ptsd Just Got Back From Appt With Va Psych....grrrrr

[Gridsmasher11]

I just returned from an appointment with my VA psychiatrist....She just seems to want to keep increasing my meds but doesn't really want to help with my claim.....I asked her to specifically write me a nexus letter or to put into my treatment notes that my PTSD 'is more likely than not caused by my time in the Gulf"....She says that she has already stated that it is service connected and that she wants me to be service connected for this but will not write this as I have asked....Are they instructed to not write it plainly so we can support our claims????? She said it would be a conflict of interest.????I asked her how it would be a conflict of interest, wasn't she my treating Phsychiatrist (she said yes) but she just wants to him and haww........GRRRRRRRRR...VA causes us more stress and just wants to dope us up and hope we forget...............................................Did find out some things that may help my claim......The doctor that did my PTSD C&P back in March is only an MD.....According to VA regs it should have been a Psychiatrist or Phsycologist...So I have a point there....Still gathering the stuff to keep fighting my claim.............................GRID

[john999]

You need to hire your own psychiatrist if you want them to say what you want them to say. This is called an IMO or IME. You get what you pay for in the medical world.

[LarryJ]

You need to hire your own psychiatrist if you want them to say what you want them to say. This is called an IMO or IME. You get what you pay for in the medical world.

BUT, bear in mind, the VA will ONLY accept a PTSD diagnosis from one of IT'S OWN Psychiatrists or Board-certified Psychologists. They WILL NOT accept an IMO or an IME for PTSD. Period.

[LarryJ]

I just returned from an appointment with my VA psychiatrist....She just seems to want to keep increasing my meds but doesn't really want to help with my claim.....I asked her to specifically write me a nexus letter or to put into my treatment notes that my PTSD 'is more likely than not caused by my time in the Gulf"....She says that she has already stated that it is service connected and that she wants me to be service connected for this but will not write this as I have asked....Are they instructed to not write it plainly so we can support our claims????? She said it would be a conflict of interest.????I asked her how it would be a conflict of interest, wasn't she my treating Phsychiatrist (she said yes) but she just wants to him and haww........GRRRRRRRRR...VA causes us more stress and just wants to dope us up and hope we forget...............................................Did find out some things that may help my claim......The doctor that did my PTSD C&P back in March is only an MD.....According to VA regs it should have been a Psychiatrist or Phsycologist...So I have a point there....Still gathering the stuff to keep fighting my claim.............................GRID

You actually have no point there. You are without a PTSD diagnosis UNTIL you receive one from a VA psych or psychologist. Now, IF this psychiatrist has stated that you do, in fact, have a diagnosis and that it is service-connected........then what's the problem? This is all that it takes to receive a PTSD rating under the new rules. Some of the doctors hired by the VA are a little bit afraid to take too active an advocacy stance in support of their VA patients (something about being afraid to bite the hand that feeds you.............regardless of the NON-advesarial supposed policy of the VA).

You need to read the new VA Fact Sheet on the new guidelines for a PTSD claim.

[john999]

Larry

Are you sure that only VA shrinks can make PTSD DX. If this is true they can DX every vet with a personality disorder and you can't fight it via an IMO or IME. Please guide me to where it says only VA doctors can make the PTSD DX. They have a very significant dog in the fight. A vet could have spent five years in Vietnam and dream about Nam every night and see NVA crawling on his roof at night, but his VA shrink may say "Aw, just vivid imagination" and you are screwed. If I have been getting treatment from a private doctor for 30 years for symptoms of PTSD and my VA C&P doctor says no PTSD, but pre-existing anxiety disorder I am in the toilet. If what you say is true this is a horrible blow to PTSD vets.

[LarryJ]

Larry

Are you sure that only VA shrinks can make PTSD DX. If this is true they can DX every vet with a personality disorder and you can't fight it via an IMO or IME. Please guide me to where it says only VA doctors can make the PTSD DX. They have a very significant dog in the fight. A vet could have spent five years in Vietnam and dream about Nam every night and see NVA crawling on his roof at night, but his VA shrink may say "Aw, just vivid imagination" and you are screwed. If I have been getting treatment from a private doctor for 30 years for symptoms of PTSD and my VA C&P doctor says no PTSD, but pre-existing anxiety disorder I am in the toilet. If what you say is true this is a horrible blow to PTSD vets.

I've been trying to tell everybody. Everyone thinks that this NEW and IMPROVED method for handling Veterans' PTSD claims is GREAT.

HERE IT IS:

1

July 12, 2010

New Regulations on PTSD Claims

Quick Facts:

This new rule is for Veterans of any era.

