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Psych Doc @ The Va

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SouthernBelle

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  • HadIt.com Elder

My husband and I have asked for a MEDICAL OPINION from the treating psychiatrist several times. Each time we ask, he says he will evaluate. He gives us PROGRESS NOTES. No opinion. The only thing that could be an opinion is the GAF score (averages 50). What can I do to get his OPINION and not him restating what my husband says?!

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Just wondering have you obtained his doctor's notes as of yet? This is a break down of the GAF Score. See where the symptoms for a GAF of 50 falls within the general rating criteria for mental issues.

Also could you please add a little more of your aruguments you presented in the appeal?

Also could you please scan and post the reasons for denial of the increase?

GAFSHEET.pdf

Edited by Ricky
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  • HadIt.com Elder

Sure, Ricky, some of the evidence I submitted is as follows:

Incidents and Dates

MAY 2007

08 May 2007- While dreaming, kicked and left bruises on spouse, was dreaming about combat.14 May 2007- Did not get out of bed-felt like the world was “just too much” to deal with.

18 May 2007- Did not get out of bed-wanted to “crawl under a rock and never come out.”

23 May 2007- Woke up from dream of being suffocated during combat-couldn’t breathe.

29 May 2007 Emotional outburst over sliced cheese.

JUNE 2007

02 June 2007- Emotional outburst at local Wal-Mart over a smell in the store. It “took [him] right back to the desert…”

07 June 2007- Did not get out of bed-couldn’t deal with the pressure of life.

12 June 2007- Had to be talked out of cancelling VA appointment with Dr. XXX- did not want to be around people.

13 June 2007- While driving- got very agitated with other traffic- they were “driving too fast, like idiots!”

14 June 2007- Medication Change-Taken off Citalopram Hydrobromide 40 mg tablets-the side effects were too severe. Side effects of the medication are as follows” Chest pain, emotional outbursts, unable to cope with daily life, heart palpitations, mood swings, insomnia, increased sweating, headaches, blood pressure changes, ejaculatory problems, and erectile dysfunction.

18 June 2007- Began “half a pill” regimen to come off the medication.

19 June 2007- Emotional outburst- no known provocation, feeling useless and helpless.

20 June 2007- Emotional outburst- cat meowed.

20 June 2007- Had to be talked into going to VA appointment.

21 June 2007- Did not go to baby’s doctor’s appointment because he did not feel like he could get out of bed.

21 June 2007- “Electrocution” feelings began.

22 June 2007- Emotional outburst- No known provocation.

27 June 2007- VA appointment- went even though would rather “be under a rock somewhere.”

30 June 2007- Left a going away bar b que at childhood best friend’s house because there were too many people and too much going on-didn’t get to say goodbye to lifelong friend.

JULY 2007

03 July 2007- Emotional outburst X 3.

03 July 2007- Continuous “electrocution” feeling.

03 July 2007- Had to stop driving because the “electrocution” feeling was so distracting and painful.

04 July 2007- Went to see fireworks-left before they started because of the noise and people.

05 July 2007- Emotional outburst- had to confine self to keep from “hurting others’ feelings.”

14 July 2007- Emotional outburst with neighbor present.

17 July 2007- Experienced severe side effects from coming off Citalopram Hydrobromide 40 mg tablets- stopped at Fire Station and EMS was called for dizziness, nausea, “electrocution” feeling, sweating, high blood pressure, chest pain and numbness in the left arm. Actually thought he was “going to die.”

17 July 2007- Emotional outburst-scared the baby into tears by sudden screaming.

20 July 2007- Nightmare- violent kicking and flailing, left bruises on spouse.

21 July 2007- Chest pain, nausea, dizziness, “…head feels upside down, like hanging upside down…” shortness of breath, sick to stomach, right arm pain.

As evidence and argument in my request for an increase in disability rating I present to the Department of Veterans’ Affairs their own standards for a rating of 70% disability rating. According to the letter I received from the Department of Veterans’ Affairs Atlanta Regional Office dated 24 June 2008 “General Rating Formula for Mental Disorders” says

“Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical , obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships…………………………………....70%”

By the Department of Veterans’ Affairs own standards of rating, I am currently at a 70 percent disability rating. One of my more recent GAF Scores was 49. According to Dr. XXXX’s Progress Note dated 05 June 2008, “Pt with significant inability of function in social/ occupational/ relationship interactions.”

So, by the Department of Veterans’ Affairs standards I have almost all of the requirements for a rating of 70%. The only symptom I do not suffer from is suicidal ideation. I suffer from every other symptom listed on your standards for a 70 percent Disability Rating.

