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


Gridsmasher11

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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

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  • HadIt.com Elder

My impression was that Filner believes PTSD started with the OIF?OEF wars. There were no vets with PTSD before this time. Everything this guy thinks about started in 2001. Trusting the VA to do the right thing with PTSD vs PD DX is like believing in the tooth fairy.

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Jim- I raised that exact issue with COngressman Filner last night at SVR radio-

Veterans with PD diagnosis have in some cases proven to the VA they had, in fact, PTSD.

The new regs specifiy that the diagnosis MUST come from a VA mental health care practitioner.

This means, I mentioned, that if the VA says the vet doesnt have PTSD but he or she has the diagnosis from an independent doctor and conforms to the stressor criteria then how do these vets receive 38 USC 1154 b Benefit of Doubt- that allows the VA to weigh evidence for and against the claim-and if of equal merit -then veteran will succeed.

His response to this part of the reg was " We are going to look into that." and "Congress can make some changes."

He was fully aware of how this reg was worded. I raised the fact that this could be a situation that impacts on the H VAC hearings on Personality Disorder diagnoses which will be on Sept 15 at the Cannon Building in DC available live in streaming video.

I intend to send him a letter too again mentioning these concerns that every vets advocate should be concerned about as well.

If VA can attempt to erode any of our DTA and Benefit of Doubt rights we cannot sit by and allow them to do that.

The VA is probably the best in the world at diagnosing and treating PTSD hands down-

but they have certainly misdiagnosed PTSD as PD or any other non service connectable disability- Congressman Filner even briefly mentioned with no names the PTSD fiasco a few years ago (it was the Norma Perez bull crap)

and the H VAC is very aware of how PTSD has been "downplayed" by VA in attempts to not award compensation for it.

We cannot allow any VA erosion to any of these regs you stated:

"Do 38 CFR "Relative Equipoise" provisions still apply?

(38 U.S.C 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990)

Do 38 CFR "Benefit of the Doubt" provisions still apply?

(38 U.S.C.A. § 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2002)

Do 38 CFR "Preponderance of the Evidence" provisions still apply?

(38 U.S.C. § 5110(a); 38 C.F.R. § 3.400 (2001)

Do 38 CFR "VA required to analyze and evaluate ... all pertinent medical and lay evidence" still apply?

(38 U.S.C. § 1154(a) (2000); 38 C.F.R. § 3.303(a) (2002)"

RE and BOD regs are the foundation of -and as I mention to COngressman Filner the reason why- many many claims that do get awarded.

Berta, I would like to ask you a question and I hope you do not take it the wrong way. I listened to the radio show last night and you were quoted as saying that YOU can tell when some vets have ptsd or are just typing what they think is ptsd but you know they dont have it just because you also quoted you have been around along long time and can tell when someone has ptsd are not. My question to you is are you a licensed pshyc or psychologist that is qualified to make such statements in that radio show?? If not, how in the world can you make that statement?? Just asking?

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Gridsmasher11, Thank you for starting this thread! I bet you didn't count on these responses. Follow the advice of the more learned Hadit members and you will more likely than not succeed with your claim. (Pun intended!) Good luck with your efforts!

Berta, I just finished listening to last night's SRV program with Congressman Filner. Like you, I noted, albeit with some disappointment, that he was "fully aware of how this reg was worded." I would have preferred some preemptive action on the part of the HCVA rather than "We are going to look into that" and "Congress can make some changes." I wonder what kind of advanced notice the Committee received from the VA before publishing the rules. But, I suppose we have to accept what help we can get. His response to your question about the new PTSD regulations included the comment that "a diagnosis is a diagnosis." It is my understanding that prior to July 12/13, 2010 that was indeed the case. I believe you felt that way also as did LarryJ and many others with whom I have discussed this issue. However, after reading (and rereading and rereading…) the new regulations, I am left with the unnerving conclusion that, with respect to the diagnosis of PTSD—and only PTSD, veterans are no longer entitled the benefits and protections of the "Relative Equipoise,""Benefit of Doubt," "Preponderance of Evidence" or the requirement that the VA analyze and evaluate "all pertinent medical and lay evidence."

Viewed another way, the VA has created an identifiable class of veterans who have to meet a much higher threshold in order to receive disability compensation than other similarly situated veterans with other disabling conditions. All other veterans seeking disability compensation for all other conditions are afforded the benefits and protections listed, but veterans seeking disability compensation for service-connected PTSD no longer do. On its very face, this is the functional definition of "discrimination." Discrimination is prohibited by the Constitution. These regulations will be litigated.

Berta and LarryJ, you are so right to be concerned about "so much is missing from the reg." There are no legal definitions as far as I can tell. There are no indications of appellate rights. There is no information about how to get an existing claim adjudicated under these new regulations. The list goes on and on. These issues will have to be sorted out through the appeals processes. It is both sad and ironic that even though we put PTSD on the proverbial map, not many of the Vietnam generation will be around to see the outcome.

If one takes the time to read and digest the final rules, the rational for them, and the responses to comments about them, the objective of the rules becomes very, very clear.

