ptsd New Dude - Previous Lurker

[Roly]

Hello All,

I have read postings for a couple of years or more, as I navigated my way to 10% tinnitus, 2006, followed by 30% PTSD, 2008. I am a Navy Nam Vet. I learned Vietnamese after boot camp in 1968 at Defense Language Instititute in Monterey, then spent a year in country, NSA Danang, Camp Carter and NSA Saigon, Air Cofat. After that I was in VA115, an A6 squadron out of Oak Harbor WA, which did a Westpac deployment on the USS Midway. Then I went home. Now I'm 60 and retired out of federal civil service (at the earliest minute possible).

Where on the forum should I ask knowledgable members about proceeding now that my NOD was answered last week by a SOC that refers me to the BVA? I had requested a de novo review at the regional level, but their SOC came before they saw my non medical support letter challenging points in my award letter and the C&P exam, and my wifes support letter.

I need to choose the type of BVA review. What is the rate of success with the BVA?

Thanks, Pleased to Meet Ya, Roly

[cowgirl]

Roly, sorry took me a few to make it back here. Now that Hadit and me see a little bit more of what is going on, good advice has been given.

I am thinking a few things, just in case,

It seems to me that you do have copy of your C&P that you are rebutting. Had you submitted a vcaa form (required to be sent from the VA)already asking for more time before a decision was to be made? How close were you to the dates the VA presented?

Keeping a file is crucial at this point, every letter, postmarked envelope, telephone call, the works. Long time ago I too depended on an ancient vso, until I woke up here at Hadit. After getting my SMR's and Cfile, direct access to M21-1 and CFR38 via the VA website I am more confident, honestly. First file was a the old cardboard box, grew outta that now, much better organized.

Let me mention the truths we constantly learn here. Medical opinions well stated to the facts in a veterans claim case are key. The last claim I put in had VA doctors statements. VA contracted doctor, USAF doctor, private physician and SSA doctor. Sounds like a bit of overkill? Well, from what I learned here, medical opinions do support and or topple raters opinions if regulations are applied correctly.

Out of curiosity, did your VSO file the papers for you or did you go it alone? My current VSO is a good channel if nothing else to keep the dots connected. I have learned that unless I call and ask questions, there are few VSO generated calls my way.

On a side note, I learned to be cautious about stating 'flaws' in c&p's to the VA without support. Sounds like you are on the ball. Claim SOC referred to a telephone conversation I had challenging my c&p exam. No, they do not have to complete a second exam; its 'thier' choice. Using the regulations, fast letters and other VBA cases to support a claim issue is important. I've learned to post drafts and thoughts here for a second or third set of eyes. Like you have already done, as the vet showing specific support to a claim, that could help the rater look at the condition correctly. Be prepared for manipulation of words, near experts everywhere.(or nowhere).

Another thought, since this seems to be your first claim, caution you be patient. The process is a big learning curve. On your next claim, if you have one I suspect, be sure to identify specifically those issues that you attribute to service connected disabilities. Meaning, its common to submit for all related health conditions and expect the highest rating possible. (When I retired, I submitted several items per advice, some were approved at 0%, but most important was the established 'date of the claim'.) More on that later...er, another time.

Making a decision in five months is fair for the VA but its from the date of your claim that you have to get your notice of denial (NOD) in. Or if you already are assigned a percentage, even though you think its low, the VA doesnt know until you tell em. Consider simply submitting a 'claim for increase' identifying the medical opinions and facts from the regulations as support for correcting the Service Connection date.

Hope most of this made sense,

Best to ya, and for abbreviations go to the search bar/tab up there /\ on the right top and input 'abbreviations'. Take ya right there.

Cg'up2009!

P.S.

Good luck on dependent compensation, the VA tied that into a claim I had in at the time, so it took a longer time than I thought. There are many priorities when it comes to claims and approving dependents claims isnt first most. Of course, keep a date stamped copy or request a date stamped copy of the dependent certification you submit. My dependents didnt change all these years, but had to reprove them to the VA. Ever read the VA morning reports to see how your VARO fairs in handling claims? interesting snapshot.

Edited February 3, 2009 by cowgirl

[Roly]

Hi, Cowgirl, Thanks for the follow-up,

It seems to me that you do have copy of your C&P that you are rebutting. Had you submitted a vcaa form (required to be sent from the VA)already asking for more time before a decision was to be made? How close were you to the dates the VA presented?

