ptsd C&p Exam Finally Pops Up

[out_here04]

envelope came in mail saturday saying i had my first-ever c&p follow-up scheduled for 1 feb 10 to my award a year or two ago of 100 percent temporary, total disability from anxiety/depression. i was pretty surprised at the immediacy, although in the back of my mind i figured it was coming,and had a panic attack of sorts at the idea of feeling that i have to defend my benefits on short notice. i may or not have gotten better, likely just became more apathetic about life in general. this officially gives me about ten days to wrap my mind around this before seeing a contracted c&p psychiatrist for evaluation. i know i could have been more of a student of va strategy by reviewing my c-file (which i haven't, although i got the letter saying i could go three hours away after making an appointment)' i do have a "card" to play to delay this, which i discuss below.

anyway, i have a few other questions to throw at the hadit wall and see if anything sticks...

i am pretty aware of what a psych c&p looks and feels like, although it has been a while. any reminders of what to expect are appreciated.

THE THING i have with this particular exam location and psych doc is THIS:

before i got in the pipeline for seeking tdiu or increased award (was previously rated 50 percent for anxiety/depression, with various others that top the 60 percent mark) i was trying to pursue voc rehab. my primary health plan was NOT va but through tricare. my wife grabbed a phone book looking for a psychologist or whoever for me to, for one, get back on track with mental health services, and two, to meet a requirement for voc rehab to have a psych doc verify that i was mentally stable for three months. i began seeing a psychologist who specializes in cognitive repair and ptsd among other things. during therapy he told me he had interned or whatever at va hospitals and was familiar with veterans issues. i told him initially that i was there to both continue treatment, to get my ticket punched for voc rehab, and to further document how ptsd affected me after viewing morbid remains while on active duty. as i progressed in the treatment i opened up to the doc and he seemed very "vet friendly". he had some ideas on how to "ease my troubled mind" and i was very ready, as always, to do so.

at one point i discussed with him an event in my youth that still bothers me somewhat. i then said "that's when it all started". what i meant was that's when i first became aware of an event that wasn't all hunky-dorey with my idea of a perfect world. he seemed to latch onto it, almost with a "gotcha" attitude reserved for those within the depths of the va rating boards. from that point on i half-heartedly continued therapy with him, finally requesting a decision on whether or not he would deem me three-months stable. oh, but he wasn't in the business of providing such a vocationally-related decision, he informed me. the relationship was becoming more and more adversarial, i thought. and all this from a guy who was, for all practical purposes, supposed to be an imo.

SO, when i submitted my claims package to va for tdiu (which they denied, instead rating me 100 percent temporary for anxiety/depression+60percent, qualifying me for the additional "statutory housebound" allowance) i purposely omitted the psych doc's rendered opinion because, thanks to hadit, i knew that it was not going to benefit my case, most likely to have given va the basis to revoke any award because of "personality disorder". being honest, i also did not include a report from the va resident psych doc who did an initial evaluation of me for voc rehab. he noted all of my challenges but indicated a small arena of highly supervised vocational options for me. i figured if they wanted to use his opinion against me in my claim, let THEM dig it up. however, after i gave social security permission to purge my va files, they used the same report to deny me benefits, so i have all but given up pursuing ssdi and halfway expect their report to make its way into this upcoming c&p process.

BACK TO this latest scheduling of a c&p exam. my initial c&p exam was scheduled for a psychiatrist working out of THE VERY SAME practice as the psychologist i had basically "fired". i called the va contract, what's their names(qtc?), and told them i wanted another psychiatrist because i had a conflict of interest with the practice. i envisioned showing up for an appointment and running into the psychologist who i fired and him chatting with his co-worker and gaining access to my c&p process) apparently, there was a c&p psych doc retirement, limiting options in the vamc city, etc, and i was scheduled hours away to another one, but i had to cancel because i was hospitalized for an unrelated medical issue. by the time i reschedule, it was with another c&p exam psychiatrist. the exam went well, with him apparently documenting and opining enough to support the other items in my package and grant me the subsequent 100 percent temporary award for anxiety/depression.

IRONICALLY OR NOT, the psychiatrist i am most recently scheduled to see on 1 feb is THE VERY SAME psychiatrist i took issue with (because of working at the same practice as the psychologist) before from my initial c&p exam. on a side note, i recently checked out this practice's website and the founder of the practice had been a psych doc at the same local vamc where i get my treatment before going into business himself (and SOMEHOW landing a contract with the va contactor, HMMMM>>>...and swooning at least one other psych doc with the same vamc on his resume, not to mention the other guy, my initial psychologist with this practice whom i "fired". smell it?

TO FURTHER COMPLICATE all of this, i am considering trying to "dumb down" my rating from 100 percent because of the stigma (i believe illegal/unwarranted) of 100 percent mental vs. physical veterans being penalized if they attempt to utilize their gi bills or to seek some form of employment. those of you who remember me, may recall that i have expressed wanting to use my mgib or 90 percent of the post 9/11 gi bill i also qualify for. i would even attempt to self-employ doing something. i admit to feeling cabin fever and like i'm just rotting away doing nothing. i know, volunteer, right?

before i call the va contract schedulers and request another doc this time, i thought i'd run ALL THIS past the minds of hadit. my basic areas of questioning are:

1. thoughts, opinions on requesting an alternate c&p examiner based on "conflict of interest". legal standing of this?