The new rule will apply to claims:

o received by VA on or after July 13, 2010;

o received before July 13, 2010 but not yet decided by a VA regional office;

o appealed to the Board of Veterans' Appeals on or after July 13, 2010;

o appealed to the Board before July 13, 2010, but not yet decided by the Board; and

o pending before VA on or after July 13, 2010, because the Court of Appeals for Veterans Claims vacated a Board decision and remanded for re-adjudication.

QUESTIONS AND ANSWERS

"Stressor Determinations for Posttraumatic Stress Disorder"

1. What is Post-Traumatic Stress Disorder (PTSD)?

Post Traumatic Stress Disorder (PTSD) is a condition resulting from exposure to direct or indirect threat of death, serious injury or a physical threat. The events that can cause PTSD are called "stressors" and may include natural disasters, accidents or deliberate man-made events/disasters, including war. Symptoms of PTSD can include recurrent thoughts of a traumatic event, reduced involvement in work or outside interests, emotional numbing, hyper-alertness, anxiety and irritability. The disorder can be more severe and longer lasting when the stress is human initiated action (example: war, rape, terrorism).

2. What does this final regulation do?

This final regulation liberalizes the evidentiary standard for Veterans claiming service connection for post traumatic stress disorder (PTSD). Under current regulations governing PTSD claims, unless the Veteran is a combat Veteran, VA adjudicators are typically required to undertake extensive record development to corroborate whether a Veteran actually experienced the claimed in-service stressor. This final rulemaking will simplify and improve the PTSD claims adjudication process by eliminating this time-consuming requirement where the claimed stressor is related to "fear of hostile military or terrorist activity," is consistent with the places, types, and circumstances of their service, and a VA psychiatrist or psychologist, or contract psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD.

3. What types of claims for VA benefits does the final regulation affect?

The final regulation will benefit Veterans, regardless of their period of service. It applies to claims for PTSD service connection filed on or after the final regulation’s effective date, and to those claims that are considered on the merits at a VA Regional Office or the Board of Veterans’ Appeals on or after the effective date of the rule.

4. Why is this final regulation necessary?

The final regulation is necessary to make VA’s adjudication of PTSD claims both more timely and consistent with the current medical science.

5. How does this final regulation help Veterans?

The final regulation will simplify and streamline the processing of PTSD claims, which will result in Veterans receiving more timely decisions. A Veteran will be able to establish the occurrence of an in-service stressor through his or her own testimony, provided that: (1) the Veteran is diagnosed with PTSD; (2) a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted confirms that the claimed stressor is adequate to support a PTSD diagnosis; (3) the Veteran's symptoms are related to the claimed stressor; and (4) the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service and the record provides no clear and convincing evidence to the contrary. This will eliminate the requirement for VA to search for records, to verify stressor accounts, which is often a very involved and protracted process. As a result, the time required to adjudicate a PTSD compensation claim in accordance with the law will be significantly reduced.

6. How does VA plan to monitor the need for examiners in various regions of the country, and how does VA plan to respond if is determined that more examiners are needed in a particular region?

The Veterans Health Administration (VHA) has written in to the FY11-13 Operating Plan the need for additional staff to support doing adequate, timely exams. VHA proposes: "A8. Increase mental health field staff to address the increase in C&P examinations and develop monitoring system to ensure clinical delivery of mental health services does not decrease in VHA." Specifically, VHA has requested 125 clinicians for FY11 with additional 63 staff in FY12 if the need exists. If the Operating Plan and the proposed budget are approved, VA proposes asking the Veterans Integrated Service Networks (VISNs) to develop plans for distributing the funds in order to ensure adequate coverage at sites based on number of claims being processed; the VISNs are well positioned to determine these regional needs.

7. How does the regulatory revision affect PTSD service connection claims where an in-service diagnosis of PTSD has been rendered?

The new regulation does not apply to the adjudication of cases where PTSD has been initially diagnosed in service. Rather, under another VA rule, 38 CFR § 3.304(f)(1), if a Veteran is diagnosed with posttraumatic stress disorder during service and the claimed stressor is related to that service, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor.

8. Is the new regulation applicable only if the Veteran's statements relate to combat or POW service?

No. The rule states that the stressor must be related to a "fear of hostile military or terrorist activity," and the claimed stressor must be "consistent with the places, types, and circumstances of the veteran’s service."

9. What circumstances will still require stressor verification through DoD’s Joint Services Records Research Center (JSRRC) , VBA’s Compensation &Pension Service (C&P Service), or other entity if a Veteran claims that his or her stressor is related to a fear of hostile or terrorist activity?