I also submitted a personal statement about life with my husband. We haven't won yet, but I'm hopeful. I hope this helps someone. I kept very diligent records, and still do, of my husband's mood, including sudden changes, mood swings, and any time he feels happy (never), or has a panic attack. Sorry it is so long, but that is some of the evidence. I also submitted (on the front of my stack of evidence) a list detailing what I was submitting. It went like this:

EVIDENCE LIST

This is a list of Evidence being submitted at this time:

Department of Veterans’ Affairs “General Rating Formula for Mental Disorders”

Statement from Spouse- Melissa XXXXX

Incidents and Dates May 2007-July 2007

Progress Notes Dated February 2008-CURRENT

I started keeping records because the VA initially denied our request for increase. My husband had a horrible psych doctor in Atlanta and (SERIOUSLY) she laughed when my husband asked for THERAPY as well as medication, so we had poor records from her. She simply drugged him, and moved him out. I finally got tired of it and went a little nuts on her, so she transferred him to East Point CBOC, where he got good therapy, then we moved.... and luckily, he has another good therapist and psych doctor, even if he won't give us an OPINION, he's still VERY good. He monitors medications, and he actually believes that this doesn't just have an impact on my husband, he talks to me, too, something NO other doctor had done at the VA. His therapist is the same way. My husband had to tell them they could, and he encouraged it, because I pay attention to his moods etc. so I know what to tell the doctors; what's working, what isn't, how therapy could be improved, etc. Again, I'm sorry this is so long, but you asked!

Just wondering have you obtained his doctor's notes as of yet? This is a break down of the GAF Score. See where the symptoms for a GAF of 50 falls within the general rating criteria for mental issues.

Also could you please add a little more of your aruguments you presented in the appeal?

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Sure, Ricky, some of the evidence I submitted is as follows:

Incidents and Dates

MAY 2007

08 May 2007- While dreaming, kicked and left bruises on spouse, was dreaming about combat.14 May 2007- Did not get out of bed-felt like the world was “just too much” to deal with.

18 May 2007- Did not get out of bed-wanted to “crawl under a rock and never come out.”

23 May 2007- Woke up from dream of being suffocated during combat-couldn’t breathe.

29 May 2007 Emotional outburst over sliced cheese.

JUNE 2007

02 June 2007- Emotional outburst at local Wal-Mart over a smell in the store. It “took [him] right back to the desert…”

07 June 2007- Did not get out of bed-couldn’t deal with the pressure of life.

12 June 2007- Had to be talked out of cancelling VA appointment with Dr. XXX- did not want to be around people.

13 June 2007- While driving- got very agitated with other traffic- they were “driving too fast, like idiots!”

14 June 2007- Medication Change-Taken off Citalopram Hydrobromide 40 mg tablets-the side effects were too severe. Side effects of the medication are as follows” Chest pain, emotional outbursts, unable to cope with daily life, heart palpitations, mood swings, insomnia, increased sweating, headaches, blood pressure changes, ejaculatory problems, and erectile dysfunction.

18 June 2007- Began “half a pill” regimen to come off the medication.

19 June 2007- Emotional outburst- no known provocation, feeling useless and helpless.

20 June 2007- Emotional outburst- cat meowed.

20 June 2007- Had to be talked into going to VA appointment.

21 June 2007- Did not go to baby’s doctor’s appointment because he did not feel like he could get out of bed.

21 June 2007- “Electrocution” feelings began.

22 June 2007- Emotional outburst- No known provocation.

27 June 2007- VA appointment- went even though would rather “be under a rock somewhere.”

30 June 2007- Left a going away bar b que at childhood best friend’s house because there were too many people and too much going on-didn’t get to say goodbye to lifelong friend.

JULY 2007

03 July 2007- Emotional outburst X 3.

03 July 2007- Continuous “electrocution” feeling.

03 July 2007- Had to stop driving because the “electrocution” feeling was so distracting and painful.

04 July 2007- Went to see fireworks-left before they started because of the noise and people.

05 July 2007- Emotional outburst- had to confine self to keep from “hurting others’ feelings.”

14 July 2007- Emotional outburst with neighbor present.

17 July 2007- Experienced severe side effects from coming off Citalopram Hydrobromide 40 mg tablets- stopped at Fire Station and EMS was called for dizziness, nausea, “electrocution” feeling, sweating, high blood pressure, chest pain and numbness in the left arm. Actually thought he was “going to die.”

17 July 2007- Emotional outburst-scared the baby into tears by sudden screaming.

20 July 2007- Nightmare- violent kicking and flailing, left bruises on spouse.

21 July 2007- Chest pain, nausea, dizziness, “…head feels upside down, like hanging upside down…” shortness of breath, sick to stomach, right arm pain.

As evidence and argument in my request for an increase in disability rating I present to the Department of Veterans’ Affairs their own standards for a rating of 70% disability rating. According to the letter I received from the Department of Veterans’ Affairs Atlanta Regional Office dated 24 June 2008 “General Rating Formula for Mental Disorders” says

“Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical , obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships…………………………………....70%”

By the Department of Veterans’ Affairs own standards of rating, I am currently at a 70 percent disability rating. One of my more recent GAF Scores was 49. According to Dr. XXXX’s Progress Note dated 05 June 2008, “Pt with significant inability of function in social/ occupational/ relationship interactions.”

So, by the Department of Veterans’ Affairs standards I have almost all of the requirements for a rating of 70%. The only symptom I do not suffer from is suicidal ideation. I suffer from every other symptom listed on your standards for a 70 percent Disability Rating.