2. thoughts, opinions, experiences on issue of va (to their obvious benefit) of them pursuing "personality disorder", especially considering it was the unsolicited, subjective opinion of one imoish psychologist hired/fired by me? i still have all the hipa, privacy blahblahs, and have wondered what it would take for this to be "leaked" to va. lot of legal potential in my paranoid state, although i am pissed that the psych doc made me feel like i was admitting on record something that has nothing to do with the service-connected stressors that i claimed caused the beginnings of my anxiety/depression and va involvement with this.

3. thoughts, opinions on va-tainted psych docs who wind up in private practice and obtain (likely lucrative) contracts with va to evaluate veterans via supposedly(?) un-biased c&p exams.

4. thoughts, opinions on:

a. holding on like a beachhead to my 100 percent rating, possibly holding out for permanent and total,

b. begrudgingly easing up on a firm grasp of a 100 percent rating, so that at age late 40s, starting to feel old age aggravated by disability, but somehow gathering a second wind and settling for a lower rating, however freeing up the chance to go back to school and possible fulfillment through vocational means. i was initially denied voc rehab, buty may qualify if i reapply, another option.

i eagerly await the good, the bad and, even the ugly on this (i have meds). fire away.

[carlie]

So a physicians assistant should not have done the c and p? IF the varo tries to reduce/sever me because of this p.a., can i ask for another c and p with at least a doctor?

blanco,

In most cases, a doctor with the proper credentials will simply sign off

on the C&P done by the pa.

jmho,

carlie

[Berta]

All blank C & Ps are here:

http://www.vba.va.gov/bln/21/Benefits/exams/index.htm

[carlie]

carlie,

after i filed for ssd, as many on here say we should also do, social security administration processor called me and said in order for them to verify my ssd claim per va treatment medical records and claim items (i guess), as well as some post-service medical records from my last base (where i was able to seek treatment as a retiree through tricare) they needed my written permission, which i gave. this allowed social security to directly contact my last base (not much there) and vamc.

out,

OK, so you signed a ROI from VA to SSA.

in ss's letter denying my claim, they cited a diagnosis from a vamc staff psychiatrist who was evaluating me for the voc rehab program as saying that although i had this and this and this disability, i may be suited for employment for a highly supervised, non-confrontationalish career (like those exist). don't have the reports with me, but that's basically the deal.

i didn't give ssa permission to disregard medical evidence, it's like they found what they needed to deny(have no idea if they got a stack or just this one report).(now i'm wondering if they got one page or access to my whole claim package... did they just pull from vamc or va ro?) arghgh

out,

When you posted "purge" that meant to throw away or disregard.

Was this an original denial for SSD benefits?

Most SSA claims are denied the first time around.

Have you submitted an appeal on SSA's denial?

Do you have an attorney or law firm representing you on the denial?

If not, I suggest getting one.

jmho,

carlie

[Berta]

Did you appeal or file a reconsideration request with SSA in time?

Did you obtain a SSA lawyer to appeal the denial? Did you contact ALLSUP to see if they could help with the SSA matter?

http://www.allsup.com/

(Gee carlie we both have dejavu-you asked these questions already- sorry bout that)

[carlie]

carlie, to answer your questions, comments:

my "100 percent temporary, total disability from anxiety/depression" rating is not a convalescence rating. they are saying that i am "totally" disabled from one condition .... anxiety/depression. BUT i rated "totally disabled" only on a "temporary" scale because i "may improve," thus my rating itself is not "permanent and total".

out,

The way you worded it above is much easier to understand.

How it was worded before was a bit confusing,

"my award a year or two ago of 100 percent temporary, total disability from anxiety/depression".

I would be able to better understand something like,

a year or two ago I was awarded 100 percent schedular for anxiety/depression disability alone, but have not yet been granted P&T status.

Sometimes it is hard for me to follow posts and then I feel like I can't help any.

how long had you held that 50% rating ?

i was rated at 50 percent for anxiety/depression for about three years after my initial claims at discharge from active duty.

out,

I don't know when you were discharged from active duty, so how long

had you held the 50% rating prior to the increase to 100% ?

i was granted an increase just over a year ago with retro pay going back about nine months before that.

correct, there is no proposal for reduction in benefits, only a scheduled c&p exam. just hear so much about folks here having to go through the bva and such. so far i haven't and don't want to.

i actually GOT my 100 percent temporary schedular rating AFTER submitting the tdiu form 21-8940 to va. they came back with the award as such, stating that tdiu "is moot" since they were awarding me 100 percent temporary. i took it, as some here have, as "too soon to tell" how bad off i am. guess this c&p is part of doing just that.

out,

OK. So at this point it sounds to me like VA has ordered a Re-examination

to accertain your current level of disability for MH disability/s.

Did you ever file a NOD on basically the denial of TDIU, when VA stated it was a

"moot" point?

