

It would be helpful if Dr. P. would provide the basis for his opinion linking the onset of the veteran's psychiatric disability to service, and whether he has any specialized training or expertise in the field of psychiatric illness.

In contrast to Dr. P.'s opinion, and that of a VA

psychologist in an October 2004 report, a board of two VA

staff psychiatrists found that the veteran's symptoms were

primarily consistent with a personality disorder and that it

did not appear she developed a chronic psychiatric disability

while on active duty.

The veteran subsequently submitted additional evidence in

support of her claim including correspondence dated in May

2005 from B.C.C., M.D., in essence, recalling his having

treated her in February 1964 and prescribing medication for

anxiety. In correspondence dated in January 2006, Dr. P.

disputed the April 2005 opinion as to the veteran's having a

personality disorder.

Finally, submitted was a statement from a pastor, Reverend

B.O.B. who reported having counseled the veteran during the

period from 1965 to 1978, at which time she relayed some of

the events in service on which she bases the development of

her psychiatric illness, specifically the "near drowning"

incidents, and "abuse" directed at her by physicians.

Obtaining a copy of these counseling records would be

beneficial in adjudicating the veteran's claim.

Therefore, the Board finds additional development is required

prior to appellate review. Accordingly, this matter is

REMANDED for the following:

1. The veteran must be provided

notification (1) of the information and

evidence not of record necessary to

substantiate her claim, (2) of the

information and evidence that VA will

seek to provide, (3) of the information

and evidence that she is expected to

provide, and (4) to request or tell her

to provide any evidence in her possession

that pertains to the claim. These notice

requirements are to be applied to all

elements of the claim.

2. Appropriate efforts should be taken

to obtain the veteran's complete service

personnel records, as well as any other

service medical records which have not

been forwarded to VA. Those records,

along with the additional records

submitted by the veteran directly to the

Board, should be incorporated into the

claims file.

3. It should be ascertained through

appropriate procedures whether or not the

veteran filed a claim for service

connection for psychiatric disability in

1978 or thereabouts. If so, any records

compiled in association with such claim

should be incorporated into the claims

folder.

4. In the event the veteran provides

sufficient identifying information, it

should be ascertained whether a trainee

died as a result of drowning, at the time

the veteran was in training, and the

circumstances surrounding such incident.

5. After any necessary authorization has

been received, Reverend B.O.B. should be

asked to provide copies of his counseling

records pertaining to the veteran,

covering the period from 1965 to 1978.

6. Dr. P. should be contacted and asked

to provide the basis for his diagnosis of

the veteran, and whether he has any

medical training or expertise in treating

or evaluating psychiatric disability.

7. After the above development has been

completed, the veteran's claims file

should returned to the board of VA

psychiatrists who participated in the

April 2005 examination for clarification

of the provided opinion. They should be

requested to review the record and

reconcile their opinion as to etiology in

light of the evidence added since their

examination of the veteran, including the

May 2005 statement of Dr. B. C.

CXXXXX and the January 2006 statement of

Dr. MXXXXX PXXXXX.

If neither of these examiners is

available, the RO should consider whether

the veteran should be scheduled for an

additional examination by a board of two

VA psychiatrists for an opinion as to

whether there is at least a 50 percent

probability or greater that an acquired

psychiatric disorder was incurred in or

aggravated by active service. All

indicated tests and studies are to be

performed. Prior to the examination, the

claims folder must be made available for

review of the case. A notation to the

effect that this record review took place

should be included in the report.

Opinions should be provided based on the

results of examination, a review of the

medical evidence of record, and sound

medical principles. All examination

findings, along with the complete

rationale for all opinions expressed,

should be set forth in the examination

report.

8. The veteran must be given adequate

notice of the date and place of any

requested examination, if such is deemed

necessary. A copy of all notifications,

including the address where the notice

was sent must be associated with the

claims folder. The veteran is to be

advised that failure to report for a

scheduled VA examination without good

cause shown may have adverse effects on

her claim.

9. After completion of the above and any

additional development deemed necessary,

the issue on appeal should be reviewed.

If any benefit sought remains denied, the

veteran and her representative should be

furnished a supplemental statement of the

case and be afforded the opportunity to

respond. Thereafter, the case should be

returned to the Board for appellate

review.

As You read in the denial Dr. Mxxxx was never mentioned in the final decision. Is this the way the Va rates the claims.

