ptsd Does This So Have A Clue

[Hoppy]

The claim was denied a couple weeks ago. The RO claims there is no usable evidence from the DSM II diagnoses noted in the SMR until the veteran has the SMR re-evaluated under provisions of the DSM IV. I asked when we get the re-evaluation do we request a reconsideration based on submission of the new evidence? The SO says NO, our only option is to file an appeal.

A board certified psychiatrist reviewed the SMR and said the veteran symptoms in the military are DSM IV panic attacks. I brought to the attention of the SO that I have found literature that states that untreated panic attacks are known to be early symptoms in the progression and development of major depressive disorder. The veteran is currently diagnosed with major depressive disorder. I told the SO that I can get a shrink to write a report stating that the symptoms in the military and the decisions made by military psychiatrists not to treat the in service symptoms are early symptoms and known treatment options that occur in the progression of a known disease of major depressive disorder. I asked if we could get the major depressive disorder sc’d due to early symptoms of a known progression. The SO said NO. We need to get the panic attacks service connected first then have the major depression as secondary to the untreated panic attacks.

I have read cases many years ago that I recall were awarded when early symptoms of a known disease entity first occurred while in the military. I would like to file the claim for direct service connection based on the report I get showing the link between untreated panic attacks and major depression. The reason at this time is that the a claim for major depression with link to service has not been filed and in filing it as a new claim based on diagnoses and reports that were not previously considered we might be able to get a C&P. I am trying to cause the VA to schedule a C&P and this is just one more avenue I want to work.

At this time the burden of acquiring the review and assignment of DSM IV diagnoses is being assigned to the veteran prior to the scheduling of any Compensation and Pension exam that might provide this type of analysis. It is not clear if the veteran is being required to develop the review of the SMR due to the fact that this is a requirement of new and material evidence or if the veteran would be required to provide this type of review on any new or re-opened claim involving an old DSM diagnoses. This issue needs to be clarified so the veteran can decide if he wants to dispute the determination that his anxiety claim was an attempt to re-open previously closed claims for a respiratory condition or and PTSD. If a review of the old DSM II diagnoses and symptoms is required in a new claim as well as a re-opened claim the veteran would then only have one option to obtain the reviews of the SMR at his own expense.

The rest of this post addresses some other problems we are having.

The veteran is of the opinion that if he needs to obtain a re-evaluation of the SMR under provisions of the DSM IV that he should have been told this in the initial letters that advised him of the type of evidence he needed to provide. The veteran is of the opinion he adequately complied with the procedure explained in the letter from the VA dated January 26, 2009 that would allow the scheduling of C&P exams. The way in which this claim is being represented by the RO resulted in a bait and switch of the evidentiary requirements which have caused the veteran undue effort and prolonged delay in advancing his claim.

The veteran disputes any final decision on his claim prior to a C&P exam citing that the numerous clinical notes of various anxiety conditions observed by at least a half a dozen different clinicians contained in the SMR over a period of sixteen months has significant probative value and would summarily suggest a reasonable possibility that a chronic anxiety condition existed prior to discharge. A C&P exam to address the possibility of a chronic condition prior to discharge would be required due to the fact that the adjudication laws are significantly different for diseases that are known to have been chronic in service. The reasonable possibility that a chronic condition existed in the military should override all adjudicational issues that were previously considered in the absence of an exam that would either confirm or deny a chronic condition prior to discharge. Additionally, using the same logic the VA has advanced that the SMR diagnoses are obsolete and not the legal basis for a medical determination the DSM II assignment of an underlying personality disorder by military clinicians is of no probative value.

Edited August 17, 2009 by Hoppy

[LarryJ]

Well, Hoppy.......? Hmmmm? Lessee, if you can get a psych doc to state that he had MDD in service and that the panic attacks are overt symptoms of such MDD, then that would be great. However, and I lean toward the SO's reasoning, if you cannot get such a diagnosis, and that is to go with what you have "paper" on...the panic attacks...and then get the MDD as secondary to the panic attacks. That would be the "easiest". But, not necessarily the "bestest".

