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.

[poolguy11550]

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.

It was depression that enabled me to find out that I had panic disorder.

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 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.

Pete, I also suffer from panic attacks and I discovered such in the same manor as you. I completely agree with you.

[Pete53]

Pete, I also suffer from panic attacks and I discovered such in the same manor as you. I completely agree with you.

Thank you Poolguy that helps just seeing your comment. I usually don't talk about it cause no one who has not suffered with it could even come close to understanding.

Its also weird cause people with panic can be a lot different. I know people who can travel and some who cannot. Almost all panics I know seem very quirky cause they go to great lengths to avoid stressors that they think cause panic attacks.

I always have a cell phone with me. I don't go anywhere without someone I trust being with me. I avoid a lot of stuff or put off doing something that exposes me. There are some things that I can do today that I could not a while back.

Today I went to my grand daughters first soccer game and I did ok and so did she.

[Hoppy]

poolguy

I appreciate your continued input with this claim. I put up more history below. Would you believe I also have had panic attacks at several times in my life. I am aware of all the info Pete posted. I was a passenger in a car on my way to play golf. Next thing I know I can't catch my breath and my heart rate goes through the roof. I told my friend to get off the freeway and to a phone. I was so dizzy I could barely get out of the car. I called 911 and the paramedics showed up and told me I would be wasting my money by having them transport me to an ER. 20 years later I started having them on a regular basis.

To counter your experiences with UA. I wonder how many folks you encountered had a confirmed diagnosis of panic attacks. People with untreated panic disorder make many changes to do what they think might cause the problems not to re-occur. As a result of your input I have added the issue of credibility for the purpose of the IMO. I will have the IMO address specific reason to establish that the veteran's statements to military doctor were credible.

The veteran was seen by military clinicians over twenty times for symptoms of panic attacks including an assessment by a military psychiatrist that his condition was not treatable. These clinicians were capable and trained to investigate deception. I have read reports from military clinicians who have suspected deception and noted such in SMR notes. The fact that not one of the military clinicians identified any suspicion of malingering or deception on the part of thos veteran weighs heavy in determining that the veteran’s statements to military clinicians were credible

I am familiar with many cases involving anxiety disorders. There have been several veterans here on hadit who have won claims for anxiety disorder. Clark Evans was an attorney who posted on hadit. He passed away last year. I have read claims that he won for anxiety disorder. All these claims had several things in common. The in-service symptoms were noted as “anxiety” and somatic symptoms of “stress headaches”. They were discharged for “emotional instability reaction”. They were all service connected decades after discharge for anxiety disorder. Not one of these claimants were required to prove that their statement to military clinicians were not deceptive. As you noted they were fought vigoursly by the VA and took years to settle.

I have read several cases involving deception and malingering. In these cases there are disputes as to whether or not the patient is deceptive or a poor historian. I have not seen any testing scheduled for deception unless there was a previous suspicion from a clinician that a veteran was deceptive. When this occurs it appears that they are referred to existing standard psycho metric tests. The cases I found were for recent claims as to the level of current disability. I am not aware of any existing test that would distinguish the individual’s abilities as a historian from his tendencies for deception. This is not a case that would rest on a determination of his current functioning. The case rests on the credibility of his statements to military clinicians. The veteran who I am helping has never been identified as deceptive or malingering in any in-service or post service examination. As such, I do not see how the issue of deception at this point would require any further investigation.

I would contend that determining that he went UA due to the symptoms of panic attacks is first hand knowledge within the meaning and context of the citation below. The fact that he stated this three times and that he was not found to be malingering or deceptive by military clinicians makes the statement credible.

The veteran can attest to factual matters of which he had

first-hand knowledge, e.g., experiencing pain in service,

reporting to sick call, being placed on limited duty, and

undergoing physical therapy. See Washington v. Nicholson, 19

Vet. App. 362, 368 (2005).

Additionally, my education in psychology includes training in “experimental design”. As such I am aware of the rigid standards that are required before a test is considered reliable by mainstream clinicians and their associations. If a test were given to determine credibility of statements made thirty years ago I would contend that the test be certified as accurate before allowing such test to given weight.

It should also be noted that the determination that he went UA due to panic attacks is one of three requirements of the diagnosis of panic disorder. Only one of the three is necessary. Another criteria is to establish that he had a persistent concern that the attacks would continue for one month. This is much easier to show in the SMR. On a recent review of the file I found evidence that he met this second requirement.

Edited March 9, 2009 by Hoppy

[Hoppy]

Pete,

Recently I ran into a waiter who was working a party of returning Iraq veterans. One of the guys stood up in middle of the dinner and started "freaking out" that he was dying. The other veterans came to his aid. However, they could do nothing. The event continued into a tonic-clonic seizure.

The waiter thought the guy was faking. I had to explain to him that he was just a "dumb waiter".

I also have had a tonic-clonic seizure with one of my panic attacks. As such the minute I feel the least bit uncomfortable driving I pull over immediately. The seizure took about five minutes to develop so I feel like I would have some time if it were to re-occur. I am having heavy deja vue. I think I told you about this ten years ago.

Edited March 9, 2009 by Hoppy

[Hoppy]

Betty,

WOW, I never read his credentials before. Maybe I should have him do the review.

[Josephine]

Betty,

WOW, I never read his credentials before. Maybe I should have him do the review.

Hoppy,

This was my discharge " emotional instability reaction". Dr. Crowley read and studied all of my military and post military medical records and faxed his opinion straight to the BVA Judge . I did go to his office in D.C for about a 3 hour examination. He is quite well known in his field. I was later granted benefits for " Chronic Anxiety severe". Yes his credentials are impeccable. He is certainly not one to dicker with.

I will paste a link to his website

http://www.drcrowley.yourmd.com/

I thought a copy of his IME may help you.

Always,

Betty