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Confused About "secondaries"



Hi Folks - thanks for all your help and advice in the past

I have PTSD at 50% at present. I filed a claim for IU and at the same time consideration for increase on my PTSD rating. I received a call from my VSO at VA (wasn't happy with my outside rep so filed directly with VA). Very nice and very helpful actually. After reviewing my VA med records, he sent me a cover letter and forms etc, for more info (21-4138) for "Depression secondary to PTSD" and "Suicidal tendencies (claimed as emotional problems) secondary to PTSD". Note that this is pertaining to my IU claim and not, my PTSD.

So with that in mind, I need help/advice about wording to not have my "depression" issues sound like a repeat of my "PTSD" submital - the two seem closely liked as far as description!

Confused in MN.......welcome home Vets!

PS: My rep has already submitted a request for examination (MH)

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You can only be rated for one mental condition. Your depression may increase the overall disabiliy picture. It will probably just be viewed as part of the PTSD picture.

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Nam67 check this out

General Rating Formula for Mental Disorders

Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name... 100

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships...70

Occupational and social impairment with reduced reliability and productivity due to such

symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships...50

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events)...30

Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication...10

A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication...0 I hope this helps


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Appreciate that advice folks. I guess I am hoping the depression and suicide ideation might increase my rating to qualify for IU. I am being treated for both at the VA in addition to my ongoing ptsd.

As I am struggling with the anxiety and stress of my wife recently diagnosed with terminal cancer, I'm not sure if the c&p will see these issues as related to my ptsd or not - not sure if I know myself! Been so tired lately and all my focus has been on my wife, I haven't got much left over to fight the VA.

Again, thanks for having taken the time to respond and advise. And wish me luck: my c&p is 07/19! Be Well.

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Hang tough, Nam!

Remember that with IU, everything has to do with your Ability To Work.

So- you want the documentation from doctors, therapists, etc to reflect all the ways that any afflictions Negatively impact your ability to work:

impaired judgment; memory loss etc.

Go through that whole list and come up with examples in your life that apply. Give that list to every appropriate treating authority to review and record in your records.

Also ask them, in writing, to record a statement of why you can't work. I handed them one I wrote and just asked to sign or re-word.

Documentation is key.

All the best!


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