ptsd Review Exams

[jsdwd]

My original claim was rated at 30% for ptsd (a low rating given my C & P exam report, a GAF of 45 and another of 32, etc). I have appealed. I have also retained an attorney.

I have been scheduled for a second C & P exam (same examiner) this month (which will be about a year later. First exam 3/09 this one is sched. for 5/10.) I assume it is a ptsd review exam and not an initial one. Does this make sense?

Has anyone had experience with these review exams? Do the examiners pretty much stick to the script? (http://www.vba.va.gov/bln/21/Benefits/exams/disexm56.htm) The original exam did stick to the script for initial exams (http://www.vba.va.gov/bln/21/Benefits/exams/disexm43.htm)

Any surprises likely to be coming? My basic strategy is to be honest (as I was first time) and say nothing really has changed, which is the case.

What are the chances that the examiner has been told to produce a report more in keeping with the low rating? The initial report read much more like a 70% than a 30% even using the VA's own language.

[john999]

If you say nothing has changed then you are going to get the 30% again. Too bad you don't have some new evidence to give to the exam doctor to show you have gotten worse. Are you working? That is a big factor in PTSD claims.

[jsdwd]

I am not working and have not been for years. I am on SS disability. The criteria on original C & P meet at least the 70% level and that is using the wording right out of the VA rating guide for mental health disorders. The original C & P says (I'm quoting):

"The extent of XXXX's social and occupational impairment is reflected in his

Global Assessment of Functioning score above (45). From a practical standpoint, it

is felt highly unlikely that XXXX will be employed again. His lack of

return to competitive employment appears related to the combination of his

nedical and mental health problems; however, for the purposes of this

evaluation, his posttraumatic stress disorder with secondary depression,

anxiety, and alcohol dependence is considered sufficienl grounds for his

unemployability."

I was honest in answering the questions and the examiner's report is accurate.That is why I am appealing the 30% rating. It was too low. The examiner's opinion is that I have complete occupational impairment. What I am afraid of is that the examining doctor (the same as did the first one) will be pushed to produce a report that supports the 30% rating more closely. Does the VA do that sort of thing? It would require a conscious decision to shape a given claim...seems like they just issue their decisions randomly. What are others' experience with this. I am thinking of getting an independent assessment.

If I get an independent assessment do I have to inform the VA about it if the results don't strengthen my case?

If you say nothing has changed then you are going to get the 30% again. Too bad you don't have some new evidence to give to the exam doctor to show you have gotten worse. Are you working? That is a big factor in PTSD claims.

[broncovet]

You have been lowballed. Its just another VA dirty trick. Your doc has clearly given you irefutable evidence for TDIU.

If its any consolation that is not the worst thing that can happen, as some get denials or, even worse, no decision at all which is very difficult to appeal! At least you can, and should appeal. JMHO, but I am not all that certain an IMO/IME will help you. You already have the evidence with a GAF of 45 and your doc declaring you unemployable. Appeal, persist, appeal again.

[jsdwd]

Thanks. I have appealed. But I'm worried that the review exam will not be as strongly worded as the first one. It pisses me off. The first exam was fair and honest and strongly supported at least 70% if not TDIU (I think it should have been a straight TDIU call), but when I got 30% I was disgusted. I don't even know if the rater even read the damn report.

Do you think the doctor might be instructed to tone it down? Can the VA be that lowdown?

You have been lowballed. Its just another VA dirty trick. Your doc has clearly given you irefutable evidence for TDIU.

If its any consolation that is not the worst thing that can happen, as some get denials or, even worse, no decision at all which is very difficult to appeal! At least you can, and should appeal. JMHO, but I am not all that certain an IMO/IME will help you. You already have the evidence with a GAF of 45 and your doc declaring you unemployable. Appeal, persist, appeal again.

[carlie]

The first exam was fair and honest and strongly supported at least 70% if not TDIU (I think it should have been a straight TDIU call), but when I got 30% I was disgusted.

Do you think the doctor might be instructed to tone it down? Can the VA be that lowdown?

jsdwd,

Did you ever complete, sign and submit a VA Form 21-8940 for IU ?

IMO, no, "the doctor won't be instructed to tone it down".

As someone posted earlier, if your PTSD continues to have the same effect

on your daily life as it did during your last C&P exam, you should get the

same results.

jmho,

carlie

[Wings]

jsdwd,

Did you ever complete, sign and submit a VA Form 21-8940 for IU ?

IMO, no, "the doctor won't be instructed to tone it down".

As someone posted earlier, if your PTSD continues to have the same effect

on your daily life as it did during your last C&P exam, you should get the

same results.

jmho,

carlie