ptsd Depression Service Connection Vs. Ptsd Possible Triggers

[MikeR]

Well I am waiting on the results of my foot after my second C&P, I have been sending in evidence constantly in support of the PTSD claim. The records center sent back a vague acknowledgement of one stressor, and informs for me the vet to provide more in formation on the second set of stressors. I did, as much as possible. The person in charge of the MACOM HR basically told me that they have the most vague non-detail records for old members of the organization. I have provided all I can, letters, write-ups, awards, buddies, etc... The VA psych provided service connection, and a diagnosis for Severe PTSD (Which is my claim). My other diagnosis is Severe Depression, for which the VA notes I was treated for on Active Duty. I have yet to claim it. Assuming they deny my PTSD claim, will they offer the Depression, or do I have to claim it on a new claim?

Edited June 3, 2009 by Tbird
POSSIBLE TRIGGER Added to Topic Title

[MikeR]

I refused to start a new claim for hypertension like the DAV SO wanted to do in 2006, my claim for heart problems had been on appeal only 4 years at that point and I refused to "start over" why throw away a 100% claim for a 10% award for high blood pressure to me it made no sense and the BVA Judge vindicated me on April 7 2009

sometimes you do just have to wait them out

That is what I was thinking. BTW congrats.

[Hoppy]

MikeR,

I have assisted on many psych claims. Before I can offer any assistance I need to know specifically if you were seen by a psychiatrist in the military and if the psychiatrist made a diagnosis. Also, if you were not seen by a psychiatrist did the clinicians who saw you make a diagnosis. Depression is a symptom that is identified in many different mental conditions including personality disorders.

The fact that you were not service connected at discharge for a mental condition implies that you were diagnosed with a personality disorder or that they did not think you had a chronic psychiatric condition. Depending on exactly what the symptoms and diagnosis was in the military determines if you seek a re-diagnosis or link your current condition to military service. I need to know how many times a clinician stated in the SMR that you reported depression and how long of a period was between the first and last notation of depression by a clinician. Did they state what was causing the depression? Such as a recent death in the family, girl friend problems, etc. They had the option of service connecting the depression at discharge and chose not to service connect it. Getting the depression service connected without an association to the PTSD will be a battle. Several here on hadit battled through many C&P's and IMO's to get a psych condition service connected after discharge.

You can file a new claim for depression and advance the PTSD claim at the same time. However, if the VA thinks that the issues in the PTSD claim and the depression claim overlap the VA will not consider it a new claim. If they determine the depression in the military was not a symptom of PTSD then they would consider the Depression a separate claim. My guess is that they would adjudicate both claims at the same time. They would require full development of both the PTSD claim and a claim for depression then make a decision.

Pasted from a BVA case:

The Federal Circuit Court recently held that claims that are

based on distinctly and properly diagnosed diseases or

injuries must be considered separate and distinct claims.

See Boggs v. Peake, 520 F.3d 1330 (Fed. Cir. 2008). See also

Ephraim v. Brown, 82 F.3d 399, 402 (Fed. Cir. 1996) (a newly

diagnosed psychiatric disorder (e.g., PTSD), even if

medically related to a previously diagnosed disorder

(such as depressive neurosis), is not the same for

jurisdictional purposes).

[Hoppy]

They also have the option of scheduling a psych C&P. If they do not confirm the stressor they can schedule an exam excluding PTSD. They will only schedule a C&P to develop a PTSD claim after they have confirmed a stressor.

They have scheduled a psych C&P for some vets here on hadit who submitted treatment reports from post service doctors for a mental condition.

[MikeR]

MikeR,

I have assisted on many psych claims. Before I can offer any assistance I need to know specifically if you were seen by a psychiatrist in the military and if the psychiatrist made a diagnosis. Also, if you were not seen by a psychiatrist did the clinicians who saw you make a diagnosis. Depression is a symptom that is identified in many different mental conditions including personality disorders.

The fact that you were not service connected at discharge for a mental condition implies that you were diagnosed with a personality disorder or that they did not think you had a chronic psychiatric condition. Depending on exactly what the symptoms and diagnosis was in the military determines if you seek a re-diagnosis or link your current condition to military service. I need to know how many times a clinician stated in the SMR that you reported depression and how long of a period was between the first and last notation of depression by a clinician. Did they state what was causing the depression? Such as a recent death in the family, girl friend problems, etc. They had the option of service connecting the depression at discharge and chose not to service connect it. Getting the depression service connected without an association to the PTSD will be a battle. Several here on hadit battled through many C&P's and IMO's to get a psych condition service connected after discharge.