The regulatory revision will greatly lessen the need for undertaking development to verify Veterans’ accounts of in-service stressors. Now, stressor development may only need to be conducted if a review of the available record, such as the Veteran’s service personnel and/or treatment records, is inadequate to determine that the claimed stressor is "consistent with the places, types and circumstances of the veteran’s service." In such circumstances, the Veterans Service Representative (VSR) will determine on a case-by-case basis what development should be undertaken.

However, it is anticipated that in the overwhelming majority of cases adjudicated under the new version of § 3.304(f), a simple review of the Veteran’s service treatment and/or personnel records will be sufficient to determine if the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service. We also believe that, in some cases, a Veteran’s separation document, DD-Form 214, alone may enable an adjudicator to make such a determination.

10. As the regulatory revision seems to require an enhanced role for the examining VA mental health professional, whose role is it to determine whether the claimed stressor is consistent with the Veteran’s service?

VA adjudicators, not the examining psychiatrist or psychologist, will decide whether the claimed stressor is consistent with the Veteran’s service.

11. Is a Veteran's testimony about "fear of hostile military or terrorist activity" alone sufficient to establish a stressor?

Yes, if the other requirements of the regulation are satisfied, i.e., a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a PTSD diagnosis and that the Veteran's symptoms are related to the claimed stressor, and the stressor is consistent with the "places, types, and circumstances of the Veteran’s service."

12. Are the stressors accepted as adequate for establishing service connection under new § 3.304(f)(3) limited to those specifically identified in the new regulation?

No. The examples given in the revised regulation do not represent an exclusive list in view of the use of the modifying phrase "such as" that precedes the listed examples. Any 4

event or circumstance that involves actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, would qualify as a stressor under new § 3.304(f)(3).

13. How will the Veterans Health Administration (VHA) work with Veterans Benefits Administration (VBA) on the new regulation?

VHA was actively involved in discussion with VBA of the new regulation and fully supports the new regulation.

The new regulation will provide fair evaluation for Veterans whose military records have been damaged or destroyed, or for whom no definitive reports of combat action appeared in their military records, even though they can report such actions and it is reasonable to believe that these occurred, given the time and place of service.

This will be especially beneficial to women Veterans, whose records do not specify that they had combat assignments, even though their roles in the military placed them at risk of hostile military or terrorist activity.

This means that more Veterans will become eligible for VA care and thus be able to receive VA care for mental illness related to their military service, as well as receiving full holistic health care.VHA will work actively with VBA on implementing the regulation. VHA staff’s main role is as clinicians conducting C&P interviews to establish diagnoses and obtain other information to be used by VBA raters to determine the outcome of claims.

The new regulation will not change the diagnostic elements of the C&P interview, but may change what additional data are collected for use by VBA raters.

[john999]

Larry

I see the high lighted sections and this is bad news for vets. I think there will be a great increase in the number of "adjustment reaction" and "personality disorder" DX'es if PTSD finding is left up to the VA. This is a ticking and hidden time bomb.

[LarryJ]

Larry

I see the high lighted sections and this is bad news for vets. I think there will be a great increase in the number of "adjustment reaction" and "personality disorder" DX'es if PTSD finding is left up to the VA. This is a ticking and hidden time bomb.

Actually, all the VA pscyhiatrist or psychologist has to say is: "The veteran's claimed stressor is not adequate to support a diagnosis of PTSD." That's it. Case Closed. I see no recourse. No way of winning. No IMO or IME will do any good. Appeals, what appeals, when the VA has closed the door on anything EXCEPT their opinion?

Everyone was HOPING that this NEW and IMPROVED PTSD regs would solve a lot of useless, time-wasting, searches for the Stressor Story.............so, it did, I guess, but only to slip in another, HARDER hurdle to hop, one whereby the WORD is left up to the VA psych. They MUST diagnose you with PTSD. And, then, you look at Item #10 and it states that the VA adjudicator will decide if the veteran's claim is consistent with his/her service...............so, even though you have boots on the ground in Afghanistan, for example, and you served in Afghanistan as a field radio operator, for example, you will still wind up relying upon a VA Adjudicator to say whether or not you had service consistent with your claim (and half the folks at the VA making these type decisions would not have an inkliing what a "field radio" MOS has you actually doing. They would probably have an instant picture in their minds of someone sitting at a console, somewhere in the headquarters, tuning knobs and listening to the BBC, etc.

just sayin'......................

[john999]

I wonder where was the DAV, VFW and American Legion when this regulation was handed down. I wonder if they read it like we do? They are only thinking of OIF/OEF vets fresh from combat. This was a Trojan Horse. Is there some clarification on this you could get, Larry?

