lumbosacral Mental Health Advice

[mac mcqueen]

I had a C/P for Mental health that had been deffered and I was just wanting to know if anyone might know what it might rate at. The claim has been deffered since 2008: I'll put it into two post

HISTORY OF THE PRESENT ILLNESS: There is no C-file available for review, although the request for examination indicates that the patient is service connected for several orthopedic difficulties, most particularly lumbosacral and cervical strain. The patient himself appears to be a reliable historian. The patient presents a history of increasingly debilitating back pain which has resulted in 3 previous surgeries on his back and another surgery is planned for later this month. AS the patient has chronic daily pain in both his knees and in his back, he is now enduring increasing limitations on previously pleasurable activities as well as suffering, again, chronic daily pain which he finds understandably quite discouraging, demoralizing and depressing and at this point the patient describes a symptom pattern indicative of major depression with decreased mood, decreased energy, decreased interest, decreased self-esteem, sleep and appetite disturbance, difficulty with concentration and focus, feelings of hopelessness and helplessness, increased impatience and irriLability and vague suicidal ideation, although no suicidal plan or Intent. The patient states that he did seek out psychiatric care within the past year at the Ft. Smith Veterans Administration Outpatient Clinic but was told there was not much that could be done for his depressive symptoms. He is currently being treated with a hypnotic agent Restoril to help with his disturbed sleep patterns but is otherwise not receiving ongoing psychiatric care. The patient is currently working aA an Air Force Junior ROTC teacher at a local high school; however, he states that he will no longer be able to work at the end of this month when he will have surgery yet again. He describes increasing difficulty at work because of the impact of hIs chronIc pain dud his dep~ession on hiG concentration and focus as well as the impact of his increasing fatigue and irritability on his work performance. He reports that his wife also complains of his becoming inc~easingly socially and emotionally withdrawn and irritable and she encouraged him to seek out psychiatric care.

[mac mcqueen]

MENTAL STATUS EXAM: The patient is alert, oriented and cooperative. He appears to be depressed. His affect is constricted. His thoughts are clear and goa] oriented. There is no evidence of delusions or hallucinations. His coqnitive abilities, including capacity for abstraction, memory and judgment are intact although he describes difficulty with concentration and focus on a daily basis having a significant impact on his work performance due to the impact on his concentration of his pain and depression. The patient's groominq and hygiene are appropriate. The patient appears to be in discomfort as he walks and he walks with the aid of a cane. Speech and communication is appropriate. There is no panic, paranoia or obsessional rituals. There is no hypervigilance. There 15 some vague suicidal ideation but no suicidal plan or intent.

DIAGNOSES:

AXIS I: Major depression. AXIS II: None AXIS III: Chronic back und knee pain. AXIS IV: Difficulty with concentration, focus and irritability in the work place, increasing difficulty with marital and familial discord due to irritability and impatience, increasing social isolation, some vague suicidal ideation. AXIS V: Global

Assment of Functioning of 55 indicating the above mentioned depressive symptoms impacting on social, occupational and interpersonal functioning.

The patient is competent for Veterans Administration pay purposes.

ADDENDUM TO PSYCHIATRIC C&P: The patient's C-file was not available at the time of the interview. but was made available today_ it is helpful in that it contains extensive documentation of the patient long-standing difficulty with service-connected back pain and rating decisions describing the patient's disability from degenerative disc disease. My diagnosis of major depression, which is a direct result of and caused by the patient's chronic pain and his resultant discouragement, demoralization and depression, remains unchanged.

[john999]

I think you should get an IMO saying that you have service connected depression and chronic pain disorder and that due to that and you physical injuries you cannot work. Can you take disability retirement from your job. You should also put in for SSDI. The VA doctor did not say you could not work. That is what you need is a statement that you are permanently and totally disabled from all work.

