ptsd I Wonder If The Psychiatrist Will Sign This

[carlie]

A buddy of mine just left here for his Psyc appointment.

His counselor, a MSW at the Vet Center has written him

a bang up letter of support we will be submitting soon.

All he has so far from his Psychiatrist is Progress Note's in his

Medical records.

I asked him several times if he is very comfortable with his

Psyc doc and he said he is very much so and that this Psyc always

tells him, "If I can help you any just let me know".

Well I went through all of the Psyc's notes, the Vet Center, MSW notes

and Medical records and came up with this letter (2 copies) for him to take

to the Psyc today.

I told him to ask the Psyc to read it and

1) if he agreed with it ask him if he will sign it and keep a copy for himself

to enter into the progress notes from today

OR

2) keep both copies - tweak it to his liking - and provide, at their next appointment

something that would be supportive in helping with getting his claim granted.

Now, I was not shy in writing this letter - this will show us if this Psyc really

means what he says.

11 March 2009

In regards to:

Full Name

SS # XXX-XX-XXXX

DOB: XX/XX/XXXX

Address : XXXX - XX Ave. XX.

XXXXXX,Fl. XXXXX

To Whom It May Concern:

As the provider for mental health care for this veteran, it is my medical opinion that this veterans Post Traumatic Stress Disorder and comorbid Depression(DC 9411, 9434) is more likely than not,a direct result of his two tour's of combat in The Republic of Vietnam.

This veteran often engaged in combat with the enemy as evidenced by his Military records and by his Military Occupational Specialty (MOS) of 16F10 Lt AD Arty Crmn (Light Air Defense Artillery Crewman).

This veteran was frequently in fear of his life during combat resulting in Post Traumatic Stress Disorder with comorbid depression, of which he continues to recieve counseling, treatment and medications for.

This veteran continually presents with a flattened affect, has difficulty understanding complex commands; show's objective symptoms of impairment of short- and long-term memory, has a definite decrease in work efficiency and intermittent periods of inability to perform occupational tasks,shows all symptoms of depressed mood, anxiety, suspiciousness, and has difficulty in establishing and maintaining effective work and social relationships.

In my Medical Opinion the veterans Mental Health Disabilities would preclude him from any form of substantial gainful employment on any regular basis. I feel this veterans disabling Mental Health Conditionis static in nature.

con't p.2 - Full Name - SS# XXX-XX-XXXX

AXIS I : 309.81 PTSD, Chronic

AXIS II : Deferred

AXIS III : See medical problem list.

AXIV IV : Comorbid depression, dealing with posttraumatic stress disorder.

AXIS V : Global assessment functioning 60

MEDICAL PROBLEMS :

1. Digenerative Joint Disease

2. Gastroesophageal Reflux Disease

3. Shoulder

4. Skin

5. Left foot

Thank you for assisting our Veterans.

Sincerely,

XXXX XXXXX - Psychiatry MD

Edited March 11, 2009 by carlie

[rentalguy1]

Purple, that is the exact language that the VBA spells out in the M21-1MR. I doubt seriously if any of them know the difference between passive and active voice. It is also very hard to make a direct statement with the majority of medical conditions.

Carlie: I am against Pete, John, and Larry on this one. I have written letters for myself and others that the docs have signed willingly. I can only think of one that wanted to change the way the letter was written slightly, and none that refused. I think we all give our docs too little credit when it comes to wanting to help us with claims.

[ruby]

My doctors voluntairly wrote mine when I asked them too write a letter in support. Both wrote them as I was sitting in there and then made copies but told me to go get the official copies via FOI.

Both wrote 100 due to Ptsd/mst and is not employable.--No room for doubt. I can't figure out why I am going to a comp exam. My mst is/was verified that is not an issue. Think they are trying to low ball.

My docs wrote something like what Carlie wrote just stronger lang. They did not go into all my physical issues but wrote severe depression due to chronic pain.

Good letter Carlie.

[LarryJ]

Purple, here is an example of the "at least as likely.........." usage vis a vis the VA, in this instance a decision by the BVA but this nomeclature is commonly acceptable phrasing throughout the VA claims procedure:

Citation Nr: 0841563

Decision Date: 12/03/08 Archive Date: 12/09/08

DOCKET NO. 04-23 195 ) DATE

)

)

On appeal from the

Department of Veterans Affairs Regional Office in St.

Petersburg, Florida

THE ISSUE

Entitlement to service connection for a stomach disorder, to

include irritable bowel syndrome (IBS), claimed as secondary

to service-connected post-traumatic stress disorder (PTSD).

REPRESENTATION

Appellant represented by: John E. Howell, Attorney at

Law

ATTORNEY FOR THE BOARD

Tresa M. Schlecht, Counsel

INTRODUCTION

The veteran had active service from January 1943 to November

1943. This appeal initially came before the Board of

Veterans' Appeals (Board) in July 2006. The veteran appealed

that decision to the United States Court of Appeals for

Veterans Claims (Court). Following submission of briefs by

the parties, the Court set aside the Board's 2006 decision in

April 2008 and remanded the claim to the Board for further

consideration.

