From Personality Disorder To Adjustment Disorder

[blanco63]

I was honorably discharged from the navy in october, 1983 for personality disorder of mixed schizoid and schizotypal features. in november, 1983 i filed a claim for mental disorder. in may, 1985 i had my c & p exam and was diagnosed with adjustment disorder but they said it was non-compensable which was true. was i service connected at that time? in 2000, i reopened my claim and was told the same thing, you have adjustment disorder which is non-compensable. well, as of 11-7-96 it had become compensable. should the va had given me a percentage in 2000? did they make an error and would this be a reason to file a cue claim? if so, what is the best way to do one? do you fill out a certain form and send it to a certain person at the varo? i will be very grateful for any advice and opinions on this matter. thank you!

[Wings]

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38 CFR 4.127 ... disability resulting from a mental disorder [9400 chronic adj. disorder] that is superimposed upon a personality disorder [schizoid and schizotypal features] may be service-connected.

[blanco63]

The personality disorder that you were diagnosed with in the military was considered a developmental condition in was not service connectable. Trying to link other mental conditions as secondary to the personality disorder would not result in a service connectable secondary condition. Additionally, you are only linking this in your own logic. You are probably just arguing what you thought was happening with the VA. From what I've read the C&P examiner just called your condition a personality disorder with a subsequent adjustment disorder. The doctor did not specifically state that the adjustment disorder first occurred while in the military nor did he related in any other condition in the military including a personality disorder.

The specific language is very important. You have learned a lot. You're on the right track now. Reading BVA cases is a good idea. If somebody were to really dig into your SMR they could probably determine that you were misdiagnosed by military clinicians. I have assisted several veterans in getting misdiagnosed personality disorders rediagnosed and service connected for anxiety disorders and bipolar. I have worked with a VA staff clinician who has a PhD in clinical psychology and has performed compensation and pension exams for the veteran administration for close to 20 years. This clinician takes great offense to the diagnosis given by military psychiatrists. She directly confronts the diagnosis and writes reports that they were made in error. I do not think that this type of attack is necessary at this time. I'll bet that the reason you were diagnosed a personality disorder is because you are complaining of headaches in the military. In any event linking current diagnoses as secondary to the service connected migraines is a much better angle than linking a current diagnosis to the in-service personality disorder.

hi hoppy, thanks for the info. recently i applied for chr pain and fatigue syndromes secondary to migraines and my pcp typed me a letter stating this so i should receive the va's acknowledgement in a month. after that i will apply for bipolar disorder secondary to migraines and send them a letter from my psychiatrist stating my bipolar do is secon to my migraines. i see him next week and will ask him to do this and also ask him to add all the syptoms necessary for both 70 and 100% as i do have them. i also receive ssdi for migraines and bipolar so i'll also send another copy of that, it won't hurt. so hopefully next year i get something for these 3 secon claims to get my 50% increased. i'm grateful for everyone's advice, john

[Hoppy]

Superimposed conditions and secondary conditions are viewed as two different things in the cases I have read. I researched this because the guy I'm currently helping contained a statement in his service medical records from a psychiatrist that his numerous physical symptoms were due to an underlying personality disorder. The numerous physical symptoms met the DSM-IV criteria for panic attacks.

I only found one case where the veteran claimed that his current mental condition (not ptsd) was superimposed upon a personality disorder. The claim was denied because there was no evidence of symptoms in the military of any condition that was superimposed upon a personality disorder which occurred in the military. I do not think that they are applying this law in the manner that will allow you to service connected a mental condition that develops after service by saying it is superimposed on personality disorder that occurred while you're in-service with the exception of PTSD. It appears to me that they are interpreting this law to mean that if you have a diagnosed mental condition and a personality disorder they adjudicate the claim as though the personality disorder is nonexistent. Thus, you are required to show that the symptoms of the mental condition superimposed upon the personality disorder must have had their onset while in the military or are otherwise related to military. Considering that they do not view the original PD as related to service. I found many cases where the veteran had been diagnosed with a personality disorder and confirmable PTSD. The PTSD would be service connected because there is no requirement the symptoms of PTSD specifically onset while in the military.

Edited November 25, 2009 by Hoppy

[Berta]

I have Navy vet friend and it took 12 years to get him SC for Bi polar.