There could be no benefit of the doubt for all the positives had been eliminated.

b]REASONS AND BASES

As noted your appeal was remanded by the board of veterans appeals. On April 10, 2006 for notification complaint with applicable statues and regulations, the precurement of service personnel and medical records, inquiry for a claim for service connection alleged to have been filed in 1978.

Service department inquiry regarding a drown trainee ( if the veteran provides signficant identifying information ), the procurement of treatment records from Rev. B. B. Bxxxx if the veterans so authorizes, inquirities into Dr. Pxxxx credentials, re-view of the expanded record by the previous board as psychiatric examiners subsequent read adjudication.

On May 8, 2006 we sent you a letter notifying you of the evidence required for a favorable resolution of your appeal.

We also notified you that we are responsible for procuring relevant records from any Federal Agency and providing you with a medical examination if it is necessary to determine your claim.

Moreover, We informed you that we will make reasonable efforts to assist you in procuring revelant records not held by a Federal Agency, but you are ultimately responsible for insuring the receipt of such records.

We also notified you of the evidence that we may consider when establishing your level of disability evaluation and the effective date of award.

In response you sent us several hundred pages of arguments and evidence.

I only sent the AMC duplicate copies, as they lost my Personel Records May, 2006, Again when sent July 2006 and finally acknowledged them March 2007. I was told by Ms. Dunalap when I received a Statement in Support of Claim, October 6, 2007 " to please send back copies of whatever I thought they may have lost." How would I know what they had and didn't have, so I took all the important papers to the R.O and had them date stamped and the Navy Recruiter faxed them all to Ms. Dunalap. I was assured that they would not be lost. The R. O also stated that would be mailing the Original copies to the AMC.

The evidence is highly duplicated and much of it is irrelevant. It has all been reviewed and considered.

Your service personnel records have been procured reviewed and considered.

Yes, after 3 times of sending them to the AMC, they finally decided to log them in and place them in my claims file.

We requested additional service records, but NPRC infomred us that they had no more records to transmit.

You did not provide us enough information to make a service department inquiry regarding the alleged - drowned Doris.

No inquiries have been made.

I could never give the VA the last name of Doris. The last time I saw Doris she was lying on the right side of the pool not breathing.

Rev. B. B. has informed us he did not keep records of counseling you.

After 30 years past, it would be impossible for Pastor B. B to have records of counseling to me during the years of 1965 - 1978.

He only wrote what he knew to be factual and his crediablity should not be questioned.

Dr. Pxxxx informed us that he is a Board Certified Internist, but not a psychiatrists. His opinions have been reviewed and considered, and are discounted considerably as he apparently has no expert knowledge pertaining to psychiatry.

Dr. P, yes informed the VA he was not a Psychiatrist, but having been my only private doctor for almost 30 years, I am sure as he stated is as qualifed to treat and dispense my medication as any other practioner.

The expanded record was reviewed twice by the previous board of psychiatrist. They have determinded that no change is warranted in their previous opinion that your condition predates your service and underwent no increase in severity beyond its natural progress.

Yes, the explanded record was reviewed twice, why I do not know, as noted by their last examination, I shall assume we are speaking of the illness of anxiety with depression.

A pre- existing injury or disease will be considered to have aggravated by active military , naval, or air force sarvice, where there is an increase in disabilty during such service, unless there is a specific finding that the increase in disability ia due to the natural progress of the disease. Hensley V. Brown , 5 Vet. App. 155, 160 (1993).

I have read their Nov. 16, 2007 results and do not see this fact noted.

Examining Provider: L.L. Lxxxxxx, MD

Examined on : November 16, 2007

Examining Results:

The c-file, including personnel records, Dr. Pxxxxx's letters of 4/5/04, 1/23/06, 4/28/06, and 10/9/07, and Dr. B. Cxxxxx letter of 5/10/2005, was made available to the examiners and was reviewed.

The current request involves consideration of letters by Dr. B. Cxxxxxx and Dr. Pxxxx and " to reconcile their opinion as to etiology".

In our professional opinion, the preponderances of the evidence, including the letters by Dr. Cxxxxx and Pxxxx, supports the initial findings and diagnosis of the examiners and suggest that the etiology of her anxiety appears to have preceded her time in service.

Dr. L. L.

Receipt Acknowledged By:

11/19/2007

/es/Geoffrey Bader

The Va examiners have determinded that your "disability" manifested in service was an immature personality, just as noted in your service personnel record.

