tdiu Ssdi For Bipolar, Applying For Va....comments / Helpful Answers?

[ZenLife]

Hi everyone. I'm Jay, long time viewer, first time poster. I've been wading through these forums for a while, as well as dozens of other sites, and I have a couple of questions / concerns. Maybe someone can give me an idea if I have a claim or not, and if so, what to expect. Sorry if this post is a little long, it's hard to sum up 6 years in a paragraph!

Here's my Sit. Rep.:

Served USMC '99 - '04

• Didn't know it at the time, but I'm Bipolar, then and now, it's life long.
  
  • Had several disciplinary actions throughout 5 yr. service, nearly got discharged 2 months before my EAS because of repeated infractions. Got lucky, and squeaked out with a "General Under Honorable". Discipline / poor impulse control is common for Bipolar people in general, especially having the first episode after a major lifestyle change or around age 20 (i.e. entering the military at 18). I'm not certain if this would help or hurt my claim.
    
    • Diagnosed and treated one time by MACG28 BAS for Depression / sleep disturbance in 2003. Bipolar disorder is often initially misdiagnosed as Depression. Medications were ineffective and worsened my situation - I didn't want to be discharged, so I did what a lot of us do - dealt with it as best I could until my EAS to preserve the benefits I'd worked my butt off for.
      
      • I'm not certain if either of the above could help provide service connection or not - input would be most appreciated.
        

      Currently I recieve SSDI for Bipolar , the only condition I intend to apply for w/ VA

      [*]
      I bean receiving treatment early 2005.
      [*]
      Applied for SSDI in Dec. 2005.
      [*]
      Awarded Benefits May 2008.
      [*]
      Award states that I've been disabled since June 22, 2004, the day after my last day of active duty.
      [*]
      Three evaluations with average GAF's of 55 from three Dr.'s were partial basis for this award.
      [*]
      Award included documentation from my military medical record concerning the diagnosis of Depression.
      [*]
      No other medical claims or job history.

      I currently receive care for my condition, and have been receiving care since Jan. 2007

      My questions are:

  [*]Do I have service connection based on the in-service diagnosis, since depression is the precursor to or misdiagnosis of, bipolar?

  [*]My Dr. is willing to write a letter for me to serve as a nexus. He is concerned over his legal liability - is there any in this case?

  [*]If his letter is disregarded by the VA, would my SSA award serve as a nexus, since it includes the early in service diagnosis?

  [*]Since the SSA considers me disabled, will the VA look at it similarly and give weight to my award?

  [*]Do I apply for TDIU with my initial application?

  [*]Would my effective date be that of my award letter in 2008, my last date of employment in 2004, or the date I file, in a couple of days?

  Any and all input would be greatly appreciated. Thanks for taking the time to read this. And a special thank you to all the men and women who take the time to help others navigate the VA/SSA jungle!!!

  Semper Fi!

[Berta]

"I'm asking because I don't know if he'd be willing to state that they were probably early manifestations of Bipolar or not."

This is the type of statement that help my vet friend-

Most Docs doing an IMO are willing to state "as least as likely or not" or "More than likely" and then give rationale for their opinion as to an inservice nexus.

In the vet's case I mentioned he served so long ago that the mil didnt really know what bi polar was and threw him ointo the brig during a manic phase.That was a key issue the IMO doctor used.The veteran;s very brief instances of odd behavior and disciplinary actions were completely out of character for the rest of his service period.

The standard for an IMO to succeed isn't that high nor is it a way for legal liability.

As the IMO criteria shows the IMO doc is basing their opinion on all available records ,using excerpts from medical trreatises when needed, and opining with one of the above phrases.

No IMO doc would threathen their own credentials with an opinion that is not based on medical fact and fully possible due to the specific vet's med recs.

Edited January 22, 2011 by Berta

[ZenLife]

You said that "Psychosis is a "chronic presumptive"", i was just wondering if you clarify it a little for me. I'm reading the regs now, but I'm not sure if I'm reading it correctly.

It's my basic understanding that the "within 1 yr from end of service" part generally refers to the end of the veteran's active duty (EAS).

Does any additional inactive reserve obligation play a part in that if the veteran 1. served during a period of war and 2. the period of war continued beyond that veterans EAS? Or does wartime service not even come into play?

