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.

[jsdwd]

The problem is that the last results were fine. I was honest and the examiner wrote a fair report and the rater more or less ignored it. Yes I did file with the appeal, a VA 21-8940. Is there any benefit to taking additional evidence to the C & P exam? I am told they cannot accept it and really aren't even required to read it (although my first examiner did read what I brought and referenced it in the report). I have the same examiner as last time.

What can I do differently so that I don't get the same low rating?

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

[halos2]

I perceive this occurring most of the time...low balling a vet! Now be as honest as you were before but make sure you just don't answer questions with a plain and simple yes/no answer.

Here you can expand...yes I am depressed ie all the time, most of the time...I have vivid nightmares, night sweats/terrors, I argue and fight with my family/have no friends/few friends, stay shut-in and do not want to go out in public places, avoid people, have no initiative/little initiative, cry, yell, scream for no valid reasons, avoid things I use to like before, prefer to be alone...Have constant thoughts of what I witnessed/experienced and cannot excape my feelings of low/no self worth.

I am just invoking you to really think about how your issues affect you. Do not make up scenerios, but think about how not working and providing for your family has impacted you thought process's and how your mental issues has indeed hindered your lack of quality of life...

ALWAYS tell the truth, and expand just how you feel, have coping problems, and how throughout the years your life is more impacted negatively because of your mental/behavioral/social status. Sometimes a vet doesn't realize just how much BH issues affect them!

Low balling is a strategy they use to save $$...NOD, appeals is the vets strategy to get what they deserve. Relax, read up on issues common to PTSD diagnosis and bet you find you have more of these symptoms then you realize and have spoken of. Good luck with your exam, and remembering overeating/annorexia, hording could also be manifestations of your coping mechanisms, or lack of. The truth will set you free. :)

[jsdwd]

Thanks for the encouragement. I get your point. Be more complete and describing the problems I've been having.

We'll see how it goes.

It's just like I feel like I"m playing the lottery (something I don't do) and I don't think the process is supposed to be like that.

I perceive this occurring most of the time...low balling a vet! Now be as honest as you were before but make sure you just don't answer questions with a plain and simple yes/no answer.

Here you can expand...yes I am depressed ie all the time, most of the time...I have vivid nightmares, night sweats/terrors, I argue and fight with my family/have no friends/few friends, stay shut-in and do not want to go out in public places, avoid people, have no initiative/little initiative, cry, yell, scream for no valid reasons, avoid things I use to like before, prefer to be alone...Have constant thoughts of what I witnessed/experienced and cannot excape my feelings of low/no self worth.

I am just invoking you to really think about how your issues affect you. Do not make up scenerios, but think about how not working and providing for your family has impacted you thought process's and how your mental issues has indeed hindered your lack of quality of life...

ALWAYS tell the truth, and expand just how you feel, have coping problems, and how throughout the years your life is more impacted negatively because of your mental/behavioral/social status. Sometimes a vet doesn't realize just how much BH issues affect them!

Low balling is a strategy they use to save $$...NOD, appeals is the vets strategy to get what they deserve. Relax, read up on issues common to PTSD diagnosis and bet you find you have more of these symptoms then you realize and have spoken of. Good luck with your exam, and remembering overeating/annorexia, hording could also be manifestations of your coping mechanisms, or lack of. The truth will set you free. :)

[carlie]

But I'm worried that the review exam will not be as strongly worded as the first one.

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.

jsdwd,

What exactly did your other exam state that makes you feel it was "strongly worded" ?

In what way do you feel the other exam was

"fair and honest and strongly supported at least 70% if not TDIU" ?

What other disabilities are you rated for and at what percentages, besides PTSD ?

carlie

[john999]

Do you have any non service connected disabilites that were mentioned in your C&P exam? The VA clings to these kinds of things to deny IU claims. Did you claim IU. You have to claim it to get it usually. I got a 70% rating, but the VA rang me up on NSC issues to say I was unemployable due to those issues. You got to stick to SC issues for IU. All being said, that C&P exam from what you wrote sounds good enough to get IU for PTSD. I would appeal and ask for a DRO Personal Hearing. It would not hurt to get a IMO in the meantime. You are paying for the IMO, so it better support your IU claim for PTSD. You don't have to share it with the VA, but if you pay for it then it should be good evidence for you. Let's be realistic. You are not paying for an exam that says your PTSD is mild.

[jsdwd]

Carlie,

Thanks for your help.

The following is directly quoted from the exam report:

"Axis V - Global Assessment of Functioning Score: Posttraumatic stress

disorder with secondary depression, anxiety, and alcohol dependence ( in

sustained full rernission) - 45."

"The extent of Mr, xxxxs social and occupational impairment is reflected in his

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

is felt highly unlikely that Mr. 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

ewaluation, his posttraumatic stress disorder with secondary depression,

anxiety, and alcohol dependence is considered sufficienl grounds for his

unemployability."

/s MD (the exam was conducted by an MD, but not a psychiatrist)

Also in the record is a report from a VA psychologist assigning a GAF of 32.

If one looks at the GAF rating for level 45 and level 32, the descriptions are much more in line with 70% than they are with 30%. For example I don't have "occasional decrease in work efficiency, ...etc", the level of 30% as spelled out in 38 CFR §4.130. I have been unemployed since 1996 and on SSD since 1998. That is a "major occupational impairment" as required by 70% criteria in 4.130. There are several other instances such as mood disorder, social isolation, family disruption, etc. All are called out in the C & P exam report and essentially ignored in the rating decision (the rater didn't mention employment status at all).

I am also rated:

20% SC for DMII (A/O presumptive)

10% SC for Neuropathy (secondary to the DMII)

10% SC for Tinnitis

0% SC for hearing loss

I have retained an attorney. He filed a power of atty, a copy of our agreement and a cover letter waiving a hearing. I had already filed an NOD before retaining him. I received a notice of a scheduled hearing (anyway) and it lists the CA dept. of Veterans Affairs as my rep. It's like they have never received anything from him, but they have and have acknowledged that and corresponded with him...I'm guessing the new C & P exam is connected to the hearing, but, of course, I can't take any risks and will attend the exam. What I have to report is that not much has changed. I tried SSRIs and couldn't tolerate the side-effects that resulted from my liver disease. I take sleep meds, but since I've been addicted to alcohol, I use them only when I am really sleep deprived. Everything else has stayed pretty much as it was when I was examined a year ago.

Any thoughts about how best to proceed?

jsdwd,

What exactly did your other exam state that makes you feel it was "strongly worded" ?

In what way do you feel the other exam was

"fair and honest and strongly supported at least 70% if not TDIU" ?

What other disabilities are you rated for and at what percentages, besides PTSD ?

carlie