What are the reasons and bases for this statement? Immature approach to life at the age of 19 does not constitute an " Immature Personaltiy".

After reviewing the evidence in its totality, we have concluded that the most current, credible diagnosis is the one rendered by the board of psychiatrist:

The most current diagnosis by the two psychiatrist would be the November 16, 2007 examination results.

This statement is taken from the April 2005 C&P by these two Psychiatrist.

Personality Disorder not otherwise Specified, with bordline, histrionic and dependent traits.

This would be AXIS 11

Where is AXIS - 1 - Anxiety not otherwise specified?

The anxiety disorder noted in medical records was not diagnosed in service and is not noted in legible treatment records prior to 1979.

Dr. C has noted in my SMR'S Vascular V Tension Headaches. Librium TID has been added when Cafergot not effective.

Dr. C. has his notes in shorthand and has written a letter to the VA May 2005 clarifying his records that he added the Librium to my headache medicine for anxiety.

( Ilegible treatment records prior to 1979) the rater may have had diffulty reading the hand written notes, but as noted in the April 2005 C&P Dr. L has ever drug listed from 1965 to date in her write up.

[since that service, extensive medical records began in 1965 with her pregnancy and then pick up again on November 25, 1967 when Librium was ordered 5 Mg. prn. From that point through 1979 she was given, "Valium" in 1972 and 73, “Elavil in 1975, Etrafon 1975, Valium in 1976, Elixir of Butisol 1975, Valium1975, Mellaril in 1975, Adapin in 1976, Ativan in 1978 along with Stelazine for " chronic anxiety reaction" and then in 1979 she began on Valium again 5 mg daily also in 1979 there are prescriptions for Serax, Doxepin, Vistaril, Tranxene, and Ativan .In 1976 she was also given Fiorinal for headaches. In 1980 she began seeing Dr Pxxx, who continued the Valium and began Darvocet on a regular basis for headaches. She apparently took both of these medications through 1998, and reported above, continues to take Valium to date.

Dr. P also had no difficulties reading these medical records.

Entitlement to service for an acquired psychiatric disorder, to include anxiety and depression remains denied.

Always,

Betty

Edited December 18, 2007 by Josephine

[Josephine]

HI Everyone,

Just one question, How do I turn this thing around to the Axis 1 of Anxiety?

(The Psychiatrist on staff for one of my local Univerisites ask me to place Dr. Pxxx's 4 letters under his door to read.)

I believe after contacting him for 3 years, he is finally going to step in an take over.

I am concerned with this statement: The expanded record was reviewed twice by the previous board of psychiatrist. They have determinded that no change is warranted in their previous opinion that your condition predates your service and underwent no increase in severity beyond its natural progress.

1. Which illness which predates service? Anxiety or Personality Disorder?

November 2007

Examining Provider: L.L. Lxxxxxx, MD

Examined on : November 16, 2007

Examining Results:

The c-file, including personnel records, Dr. Pxxxxx's letters of 4/5/04, 1/23/06, 4/28/06, and 10/9/07, and Dr. B. Cxxxxx letter of 5/10/2005, was made available to the examiners and was reviewed.

The current request involves consideration of letters by Dr. B. Cxxxxxx and Dr. Pxxxx and " to reconcile their opinion as to etiology".

In our professional opinion, the preponderances of the evidence, including the letters by Dr. Cxxxxx and Pxxxx, supports the initial findings and diagnosis of the examiners and suggest that the etiology of her anxiety appears to have preceded her time in service.

Dr. L. L.

Receipt Acknowledged By:

11/19/2007

/es/Geoffrey Bxxxx

AMC Decision:

After reviewing the evidence in its totality, we have concluded that the most current, credible diagnosis is the one rendered by the board of psychiatrist Personality Disorder not Otherwise Specified with borline, histroian, and dependent traits.

This statement is from the April 14, 2005 C&P.

Is it that my current diagnosis needs to be addressed by the Psychiatirst who is going to read my file?

Thanks,

Betty

[hurryupnwait]

HI Everyone,

Just one question, How do I turn this thing around to the Axis 1 of Anxiety?

(The Psychiatrist on staff for one of my local Univerisites ask me to place Dr. Pxxx's 4 letters under his door to read.)

I believe after contacting him for 3 years, he is finally going to step in an take over.

