Very Odd Imo Can An Examiner Refuse To Give Weight

[Hoppy]

We have been trying to get a review of the SMR for two months from a psychologist who has been treating this veteran. After to talking to a social worker it became appearant that there was no way the psychologist was going to cooperate. When leaving the social workers office the veteran tells me he wants to see a psychiatrist who he had seen one time about a week ago. The psychiatrist says he will see the veteran for ten minutes because he had a no show for an appointment. I was not prepared and brought no written explanation of what a nexus statement was.

The psychiatrist agrees to read the SMR and determine if the veteran had a panic disorder in the military. The psychiatrist told me has never done C&P exams. He agreed to read the SMR over the next couple days and write an opinion. He later calls the veteran and asks him what he wants in the report. The veteran barely functions and has no idea what to say.

We get the report and the psychiatrist says that he meets the DSM IV requirement for recurrent panic attacks. However. he could not definitely say that he had a panic disorder. When the diagnosis of recurrent panic attacks is established all that is required for panic disorder is a one month period where there is a change in behavior after a panic attack. The veteran told a doctor in the military that he went UA five months because of panic attacks.

Does a doctor have to give weight to the statement made by the veteran to military doctors. Is this type of situation covered anywhere in the M-21 or anywhere else.

We are going to send the file back to him and ask for a simple opinion if the current diagnosis of panic disorder is related to the panic attacks in the military.

[Berta]

It should be in the IMO forum below.

or under a search for independent medical opinions-I posted it here many times.

a thought as to SMRs-some of them are very hard to read-

it even helps to blown them up in a PC program that can do that or even try to decifer them with a mirror-

also dont overlook anything that appears to be crossed out -

sometimes, after many reads-they start to reveal more then we think.

I had a vet with 4 separate inservice VD situations and the treatment records.

some of his symptoms were detailed and even a little gross-

I read this over and over again along with the rest of the SMRs.

Long story-this helped him to prove inservice diabetes.

I raised issue that although his symptoms were medical consistent to some extent with this type of Venereal Disease -they were also consistent with a very unusual penile problem that a diabetic can get without even having VD.I had three internet medical printouts on that which he used as evidence.

The RO, his NSO, the BVA and also the CAVC and his lawyers had never considered his SMRs in such detail.

SMRs have to be 'studied' as well as carefully read many times.

Edited March 6, 2009 by Berta

[Hoppy]

Berta,

You do good work!!

I have read BVA decisions that made me want to throw up. They involved cases where the veteran had an SO and the records indicated that the veteran told military doctors that they had "allergies" before service. The claims were denied on the veterans statement. No investigation or further questioning as to how the veteran determined they had allergies before service was involved.

Nobody asked if doctors made the diagnosis. There are at least five different conditions that produce symptoms similar to allergies. It is common for grandmothers, teachers, and just about anybody who has ever had allergies to tell children that they have allergies.

[john999]

Hoppy

I remember getting ink blot test from VA doctor. He said I was a schizophrenic psychopath because I said I saw bloody body parts. I was just throwing answers off the top of my head because I was mad about being an in-patient. The ink blots are entirely subjective. It is just BS.

[Josephine]

Hoppy,

Here is a copy of my Independent Medical opinion. Hope this helps!

Betty

*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. Cxxx M.D. D.L.F.P.A.

*Forensic and Clinical Psychiatry

Expert Witness*

Forensic and clinical psychiatry expert and a Yale Medical School graduate, specializes in Psychiatry, Forensic Psychiatry, and Psychoanalysis. He is Senior Attending Psychiatrist and Past Chairman of the Department of Psychiatry at Suburban Hospital in Bethesda, Maryland. A Distinguished Life Fellow of the American Psychiatric Association, Associate Professor of Psychiatry, and Executive Councilor, American Academy of Psychiatry and the Law, he has served as consultant to attorneys, examiner, and expert witness in state and federal courts and in courts martial.

Services

Areas of expertise include Malpractice, Testamentary Capacity and Undue Influence, Fitness for Duty, Independent Medical Examinations (I.M.E.), Dangerousness Assessments, Suicide, Sexual Misconduct (and Sexual Misconduct by Professionals), Sexual Harassment and Abuse, Stalking, Hospital Treatment Standards, Outpatient Treatment Standards, Workplace Violence, PTSD (Posttraumatic Stress Disorder), Stress, Psychotherapy, Psychoanalysis, Psychiatrists Peer Review, Ethics, Civil Commitment (of mentally ill to hospitals), Criminal Responsibility, Sanity, Diminished Capacity, Pre-sentence Recommendations to Court, Competence for Trial, Courts Martial, Psychiatric Evaluations, Psychiatric Malpractice, Professional Malpractice, Psychotic States, Psychosomatic Medicine, Personal Trauma: Adult, Adolescent, and Child, Medical Malpractice-Psychiatric and Custodial Issues.