Have you continued receiving treatment and services Rx's etc...

for your MH conditions, since you were increased to 100 percent?

If yes - I would take copies of the most compelling medical evidence

that would show your MH condition has remained static in nature,

and leave these copies with the C&P examiner, just say something like

"I feel these may not have made it into my file and would like to leave

them with you". The C&P examiner may or may not accept this evidence.

Sometimes they try to tell you, I'm sure it's all in there.

Keep in mind this exam does not regard an issue of IF you have a MH

disability -

BUT it does regard -

what current level of MH disability you currently fall under, which

is determined by the updated medical evidence.

Do you have someone you trust and knows your MH situation that could accompany

you to the exam ? Sometimes someone like a spouse or sig. other can add thing into the record, such as the effect your MH disability has on your daily living,

what kind of problems you have on a regular basis.

During this C&P exam YOU ALSO need to try and stay focused on the effect your MH disability has on your daily living, what kind of problems you have on a regular basis.

You posted earlier,

" i also did not include a report from the va resident psych doc who did an initial evaluation of me for voc rehab. he noted all of my challenges but indicated a small arena of highly supervised vocational options for me."

The above, to me, sounds like you were sucking it up and not being honest

during this " initial evaluation of me for voc rehab".

I advise to not do that and be honest with them about the negative effects

you MH disability's have on your daily living.

I want to clearly state here I am not even attempting to "coach" you, but

you do need to be honest with the doc.

If you stay inside most of the time,

if you feel nervous,

if you have bad dreams that you remember when you wake up and spend the day rumonating over the dreams,

if you forget to eat,if you overeat,

if you go into your bathroom and drop you britches and smell foul to yourself and realize you haven't been bathing on a regular basis,

if you have crying spells for no reason,

if you tell people to just leave you alone,

if you don't attend family gatherings or socialize because being around more

than a few people raises your anxiety,

if you need someone to remind you to take your meds, eat, bathe, etc...

if you feel you contribute nothing to this life,

if you feel like your nothing but a looser and a failure,

if you have any thoughts of homicide or suicide,

if you have an plan for either,but be careful with your honesty as you probably don't want to be Baker Acted,

etc.....

As I posted - I have no desire to "coach" anyone on here, but claimants

need to know - do not suck it up - you are no longer in the military.

It is OK to tell your doctor or C&P examiner all of our dirty little secrets,

that we spend time trying to conceal from others, on a daily basis.

When you first go into the C&P the doctor will say something like,

"Hi, how are you doing today", DO NOT just blurt out an obligatory,

"I'm just fine, how are you today".

They like to put that crap into your exam report - when all you were

trying to do is what we have been trained to do - all our life,

just being polite.

In my opinion, if you were just fine - you wouldn't be there.

jmho,

carlie

[out_here04]

carlie,

my thought processes with anxiety/depression are similar to those with mild tbi (one reason i requested an eval for tbi)... it is hard for me sometimes to write succinctly without a lot of self-editing, but i try. it's as if my mind is spinning too fast to put things in nice, neat packages of information sometimes.

i had the 50 percent rating for about four years, aug 04 - sep 08. i got the increase to 100 percent in sep 08.

i believe this upcoming c&p is a re-examination to ascertain current level of disability for MH disability/s. it is just my first one after the increase award and i got a little (a lot) freaked out about it.

i never filed a NOD regarding not getting tdiu, just figured they knew what they were doing and guess i was glad that i at least got the 100 percent, albeit not p/t.

i have continued receiving vamc psych treatment and have never been off vamc prescribed psych meds, currently citalpram, divalprox and lorazepam. i see a psychiatrist about every 6 months to check on meds, and have been going to a psych services specialist for relaxation techniques, also evaluated for ptsd (vamc psychologist said i checked out as having) and mild tbi (which cognitive tests didn't seem to indicate) and attended some ptsd group sessions. only thing i haven't done is regular talk therapy as it doesn't seem to exist or to have been offered, only ptsd group.

as far as "take copies of the most compelling medical evidence that would show your MH condition has remained static in nature", i am scheduled for the c&p in early feb, my next appt with psychiatrist who may provide such statement, i don't know, is not until march. this may be reason enough to delay the c&p, but i may be able to send in such a statement (if given) to ro seperately? i also could get copies of my treatment records and use some of that, i suppose.

my wife was with me at the initial c&p exam and she was able to honestly verify what i was saying and to give her firsthand view of how my sc anxiety/depression affects me/us. she provided a separate statement forwarded in the claim as well.

at the time i was seeking voc rehab, i was leaning forward, sucking it up, and trying to qualify for voc rehab. the outcome was i was denied voc rehab, primarily because i was not deemed to be able to be mentally stable for three months, a requirement to enter the voc rehab program, i believe.

i do suffer from many of the MH symptoms you listed and told the same to my last c&p psych examiner and will do so again at the upcoming c&p. thanks always for your straight-forward honesty and i know what you are saying and do not consider it coaching. i'm not a candidate for baker act, i am in control (much like a recovered alcoholic)in that regard. have bad days but not that bad.

thanks for pulling me off the ceiling about this.

Edited January 21, 2010 by out_here04