You can file a new claim for depression and advance the PTSD claim at the same time. However, if the VA thinks that the issues in the PTSD claim and the depression claim overlap the VA will not consider it a new claim. If they determine the depression in the military was not a symptom of PTSD then they would consider the Depression a separate claim. My guess is that they would adjudicate both claims at the same time. They would require full development of both the PTSD claim and a claim for depression then make a decision.

Pasted from a BVA case:

The Federal Circuit Court recently held that claims that are

based on distinctly and properly diagnosed diseases or

injuries must be considered separate and distinct claims.

See Boggs v. Peake, 520 F.3d 1330 (Fed. Cir. 2008). See also

Ephraim v. Brown, 82 F.3d 399, 402 (Fed. Cir. 1996) (a newly

diagnosed psychiatric disorder (e.g., PTSD), even if

medically related to a previously diagnosed disorder

(such as depressive neurosis), is not the same for

jurisdictional purposes).

Hoppy,

Thank you for your response. I will have to do some research through my medical records, but I do believe they were attempting to diagnose me with a personality disorder as was very popular, but I had suicidal Ideations and was in fact treated for depression and the VA even points that out in my remand. I need to dig through this.

Mike

[MikeR]

They also have the option of scheduling a psych C&P. If they do not confirm the stressor they can schedule an exam excluding PTSD. They will only schedule a C&P to develop a PTSD claim after they have confirmed a stressor.

They have scheduled a psych C&P for some vets here on hadit who submitted treatment reports from post service doctors for a mental condition.

Hoppy,

This is were I am confused, The bottom is from the 2005 remand:

The veteran claims that, as a result of experiencing

traumatic in-service events, he currently suffers from PTSD.

He also contends that he injured his left ankle in service

and has continued to symptoms as a result of such injury.

Therefore, he contends that service connection is warranted

for such disabilities.

With regard to the veteran's claim of entitlement to service

connection for PTSD, he states that he spent three years as

an investigator for the Fort Carson CID (Criminal

Investigation Department) office and saw many unfortunate

things there, as well as when he served in Haiti and Korea.

The veteran claims that suicides, rapes, and autopsies replay

in his head. The veteran described having pulled 400 dead

people out of the mud while he was in Haiti. During his CID

work, he claims to have seen the aftermath of rapes,

molestation, and suicide. The veteran's service medical

records reflect that he sought treatment for suicidal

ideation in January 1998 and his February 1998 separation

examination reflects reported treatment for depression and

mood swings.

At his October 1998 VA psychiatric examination, the examiner

diagnosed PTSD and stated that he met the full criteria for

PTSD, in accordance with the DSM-IV (American Psychiatric

Association: Diagnostic and Statistical Manual of Mental

Disorders (4th ed. 1994)). The examiner related that the

veteran's PTSD extended partly from his experiences in Haiti,

but more so from his experiences while working at CID and, as

such, his PTSD symptoms were directly related to both of

these experiences.

While there is a diagnosis of PTSD of record, as well as an

opinion relating such diagnosis to the veteran's military

experiences, the veteran's reported stressors have not been

verified. As such, additional development is necessary.

While on remand, the veteran should provide specific

instances of his claimed traumatic experiences while serving

in Haiti, Korea, and CID and, thereafter, verification

information should be obtained. If the veteran's alleged

stressor(s) is verified, he should be afforded a VA

psychiatric examination for the purpose of determining

whether he has PTSD related to a verified in-service

stressor.

Also relevant to the veteran's claim of entitlement to

service connection for PTSD, it appears that there are

outstanding, relevant records. At his February 1998

separation examination, the veteran reported being treated

for depression at "CMHS" at Fort Irwin. The clinical

evaluation noted that the veteran had an

adjustment/personality disorder and was being followed by

"CMH" and psychiatry. Such relevant records are not

contained in the claims file and therefore a remand is

necessary to obtain them.

Accordingly, this case is REMANDED for the following:

1. Regarding his claim of entitlement to

service connection for PTSD, the veteran

should be sent a letter requesting that

he provide specific information pertinent

to his claimed in-service stressors

involving his experiences in Haiti,

Korea, and with the CID. The veteran

should be advised to be as specific as

possible, to include providing relevant

names, dates, places, and descriptions of

stressful events.

2. Appropriate steps should be taken to

obtain records from "CMH" or "CMHS"

and psychiatry at Fort Irwin detailing

the veteran's treatment for depression

and/or an adjustment/personality

disorder. A negative response for any

records that cannot be obtained should be

associated with the claims file.