[LarryJ]

I wonder where was the DAV, VFW and American Legion when this regulation was handed down. I wonder if they read it like we do? They are only thinking of OIF/OEF vets fresh from combat. This was a Trojan Horse. Is there some clarification on this you could get, Larry?

Well, this information was straight from the VA. Taken from the VA Fact Sheet published for this PTSD regulation. I'll do some more checking and see what I can come up with.

[Pete53]

I think it will be better there are many Vets who are diagnosed by VA with PTSD and not a chance in hell of proving stressor to satisfy the paper pushers at the VARO's

[mobie16r]

LarryJ Wrote and a VA psychiatrist or psychologist, or contract psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD.

My interpretation of this is that you can be diagnose with post truamatic stress disorder (ptsd) by any psychiatrist of clinical psychologist whether va of private imo,but only va psy, can corrobate ptsd with inservice stressor so if i was diagnose with ptsd and ongoing treatment by a private psychiatrist of clinical psychologist,i would get him to write me a statement out and when i went for C&P i would give the statement to the examiner.

[LarryJ]

LarryJ Wrote and a VA psychiatrist or psychologist, or contract psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD.

My interpretation of this is that you can be diagnose with post truamatic stress disorder (ptsd) by any psychiatrist of clinical psychologist whether va of private imo,but only va psy, can corrobate ptsd with inservice stressor so if i was diagnose with ptsd and ongoing treatment by a private psychiatrist of clinical psychologist,i would get him to write me a statement out and when i went for C&P i would give the statement to the examiner.

And, all that examiner has to say is: No, your claimed stressor is not adequate to support a diagnosis of PTSD.

Whatcha gonna do then?

[LarryJ]

I think it will be better there are many Vets who are diagnosed by VA with PTSD and not a chance in hell of proving stressor to satisfy the paper pushers at the VARO's

BUT, Pete, you're MISSING this little ZINGER:

Under item #10 on the VA Fact Sheet:

VA adjudicators, not the examining psychiatrist or psychologist, will decide whether the claimed stressor is consistent with the Veteran’s service.

SO YOU STILL HAVE TO SATISFY THE PAPER PUSHERS AT THE VARO'S!

STILL!

This NEW DEAL is just a NEW WAY of SCREWING YOU!

They slid this rotten fish in, right under our noses and told us it smelled like ROSES!

[LarryJ]

What the "new and improved" and approved (all the way to the "top") rules/regs now state is that you must be diagnosed BY A VA PSYCHIATRIST OR BOARD-CERTIFIED PSYCHOLOGIST OR ONE OR THE OTHER THAT IS CONTRACTED BY THE VA as having PTSD.

THEN your claims must still go through the VARO and be APPROVED by the VA as you having met the requirements concerning whether your claim is in agreement with the TIME, PLACE, & ETC. according to your military records are concerned (were you really where you said you were and were you really where you could have been injured, etc, by hostile enemy action).

All they have done is take away your ability to come up with an IMO that will cancel out THEIR C&P examiner. There is NO mention in there about the "Benefit Of The Doubt" rule, no mention of what you are to do if the VA Psych does NOT diagnose PTSD.......what your appeal rights are. It just states flatly that you WILL have to be diagnosed by the VA as having PTSD!

Correct me if I'm wrong. This is ONE TIME that I WANT TO BE WRONG.

[mobie16r]

Under the new rule, VA would not require corroboration of a stressor related to fear of hostile military or terrorist activity if a VA doctor confirms that the stressful experience recalled by a Veteran adequately supports a diagnosis of PTSD and the Veteran's symptoms are related to the claimed stressor.

Examper: John Doe been diagnose with PTSD by a IMO or IME and the reason for his symptoms he served in IRAQ and during his tour of duty,he witness a lot of traumatic events, in and around Bagdad that cause his ptsd symptoms.Ok,when ever John Doe is schedule for a C&P, he take the statement that his IMO or IME write for him and give it to the C&P examiner (This include the ladys, not to leave them out,because they served too)and when interview by the examiner tell he/she how these trauma's effect you in everyday life and he/she write up there report and forward it to the regional office for a rating,before rating is done,the va will send out a inquirer to the US army research center of other departments that do researches to to confirm that John Doe served in Iraq or in and around Bagdad and when confirmed that he served in Iraq,it will be sent back to his regoinal office for a rating.