I am concerned with this statement: The expanded record was reviewed twice by the previous board of psychiatrist. They have determinded that no change is warranted in their previous opinion that your condition predates your service and underwent no increase in severity beyond its natural progress. I have been trying to follow your claim, but this statement is very confusing

1. Which illness which predates service? Anxiety or Personality Disorder?

November 2007

Examining Provider: L.L. Lxxxxxx, MD

Examined on : November 16, 2007

Examining Results:

The c-file, including personnel records, Dr. Pxxxxx's letters of 4/5/04, 1/23/06, 4/28/06, and 10/9/07, and Dr. B. Cxxxxx letter of 5/10/2005, was made available to the examiners and was reviewed.

The current request involves consideration of letters by Dr. B. Cxxxxxx and Dr. Pxxxx and " to reconcile their opinion as to etiology".

In our professional opinion, the preponderances of the evidence, including the letters by Dr. Cxxxxx and Pxxxx, supports the initial findings and diagnosis of the examiners and suggest that the etiology of her anxiety appears to have preceded her time in service.

Dr. L. L.

Receipt Acknowledged By:

11/19/2007

/es/Geoffrey Bxxxx

AMC Decision:

After reviewing the evidence in its totality, we have concluded that the most current, credible diagnosis is the one rendered by the board of psychiatrist Personality Disorder not Otherwise Specified with borline, histroian, and dependent traits.

This statement is from the April 14, 2005 C&P.

Is it that my current diagnosis needs to be addressed by the Psychiatirst who is going to read my file?

Thanks,

Betty

Hi Betty

I think I would copy this guideline and ask the doctor to do an exam following this guide. guideline

To keep your thoughts on track, I would make a chronological sequence of events that took place. This would be your guideline.

The doctor also needs to make a statement as to service connection, this is copied from "A 21st Century System for Evaluating Veterans for Disability Benefits 2007"

In addition to medical information, such as the results of tests or examinations, the examiner may be asked to provide an expert opinion on such questions as whether a condition is related to a specific event during service in the military, or a preexisting condition was aggravated in service, or a condition may be a secondary manifestation or consequence of a condition that previously was service connected. In these cases, the examiner is asked to use the following terminology:

*

is due to (100% sure);

*

more likely than not (greater than 50%);

*

at least as likely as not (equal to or greater than 50%); and

*

not at least as likely as not (less than 50%) (VA, 2002a).

Hope this helps.

Happy Trails

Paul

Edited December 24, 2007 by hurryupnwait

[Josephine]

Hi Betty

I think I would copy this guideline and ask the doctor to do an exam following this guide. guideline

To keep your thoughts on track, I would make a chronological sequence of events that took place. This would be your guideline.

The doctor also needs to make a statement as to service connection, this is copied from "A 21st Century System for Evaluating Veterans for Disability Benefits 2007"

In addition to medical information, such as the results of tests or examinations, the examiner may be asked to provide an expert opinion on such questions as whether a condition is related to a specific event during service in the military, or a preexisting condition was aggravated in service, or a condition may be a secondary manifestation or consequence of a condition that previously was service connected. In these cases, the examiner is asked to use the following terminology:

*

is due to (100% sure);

*

more likely than not (greater than 50%);

*

at least as likely as not (equal to or greater than 50%); and

*

not at least as likely as not (less than 50%) (VA, 2002a).

Hope this helps.

Happy Trails

Paul

Thanks Paul,

I will do as you said. Gee, am I glad that I decided to call him again.

I felt stupid, but desperate.

At least, he will also have higher qualifications than she does.

I am hoping to get a call from him right after Christmas.

I was shocked that he wanted to read Dr. Pxxxx's letters. I will print a copy of the guideline .

Thanks a bunch and have a Wonderful Christmas.

Always,

Betty

[free_spirit_etc]

I was thinking that the C&P docs (the second two) ALSO gave you a diagnosis of Anxiety on Axis one..and that they stated that the majority of your symptoms were related to your personality disorder (thus causing your disability).

However, I don't recall that they gave any medical rationale for discerning which symptoms were caused by the Anxiety and which were caused by the so called personality disorder.

It is my understanding that if they can't seperate out which symptom is caused by what - they have to give the benefit of the doubt to the service connected condition.

I know you haven't got service connection yet - but still.

No problems before service.

Anxiety Problems and treatment in service.

Treatment for Anxiety over many years.