I don't know what a vcaa form is. Their letter said I had a year to submit stuff, but they decided in 5 months.

Keeping a file is crucial at this point, every letter, postmarked envelope, telephone call, the works. Long time ago I too depended on an ancient vso, until I woke up here at Hadit. After getting my SMR's and Cfile, direct access to M21-1 and CFR38 via the VA website I am more confident, honestly. First file was a the old cardboard box, grew outta that now, much better organized.

My semi organized file is where I found their earlier correspondance that made them set the effective date back.

Out of curiosity, did your VSO file the papers for you or did you go it alone? My current VSO is a good channel if nothing else to keep the dots connected. I have learned that unless I call and ask questions, there are few VSO generated calls my way.

I send my papers to the VA through my American Legion VSO. Now I find her hard to get on the phone or via email.

On a side note, I learned to be cautious about stating 'flaws' in c&p's to the VA without support. Sounds like you are on the ball. Claim SOC referred to a telephone conversation I had challenging my c&p exam. No, they do not have to complete a second exam; its 'thier' choice. Using the regulations, fast letters and other VBA cases to support a claim issue is important. I've learned to post drafts and thoughts here for a second or third set of eyes. Like you have already done, as the vet showing specific support to a claim, that could help the rater look at the condition correctly. Be prepared for manipulation of words, near experts everywhere.(or nowhere).

Here is what I sent that they hadn't seen before sending the SOC:

Dear Sir or Madam,

I write this letter to support my disagreement with the rating decision of -/--/2008.

· My present ability to work is more seriously negatively affected by PTSD than was indicated in the rating decision.

My previous employment consisted, for about 26 years, of civil service jobs with closed, safe, secure, predictable environments. It was just due to luck that I became a career Federal Employee. In the private sector, my employment would not have been continuous. I worked within a chain of command similar to that experienced during my earlier Navy enlistment. I worked for the Navy at a shipyard as an apprentice and a blue collar journeyman for 12 years and at *** for 14 years as a blue collar mechanic, then a planner/estimator, then a building repair and alterations project manager. I found that I could function within my several job titles, knowing that even meeting minimum requirements would keep my income safe. Although interacting with managers, clients, contractors, and peers was taxing, and difficult for me, and nearly intolerable during the last few years, I eventually felt that I must suffer the stresses until I could qualify for retirement, as an obligation to my wife, and some family members I had become obliged to support. I always, during the entire time, avoided interactions as much as I could; i.e. shop or office parties, events, “Teambuilding” exercises, meetings, friendships. Even if there were good people that very much liked me and my company, good food for free, I would still avoid them. If I had to attend I would leave after only a few minutes preferring to sit in my cubicle alone.

Agency mandates from above were oblivious to the reality of actual work being attempted at my level. This led to extreme feelings of powerlessness for me. I feared being under the ultimate control of such deluded people made me vulnerable to any number of incompetent decisions or whims and could ultimately extend to dangerous conditions for me or others, or so it felt. It would cause me anxiety attacks on a regular basis for it seemed to mimic my sense of loss of control I experienced in Vietnam.

I left my job, on -----, immediately that I was minimally qualified for any annuity. I was working for an unqualified, seemingly sociopathic bully of a supervisor with whom I did not get along. I wished that she would die. I am certain that I could not resume in a project management field in the private sector; impossible because what was barely tolerable in the Civil Service is extremely stressful competitive, insecure, and cutthroat, in the private sector. Private sector work is too anxiety producing for me to attempt, with arbitrary employment rules, unsecure, and unsafe. My PTSD symptoms would prevent any employment including most self employment, due to the need for appropriate interaction with others.

· VA contracted C&P Examiner, -------------- and Associates provided a flawed evaluation and the examiner was purposely intimidating and callous.

I suspect this Government contracted (Contract #------------) psychologist to be biased toward his employer’s implied desire to deny or minimize Veteran’s claims. I believe that a direct VA employee, such as I had expected to see for the C&P exam, could provide a less biased opinion since his or her employment is not cyclically reviewed for continuation by a contracting officer.