Before the new ruling if John Doe didn.t have a CIB,CAR,PURPLE HEART,of any other medal that proved that he was in combat,he would have had to a inservice stressor that cause his ptsd symptoms like a buddy he seen get killed of injured of there was a rocket attack on his base camp of some other traumatic event that happen to him,and this had to be the nexus and the reason for his ptsd, and this had to be confirmed two months before of two months after the inservice stressor ocurred.This have been the reason that it have been so hard for the Vietnam veteran to get service connected for ptsd who was not a infantryman of recevied a purle heart,but went through hell and trying to prove something that happen forty years ago,so the new ruling will help a lot of vietnam veteran and veterans that are suffering from ptsd.

[LarryJ]

Under the new rule, VA would not require corroboration of a stressor related to fear of hostile military or terrorist activity if a VA doctor confirms that the stressful experience recalled by a Veteran adequately supports a diagnosis of PTSD and the Veteran's symptoms are related to the claimed stressor.

Examper: John Doe been diagnose with PTSD by a IMO or IME and the reason for his symptoms he served in IRAQ and during his tour of duty,he witness a lot of traumatic events, in and around Bagdad that cause his ptsd symptoms.Ok,when ever John Doe is schedule for a C&P, he take the statement that his IMO or IME write for him and give it to the C&P examiner (This include the ladys, not to leave them out,because they served too)and when interview by the examiner tell he/she how these trauma's effect you in everyday life and he/she write up there report and forward it to the regional office for a rating,before rating is done,the va will send out a inquirer to the US army research center of other departments that do researches to to confirm that John Doe served in Iraq or in and around Bagdad and when confirmed that he served in Iraq,it will be sent back to his regoinal office for a rating.

Before the new ruling if John Doe didn.t have a CIB,CAR,PURPLE HEART,of any other medal that proved that he was in combat,he would have had to a inservice stressor that cause his ptsd symptoms like a buddy he seen get killed of injured of there was a rocket attack on his base camp of some other traumatic event that happen to him,and this had to be the nexus and the reason for his ptsd, and this had to be confirmed two months before of two months after the inservice stressor ocurred.This have been the reason that it have been so hard for the Vietnam veteran to get service connected for ptsd who was not a infantryman of recevied a purle heart,but went through hell and trying to prove something that happen forty years ago,so the new ruling will help a lot of vietnam veteran and veterans that are suffering from ptsd.

But, you are STILL going to have to be diagnosed BY the VA Psychiatrist or Psychologist. If they do not think that you have PTSD, whatcha gonna do? You STILL have to have THAT diagnosis, by THEM. You can't just walk into your PTSD C&P and hand them a letter from an outside psychiatrist, saying you have PTSD, that concept has been done away with. And, you STILL must pass muster with the VA Regional Office for they are going to be the ones to "verify your presence" as to whether you were where you were and you were in danger to the point of it being possible that you could have PTSD.

So, just you saying that you have PTSD or that you have the stressors that should lead to PTSD...........still ain't gonna cut it.

[john999]

What about getting treatment and DX of PTSD from a Vet Center? Will that act as official stamp of approval for PTSD claim? I know that back in 2001 the local Vet Center was recruiting anyone for treatment.

[mobie16r]

LarryJ,show me where you got to be diagnose by a va psy for ptsd,because what you wrote on your post do not say you have to be diagnose with ptsd by a va psy.IT says VA psychiatrist or psychologist, or contract psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD.

ADEQUATE MEANS:Equal to or sufficient for a specific requirement

Edited August 8, 2010 by mobie16r (see edit history)

[mobie16r]

Remember a psychiartist,psychologist is just like policeman a brothehood, one dont go against the other

[LarryJ]

LarryJ,show me where you got to be diagnose by a va psy for ptsd,because what you wrote on your post do not say you have to be diagnose with ptsd by a va psy.IT says VA psychiatrist or psychologist, or contract psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD.

ADEQUATE MEANS:Equal to or sufficient for a specific requirement

Mobie, you may very well be correct.

I certainly HOPE that you are correct (one of the FEW times that I'd like to be wrong in my understanding of this PTSD mess)!

So, what you think that that passage is saying is that the VA psychiatrist/pyschologist has to "confirm" that the claimed stressor was (or was not) good enough (a powerful enough stressor) to support the diagnosis of PTSD (regardless of who actually DID the diagnosis). You are saying that the VA pscyh just has to "pass or approve" the claimed stressor as being serious enough. Right?

Well, if that is what you are saying, then, if it's true, we may be a LITTLE bit better off with this new PTSD regulation (I say a LITTLE bit better off because the VA psychiatrist or psychologist STILL has to approve the stressor itself, but it will keep hundreds of veterans from having to go looking all over hell and half an acre, trying to come up with some officially written proof that they were stressed). And, the VARO staff still has to okay the fact that the veteran was, physically present, when the stressors were occurring, by evidence in the veteran's service files.

I still hope your interpretation is the right one.