[hulamatt]

MENTAL STATUS EXAM: The patient is alert, oriented and cooperative. He appears to be depressed. His affect is constricted. His thoughts are clear and goa] oriented. There is no evidence of delusions or hallucinations. His coqnitive abilities, including capacity for abstraction, memory and judgment are intact although he describes difficulty with concentration and focus on a daily basis having a significant impact on his work performance due to the impact on his concentration of his pain and depression. The patient's groominq and hygiene are appropriate. The patient appears to be in discomfort as he walks and he walks with the aid of a cane. Speech and communication is appropriate. There is no panic, paranoia or obsessional rituals. There is no hypervigilance. There 15 some vague suicidal ideation but no suicidal plan or intent.

DIAGNOSES:

AXIS I: Major depression. AXIS II: None AXIS III: Chronic back und knee pain. AXIS IV: Difficulty with concentration, focus and irritability in the work place, increasing difficulty with marital and familial discord due to irritability and impatience, increasing social isolation, some vague suicidal ideation. AXIS V: Global

Assment of Functioning of 55 indicating the above mentioned depressive symptoms impacting on social, occupational and interpersonal functioning.

The patient is competent for Veterans Administration pay purposes.

ADDENDUM TO PSYCHIATRIC C&P: The patient's C-file was not available at the time of the interview. but was made available today_ it is helpful in that it contains extensive documentation of the patient long-standing difficulty with service-connected back pain and rating decisions describing the patient's disability from degenerative disc disease. My diagnosis of major depression, which is a direct result of and caused by the patient's chronic pain and his resultant discouragement, demoralization and depression, remains unchanged.

There is no telling what kind of rating you will get, id guess 50% but you have a lot of the 70% criteria, all depends on your rater

[Berta]

I don't see the nexus statement-

Did the examiner state as li kely as not that the depression is caused by the pain and limits of your SC condition?

Did you claim depression as directly due to an inservice event or as secondary to the SC disability?

[hedgey]

Berta, doesn't the statement in the ADDENDUM work as a nexus?

My diagnosis of major depression, which is a direct result of and caused by the patient's chronic pain and his resultant discouragement, demoralization and depression, remains unchanged.

[mac mcqueen]

this is why I'm so confused. Back in 2008 When I had the first back surgery The questions during the C/P for my back was asked, and I stated that I was depressed because of the ban and that I was unable to do all the things I used to be able to do. I am a outdoors person, or at least I used to be. I am now restricted somewhat to the house and I really can't go out with some sort of supervision. The item for depression just showed up on my paperwork as deffered as well as edd and painful urination. all three things were on my rating decesion and were deffered. When My recordes got caught up on a STAR review the requested a C/P on all three. When I went to the GU exam I stted that the painful urination had faded away I guess it was due to the medication I was on and I told them that. The EDD still continues and it causes some problems, but with a back that doesn't work very well what good does it do to get medication when I physically really can't have sex. I told the doctor this in the examination. I told her that I hadn't had sex since 2008 . The mental health examination lasted about thirty minutes. I had at the advise from my wife to seek help at the local va clinic and the lady there stated that there wasn't much she could advise, because my depression was due to the pain from the back. At the C/P the MD stated that I had major depression and that it was a problem and I never got wheather to seek treatment or not. My wife stated that I need to see my PCP to get some meds for it , but dammn I already take so many drugs that I feel like a zombe half the time. I have a claim that is pending from my surgery last june for knee and back surgery and I guess that the Mental and EDD are dated back to 2008. I just waiting for they decision and its supposed to be at the rating stage now. I talked to the VSO and I have a PCP letter already stating that I can't get substantial emplyment based on my service connected disabilities. I am going to tr and get a SSDI appointment for tommrow and hope that all of the imformation I have. I know the va but ai really don't know the SS part. I want to get things in order, but just don't know how to go about it thats why I'm asking you guys who have been doing this for awhile. Any checklist as to what to bring or what to have ready for there judgment. thanks for any help or advise you can give me.