tdiu Decoding C&p Language

[navydoc2]

I received copies of my c&p physicals today for both my claims of increased depression and bilateral hearing loss with tinnitis. Here are the findings of the increased depression: I also have a TDIU claim

Axis I Major Depression

Axis II defer

Axis III See Med list

Axis IV Unemployment

Axis V GAF score is 50

The veteran cannot work due to anxiety, agoraphobia and worsened depression

The prognosis is guarded. He is mentally capable of managing benefit payments in his own best interest. Mentally, he occasionally has some interference performing activities of daily living because of his left Knee and depressive problems. He has difficulty establishing and maintaining effective work/school and social relationships because of his isolation. The best description of the claimant's current psychiatric impairmentis: psychiatric symptoms cause occupational and social imparment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks although generally the person is functioning satisfactorily with routine behavior, self care and normal conversation. The above statement is supported by the following symptoms: depressed mood, anxiety, suspiciousness, chronic sleep impairment and mild memory loss such as forgetting names directions or recent events . He has no difficulty understanding commands. Based upon the examination, the claimant needs to seek follow up treatment. The claimant requires therapy and medication management. This information was conveyed to the claimant during the examination. The claimant does not appear to pose any threat of danger or injury to self or others.

Audiology: puretone

right

500hz 1000hz 2000hz 3000hz 4000hz b+C+

30 40 35 50 40 41.25

left

500hz 1000hz 2000hz 3000hz 4000hz b+C+

35 40 40 65 60 56.25

Diagnosis:

For the claimant's claimed condition of BILATERAL HEARING LOSS, the diagnosis is bilateral hearing loss. The subjective factors are the claimant report of hearing loss. The objective fators are audiometric findings.

For the claimant's claimed condition of TINNITUS, the diagnosis is bilateral persistent tinnitis. The subjective factors are claimant report of tinnitus. The objective factors are the claimant's subjective report.

For the right ear, the claimant has moderate, mixed (sensorinural and conductive) hearing loss. For the left ear, the claimant has a moderately severe mixed (sensorineural and conductive) hearing loss. If treated the problem will cause a change in the hearing threshold level because resolving any middle ear pathology can improve air conduction thresholds.

Answers to the questions from VA

In reference to the question "IT IS LESS LIKELY AS THAN NOT THAT THE VETERAN'S HEARING LOSS IS RELATED TO ACOUSTIC TRAUMA FROM COMBAT NOISE", due to the presence of an air-bone gap bilaterally with flat tympanograms normal ear canal volumes and absent ipsilateral acoustic reflexes.

It is as least as likely as not that the veteran's tinnitis is related to acoustic trauma from combat noise due to the reported time of onset and the noises inherentin those duties that are known to cause tinnitis.

If anyone can shed some light on these findings and what to expect from my RSO please help me. thanks in advance.

navydoc

[navydoc2]

Yes but the statement, "The veteran cannot work" means "he cannot work." I don't see how the VA could spin this. This is a direct statement and if this doesn't incenuate Unemployable I don't know what would.

I think you have a great chance and will hear something soon. Looks like you won't get Tinnitus NOW but will in the future. Just keep up the fight and you will prevail.

Billy

you see how much of a crap shoot this is, I would have thought the bilateral hearing loss was the one that I would be denied and I would get the tinnitis. I'm glad to see everyone giving their advice all of it is good info. thanks

[Hoppy]

WOW, Somebody used the crap shoot phrase. I just explained this term in a prior post. I learned this phrase from lawyers who represented me in several civil claims.

Good the doctor says you cannot work. Not so good that he did not in the next sentence explain in detail how your depression prevents you from working. As John says the report is inconsistent. Due to the fact that the statement is inconsistent I do not see a rater going with the worse case interpretation.

“The veteran cannot work due to anxiety, agoraphobia and worsened depression”

The weakness I see in this phrase is that he does not call it the “best” description. He saves the term “best” for his later detail. As such if I was a rater I would wonder if this was the medical opinion of the examiner or if the examiner was stating the veteran’s subjective opinion about his ability to function. The fact that he says treatment is needed makes me wonder if the doctor thinks that with treatment you would be able to return to work. It would be stronger if he recommended that you be evaluated for TDIU rather than referred to treatment.

Trying to get TDIU without prior hospitalization or ongoing treatment will be a battle. I have told veterans in the past that if you are trying to get 100% without being in treatment a single C&P will not be as strong as a treatment record in which the treating doctor says you can not work. A strong C&P is based on a review of treatment records. Without new treatment I would expect that the raters would pull the last decision and compare the current C&P to statements made in the previous decisions. They did this to me. The raters ran me through a ringer before I was TDIU. They requested statements from employers and potential employers. I had been denied both employment and voc rehab under labor law.

