ptsd Appealling And Trying To Understand Denial Wording. Thanks.

[cowgirl]

Working on my appeal and I am having difficulty understanding the "of rule out" portion of the statement I recieved on my denial; Help anyone? Maybe the word "of" has got my goat, I dont speak legalize often.

"records show provisional diagnosis of rule out PTSD on the basis of your subjective reports of traumatic experience upon PTSD screen" Anyone have a clue? Thanks,CG

[bigvic]

I understand that you ended up 100% but if they send you a SOC saying that it's the max that you can get for that SC injury can you get more?

[timetowinarace]

"Rule out" means that you possibly have PTSD and further testing/evaluation is needed to rule it out as a cause for your problems.

Basically it is an unofficiall/unverified diagnoses. C&P examiners are not supposed to use words like Rule out. They are supposed to follow up and get a diagnoses. VARO is not supposed to simply deny claims with a "rule out dissorder" mentioned in an exam. Rather, they should honor the Duty to Assist Law and request the testing/evaluations needed to rule out the dissorder.They KNOW they are making a decision without all of the necissary information.

They did this to me (denied claim). Get your C-File and find out what axaminer/doctor used Rule out PTSD (AXIS I) and if/and what testing/evaluation was suggested (if any) and pursue it. If nothing was suggested the exam is useless and should not be used for rating purposes. File a NOD citing an inadaquate exam/diagnoses.

Time

[Berta]

BIGVIC stated:

"I understand that you ended up 100% but if they send you a SOC saying that it's the max that you can get for that SC injury can you get more"

Many vets , due to other SC conditions can receive Special Monthly Compensation.

Those regs and criteria are within 38 USC 1114. It pays to check that all out.

SMC is an inferred issue when the disabilities warrant consideration. However the VA does not always consider this benefit.

Examples are: Vet is 100% SC for renal disease and dialysis.

Vet is also 60% for PTSD

The vet is entitled to the SMC "S" award

or vet has SC loss of use of foot rated at 40% SC. He also is entitled to SMC "K' award which adds a little more to his comp.

The highest payable SMC award (this includes the 100%) is the SMC R-2 level-for catatrophic service connected disability :

single vet with no dependents- $6,845 per month.

[timetowinarace]

This was posted in the Forum earlier by another member. (maybe Allen) Check out the diagnosis don'ts and 38 CFR 4.2 . Hope it helps.

This is from the VA's 2002 "Clinicians Guide".

1.12 Diagnoses do’s (also see diagnoses don’ts)

1. Definite diagnosis: Give a definite diagnosis or use the previously established diagnosis.

2. No Diagnosis found: If no diagnosis is found for any claimed condition, state this. For example, state “Lower back pain: There is insufficient evidence to warrant a diagnosis of an acute or chronic low back disorder or its residuals.” Explain in detail the reason why a diagnosis cannot be established for the condition claimed.

3. Diagnosis of Unknown Etiology: If a disability does exist but a definite diagnostic name cannot be given to it, state this. For example, state “Muscle strain of unknown etiology”. (See Gulf War Examination Worksheet concerning “undiagnosed illnesses” in Gulf War veterans.)

4. Support each diagnosis: Support each diagnosis with subjective (history) and objective (physical) data.

5. Effect on daily activities and work: Comment on the disability’s effect on the veteran’s daily activities and his ability to work.

1.13 Diagnoses don’ts (also see diagnoses do’s)

1. Non-committal diagnosis: Don’t use phrases such as “differential diagnosis” or “rule out”.

2. Symptoms or signs: Don’t use symptoms (pain) or signs (tenderness) for a diagnosis if a more exact diagnosis is known. If a disease appears to exist but an etiology cannot be determined, you may say, for example, “fatigue of unknown etiology”.

3. Opinion for further studies, evaluations, or laboratory tests: If further studies, evaluations or tests are necessary, perform them before making a final decision. Otherwise the examination is incomplete and will be returned as inadequate.

4. Change the previously established service connected diagnoses: Don’t change previously established diagnoses, unless you carefully explain the discrepancy and adequately substantiate the new diagnoses.

38 CFR

4.2 Interpretation of examination reports.

Different examiners, at different times, will not describe the same disability in the same language. Features of the disability which must have persisted unchanged may be overlooked or a change for the better or worse may not be accurately appreciated or described. It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. Each disability must be considered from the point of view of the veteran working or seeking work. If a diagnosis is not supported by the findings on the examination report or if the report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes.

[41 FR 11292, Mar. 18, 1976]

[john999]

Does the VA ever actually include SMC in an award without being pressed for it. Someone with agoraphobia is by definition homebound but I have never heard of someone being given housebound without having to fight for it. It seems when you get the 100% the VA wants to be done with you as a writeoff.

[cowgirl]

timetowinarace, thanks so much for the "rule out" information, i understand so much more now. Meanwhile I have submitted a seperate claim for the current VA diagnosis of 'depression" I am still pursuing the PTSD claim, funny thing is supporting documentation for both "depression" and "ptsd" claim are exactly same. I am continuing to pursue and learn more each day thanks to HADIT members like you, Berta, viking and all the others who are faithful to the battle.