Letter From Psychiatrist

[SouthernBelle]

Okay, FINALLY we are getting the doctor to write a letter, not just progress notes, about my husband's current condition. The doctor says he doesn't know what to say. He wants me to tell him. I've gone over the rating schedule for 70%, and I plan to give him that so he can compare it to my husband, and then he can..... do what? Copy it and apply it to my husband with examples? I'll post the sample letter I've drafted for him, and you tell me what you think. Please help, this has taken almost a year to get the doctor to do this, so we need it to be accurate and in VA lingo! Thanks for all replies!

To Whom It May Concern:

[SouthernBelle]

Thanks a million!

I am going to my post and see if I can locate the IME from the

Forensic Psychiatrist. Several on the site have pasted it to use

as a guideline.

Perhaps, you can use bits and pieces of it to help you.

Betty

[Josephine]

Introduction: On January 11, 2008, I saw Betty xxxx in my office for independent medical (psychiatric) examination. She was accompanied by her husband of 42 years. XXXXX. He met her in U.S. Navy Corps School in 1963 at Great Lakes Illinois. He described her as then having been a very attractive, youthful female, who took part in on-base activities, but her hands perspired a lot and she was fearful of the swimming pool.

Review of Medical and Personnel Records:

I have reviewed the following service medical records and personnel records for this veteran, for the period when she was en-listed Navy Corps Wave during the period of Mar. 15, 1963- May 1964.

Psychiatric Consultation by Dr. F. D. Jxxxx 12 March 1964, Dr. G MCMxxxxx 27 March 1964, and a letter by Dr. B. C Campxxx, the veterans military treating physician clarifying his shorthand of his treatment for anxiety with Librium and Cafergfot for headaches.

The treatment records of Dr. George Smxx and Dr. Clarence Tayxxx, his partner.

Although stated in the SSOC of December 7, 2007, to be illegible. Dr. Georxxx Smxx. has written a letter of clarification of treatment of this veteran.

The treatment records of Dr. Milxxx Kxx, 1975-1976 also stated as illegible, I have read 4 letters by Dr. Michael Pxxx 4/5/04, 1/3/06/4/28/06, and 10/09/07 and reviewed the treatment records of Dr. Michael Payxx August 1979 - 2007.

Medical History:

Mrs. XX is a 63 year old female whose medical conditions are: TIA, Rheumatic heart disease, Hypertension, Diabetes, Anxiety, Depression, Headaches, Hypothyroidism, and inner ear/Vestibular disease and de-generative disc disease, Orthostatic hypotension.

Psychiatric History:

This veteran has a very long history of anxiety with depression, with treatment beginning in service by Dr. B.C Cxxxx with medication of Librium; treatment 1965-1979 with Dr. G. Smixx and Dr. Clarence Tayxxx; Radford Psychiatrist, Dr. Miltxxx Kibxxx, 1975-1976 to 2007 with Dr. Michael Payxxx and she remains in treatment with Dr. Michxxx Payxxx.

Mental Status Examination:

Mrs. xxxx presented in my office as a pleasant, cooperative white female, appearing about her stated age of 63. She was in good contact with the examiner, understood the purpose of this examination - independent evaluation, regarding veterans benefits - and gave permission for me to write this report. She was well oriented for time, place and person. There was no abnormality of thought process or content. She spoke of having had much difficulty with anxiety and depression over many years.

She reports she had no psychiatric difficulties whatsoever prior to military service. Her file contains records related to her Honorable Discharge due to unsuitability regarding emotional difficulties.

She spoke of chronic anxiety with depression over the years. She became emotionally labile and tearful as she described some of her experiences in the service and feeling like a disgrace upon leaving the military. She has panic attacks, fear of driving a vehicle, fear of the unknown, fear of heights and water, white -coat syndrome, headaches, dreams of the stairs leading to the pool. She has night terrors and is desperately trying to get her husband to wake her up. She sleeps about 6 hours a day, but states this does not harm her much;her hands stays visibly wet and becomes wetter as she talks about her service time. There were some memorable upsetting experiences in her Navy service including a near drowning, etc. She has never bee able to have any gainful employment for any substantial time since the military and had to give up and seek veterans compensation in 1978. She last worked part time in 1983.

The veteran was given tranquilizer Librium by Dr B. C. Campxxx for the treatment of anxiety as documented in her SMR'S and it is also clarified in his letter of May 10, 2005, and has continued with symptomatic treatment for anxiety for the last 44 years with the physicians listed above.

After the brief evaluations by Drs. MC Mahxxx and Jones in March 1964, the veteran was deemed unsuitable for continuing military service due to a Personality Disorder, and was discharged without medical or other benefits.

Summary of Professional Opinion:

My review of the records show no documentation which would support the diagnosis of Personality Disorder. There simply are no data which would support that diagnosis under the criteria provided in the Diagnostic and Stastical Manual of the American Psychiatric Association. No psychological or personality testing was done. There was never any showing of an " enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture... is inflexible and pervasive across a broad range of personal and social situations... is stable and of long duration... (and) is not better accounted for as a manifestation or consequence of another mental disorder." DSM IV TR, pages 287 - 288.

The " other mental disorder" which she clearly DID and DOES have, and for which she has been treated for 43 years, is Anxiety Disorder.

The veteran had no childhood psychiatric, difficulties or treatment, Her anxiety disorder began during her time in service. She has been treated for anxiety disorder for 43 years by a number of physicians.

Diagnosis: 300.00 Anxiety Disorder, NOS,Chronic, Severe, with Depressive Features.

This chronic, and in this veterans' case, disabling, mental disorder first manifested itself while in service and has required treatment ever since. There is no evidence to support the diagnosis of personality disorder made in 1964 and used as a basis for her separation from service.

Sincerely.

B. Cxxxx M.D. D.L.F.P.A.

[SouthernBelle]

Thanks, Betty. Looks good, I'll give him both letters and he can take what he wants from each.

[Josephine]

You are certainly welcome.

Betty

[SouthernBelle]

He said he didn't know what to write because he has never written a letter like this. He really thinks my husband is bad off, and needs more help than he's getting with compensation. He kinda gets the injustice of it all, which is nice. He also says he works for the VA because they need him the most. Good doctor, good person. Rare in the VA! We're glad we've got him on our side.

You are certainly welcome.

Betty

[Josephine]

I like this statement in Dr. Crowley's letter. He is one of the top

10 Expert Forensic Psychiatrist in the United States.

This chronic, and in this veterans' case, disabling, mental disorder first manifested itself while in service and has required treatment ever since.