So called Personality Disorder diagnosed after no type of testing that is under the standard of care for the field - many YEARS after the service.

All of a sudden - they want to attribute your symptoms to personality disorder - and say it predates service.

Again - it is not a bad thing that they are putting it WAY back there, because you have good lay evidence you had no noticible problems pre-service.

But if your so-called personality disorder is so disabling, why did it take so many years to diagnose it though you were under constant medical care? And why was it diagnosed ONLY by two C&P docs who didn't do the appropriate tests?

And again, wasn't it a PSYCHOLOGIST who gave you your first C&P. Why are they disregarding that?

Psychologists are MORE qualified to do psychological testing and diagnosing than PSYCHIATRISTS.

In fact, psychiatrists SEND their patients to psychologists to have the psychologistdo the testing and interpreting of tests.

Psychiatrists do very little training on testing and interpretations of tests in their medical training - because that is the realm of psychologists.

Just like you medical doctor sends you to radiologists, physical therapists, etc... to people who are TRAINED to do that specific thing, - psychiatrists send patients to psychologists to do the testing and intepretation of tests.

Anyway - even THEY gave you an anxiety diagnosis. But they gave NO medical rationale as to why they have determined in ONE visit that your ongoing problems are related to your so called BPD, rather than the anxiety that even they diagnosed.

Free

[Josephine]

And again, wasn't it a PSYCHOLOGIST who gave you your first C&P. Why are they disregarding that?

Free,

Dr. Muller is not one time mentioned in this complete write up by the AMC, it is as though he never existed.

In the write up they state, " Dr. Payne alleges he treated me for " Anxiety", I would take this to mention, they feel that he is not as credible as that Darn Bxxxx Psychiatrsit.

The AMC does not mention Dr. Campion either.

Everything is about her!

Their stupid, " Most current credible diagnosis of me is now just about 3 years old."

Dr. Payne sent them a letter as to my conditon October 15, 2007.

They are not using his present and past diagnosis.

I made sure when I saw the Neurologist on Friday concerning my arm shocking me, I happen to notice his diploma in his main lobby that read, " Board of Psychiary and Neurology.

I ask his receptionist, if he was a Psychiatrist also and she said, yes.

Being that Dr. Payne referred me to him, I made sure that his tape machine was taking in all this mess about Dr. Payne's crediability being questioned by the VA.

He began asking me about my meds and what happened when I didn't take them and what my symptoms were.

I will be honest with you Free, I have not been to a doctor who checked me that did not write down Anxiety.

My hands have visible water dripping off of them from fear.

They have been that was since the high dive of the pool.

thanks and nice to hear from you,

Betty

Edited December 24, 2007 by Josephine

[Josephine]

Free,

What do you think of this?

The first official manual of the American Psychiatric Association (APA), the Diagnostic and Statistical Manual of Mental Disorders (DSM-I; 1952), reflected the views of dynamic psychiatrists, especially of Adolf Meyer, the most prominent American psychiatrist of the first half of the twentieth century (Grob, 1991).

Specific diagnostic entities had a limited role in the DSM-I and its successor, the DSM-II (1968). These manuals conceived of symptoms as reflections of broad underlying dynamic conditions or as reactions to difficult life problems. Dynamic explanations posited that symptoms were symbolic manifestations that only became meaningful through exploring the personal history of each individual. The focus of analytic explanations and treatment, therefore, was the total personality and life experiences of the person that provided the context for the interpretation of symptoms (Horwitz, 2002). The DSM-I and DSM-II made little effort to provide elaborate classification schemes, because overt symptoms did not reveal disease entities but disguised underlying conflicts that could not be expressed directly.

Karl Menninger, a leading dynamic psychiatrist at the time, argued that separating individual mental disorders into discrete categories with unique symptom characteristics—scientific medicine’s modus operandi—was a mistake. Instead, Menninger viewed all mental disorders “as reducible to one basic psychosocial process: the failure of the suffering individual to adapt to his or her environment. . . . Adaptive failure can range from minor (neurotic) to major (psychotic) severity, but the process is not discontinuous and the illnesses, therefore, are not discrete” (Wilson, 1993, p. 400). Rather than treating the symptoms of mental disorder, he urged psychiatrists to explain how the individual’s failure to adapt came about and its meaning to the patient. In other words, “What is behind the symptom?” (Menninger, 1963, p. 325).

Thanks,

Betty