I'm wondering because my second diagnosis came 1 1/2 yrs after my EAS, but one yr before the termination of my reserve obligation.

[Berta]

Here is the regulation:

"Service connection may also be granted on a presumptive basis

for certain chronic diseases, including psychoses, if

manifested to a compensable degree within one year from the

date of separation from service. 38 C.F.R. §§ 3.307(a)(3),

3.309(a) (2009). "With chronic disease shown as such in

service (or within the presumptive period under § 3.307) so

as to permit a finding of service connection, subsequent

manifestations of the same chronic disease at any later date,

however remote, are service connected, unless clearly

attributable to intercurrent causes." 38 C.F.R. § 3.303(b)

(2009)."

The "compensable degree" part could require an IMO, and even buddy statements in some situations.

"MDD is what I was originally seen for in service. (A copy of that service record was part of the SSA decision.)

1 1/2 yrs later I resumed treatment for that, and the Dr. added Bipolar Disorder. (That exam was also part of the SSA award.)"

It seems to me that the MDD would be fully service connectable with Bi polar disorder as part of the MDD or secondary to it.

VA only awards one MH rating and it can include other related MH issues.

I think the VCAA letter will help here as to how the VA defines the MH disability.Your claim shuld be for the MH issue with the Strongest links to your service and should included any other MH disabilities t s associated with.

"'m wondering because my second diagnosis came 1 1/2 yrs after my EAS, but one yr before the termination of my reserve obligation."

Make that point very clear to the VA when you respond to the VCAA letter.

Do you have a vet rep?

Can you tell us the exact wording of how the doctor added the Bi Polar to the MDD?

"MDD is what I was originally seen for in service. (A copy of that service record was part of the SSA decision.)

1 1/2 yrs later I resumed treatment for that, and the Dr. added Bipolar Disorder. (That exam was also part of the SSA award.)"

Make sure you follow up on VA's attempt to get your SSA records.They will require an authorization form from you which VA should send to you. Sign it and ake copy of it before you send it back to them.

SSA is in essence an IMO and often SSA records like yours are very crucial to a claim.

[ZenLife]

Thank you, that makes it much clearer.I've also been reading the BVA cases like Hoppy pointed out, that helped to understand it better as well.

It seems like right now, my best chance is to allow the VA to make an initial decision based on SSA records and my treatment history. That alone may serve for SC like you said.

There seem to be two other ways to establish SC.

1. - An IMO from my doctor, which will also serve to counterpoint any C&P exam. It would likely carry more weight as well since I have a longer history of treatment there.

I think I'll ask him to include his opinion about the in service infractions as being early manifestations of BP as well. He told me that headaches aren't uncommon for people with my symptoms, so I'll ask him to note that as well.

2. - I might be able to establish continuity of symptomology by "lay observation" letters. Especially since the in service diagnosis was a singular one.

All references I can find in my service & medical record books only serve to cover a two month period out of those 6 months of treatment, so that might make it hard to prove the "chronic" part.

The other records would just be the prescription refills over the following months, and I'm not counting on them to be able to locate those.

I've noticed in the case files that lay statements can help with the depression part, but usually not in BP cases, since that's considered more complex than the average person can attest to.

As for how the doctor added the BP. I don't have that record, so I don't know exactly how it was worded.

Basically, I was seeing him about the depression and he asked if I had ever heard of BP. I had heard of it but didn't know exactly what it was.

He said that my symptoms seemed to be very descriptive of BP, and added treatment for it. He said that most BP patients are usually treated for MDD first, because that's when they are most likely to seek treatment.

Plus the symptoms seem to overlap a lot so it's usually incorrectly diagnosed.

Since I thought that was my current diagnosis had changed to, that was what I applied to SSA for. I didn't know it at the time, but both diagnosis were still present, and still are. Another doctor added Social Anxiety Disorder later because of my panic attacks.

I'm going to look into a rep over the coming weeks. I know there is an American Legion here and a VFW, but I've never contacted either. I remember getting an invitation from AL to join but never replied.

By the way, in reading this forum one can't help but notice that you're everywhere Berta! I'm certain you've been thanked a million times over, but let me add my thanks to that list. I don't know where you find the time but I'm most grateful!