I walked to my appointment, at -----, and found the office to be an intimidating penthouse luxury suite occupying all of the 41^st and 42^nd stories of a 42 story, class A, downtown --- high-rise; an environment designed to exalt the Psychologist and diminish the “claimant,” with 8’ doors, marble lobby floor, broad internal private stairway joining the two floors. Psychologist ------------ presented a snotty attitude, implied that I barely suffer from PTSD – “I see a LOT of Veterans, and most of them are LOTS worse off than you.” My C&P exam was a late afternoon, 3:30 pm, appointment, by this contractor’s choice, and shortly into the exam ------- instructed me to speak faster, “Or we will be here all night.” This exam was very obviously vastly more important to me than it was to him. It appeared to me that the VA is Mr. ------’s wealthy client, and that his job is to make assessments beneficial to his client. After I came home and reflected on my P&C Exam, I really wanted to strangle that officious, offensive man. When I later read his report, that reinforced my opinion.

Mr. ------ report to the VA indicated a GAF score of 70, and incorporated verbiage that was chosen so as to fall in line with the VA’s definition for 30% disability.

The VA, in its rating decision letter dated --------, 2008, on page 4, stated that a higher rating than 30% was not warranted unless there is reduced reliability and productivity due to such symptoms as: ”………..(1) Flattened affect…………; (2) difficulty in understanding complex commands; (3) impairment in short and long term memory; …..(4) disturbances of motivation and mood; (5) difficulty in establishing and maintaining effective work and social relationships.”

However, in the C&P evaluation, on page 3, is stated, among other things:

(1) “There is a persistent restricted range of affect. The restricted range of affect is observable clinically.” Further,

(2) On page 4, “….. Claimant shows difficulty understanding complex commands. ….would lose focus frequently at work and now he has difficulty maintaining concentration without going off on tangents.” And he further writes, in the next paragraph,

(3) “Memory is impaired and the degree is moderate – problems with retention of highly learned material, forgets to complete tasks. He forgets what his wife has just told him, he forgets a decision he has already made, and he forgets errands.”

(4) Page 4,”Affect and mood are abnormal, with depressed mood which occurs near continuous….”

(5) Page 1, “He feels numb, or a lack of emotion. He avoids crowds, trips, and vacations. The symptoms described occur constantly. The effect the symptoms have upon daily functioning is that he has avoided friendships. His marriage is strained;”….and on page 2, “There have been some major social function changes since he developed his mental condition, for example, he has become very withdrawn. He says that being around people adds complications, stresses, and even danger. He states that he is currently not working, and he has not been working for (sic) 3/2008 because he retired. He was employed as a real estate project manager for 14 (sic). He says that he retired at the earliest possible time. The reason that he retired was that he did not enjoy the constraints and restrictions of the job. He had a terrible supervisor.”

Mr. ---- contradicts himself in his report by stating in remarks, page 5, “He has no difficulty understanding commands,” but on page 3, “Claimant shows difficulty understanding complex commands.”

Mr. ----- was impatient and acted annoyed if I spoke to any degree beyond the scripted questions he asked. I had written a statement for the P&C Examiner before my appointment because I feared I might fail to impart information I felt was pertinent, due to my discomfort in a situation of being scrutinized. He would not accept my statement, nor would he read it. Many of Mr. -------’s conclusions regarding my emotional state seem to be in opposition to how I feel. For example: he states that my response to psychotherapy has been very good, but in reality it has helped to a limited degree only; per Mr. ------, the only reason that my work was adversely affected is due to avoidance of non work activities, but there was a lot more to it than that, as I indicated above. Mr. ------- states that the relationship with my last supervisor was fair. But it definitely was not, and I said so. (In another part of his report, under Family and Social History, Mr. Smith stated that, “He had a terrible supervisor.”)

I also believe that a GAF score of 50-60 is more accurate than 70 in view of the following definitions:

71 – 61 Some mild symptoms (e.g. depressed mood and mild insomnia) OR some difficulty in social, or occupational environment, budgetary functioning pretty well. Has some meaningful interpersonal relationships.

60 – 51 Moderate Symptoms (e.g. flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational environment (e.g. few friends, conflicts with peers or co-workers.)

50 – 41 Serious Symptoms (e.g. suicidal ideation, severe obsessional rituals, OR serious impairment in a social, or occupational environment (e.g. no friends, unable to keep a job).

