tdiu Dysthymic Disorder And Other Questions

[Paul Allison]

I've been a long-time lurker on this site. Thank you all for your wonderful service to disabled veterans.

I recently received a decision on my claim for service-connected compensation. My old rating was 20%. My new rating is 90%. I feel fortunate (though it is deserved) given the experiences of many of the veterans and their struggle with the Va.

But there are inaccuracies within the decision letter. So, I'm hoping that several of you will offer me some guidance on how to proceed.

1) I was rated 50% for Dysthymic Disorder. What is needed to be rated 100%?

2) I disagree with the examination from VA Medical Center XXX, 2008, which showed that I denied current suicidal ideation or any past attempts. I did NOT deny current suicidal ideation. I did deny homicidal ideation. At the time of the examination, I DID have suicidal ideation and stated as much to the examiner. Suicidal ideation is corroborated by the results of the MMPI-2. Further, I did NOT report having five friends. I reported having less than five friends. There is also documentation supporting deficiencies in work, family relations, thinking and mood.

This is important because my medical evidence (i.e., letter from medical doctor, letter from psych

iatrist, letter from psychologist, and MMPI-2 results) support (at minimum) a 70% rating.

How do I get this corrected within my record? Can this be accomplished within the NOD?   

4) What are comorbid or secondary conditions that I should be exploring given the Dysthymic Disorder?

5) I disagree with the examination from VA Medical Center XXX, 2008, which showed that I am currently employed part-time with XXX. I am NOT (nor was I at the time of the examination) employed by XXX. My last month with XXX was XXX, as indicated in my federal tax records. This is an error that must be amended in my C-file. I am unemployed and have been unemployed since XXX.

This is important because I filed for individual unemployability. It was denied. However, the decision letter states, "It is the examiner's opinion that you are not a candidate to work because of your service connected disabilities." It is also supported by an evaluation of 50% for Migraine Headaches, 

which indicates "very frequent, completely prostrating, and prolonged attacks productive 

of severe economic inadaptability", and a letter from my medical doctor indicating life-long difficulties regarding acquiring and maintaining a job.  

How do I get this corrected within my record? Can this be accomplished in the NOD?

If you've made it this far, thank you.

Paul 

[Paul Allison]

Everyone-

Thank you for the useful advice. I did not intend to exclude by indicating Berta within my last post.

Do I send the Reconsideration Letter to the same place as the NOD?

And regarding the urinary problems... I actually brought the medical examiner a copy of a "pee" log. If that wasn't enough, the legit 12+ visits to the restroom over the course of my examination probably helped convince him. The psychological examiner verbally indicated that the "pee" log was not relevant to that examination. I disagreed with him and pointed out that it affected my quality of life, but that never made it into the decision letter either...

Paul

[donews]

Excuse me if I missed this or am covering something already mentioned.

I see the mentioning of Frequent Urination.

Are you rated for this separately or as part of another disability?

I have a claim in for Frequent Urination as Secondary to taking Furosimide for my Chronic Congestive Heart Failure.

I do not have a clue what they will say,I have not heard anything back yet on this one, but it is listed in the Rating Schedules.

Urinary frequency:

Daytime voiding interval less than one hour, or; awakening to

void five or more times per night ................................................................. 40

Daytime voiding interval between one and two hours, or;

awakening to void three to four times per night .......................................... 20

Daytime voiding interval between two and three hours, or;

awakening to void two times per night ....................................................... 10

Someone please correct me if I am wrong.

[Paul Allison]

Interesting. I had NO clue of this rating. Thank you for providing it. I am rated for Diabetes Insipidus (DI) due to damage in my hypothalamus. It causes a variety of problems (e.g., urination, fatigue) AND can lead to congestive heart failure. It might be worth you checking out DI.

Anyone, does the DI subsume the Urinary Frequency rating?

[donews]

I think the areas I can argue include diabetes insipidus and dysthymic disorder. The DI was rated at 20% because the blood work records I submitted proving two separate periods of dehydration without parenteral hydration were outside of the one year required for the 40%. And since my endocrinologist has placed me on desmopressin, my BUN/Creatine ratio (used to gauge dehydration) is within the (high) acceptable range. The DI is awful though... I urinate (on medication) 3-4 times/hour. I am quite sure it contributes to my low quality of life. I don't know how to argue to have this rating increased given the lack of medical evidence.

I just read your post again, and wanted to ask for clarification of why you got a 20% rating for the DI. I want to make sure I am reading your explanation correctly.

Above you said it was due to needing two separate periods of dehydration within a year, but I read the regs to say that you only need to have Polyuria with near continuos thirst and ONE or more episodes of dehydration in the past year not requiring parenteral hydration to get 40%.

Again, sorry if I covered something already in here, some of these are long and my eyes can wander sometimes.

Just trying to offer any help I can.

[Paul Allison]

I just re-read the decision letter. You are correct. I only need one or more episodes

of dehydration in the past year not requiring parenteral hydration. Thank you. I made

the correction in my tentative NOD and REQUEST for RECONSIDERATION letters. However, I still don't have evidence within their one-year frame. The last blood work that indicated severe dehydration was in 2006. Since that time, they have increased my desmopressin (medication) to a very high level.

What is the code for the Urinary Frequency you indicated below?

Can I include this code in the REQUEST given that the decision letter indicates that

I have "polyuria with 3-4 per hour voiding" and their examiner wrote, "ongoing

severe poluria or almost continuous epidodes, day and night, of urination."

[Paul Allison]

Another question:

Can this be included in a REQUEST for RECONSIDERATION?

I request reconsideration for back pay to XXX.

According to § 4.129 -- Mental disorders due to traumatic stress:

“When a mental disorder that develops in service as a result of a highly stressful event is severe enough to bring about the veteran's release from active military service, the rating agency shall assign an evaluation of not less than 50 percent and schedule an examination within the six month period following the veteran's discharge to determine whether a change in evaluation is warranted.”

As my PEB indicates, I was honorably discharged from active military service with a service-connected injury to my brain incurred in XXX. Despite this highly stressful event, I was NOT awarded 50 percent and scheduled an examination within the six month period following discharge. Instead, I was rated with post concussive syndrome with chronic headaches, cognitive disorder and mild dysthymia at 10% disabling AND rated with left upper extremity (minor) weakness due to herniated discs, cervical spine, with radiculitis at 10% disabling.

In consequence, given the above evidence documented within my records, I request back pay.