Profile

Yale Medical School alumnus and graduate of the Washington Psychoanalytic Institute, has been practicing psychiatry-- clinical, forensic, and administrative-- for over forty years. His office is on upper Connecticut Avenue in Washington, DC (where he sees adolescents, adults, and couples for consultation and treatment), and he also treats inpatients at Suburban Hospital in Bethesda, Maryland, where he is Senior Attending and Past Chairman of the Department of Psychiatry.

Forensic practice, which is both extensive and varied, served as psychiatric consultant, examiner, and expert witness in all types of civil and criminal cases, in the courts of several states (CA, DC, FL, KY, LA, MD, MI, NC, NJ, NV, NY, OH, PA, SC, TN, TX, VA, WI, WV) as well as in federal courts and courts martial. He has worked on matters of all kinds where state of mind is at issue. His recent cases have involved issues of: malpractice; personal injury; stalking; sexual harassment; testamentary capacity; sexual misconduct by professionals; hospital standards; dangerousness assessments in the workplace; fitness for duty; criminal responsibility; competence for trial; presentencing recommendations to Court; eligibility for release from incarceration; Courts Martial.

Teacher of medical students at the Uniformed Services University of the Health Sciences in Bethesda, where he is Adjunct Associate Professor of Psychiatry. In May 2003 he received the Roeske Award for Excellence in Medical Student Education from the American Psychiatric Association.

Actively involved in the USUHS clinical research team which leads in the study of PTSD and other stress disorders. Dr. Crowley is a member of The Center for the Study of Traumatic Stress. He also does work at the Department of Defense’s Deployment Health Clinical Center at Walter Reed, for which in 2001 he was awarded the Army Certificate of Achievement by the Commanding General, North American Regional Medical Command.

Active in leadership roles in psychiatric organizations; Past President of the Washington Psychiatric Society; Distinguished Life Fellow of the American Psychiatric Association; and Fellow of the American Academy of Psychoanalysis. In the American Academy of Psychiatry and the Law, he was recently elected to the Executive Council, and earlier served on the Committee on Peer Review of Psychiatric Testimony. For three terms he was Chair, Guttmacher Award Board, the joint committee of the American Psychiatric Association and American Academy of Psychiatry and the Law which annually judges and awards the prize for the best contribution to the literature of forensic psychiatry. Currently he serves on the Isaac Ray Award Committee, which annually selects a person who has made outstanding contributions to forensic psychiatry or to the psychiatric aspects of jurisprudence.

Licenses

Licensed: D.C. and Maryland

Distinguished Life Fellow, American Psychiatric Association

Fellow, American Academy of Psychoanalysis and Dynamic Psychiatry

Executive Council, American Academy of Psychiatry and the Law

Professional Experience

Present Professional Practice:

Private practice of Psychiatry, Forensic Psychiatry, and Psychoanalysis in Washington, DC

Senior Attending Staff and Past Chairman, Department of Psychiatry,

Suburban Hospital, Bethesda, Maryland

Psychiatrist, Deployment Health Clinical, Department of Defense, at Walter Reed Army Medical Center, Washington, DC.

Current Academic Positions:

Adjunct Associate Professor of Psychiatry, Uniformed Services University of the

Health Sciences, Bethesda, Maryland

Member, Center for the Study of Traumatic Stress

Past Professional Positions:

1982-1995

Staff Psychiatrist and Coordinator of Not Criminally Responsible Hearings -

Clifton T. Perkins Hospital Center, Jessup, Maryland

1972-1977

Executive Director - The Medical and Psychiatric Study Center, Inc.,

1969-1971

Founding Partner - The Potomac Foundation for Mental Health - Medical Director,

1963-Present

Private Practice of Psychiatry, Psychoanalysis, and Forensic Psychiatry - Bethesda, Maryland, and Washington, D.C.

1963-1968

Psychiatrist, Montgomery County Mental Health Center

1961-1963

U.S. Navy Medical Corps: Active duty as Psychiatrist

1961-1963

Staff Psychiatrist, St. Elizabeth's Hospital 1963

Legal Experience

Served as consultant and expert witness for attorneys in most types of civil and criminal cases in state and federal courts, as well as in courts martial.

Has qualified as an expert in a number of jurisdictions, from Maryland and D.C. to California, from Michigan to Louisiana, Texas, and Florida, and enjoys traveling to meet the demands of suitable cases.

