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]

To Whom it May Concern:

Please be advised that Mr. XXXXXXX has been under my psychiatric care at the VA Savannah Civilian Based Outpatient Clinic since January 2008, though he was followed by Dr. XXX, M.D., prior to that. Mr XXXXX has been diagnosed with Post Traumatic Stress Disorder (PTSD) with anxiety and major depression, chronic type, related to combat experiences he withstood during the Gulf War. Mr. XXXXXXX endorses PTSD symptoms in all three core areas: 1) Re-experiencing Trauma- he has chronic flashbacks and nightmares of trauma, 2) Avoidance- he is emotionally numb and detached from others and does not socialize with others, he is anhedonic, to the point where he often doesn't leave the bed, and 3) Hyperarousal- Mr. XXXXXXX has difficulty falling and staying asleep, experiences night sweats during sleep, will "fight" in his sleep (to the point in which his wife has sustained bruises), has hypervigilance and hyperstartle responses to normal everyday stimuli. He has obsessional rituals that interfere with daily activities which include constantly checking doors and windows, staying by windows watching, sitting facing the door at all times, laying facing the doors and windows, etc. Furthermore, he has severe anxiety and is unable to relax, even with increased dosages of Paroxetine, he still has break-through panic attacks requiring the additional medication, Lorazepam. Mr. XXXXXXX suffers from spatial disorientation that requires the use of a GPS and cell phone so he may call his wife for help; keep in mind that the routes he often gets lost on are those that are driven daily. Mr. XXXXXXX continues to exhibit marked feelings of being unworthy of having healthy relationships and is only a burden to others as evidenced in therapy sessions where he states to this clinician, his wife and family would be better off without him in their life due to his increased failures and medical problems. Mr. XXXXXXX has difficulty dealing with stress, to the point of being unable to maintain gainful employment.

Mr. XXXXXXX is also being treated by Dr. Matt XXXXX for therapy. Mr. XXXXXXX has also been prescribed numerous medication trials, but, unfortunately has had intolerable side effects to all of them thus far. He is currently on a medication trial with Paroxetine. He has been compliant with treatment plans which have included evaluation, medication management and follow-up, supportive and cognitive-behavioral therapy.

Sincerely,

Dr. XXXXXXXXXXXX, M.D.

**** Dr. XXXXX, this must be written on VA letterhead with XXXXX’s name and SSN at the top and faxed to the VARO today. They are waiting on this letter. The FAX # is: 404-929-5467

[john999]

Stay with us, Betty. You case is an inspiration to all of us. SC'ed after 44 years is great. What it goes to is your persistence and the VA's many attempts to block you getting what you deserve. Now if Rockhound gets his schizophrenia claim in shape it will be a real display of overcoming the odds. I know it took you a while to agree to get the IMO, Betty. Sometimes it is hard to believe that spending money can get you a big payday when you are broke.

[carlie]

southern,

I'm sorry I kind of get off topic in this thread but I just keep

wanting to help give you more information.

The part of the doctor's letter that states,

"Mr. XXXXXXX has difficulty dealing with stress, to the point of being unable

to maintain gainful employment."

This is a bit weak as a decision maker will see this as, everybody has difficulty

dealing with stress.

I feel this needs cleaned up a bit, something like:

In regards to Mr. XXXX's ability to maintain substantial gainful employment, it is my

Medical Opinion that currently and/or any future employment would only continue to

exacerbate Mr. XXXX's service connected disability. In my Medical Opinion

Mr. XXXX's prognosis for improvement is minimal.

If you want, where ever it would be applicable in the letter put things like the

supporting regulation and you don't really have to put the entire regulation, it can be

something like example;ref. 38 CFR, 3.157 (a) - what ever reg applys.

You could also list the reg for unemployability and put the definition of

substantially gainful unemployability.

Social Security:

Is he still employed any?

When did he stop paying into SSA through payroll deduction?

Voc Rehab.

Are you aware of all of the benefits that go with Voc. Rehab. ?

I know Dental benefits is at least one additional benefit and I'm

pretty sure there are somemore.

Check your PM messages in a bit.

Hope this helps a vet.

carlie

[Josephine]

Stay with us, Betty. You case is an inspiration to all of us. SC'ed after 44 years is great. What it goes to is your persistence and the VA's many attempts to block you getting what you deserve. Now if Rockhound gets his schizophrenia claim in shape it will be a real display of overcoming the odds. I know it took you a while to agree to get the IMO, Betty. Sometimes it is hard to believe that spending money can get you a big payday when you are broke.

John 999,

I am not going anywhere. I know that my dealings with the VA are not

over.

Knowledge of the VA, after all I have been through, I still have very

little of, I just have one leg shorter than the other.

Yes, you guys pushed me right into that IME.

Berta and I must laugh now, came on with that bite of hers'.

If she reads this, I hope she will have to laugh also. " I hope".

The day that I did the google search was my best day for I finally

found a doctor not afraid of those two quacks.

No one in my neck of the woods would tackle them.

They knew that also.

I will post my Increase and TDIU letter when I receive it, for I know

it is not going to be all that I want.

Always the Best to You, John,

Betty

[SouthernBelle]

Thanks, Carlie. I like your wording better. I'll send that information on to the doctor. My husband is NOT currently working. He can't deal with people. Normal things that normal people look over as just people being people, he can't look over it. He walked out of his last job because a girl wouldn't stop saying "pickle" over and over again, in a not so nice manner. He last worked a year ago, and prior to that he last worked in November 2005. He is currently getting his dental benefits, the VA purchased a computer for him to use for school, (his degree program requires a computer). We've gone over all the Voc Rehab benefits with his counselor, so we know what is available as far as that goes. Thanks for all your help, I know it took me a while to get on here and actually talk about me and my husband, I just haven't had good experiences with getting useful help.

southern,

I'm sorry I kind of get off topic in this thread but I just keep

wanting to help give you more information.

The part of the doctor's letter that states,

"Mr. XXXXXXX has difficulty dealing with stress, to the point of being unable

to maintain gainful employment."

This is a bit weak as a decision maker will see this as, everybody has difficulty

dealing with stress.

I feel this needs cleaned up a bit, something like:

In regards to Mr. XXXX's ability to maintain substantial gainful employment, it is my

Medical Opinion that currently and/or any future employment would only continue to

exacerbate Mr. XXXX's service connected disability. In my Medical Opinion

Mr. XXXX's prognosis for improvement is minimal.

If you want, where ever it would be applicable in the letter put things like the

supporting regulation and you don't really have to put the entire regulation, it can be

something like example;ref. 38 CFR, 3.157 (a) - what ever reg applys.

You could also list the reg for unemployability and put the definition of

substantially gainful unemployability.

Social Security:

Is he still employed any?

When did he stop paying into SSA through payroll deduction?

Voc Rehab.

Are you aware of all of the benefits that go with Voc. Rehab. ?

I know Dental benefits is at least one additional benefit and I'm

pretty sure there are somemore.

Check your PM messages in a bit.

Hope this helps a vet.

carlie

[SouthernBelle]

Hey, just wanted to update! The letter the doctor wrote was even better than I ever expected. He nailed it. I'll post his letter when I figure out how to get the thing from the counter, to the scanner, to the computer!