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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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cowgirl

Old Diagnosis Manual And New

Question

Anyone recall a rating nod, etc, that connects a current DSM IV diagnosis supported by older DSM III diagnosis?

If a diagnosis was in smr's before IV - it should have been good then. I think? Sure be something to prove or connect. Advice? (maybe this has been asked by me or others, can't find it myself).

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3 answers to this question

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cg,

Maybe Hoppy or Wings will come along with an answer.

They are both great with questions like this.

carlie

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Cowgirl,

Alex Humphries taught time to win claims with medical evidence. If there is a CFR and medical evidence that will help your claim do not forget to address the medical evidence. Do not rely solely on the CFR. They will still cite a lack of medical evidence.

With this in mind, when the evidence consists of old DSM diagnoses I always obtain a current review of the old DSM reports. I have a clinician include a statement that the old records contain sufficient recorded statements made by the veteran and clinical observations made by the military clinicians to apply current DSM IV principals and diagnostic criteria. I then have a clinician specifically relate symptoms noted by military clinicians to the current DSM-IV criteria. This is worked for me.

I was recently told by a service officer that a review of the SMR and the subsequent report that was written by the primary care doctor that used general terms that the conditions noted in the military shows that the current condition is a service connected illness was cited as being insufficient and of no probative value and the reason for a denial. I had planned to get a more detailed report as I explained above. However, the veteran obtained a general statement from his primary care doctor and the RO denied the claim. The denial was so vague as to give the veteran the impression that he had no recourse to win his claim. I call this a closeout statement. They did it to me two times on my angioedema claim. They will not tell you the specific terminology they need the doctor to state. The procedure I defined above including the statement the old pre-DSM-IV records contain sufficient statements to allow for a current application of DSM-IV principals in diagnoses has worked in about 10 cases I am familiar with. I am now submitting a more detailed report as I described above for the veteran I am currently assisting.

The problem occurs when the service medical records only have the minimal amount of clinical notes regarding the symptoms in the military. Depending on the post service diagnosis some clinicians can show those minimal reports as early evidence of the onset of the condition. However, in some diagnoses this becomes more difficult because the clinicians don't think there's enough noted symptoms to establish a link between the in-service symptoms and current symptoms.

I also argued in a claim were there was a definitive diagnosis made in the military as sufficient to allow for service connection and that any attempt by a post service clinician to argue that the in-service diagnosis was an error must be supported by either compelling or clear and convincing evidence cited by the post service Dr. I think there are some CFR's that would apply if you have a service connectable diagnosis in the military and would protect that diagnosis as I stated here. If this is what your looking for let me know and I'll look around for them. Otherwise, if all you have are symptoms without a diagnosis noted in your service medical records I think you'll definitely need to obtain a review that states the in-service symptoms are diagnosable under the DSM IV or that the symptoms noted in the military were early symptoms of a currently diagnosed DSM-IV condition.

The claim I am currently working on this for a psychiatric condition where the veteran had been seen for 16 months while on active duty and his complaints are clearly for a panic disorder. The problem is panic disorder did not appear in its current nomenclature until the DSM III. The veteran served in the military prior to the publication of the DSM III. The veteran went AWOL to try and suppress the panic attacks that have been occurring for over a year without any referral to treatment. He was discharged for going AWOL. The symptoms so clearly meet the DSM-IV criteria for panic disorder that I tell him that they should have named the condition after him rather than calling that panic disorder. I found a clinical psychologist who was an expert witness on panic disorder who has written a detailed report connecting statements made by the veteran and clinical observations to the DSM-IV and staining that the veteran had panic disorder while in the military and the condition was chronic prior to discharge. This is a very strong statement. The RO had refused to schedule a C&P exam for this veteran and has denied his claim without the benefit of a C&P exam two times.

