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:

[mountain tyme]

Southernbelle...Carlie advice is very sound your husband is seeking an increase in order to be awarded an increase your husband needs to show that his condition has deteriorated to meet the requirment of 70% or 100% to be awarded the increase by the VA. It would help his doctor if you brought in a copy of the Schedual of rating that the VA has est. to meet the higher rating...

General Rating Formula for Mental Disorders:

Total occupational and social impairment, due to such symptoms as:

gross impairment in thought processes or communication;

persistent delusions or hallucinations; grossly inappropriate

behavior; persistent danger of hurting self or others; intermittent

inability to perform activities of daily living (including maintenance

of minimal personal hygiene); disorientation to time or place; memory

loss for names of close relatives, own occupation, or own name 100

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

Occupational and social impairment with reduced reliability and

productivity due to such symptoms as: flattened affect; circumstantial,

circumlocutory, or stereotyped speech; panic attacks more than once

a week; difficulty in understanding complex commands; impairment

of short- and long-term memory (e.g., retention of only highly learned

material, forgetting to complete tasks); impaired judgment; impaired

abstract thinking; disturbances of motivation and mood; difficulty in

establishing and maintaining effective work and social relationships 50

Occupational and social impairment with occasional decrease in work

efficiency and intermittent periods of inability to perform occupational

tasks (although generally functioning satisfactorily, with routine

behavior, self-care, and conversation normal), due to such symptoms

as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or

less often), chronic sleep impairment, mild memory loss (such as

forgetting names, directions, recent events) 30

Occupational and social impairment due to mild or transient symptoms

which decrease work efficiency and ability to perform occupational

tasks only during periods of significant stress, or; symptoms controlled

by continuous medication 10

A mental condition has been formally diagnosed, but symptoms are not

severe enough either to interfere with occupational and social

functioning or to require continuous medication 0

His doctor should be the one to determine what % he falls under and write a letter to meet that requirement.

it is important if your husband is asking for UI that the doctor states in writing that he strongly feel due to his PTSD that he can not hold substantial empolyment at this time OR ANY TIME IN THE FURTURE...

then state why.

Hope this helps

MT

[ruby]

He can say somethin like this, I have changed this some but I am told this is a good write up. I don't have a sc yet. So I don't know. Carlie is really good at wording.

Having reviewed Mr. ? clinical history and worked with him individually and in group (if it applies), my opinion is that the PTSD symptoms are caused directly by the whatever and they have increased in severity. He is UNEMPLOYABLE FOR THE FORESEEABLE FUTURE DUE TO THIS CONDITION. (I am told this gives the rater no room to low ball or guess at the rating)

Then go into why, as you did----He experiences severe, recurrent nightmares resulting in in severe insomnia, and intense fear. His mood and affect are depressed, with anhedonia (means no pleasure)

He does not leave his house except to do things that are absolutely necessary, such as come to the VA, and obtain groceries. He feels unsafe even in his own home behind lock doors. His sleep and symtoms have not appreciably improved with trial medications. Furthermore, the PTSD condition exacerbates his chronic pain disorder (if this applies). He meets full diagnostic criteria, including re-experiencing, numbming/avoidance, and chronic hyperarousal symptoms. Current GAF score = (35-40)?, indicating major impairment in several areas (e.g. unable to work, unable to trust and have intimate relationships with his wife and family; highly distressing symptoms, etc. If he has SI or HI thoughts he needs to say that also and if he has a plan is it viable plan but he has no plans today (this is the date of the visit.)

He can word it like He has SI or HI when his whatever has been intense, but denies it today. Uses alcohol socially on occasions.

I hope this helps some.

[SouthernBelle]

The goal right now is the 70%. He would only need Temporary IU because he's back in school so we can open a land surveying business, which is probably the only way he will be able to work again, but that's the plan. It may be a long shot, but he's trying to become employable. He can't really work with a lot of other people, which is why we want to open our own business. It will be family owned and operated. We were denied SSI. They said it was something about our cars.

Southere,

Also again,

Is the goal to get to at least 70% and from there IU ?

Does he get SSA yet ? If yes, is it for PTSD ?

carlie

[SouthernBelle]

And Carlie, you put into words the RIGHT way what I've been trying to say! I just didn't know how to say what I was trying to say!

[carlie]

Southern,

The only Temporary way for IU is if a vet is hospitalized for a

minimum of 21 days, and even that takes time to go thru the system.

I don't have the reg for this off hand.

By chance is he going to school thru voc rehab?

You posted SSI was denied due to "something with your cars".

This was most likely because the value of the cars is too high to

meet the requirements for SSI as SSI is based on the financial

situation of the claimant.

Did he also apply for SSD?

SSD is based on past quarters paid into SSA by the claimant

and does not have any financial restrictions on what you own.

SSD only deals with quarters paid in and the Medical Disabilities involved.

Have you studied the SSI denial to see if there is any Medical Evidence

contained in the SSI Denial, that you could utilize to support his VA claim

for an increase?

carlie

[SouthernBelle]

Carlie, we've not applied for SSDI. I don't know what that entails. I'll look into it, though. We had heard about the TDIU and hospitalization, but a VSO said there was a way around that, but I don't think there is. If there was, the folks on HADIT would know about it. He is going to school through Voc Rehab. It took me two years to get that for him. They almost let the deadline run out. I'm going to post the newly drafted sample letter, and I'm also going to fax him the rating criteria for 70%, so if he decides to add anything, he can do that.