I also submitted a personal statement about life with my husband. We haven't won yet, but I'm hopeful. I hope this helps someone. I kept very diligent records, and still do, of my husband's mood, including sudden changes, mood swings, and any time he feels happy (never), or has a panic attack. Sorry it is so long, but that is some of the evidence. I also submitted (on the front of my stack of evidence) a list detailing what I was submitting. It went like this:

EVIDENCE LIST

This is a list of Evidence being submitted at this time:

Department of Veterans’ Affairs “General Rating Formula for Mental Disorders”

Statement from Spouse- Melissa XXXXX

Incidents and Dates May 2007-July 2007

Progress Notes Dated February 2008-CURRENT

I started keeping records because the VA initially denied our request for increase. My husband had a horrible psych doctor in Atlanta and (SERIOUSLY) she laughed when my husband asked for THERAPY as well as medication, so we had poor records from her. She simply drugged him, and moved him out. I finally got tired of it and went a little nuts on her, so she transferred him to East Point CBOC, where he got good therapy, then we moved.... and luckily, he has another good therapist and psych doctor, even if he won't give us an OPINION, he's still VERY good. He monitors medications, and he actually believes that this doesn't just have an impact on my husband, he talks to me, too, something NO other doctor had done at the VA. His therapist is the same way. My husband had to tell them they could, and he encouraged it, because I pay attention to his moods etc. so I know what to tell the doctors; what's working, what isn't, how therapy could be improved, etc. Again, I'm sorry this is so long, but you asked!

Not long at all. I assume that all of the above "incidents" were put into a statement in suport of the claim by you for you are in a perfect spot (the spouse) to observe these things. Also were the doc's notes available when you submitted the original request for increase?

I assume the doc knows that your husband has quit work - what did he say about it? Have you seen his treatmen notes written by the doc on this issue?

Sorry for all the questions - but it appears that as you stated in the original post is medical evidence. It will have to be not in the form of an opinion as an opinion is not needed for you already have service connection. It is gonna have to be a current diagnosis - which should be some where in the progress notes in the form of all the axis along with a descriptive note on his functioning. If not then that is where we gotta get to.

Also did he have a C&P for the increase? if so what did the doc say in that C&P?

Edited by Ricky
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  • HadIt.com Elder

Ricky, I've read all the progress notes. I've read the notes from 1993 when he was med-evaced to Brook Army Medical Center, I've gotten all his personnel records, medical records, VA records, every thing. That list of incidents and dates is mine, I created it, I maintain it, his doctors get a copy monthly, so they have it as well. He is currently diagnosed with PTSD with Anxiety and Depression, current GAF: 49. Did I get all your questions answered? I think I did.

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Ricky, I've read all the progress notes. I've read the notes from 1993 when he was med-evaced to Brook Army Medical Center, I've gotten all his personnel records, medical records, VA records, every thing. That list of incidents and dates is mine, I created it, I maintain it, his doctors get a copy monthly, so they have it as well. He is currently diagnosed with PTSD with Anxiety and Depression, current GAF: 49. Did I get all your questions answered? I think I did.

Yes - most of them. PTSD cases are sometimes complex and it is hard to assist through the computer!!!!!!!!

However, what I was looking for was a diagnosis of PTSD with any other MH issues - and then the doctor providing, somewhere in the notes, a write using the wording from the MH general rating schedule that puts your husband in the 70 percent bracket. Normally you will find it in a C&P exam. That is why I asked if he had a C&P exam for the claim for increase. If not then that is a key factor and an issue you need to push for under the VCAA. Just an angle since I do not know anything about his claim. However, it appears that you have a very good handle on just about everything.

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  • HadIt.com Elder

Ahh, yes, the C & P exam. It was a joke. We've had one, I've filed formal complaints for several things including NOT allowing me to go into the room, spending LESS THAN 45 MINUTES with my husband, disregarding my husband's SIMPLE request (there was a small clock ticking VERY loudly and my husband asked to have it removed while he was in there because that sound really gets under his skin). I have yet to hear about a second C & P exam, but I have requested one, and hope to get one, I'm very persistent on that front. I'm also using the assistance of my senator's office, but I keep asking what is being done to correct the issues at the VA and either get "it is what it is" or "we promise to make more changes to VA" and those are both BS. We are doing the best we can, and in the process have lost our home (we are now renting again, not easy when you used to be a "homeowner") and have bills we can't pay including basic utilities like power and water! Ack, sorry for the vent, but I'm just tired.... tired of fighting, tired of calling the power company and begging them not to turn off our power (we have a child with asthma for Pete's sake!) But I'm also MAD, so that keeps me fighting. I feel like a chihuahua fighting a rottweiler!

Yes - most of them. PTSD cases are sometimes complex and it is hard to assist through the computer!!!!!!!!

However, what I was looking for was a diagnosis of PTSD with any other MH issues - and then the doctor providing, somewhere in the notes, a write using the wording from the MH general rating schedule that puts your husband in the 70 percent bracket. Normally you will find it in a C&P exam. That is why I asked if he had a C&P exam for the claim for increase. If not then that is a key factor and an issue you need to push for under the VCAA. Just an angle since I do not know anything about his claim. However, it appears that you have a very good handle on just about everything.

Edited by SouthernBelle
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