Affiliations

President, Washington Psychiatric Society, 1996-97

Distinguished Life Fellow, American Psychiatric Association

Chair, Manfred S. Guttmacher Award Board, APA, 1999-2002

Council on Psychiatry and Law, APA, 2002-2008

Isaac Ray Award Committee, APA, 2004-2010

American Academy of Psychiatry and the Law:

Executive Council, 2007-2010

Committee on Peer Review of Psychiatry Testimony, 1995-2001

Ethics Committee, Washington Psychiatric Society, 1981-1990

Other Professional Positions & Major Appointments:

Past President, Washington Psychiatric Society

Executive Council, American Academy of Psychiatry and the Law, 2007-2010

Academic & Administrative Appointments:

[poolguy11550]

My response

Asking someone questions thirty years later is not reliable in my book...... did not feel the military doctors were doing enough to treat his problems and that is why he went UA. There are no other medical issues noted in the SMR or any subjective history given to the military doctors that would confuse the issue.

Consider that this was a peace time veteran who voluntarily enlisted in the Navy.......... that would first cause an examiner to suspect possible deception before more analysis was necessary. I would get an attorney to represent this veteran before I allowed him to try and remember what happened thirty years ago. Additionally, the veteran is confused about what happens to him on a day to day basis as it is. I see this guy three times a week and spend a couple hours with him.

Why would I have to address or prove to some degree that the statements in the military "were not deceptive". What evedentiary stsndard would I ask a doctor to adhere to when testing for deception. Beyond a reasonable doubt"? Clearly? More likely than not? I do not even know why a veterans advocate would even bring the issue of deception up. I would think that this would only be an issue for the VA to show cause to investigate or for that matter prove. It just seems like more issues that I would have to pay the doctor to write up.

Depression. About half of panic disorder patients will have an episode of clinical depression sometime during their lives. Major depression is marked by persistent sadness or feelings of emptiness, a sense of hopelessness, and other symptoms.

Hoppy-

The posting I made was simple, Think like the VBA and clear up issues before you submit the claim. I simply pointed out some pitfalls as it pertains to the veteran that you are attempting to help. Do it your way, maybe the veteran will win the claim in 10 years- only if he/she is persistent and after several remands to get the facts that I suggested in the first place.

Why do service members go UA? While stationed the Philippines I witnessed a good number of depressed sailors go UA so that they could stay with their new "friends" a little longer. I seen other UAs that involved a opinion that the service memeber made a mistake in joining or they hated the deck department. To make my point, there are thousands of reason why service members in peace time that voluntary joined go UA.

My first response to the info that you gave was- maybe the veteran only stated that his panic attacks caused his UAs to hopefully advoid or reduce UCMJ punishment and now he/she is trying to connect that to the current condition to game the system.

Objectfully, if I were rating this claim as you are attempting to submit I would deny it. That is the advice I offered to you as a VBA employee with experince rating claims. I will go by line item to hopefully make my point more clear:

"The veteran needs to set down with the Dr. and go over the whole medical history and then have the Dr. opine on the facts. Mental health professionals are usually the best at determining deception. What will be needed in this case is a strong IMO where the examiner states that he/she believes that the UA's were a product of in-service panic disorder. The only way for a Dr. to determine that is to set down with the veteran and ask some specific questions relating to such and observing the veteran's reaction and reasoning. This process should be well described in the examiner's opinion".

1. If the veteran never was personally examed by the psychiatric doctor, the R/O will shoot it down in a heartbeat.

2. The veteran wants the psychiatric doctor to review all evidence and give the proper exam to establish a factual basis that the VBA cannot contest.

3. The veteran will want the psychiatric doctor to inquire into the UA's and eliminate deception as a possible factor and the doctor must report in detail the process he/she used to come to that determination.

4. Finally, the doctor should opine on the occurance of a mental disorder being present as the veteran contends- with the more likly than not or at least as likly as not statement.

If the veteran can obtain an IMO as such, then he/she has a very good chance of getting an award at the RO level.

Edited March 7, 2009 by poolguy11550

[Pete53]

Some facts about Panic:

Many have remissions that can last for years and than come back when there is stress.

Most panics not 50% suffer some form of depression or co morbid condition. I used to chat with hundreds who have panic disorder and I make this general observation. The ones I could count who just had panic could be counted on one hand. And to follow up on this the ones who said they did not have depression really did.

It was depression that enabled me to find out that I had panic disorder. I did not fimd out until I had been out of Service for 22 years.

Most undiagnosed panics think that they are crazy.

My opinion is many with panic also could be easily diagnosed as PTSD minus the traumatic stressor that the VA requires for PTSD Service Connected disability.

I had major panic attacks between 1969-70 than remission till 1973-74. Remission between 1974 till 1979. Remission from 1979 till 1985. Major panic attacks between 1985-89 and than Major depression and panic 1991 - 1996. I still have panic attacks but nowhere as severe as it was and I have a chronic fight now with depression.

It seems to always come back worse but knowledge has helped me a lot. When a shrionk tells me that no one has died from a panic attack I ask them how do you know and have you ever heard of a person being frightened to death. When adrenalin is released into your body there is usually a big part of the panic attacks that I have.

I have found that many Doctors who treat panic do not really understand it and that the best place I ever got info I could use was talking to others who have panic disorders.