The appeal is REMANDED to the RO via the Appeals Management

Center (AMC), in Washington, DC. VA will notify the

appellant if further action is required.

REMAND

The Court's discussion of the VA examinations afforded to the

veteran in this case makes it clear that the veteran must be

afforded another VA examination to determine if he has a

stomach disorder, to include IBS, as a result of service-

connected PTSD.

Accordingly, the case is REMANDED for the following action:

1. The interpretation of notice requirements

under the VCAA has changed since the veteran

submitted the claim on appeal in 2002. An

updated notice of VA's duties to the veteran

should be issued. The notice should include

information about service connection based on

a theory of aggravation, as well as direct and

secondary service connection.

2. If the veteran has received VA treatment

during the period from October 2002 to the

present, those records should be obtained.

3. The veteran should be afforded the

opportunity to identify or submit private

clinical records from March 2002 to the

present that might be relevant to support his

claim.

4. The veteran should be afforded the

opportunity to submit alternative records to

support the claim, such as employment clinical

records, employer statements, and the like.

5. The veteran should be afforded VA

examination of the gastrointestinal (GI)

tract. The examiner should review the entire

claims file, including the VA examinations and

opinions. Relevant clinical records,

including those obtained during the course of

this Remand, should be reviewed, and pertinent

facts from that review should be discussed in

the written report. The examiner(s) should

address the following questions:

(i) What GI disorders does the veteran

currently manifest? The examiner should assign

a diagnosis for each disorder. The examiner

should specifically state whether irritable

bowel syndrome (IBS) is or is not present, and

explain the findings which support the

determination.

(ii) If a GI disorder, to include IBS, is

present, is it at least as likely as not (that

is, is there at least a 50-50 degree of

probability) that the GI disorder is

etiologically related to the veteran's

service-connected PTSD?

(iii)If a GI disorder, to include IBS, is

present, is it at least as likely as not (that

is, is there at least a 50-50 degree of

probability) that the disorder was first

manifested during a period of active service,

or is etiologically related to the veteran's

service?

(iv) If a GI disorder, to include IBS, is

present, is it at least as likely as not (that

is, is there at least a 50-50 degree of

probability) that the disorder is aggravated

by (that is, permanently worsened by) the

veteran's service-connected PTSD?

It would be helpful if the examiner, in

expressing his or her opinion, would use the

language "likely," "unlikely" or "at least as

likely as not." The term "at least as likely

as not" does not mean "within the realm of

medical possibility." Rather, it means that

the weight of medical evidence both for and

against a conclusion is so evenly divided that

it is as medically sound to find in favor of

causation as it is to find against causation.

6. The foregoing requested development should

be completed. The claim on appeal should be

readjudicated. The claimant should be

notified of that adjudication. If any benefit

requested on appeal is not granted to the

claimant's satisfaction, the claimant and his

representative should be furnished a

supplemental statement of the case which

addresses all of the evidence obtained. The

claimant should be afforded an opportunity to

respond.

The appellant has the right to submit additional evidence and

argument on the matter the Board has remanded. Kutscherousky

v. West, 12 Vet. App. 369 (1999).

This claim must be afforded expeditious treatment. The law

requires that all claims that are remanded by the Board of

Veterans' Appeals or by the United States Court of Appeals

for Veterans Claims for additional development or other

appropriate action must be handled in an expeditious manner.

See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2008).

_________________________________________________

MARJORIE A. AUER

Veterans Law Judge, Board of Veterans' Appeals

Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the

Board of Veterans' Appeals is appealable to the United States

Court of Appeals for Veterans Claims. This remand is in the

nature of a preliminary order and does not constitute a

decision of the Board on the merits of your appeal.

38 C.F.R. § 20.1100(:P (2008).

[sharon]

It is "at least likely as not" fulfill the requirement of 38 CFR 3.102.

3.102 - Reasonable doubt.

It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. It is not a means of reconciling actual conflict or a contradiction in the evidence. Mere suspicion or doubt as to the truth of any statements submitted, as distinguished from impeachment or contradiction by evidence or known facts, is not justifiable basis for denying the application of the reasonable doubt doctrine if the entire, complete record otherwise warrants invoking this doctrine. The reasonable doubt doctrine is also applicable even in the absence of official records, particularly if the basic incident allegedly arose under combat, or similarly strenuous conditions, and is consistent with the probable results of such known hardships.

[Pete53]

Purple you bring up an interesting point as most of the VA require the statement to grant but as in your case some do not. Its like a secret code that how in hell could a Vet or their Doctor know?

I am glad that you got your claim done quickly it took me over 5 years and I was backed by the Head Shrink at the VA, a panel of three shrinks and another Doctor plus 2 IMOS from my Doc.

When I got it the Rater at VARO said I should have gotten it a long time before.

Carlie I am positive that you are on the right track

[john999]

My doctor at the VA had a form in her computer that she used to help me get SC'ed for a secondary condition. I did not have to give her a letter to sign. It was in her computer in language that was letter perfect. I told her what I wanted and she cranked it out!