· I request that the VA Benefits Reviewer grant at least 50% disability for PTSD.

Either through a reevaluation of the P&C Exam report in view of my comments above, or with input from a new C&P Exam, I believe that a conscientious regional VA employee reviewing my claim should revise the 30% service connection for PTSD to 50% or 70%. If there were to be any further interview or exam for this claim, I respectfully request that I not be sent to the same contracted entity as before.

Thank You,

I hereby certify that the information I have given is true and correct to the best of my knowledge and belief.

Roly

Have I screwed myself with this letter? C?ould there be CUE?

Another thought, since this seems to be your first claim, caution you be patient. The process is a big learning curve. On your next claim, if you have one I suspect, be sure to identify specifically those issues that you attribute to service connected disabilities. Meaning, its common to submit for all related health conditions and expect the highest rating possible. (When I retired, I submitted several items per advice, some were approved at 0%, but most important was the established 'date of the claim'.) More on that later...er, another time.

My first claim was in 2005 for tinnitus, hearing loss, and depression. They gave me sc for the first two, 10% and 0% respectively, and denied the depression. I sent in a NOD, saying that the depression must be PTST, which I had only recently heard of. (You'd think the VSO would have clued me earlier.) This they made into a new claim, which established the effective date they eventually awarded. So....I do understand patience.

Making a decision in five months is fair for the VA but its from the date of your claim that you have to get your notice of denial (NOD) in. Or if you already are assigned a percentage, even though you think its low, the VA doesnt know until you tell em. Consider simply submitting a 'claim for increase' identifying the medical opinions and facts from the regulations as support for correcting the Service Connection date.

Hope most of this made sense,

Best to ya, and for abbreviations go to the search bar/tab up there /\ on the right top and input 'abbreviations'. Take ya right there.

Cg'up2009!

P.S.

Good luck on dependent compensation, the VA tied that into a claim I had in at the time, so it took a longer time than I thought. There are many priorities when it comes to claims and approving dependents claims isnt first most. Of course, keep a date stamped copy or request a date stamped copy of the dependent certification you submit. My dependents didnt change all these years, but had to reprove them to the VA. Ever read the VA morning reports to see how your VARO fairs in handling claims? interesting snapshot.

Where do you find the VARO snapshots?

Thanks again, Roly

[carlie]

Roly,

I took out things that will do your claim no good. VA does not care nor take any time to read how we feel. Any rebuttal should not contain he said/she said information.

When you load a claim up with that the rater's just stop reading.

Here is what I sent that they hadn't seen before sending the SOC:

Dear Sir or Madam,

I write this letter to support my disagreement with the rating decision of -/--/2008.

· My present ability to work is more seriously negatively affected by PTSD than was indicated in the rating decision.

anxiety attacks on a regular basis for it seemed to mimic my sense of loss of control I experienced in Vietnam.

My PTSD symptoms would prevent any employment including most self employment, due to the need for appropriate interaction with others.

Needs more meat here in the form of medical evidence from a doc, psychiatrist or psychologist. Some of the info below is helpful.

Mr. ------ report to the VA indicated a GAF score of 70, and incorporated verbiage that was chosen so as to fall in line with the VA’s definition for 30% disability.

This must be rebutted with Medical Evidence such as treatment records, etc... Some of the below info is helpful.

The VA, in its rating decision letter dated --------, 2008, on page 4, stated that a higher rating than 30% was not warranted unless there is reduced reliability and productivity due to such symptoms as: ”………..(1) Flattened affect…………; (2) difficulty in understanding complex commands; (3) impairment in short and long term memory; …..(4) disturbances of motivation and mood; (5) difficulty in establishing and maintaining effective work and social relationships.”

However, in the C&P evaluation, on page 3, is stated, among other things:

(1) “There is a persistent restricted range of affect. The restricted range of affect is observable clinically.” Further,

(2) On page 4, “….. Claimant shows difficulty understanding complex commands. ….would lose focus frequently at work and now he has difficulty maintaining concentration without going off on tangents.” And he further writes, in the next paragraph,

(3) “Memory is impaired and the degree is moderate – problems with retention of highly learned material, forgets to complete tasks. He forgets what his wife has just told him, he forgets a decision he has already made, and he forgets errands.”

(4) Page 4,”Affect and mood are abnormal, with depressed mood which occurs near continuous….”