One thing I have learned is that the Vet Centers have psychologists on staff who usually treat PTSD, and family members who are grieving and several other psychological conditions. I have contacted two Vet centers and both agreed to assist the veteran I am helping by reviewing the SMR and writing any report that they can justify with currently accepted principals and diagnostic criteria to assist the veteran in winning service connection. Their attitude is much better than what you'll find at a VA hospital. The Vet centers have PHD's in clinical psychology and in some cases they work both at a VA hospital and the center. Some are even C&P examiners. For people with psych claims this can be of great assistance.

I hope this is of assistance. Feel free to ask anymore questions. I am usually a way from a computer during the middle of the week. I do most of my work on the weekends now.

P.S.

I had a service officer tell me that old DSM diagnoses were of no probative value until a current review of the old records and application of current DSM-IV diagnoses has been made by a qualified clinician. I am currently working on letters to congressional committees requiring that the VA schedule in all cases a C&P exam to perform the review and application of current DSM-IV diagnoses. The RO's are denying claims citing the lack of current DSM diagnoses as the reason for the denial without scheduling C&P exams. When I say “all cases” I am referring to claims to reopen and new claims.

I have read old BVA cases for service connection that were granted on old DSM's and as the new DSM's came into being the claims were not re-adjudicated. However, the diagnoses were changed by the doctors and service connection with continued. I saw this in cases involving anxiety neuroses that was later changed to panic disorder.

Edited by Hoppy

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Hoppy, thank you for your generous time and response. Your entire discussion was very helpful on how things go. My current status is 'in works'. Its possible that a decision will be made in the next few weeks. Without extreme detail here, I have mh and other phsyical issues clearly identified by medical diagnosis in my SMR/STRs, VA medical files, private physicain and VA C-Files.

More and more everyday, I'm finding out its the particular claim 'requested for' is often my dilema. For example, increase, reopen, reconsideration etc,,- what a tangle. I've been told instead of NOD a re-open would go faster. But doesn't a 're-open' cause a new claim date? Oh so many details. For now, my claim remains nod with the dro to save the effective date.(as far as I know!)

Haven't changed my current claim information in, feel like I have enough medical records by far to support an increase (mh condition change up) and IU. And I've had current compensation exams, physical (status quo) and mental (exhausting). Now the claim is in active hands - thats the good news, I guess.

My interest in the DSM III is two fold. I have been told by a former counselor that with all that was stated and placed in my SMR and mh notes during service, was told there was a diagnosis of onset mh issues & 'pd' - 'riding the line' that kept me in service rather than an early medical discharge. I don't recall if that was exactly stated in the notes, but they referred to DSM III and DSM IV criteria matches. Am trying to find if thats written somewhere in all the papers. It would support current diagnosis mdd and ptsd with features.

The second fold, the active diagnosis's in my VA med records does support the mh diagnosis change up. (I call it change up because of the no pyramiding - having been sc for mdd and hoping for ptsd finally - overall ptsd is the heaviest treatment issue). The recent comp exam, my recent VA medical notes and other data - a few shreds of info from my initial c&p (pd, grrr..) years ago after service and my SMRs specifically complete my mh diagnosis's for the current IU nod to dro. I understand that this is usually treated as request for increase. Only word games could mangle up whats clearly stated. I have chronic physical and serious mh issues that keep me IU.

With all that, along with chronic physical issues, I've requested IU because of my unemployability since discharge. I haven't been able to return to work. Stressful. So, I get SSDI for sc conditions (not mh though) and I haven't been employed at a gainful job in my field, only temp type help work.

So my question about DSM III and DSM IV interpetations is trying to connect the dots on paper if necessary for the rater. If other issues and ptsd were diagnosed in SMRs, near 20 years ago, and today remains validly supported by medical opinion recognizing its always been there and worsened without consistent treatment - its still ptsd with effects but even more day to day serious impact.

If I read it all correctly, its best to go with current diagnosis's supportd by current DSM IV, if possible. But to gather the correct dates of onset, it may take a small miracle. Pardon the lack of medical and claims jargon, I just want to get whats due and overdue.

Hoppy, you're a wonder!

Thank you, Cowgirl

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