The best description of the claimant's current psychiatric impairmentis: psychiatric symptoms cause occupational and social imparment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks although generally the person is functioning satisfactorily with routine behavior, self care and normal conversation.

I think baser is implying that this would be sufficient to get you a future exam for employability. Without any reported history of job lose or refusals from employers to hire you such an exam would be necessary. I do not see how this current C&P would be adequate to establish TDIU.

When reading this report I get the impression that you are not seeking work. I think it would be stronger if you reported a history of seeking work and not being able to obtain work for reasons caused by your depression.

Get back into treatment and get treating doctors to write reports. This has worked for several veterans with PTSD.

jmho

Edited July 4, 2009 by Hoppy

[navydoc2]

WOW, Somebody used the crap shoot phrase. I just explained this term in a prior post. I learned this phrase from lawyers who represented me in several civil claims.

Good the doctor says you cannot work. Not so good that he did not in the next sentence explain in detail how your depression prevents you from working. As John says the report is inconsistent. Due to the fact that the statement is inconsistent I do not see a rater going with the worse case interpretation.

"The veteran cannot work due to anxiety, agoraphobia and worsened depression"

The weakness I see in this phrase is that he does not call it the "best" description. He saves the term "best" for his later detail. As such if I was a rater I would wonder if this was the medical opinion of the examiner or if the examiner was stating the veteran's subjective opinion about his ability to function. The fact that he says treatment is needed makes me wonder if the doctor thinks that with treatment you would be able to return to work. It would be stronger if he recommended that you be evaluated for TDIU rather than referred to treatment.

Trying to get TDIU without prior hospitalization or ongoing treatment will be a battle. I have told veterans in the past that if you are trying to get 100% without being in treatment a single C&P will not be as strong as a treatment record in which the treating doctor says you can not work. A strong C&P is based on a review of treatment records. Without new treatment I would expect that the raters would pull the last decision and compare the current C&P to statements made in the previous decisions. They did this to me. The raters ran me through a ringer before I was TDIU. They requested statements from employers and potential employers. I had been denied both employment and voc rehab under labor law.

The best description of the claimant's current psychiatric impairmentis: psychiatric symptoms cause occupational and social imparment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks although generally the person is functioning satisfactorily with routine behavior, self care and normal conversation.

I think baser is implying that this would be sufficient to get you a future exam for employability. Without any reported history of job lose or refusals from employers to hire you such an exam would be necessary. I do not see how this current C&P would be adequate to establish TDIU.

When reading this report I get the impression that you are not seeking work. I think it would be stronger if you reported a history of seeking work and not being able to obtain work for reasons caused by your depression.

Get back into treatment and get treating doctors to write reports. This has worked for several veterans with PTSD.

jmho

I recieve treatment in the form of meds from my VA psychiatrist for the last three years, when I was working I had the medical insurance that allowed me to get other treatment. Unfortunately at that time I thought I was okay and did not seek treatment other than taking the meds the VA doc prescribed. I no longer have that luxury since I have not worked in a year and a half. I guess what surprises me is that I requested an increased rating due to depression and bilateral hearing loss with tinnitis. I did not ask for tdiu, after I submitted my paperwork for my claim, the VA told me I was eligible for IU, It would suck if they asked me to apply; I do and they deny my claim based on their own c&p agrees that I'm more depressed than the 30% I'm rated now. Do I really have to be suicidal and inpatient to prove that I'm unemployable or severely depressed. How does IU work anyway I applied for the increased rating in Feb 09, but lost my job in Feb 08 will they go back to my job loss or from date of the claim.

[Pete53]

VA Docs shy away from helping a Veteran with their claim. In the old days the VA would punish Docs who helped

[navydoc2]

VA Docs shy away from helping a Veteran with their claim. In the old days the VA would punish Docs who helped

Yeah I didn't know that until I asked my psych doc to write a statement on my behalf to the board and he claimed that he could not do it due to VA rules.

[john999]

Navydoc

Being an in-patient might really help your cause. Also, steady record of psychiatric treatment is very important for IU claims. You want documentation of your inability to work and your low level of functioning. You are getting good advice here. The VA knows that once you get IU you will never work again, so they make it hard to get it. I had been seeing a VA shrink for years and had a recent in-patient stay, and I still had to fight like cats and dogs to get IU even after I got SSDI, so it is not easy. You have to turn over every rock and jump through every hoop to get it. People here have been on SSDI for years and the VA still denied them IU or 100%, and they had to fight on to get it. Don't be discouraged because they make it hard and act stupid when you know you can't work due to your SC.