Requests must continue until it is

determined that the records sought do not

exist or that further efforts to obtain

those records would be futile. Any

records obtained should be associated

with the file.

3. Thereafter, appropriate steps should

be taken to verify the veteran's claimed

in-service stressors. Such may include,

if necessary, obtaining the veteran's

service personnel records and/or

requesting verification information from

the U.S. Armed Services Center for

Research of Unit Records (USASCRUR) or

any other appropriate source.

4. Following the above, a specific

determination as to whether the veteran's

claimed stressor(s) is sufficiently

verified should be made. All credibility

issues related to this matter should be

addressed at that time.

5. If and only if any stressor is

determined to be verified, the veteran

should be afforded a VA psychiatric

examination. The corroborated

stressor(s) must be specified and the

examiner is instructed that only those

events may be considered for the purpose

of determining whether exposure to a

stressor in service has resulted in

current psychiatric symptoms, and whether

the DSM-IV diagnostic criteria to support

a diagnosis of PTSD have been satisfied.

The examiner should determine whether the

veteran meets the diagnostic criteria for

PTSD and, if so, identify the verified

stressor or stressors to which any

current diagnosis of PTSD is attributed.

The examiner should also indicate whether

any other acquired psychiatric disorder

found to be present is related to

service. The examiner should include

review of the claims file, to include the

veteran's service medical records, in

offering the above requested diagnostic

and etiologic conclusions and note that

the file was available for review. The

rationale for all opinions should be

provided.

What is interesting to me is that the VA only verified the Hurricane where we almost died, and then mentioned that about 1,200 people died on the island when we were down there. I was with the Engineers and we had to go dig 400 people out of the mud. Also I have supplied many documents (awards, letters, informational items) from my time as a CID investigator, and CID themselves only say that I worked there. The VA wants specifics, and the Agency won't give them to the VA.

The VA gave me a diagnosis in 1998 of PTSD, and they downplay that. Of course after the remand in October, 2008 they give me a full PTSD diagnosis, and secondary Depression. The examiner includes the documents I provided, and says that he gives me the benefit of the doubt even though they have not verified my stressors. (I thought they would not provide this to me if they had not.) He gave me a GAF of 45. This 90 minute session with him freaked me out so badly that my doctor had prescribed me Effexor,and Buspar. I am sort of at my wits end with this claim.

The VA was contacting the USACID and trying to get information, and then they told me to do it. They told me that they only provide times of service, not details of what the agency does. I sent this letter to the AMC.

Subject: Fax

The problem with the request for the Verification of any incident is that I was an investigator from July of 1994 until January 1997 at the Fort Carson, CID in Fort Carson, CO. In July 1994 I spent the first month in the General Crimes Team Chief's office reading the Regulation CID Reg 195.1. After that I spent a year with the General Crimes team working under the supervision of Special Agent redacted, and then to the Drug Suppression team for about a year. Then in my final time there I worked on the Economic crimes team under SA redacted, but was also tasked to work cases involving molestations and rapes. My duties included participating in a roundtable group of social workers representing the agency. Asking for this type of verification is almost pointless as most information of this type is rarely released. I have supplied proof of working for the agency, a copy of an award document for an Army Achievement medal, and copies of orders to CID school held at that time in Alabama. Since I worked at the agency in an Intern capacity I am not probably in the official case files. I worked there for the time period specified above (except from 9/94 to 12/94 Haiti trip) and then went to CID school where I had the equivalent of a nervous breakdown and was sent to the desert in Fort Irwin, CA.

One of my stressors is also Haiti, and I am wondering why this does not seem to be taken into consideration. I did go down with the 52^nd Engineers and we were tasked to clean up after an extremely fatal Hurricane that left over a thousand dead and still gives me nightmares of having to recover the dead of one village whom fell victim to a landslide. The records center only shows that there was a deadly hurricane which leaves me to have very little faith in them having reliable records of any kind.

Kim, I am at my wits end here. I don't know how else to proof my life.

Help.......

Edited June 2, 2009 by MikeR

[Hoppy]

That is what I need to know. They want to tie the stressor to symptoms of re-experiencing etc, as required by the PTSD diagnosis.

Have you tried to find any news paper articles from local press. They recognize that you were there.

Can you remember names of people or a CO who was there with you. Have you tried to find them.

What was your MOS or job classification. I will try and search how claims were handled for other individuals who worked as an investigator.

I was trained as civilian Private Investigator and I am pretty good at skip tracing. I also have some resources for finding someone who is still on active duty. Maybe I can help finding a CO or other people familiar with what was going on in Haiti.

I will be back online Thursday night Pacific Time.