(5) Page 1, “He feels numb, or a lack of emotion. He avoids crowds, trips, and vacations. The symptoms described occur constantly. The effect the symptoms have upon daily functioning is that he has avoided friendships. His marriage is strained;”….and on page 2, “There have been some major social function changes since he developed his mental condition, for example, he has become very withdrawn. He says that being around people adds complications, stresses, and even danger.

He states that he is currently not working, and he has not been working for (sic) 3/2008 because he retired.

He was employed as a real estate project manager for 14 (sic). He says that he retired at the earliest possible time. The reason that he retired was that he did not enjoy the constraints and restrictions of the job. He had a terrible supervisor.”

This is bad for your claim and needs to be rebutted.

Mr. ---- contradicts himself in his report by stating in remarks, page 5, “He has no difficulty understanding commands,” but on page 3, “Claimant shows difficulty understanding complex commands.”

Mr. ----- was impatient and acted annoyed if I spoke to any degree beyond the scripted questions he asked. I had written a statement for the P&C Examiner before my appointment because I feared I might fail to impart information I felt was pertinent, He would not accept my statement, nor would he read it.

I also believe that a GAF score of 50-60 is more accurate than 70 in view of the following definitions:

This is not relevant as only a doctor can provide a Gaf score and many times Gaf scores can change frequently.

I would show past Gaf scores of record.

I request that the VA Benefits Reviewer grant at least 50% disability for PTSD.

Replace with I disagree with the percentage of _____ %

and feel that due to the Medical Evidence of

_______,_______,_______,_______,

my Mental Health disability falls in line more adequately with 50 %.

with input from a new C&P Exam, I believe that a conscientious regional VA employee reviewing my claim should revise the 30% service connection for PTSD to 50% or 70%. If there were to be any further interview or exam for this claim, I respectfully request that I not be sent to the same contracted entity as before.

Thank You,

I hereby certify that the information I have given is true and correct to the best of my knowledge and belief.

Roly

Roly,

Remember, this is just my opinion.

You want this to be brief - summarizing the evidence and stating why you fit the percentage in question. Address any unfavorable evidence and state it doesn't change the conclusion that you should recieve the percentage of _____%

due to the medical evidence.

Other's will chime in.

carlie

[Commander Bob]

Have I screwed myself with this letter? C?ould there be CUE?

Good morning Roly, I understand that you have already sent this "letter in support of your claim", to the VA. Well, to answer your questions, IMHO, & to add my 2 cents, No you haven't, & no you didn't. However, you do have a long way to go before you rest. Best wishes for a successful outcome.

[Hoppy]

Roly,

I often tell veterans not to rely on the C&P process when asking for an increase. If it were my claim I would have sought treatment and got a new report with GAF and submitted it with the claim or in support of the claim within the time frame allowed prior to a decision.

Several veterans on this site have been able to obtain such reports from VA doctors. One in particular was referred by the primary care to a mental health exam. It sounds like you might have health Ins. In any event you need a doctor to hear your contentions as to your disability and write an assessment related to your PTSD and a current GAF. I am not sure that they will grant you another C&P based on your own opinion as to your limitations or your opinion as to the quality of the previous C&P exam.

[Roly]

Hoppy,

Thanks for the advice. I do have health insurance with an HMO, who is not much interested in mental health much, or reporting for the VA at all. My problem is the need to go completely outside anything that is cost subsidized for this documentation, and its cost. How to do this, short of calling a shrink from the yellow pages, is a problem.

I am enrolled in VA health care, too, presently it seems better than the HMO. Maybe my primary care doctor there could be more useful?

Thanks, Roly

quote name='Hoppy' date='Feb 7 2009, 02:00 PM' post='129469']

Roly,

I often tell veterans not to rely on the C&P process when asking for an increase. If it were my claim I would have sought treatment and got a new report with GAF and submitted it with the claim or in support of the claim within the time frame allowed prior to a decision.

Several veterans on this site have been able to obtain such reports from VA doctors. One in particular was referred by the primary care to a mental health exam. It sounds like you might have health Ins. In any event you need a doctor to hear your contentions as to your disability and write an assessment related to your PTSD and a current GAF. I am not sure that they will grant you another C&P based on your own opinion as to your limitations or your opinion as to the quality of the previous C&P exam.