It all changed when he finally did something I begged him to do but he would keeping foprgetting-

he got his personnel records and we were able to prove that when he had a Captain's mast inservice- it was the first manifestation of his bi polar which was diagnosed years after service but the VA would not SC.

His shrink at VA was helpful and stated that the Navy didn't understand bi polar when he first showed symptoms in the 1960s.It was a long story but veteran's who get the PD diagnosis decades ago could have had in fact manic bipolar disability.

There are classic symptoms of this disability that could be documented-not in SMRs but in personnel files as disciplinary reports.The Captains Mass situation of my friend was so highly unusual that when he told me about it- it had to be the first inservice manifestation of his bi polar.

BVA agreed that it was.

[Wings]

Superimposed conditions and secondary conditions are viewed as two different things in the cases I have read. I researched this because the guy I'm currently helping contained a statement in his service medical records from a psychiatrist that his numerous physical symptoms were due to an underlying personality disorder. The numerous physical symptoms met the DSM-IV criteria for panic attacks.

I only found one case where the veteran claimed that his current mental condition (not ptsd) was superimposed upon a personality disorder. The claim was denied because there was no evidence of symptoms in the military of any condition that was superimposed upon a personality disorder which occurred in the military. I do not think that they are applying this law in the manner that will allow you to service connected a mental condition that develops after service by saying it is superimposed on personality disorder that occurred while you're in-service with the exception of PTSD. It appears to me that they are interpreting this law to mean that if you have a diagnosed mental condition and a personality disorder they adjudicate the claim as though the personality disorder is nonexistent. Thus, you are required to show that the symptoms of the mental condition superimposed upon the personality disorder must have had their onset while in the military or are otherwise related to military. Considering that they do not view the original PD as related to service. I found many cases where the veteran had been diagnosed with a personality disorder and confirmable PTSD. The PTSD would be service connected because there is no requirement the symptoms of PTSD specifically onset while in the military.

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Here's my take:

This is one of those claims/cases that require a full and complete examination of the evidence.

I would want to see the military's entrance/induction physical examination to support the "presumption of sound condition" for VA purposes. If the VA or DoD found the condition pre-existing military service, was that condition aggravated by military service? Were there other injuries or illness?

I would want to see the military's exit/separation physical examination. I would want to see military service medical records (SMR); specifically, the examinations and diagnoses of personality disorder with schiziod traits, because that examination may not have been full and complete (or lawful) according to DoD Directives.

I would want to know exactly why the military found the service member "unfit" for military duities, because I would want to apply the "fitness for duty" DoD standards --for analzing eligibility to military medical retirement.

In addition to the VA claim for a mental disorder, this may also be a case for the military discharge review boards under the equity and propriety standards: did the military fail to follow it's own regulations (propriety issues); and were the results equitable; if the same examinations were conducted today, would the results be different (equity standards)?

The DSM keeps changing (for the better, let's hope); as does the 38 CFR 4.130 Schedule of rating mental disorders. I do not have the full and complete copy of the Federal Register's updates to the schedule for rating mental disorders ... I would want to see that as well as get a copy of the DSM-III.

This veteran's SMR's state "schizoid and schizotypal features", and that symptomology is so close to the compensatable 9211 Schizoaffective disorder, that I would want to examine the historical evidence for chronic or actute symptomology, and contunuity of symptomology. I would want to know if these was any evidence of psychosis ... or if that diagnoses was sufficiently rules out when applying the "schizoid and schizotypal features".

VA's Schedule for Rating Disabilities requires that mental disorders be diagnosed according to the (DSM-IV). Although the term "psychosis" continues to be widely used, it has not served as an organizing principle in the APA Manual since 1980 when DSM-III was published. DSM-IV does not have a "psychosis" category of mental disorders.

Just thinkin' out loud. ~Wings

[john999]

I think Hoppy is right about not being able to get connected for a mental health condition superimposed on a PD if there is no evidence in the service record. The only way I got around it was I filed a claim for a MH condition within one year of discharge. The VA decided that there was a PD but the basic condition was a compensable MH condition. If you could show that you had been misdiagnosed as a PD when, in fact, you had bi-polar or PTSD they it would fly. In the bad old days most PTSD sufferers who got in trouble in the active military were thrown out as PD's.