I do know, and here I speak with authority, that panic attacks do preclude MDD. And let me assure you, you do NOT want to be in an aluminum tube at 40,000ft when a fellow of my size is having a panic attack, because that is where I had my FIRST one, in the first class cabin enroute from DFW to JFK. Believe it or not, but the flight attendants found an honest-to-gosh PSYCHIATRIST in coach, with some atavan in her carry-on. G-d Loves Me! Even if I did wind up in Bellevue for a couple of days.

[Hoppy]

Larry,

Untreated panic attacks place an individual at the highest risk to develop major depressive disorder than any group known to mankind. As far as I am concerned the link between MDD and panic attacks is undisputable. Major depressive disorder while in the military will be hard to back up. Mind you that clinicians noted in the SMR that the individual stated "Life has become torture due to these symptoms". The psychiatrist I am dealing with is very technical. The veteran I am dealing with has 16 months of solid symptoms of panic attacks. He was diagnosed with an aesthenic personality disorder and discharged. Panic attacks and panic disorder was not in the DSM II. The psychiatrist stated in a report that he cannot dispute the DSM IV symptoms of panic attacks while on active duty. The psychiatrist did not address the link between panic attacks and MDD. I found this link while doing research.

I am pursuing two angles at this time; a diagnosis of chronic panic disorder prior to discharge or MDD due to untreated panic attacks while on active duty.

The SO has no idea as to how the diagnostic or symptomology involved in the claim is weighed by a psychiatrist. The SO has never read a BVA case involving service connection of panic disorder. I have never seen a case denied by the BVA that has one tenth the evidence this veteran has.

The thing that bothered me is that the SO did not think there was any valid basis to a claim based on early symptoms of a known disease progression. It is not a question of priorities nor which is easiest. The question is asked without any specific reference to the evidence. It is a question if early symptoms of a known disease progression which first occur while in the military can be service connected or not when the resultant progression is known to have continued and developed after discharge?

I want to have all doors open that would apply. We had a medical claim here on hadit where the condition was not diagnosed in service. Yet there was one blood study in service that was consistent with a positive test for the disease even though the individual had no other symptoms of the disease. Additionally, the case I remember specifically involved schizo affective disorder that was diagnosed 15 years after discharge. A VA lawyer won service connection because there was one notation of somatic symptoms in the SMR.

The first panic attack I had was while a passenger in a car going to the beach. I could not breath and my heart rate went up to about 150. I made the driver pull over an we found a phone and called 911 (before the days of cell phones). The paramedics said that if they took me to the hospital I would be wasting my money.

[Hoppy]

Service connection may be granted for disability arising from

disease or injury incurred in or aggravated by service. 38

U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303(a).

Connecting the disability to service may be accomplished

through statutory presumption or through affirmative evidence

that shows inception or aggravation during service or that

otherwise indicates a direct relationship between service and

the current disability. 38 C.F.R. §§ 3.303(a), (d).

I found this in one of many cases as I described earlier. Early symptoms of a disease entity that was not diagnosed in the military were moted in the SMR. SService connection was granted in the cases I found.

[Pete53]

I had panic attacks in service. It was noted in my Medical Records. When I had Major Depression that the VA admitted me to Hospital my diagnosis was Major Depression and changed a few months later to Panic Disorder/agoraphobia and Major Depression.

So the dumbass rater does not have a clue.

[john999]

In the Army they said I had a PD, depression, anxiety and drug abuse. The VA changed that to schizophrenia (residual type). That is what I got SC'ed for. A few years later the VA changed it to major depression. Then to bi-polar disorder and then finally back to schizophrenia, panic disorder, social anxiety disorder, agoraphobia, PTSD and chronic pain disorder. They just throw it at the wall and see if it sticks.