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

[LarryJ]

I have to throw in with John and Pete on this one.

When I asked my psych M.D. and my psych P.A. for something to support my being tdiu p&t, they did the writing, and had no trouble doing so for me.

It's one or both of these statements that got me where I am vis a vis my percentage, tdiu and p&t.

I have found that it is not usually a good idea to try and tell a medical person what to say (I've been married to an R.N. for 35 years, rather happily, by NOT telling her what to say or to think)!

[carlie]

[name=purple' date='Mar 11 2009, 04:06 PM' post='135076]

Something I've always wondered on here.....why does everyone always use the "more likely than not" phrase?? It's passive voice and leaves room for the RO to say....."well, maybe there was another cause...."

Use active voice when writing these letters...Say what you mean. Say it was the cause....be direct...to the point. Don't beat around the bush.

Purple

This is one of the reasons I continue to say, you were one of the very fortunate to have

your service connection granted fairly and in a timely manner.

Just imagine having to learn all this and then being denied and having to continue

this legal battle of words, with no benefits or lowballed percentages and nothing for your dependants. Also, having to make co-payments for Medical treatment and your

RX drugs.

Something else rarely spoken of is a very important human aspect of disability claims,

you received validation - those still being denied legitimate claims -- have not.

So year after year the VA continues to ingrain into these veterans and/or claimants minds,

that there's nothing wrong with you - you did not incur an injury, illness or disease

with any residual disability from your active duty service - you are just fine,

you little compensation seeking weasel.

These are some of the magical, mysterious phrases spelled out in VAolaenglish.

It's not passive voice - it is very active voice to be used by C&P Examiners and hopefully

within the veterans and/or claimants medical evidence. and what it's meant to do is :

Medical statements regarding possible Service Connection:

Is due to- 100% -- (Grant claim)

More likely than not- Greater than 50% -- (Grant claim)

At least as likely as not- 50% -- (Benefit of doubt goes to Vet)

Not at least as likely as not- Less than 50% -- (Deny claim)

Is not due to- 0% -- (Deny claim)

carlie

[purple]

Then why do most here on Hadit that I read...who are submitting letters...use the "more likely than not" phrase when they are seeking a higher rating??

I say no. Go for it. How do you think I got my rating the first time?? My docs used strong language...and so did I.

Is this language set in stone somewhere? I doubt it. Maybe I'm wrong. But I doubt it's in some regulation anywhere.

[carlie]

Hey - how about sending some good luck this way.

Larry, John999 and Pete53,

My buddy came back to my house after his appointment and was smiling, very happy.

He says it's the best appointment he's ever had with Dr. XXXXX. Today was also the first

time his Psychiatrist got to see the veterans DA Form 20 that shows his MOS and his

Foreign Service:

VN Counteroffensive Phase V

VN Counteroffensive Phase VI

Tet 69/ unnamed campaign

He said while they sat there talking Dr.XXXXX read the letter from The Vet Center MSW

and the letter I had written. As they continued talking the Psychiatrist told my buddy,

yes I do need to write something up for you and he then kept talking and entering something

onto his keyboard. He told my buddy to go to ROI next week and request a copy of

today's appointment

Remember as he handed Dr.XXXXX the papers he said,

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.

LarryJPosted Today, 08:15 PM I have to throw in with John and Pete on this one.

When I asked my psych M.D. and my psych P.A. for something to support my being tdiu p&t, they did the writing, and had no trouble doing so for me.

It's one or both of these statements that got me where I am vis a vis my percentage, tdiu and p&t.

I have found that it is not usually a good idea to try and tell a medical person what to say (I've been married to an R.N. for 35 years, rather happily, by NOT telling her what to say or to think)! :D

Larry,

I know what you mean - I was raised by a hard core RN, she was so hard core they rolled their own specimen swabs - sharpened the burrs off needles to

re-use them, rode out to farmhouses at late- late hours to deliver babies

and would have to run back out to the car to check the babies color

in the headlights because an oil lamp wasn't bright enough to tell ---

and dag gone do I ever love and miss this wonderful woman terribly.

To be real truthful - I thought you - (smartie pant's, hat wearing

rough boy :), would certainly understand - that I did not have high hopes

of the DR. just signing the letter and being done with it.

I did have high hopes of the Dr.,

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.

After all this is a Medical Professional that is paid by the Goobermint to

provide treatment and service to the veteran.

Since this Psychiatrist tells the veteran at each visit,

"If I can help you any just let me know", as someone here always says

hold their feet to the fire.

I doubt very strongly that the Psychiatrist will work very hard to REBUT

his own Medical Evidence as documented in the Vista Electronic Medical

Documentation.

john999

Posted Today, 07:12 PM My experience is that you give the shrink the evidence and let them write the letter. I don't think any shrink I have ever delt with is going to sign a letter like that, especially with all those other conditions. The shrink is not competent to make medical opinions about those non-psychiatric conditions. Plus, the shrink is going to want to make his own GAF.

John,

All of the medical information is taken directly from this same Psychiatrist's Progress Notes labeled Vista Electronic Medical Documentation. These

records range from Sept. 2006 thru Dec. 2008 which was his last appointment with the Psychiatrist, at that appointment the Psychiatrist assigned

a GAF of 60.

I personally would have liked to put a GAF of 40 but I'm not the doc

and the Vista records are only showing the most recent GAF from

Dec 2008, of 60.

of

Pete53

Posted Today, 06:51 PM Actually it is not professional for a Doc to sign a letter like that. My recommendation is for the Veteran to show a checklist of what his problems are and ask the Doc to address those issues in an IMO for the patient.

Pete,

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 put 3 things in the letter that was not contained within this same Psychiatrist's Progress Notes, Vet Center MSW letter,

Dr's Progress notes from the VAMC.

1) (DC 9411, 9434)

2) Schedule for Rating Disabilities from 50% to 30% symptoms:

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.

I did this intentionally as the Psychiatrist can list whatever Medical Evidence he feels fits the veteran and is of record - but he sees in black and white the key wordsused for symptomology, several of these symptoms are already of record by this same Dr.

3) 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.

Dr. XXXXX and The Vet Center MSW have both already stated in the veterans

Progress Notes his PTSD and depression prevents him from having

employment on any regular basis.

And I am in hopes Dr.XXXXX will include the VAolaenglish word, "static".

[LarryJ]

:P

[LarryJ]

Then why do most here on Hadit that I read...who are submitting letters...use the "more likely than not" phrase when they are seeking a higher rating??

I say no. Go for it. How do you think I got my rating the first time?? My docs used strong language...and so did I.

Is this language set in stone somewhere? I doubt it. Maybe I'm wrong. But I doubt it's in some regulation anywhere.

Well, believe it or not, this language IS set in stone someplace.........I just can't recall where. Someone else with a better mind than mine can probably even tell us where.