Here is the website again:

http://www.regulatio...A-2009-VBA-0023

Pay particular attention to the rationale for demanding a "VA-ONLY" PTSD diagnosis and for refusing to reopen old claims using the new regulations. The VA says now that since current scientific research studies relating PTSD show that a "veteran's fear of hostile military or terrorist activity" is adequate to support a DSM-IV diagnosis of PTSD; a specific stressor is no longer required for a rating for service-connected PTSD. Look also at the part that prohibits the veteran's treating provider's diagnosis—even if that provider is a VAMC shrink! So all those VA Progress Notes with "AXIS I: PTSD, chronic, severe" are no longer of any value in the rating process.

The VA says it is "reducing the evidentiary standard of establishing an in-service stressor" when it is actuality doing nothing of the kind. The DSM-IV diagnostic requirements for PTSD have not changed. The VA rating requirements for service-connected PTSD have not changed. The only thing that has changed is that the VA has been forced "to acknowledge the inherently stressful nature of the places, types, and circumstances of (military) service in which fear of hostile military or terrorist activities is ongoing" is, in and of itself, a stressor powerful enough to meet the DSM-IV PTSD diagnostic requirements for some veterans.

Therefore, the evidentiary standard has not changed at all. A veteran still needs to show: 1. Exposure to a traumatic event which meets the DSM-IV requirements—military service with exposure to "hostile military and terrorist actions" being one of those "traumatic events;" 2. The existence of at least a minimum set of DSM-IV qualifying PTSD symptoms which have caused a quantifiable reduction in the veteran's earning capacity; 3. A connection/nexus between the two. Those three requirements had to be met before July 13, 2010 and they still had to be met on July 14, 2010. They still have to be met today. The VA could reduce the evidentiary standard only by eliminating one or more of the DSM-IV requirements. The new regulations have not done so.

So what we are left with is, in return for finally acknowledging the current advances in scientific knowledge regarding PTSD only after almost every other organization that deals with mental health has done so, the VA now brazenly delegitimizes every non-VA mental healthcare provider (and many VA providers) by prohibiting the use of their professional diagnostic ability. Now that takes either a set of brass ones or the knowledge that they will never be held accountable for their actions. My vote goes to the latter.

I am thoroughly convinced that the true objective of these regulations is to attempt to illegitimately reduce the backlog of claims, while at the same time drastically containing the compensation costs by:

1. Doing a Norma Perez (PD vs. PTSD) on as many claims as possible; and

2. Radically reducing the EED's of any claims that are lucky enough to survive Norma's curse.

john999, I also wonder where the service organizations were when these regulations were being developed. These regulations didn't get developed in a vacuum. And, where the hell are they now that the regulations are in force? AWOL as usual! The veteran that I am assisting was denied even though a Vet Center provider testified in person at his DRO hearing. This veteran was awarded SSDI on the very same records that the DRO used to deny the claim. Go figure!

mobie16r, I assume your award for SC PTSD occurred before July 12/13, 2010. If the VA played "the game" by the rules, there would be no need for hadit.com, or the Board of Veterans' Appeals or COVA! I would think that reading some of the horror stories on here on hadit would cause an attitude adjustment. There is certainly no "win-win" when dealing with the VA.

Pete53, I felt the same way you did until I studied the information at the website above. I came away with an entirely different point of view.

cooter, submit any/all evidence you have that supports your claim! No one knows how these new regulations will ultimately play out. You can find the requirements for the various percentages here on hadit.

One last note to LarryJ: Hell's Half Acre is located about 30 miles east of Thermopolis, Wyoming. I have visited it many, many times over the years. I didn't see any VA C&P examiners on any of those visits, unless, of course, they are about 5-6' long, have little diamond shaped patterns on their backs, and rattle when they move. They could have been VARO raters, but I couldn't tell for sure because they kept hiding behind rocks and in the shadows. The last time I drove past the whole place was for sale! Interested?

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Larry post :Mobie, they have already turned in a claim, and been denied. They need to read their SOC and see WHY they have been denied. They say that they have been diagnosed with PTSD and have a verified stressor and yet were denied. The SOC will have to come up with a reason WHY. Then, and only then, can they righteously fight this thing. Gotta know your enemy before you can beat him, right?

You right,you need to no your enemy,thats the reason we are here to help him win.To get service connected for ptsd you got to have three connection.

(1) YOU GOT TO HAVE A DIAGNOSE OF PTSD

(2) YOU GOT TO HAVE A VERTIFIBALE INSERVICE STRESSOR

(3) THE REASON YOU SUFFER FROM PTSD (BECAUSE OF INSERVICE STRESSOR)

(1)GridsmasherII been diagnose with ptsd

(2)His inservice stressor been vertify

The rater agree with his diagnose of ptsd and also his vertify stressor,if he would have stated how his inservice stressor(indetails) affected him in his daily life,He would get service connected for ptsd.What i said in a early post,you have to tell the C&P examiner everything about your inservice stressor and when his medical report is forward to the rater and he/she corroborate the three things together its a SLAM DUNK! My word

Edited by mobie16r (see edit history)
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  • HadIt.com Elder

I am a proud member of there is more than one way to skin a cat. I also believe that for some reason that our beloved VA has made things more difficult for Veterans with PTSD.

I also believe that if you are a Veteran and you have PTSD it should be presumptive for service connection but that is just me. All a Veteran should have to do is link it to service and show a diagnosis from a qualified professional.

Getting Service Connected in 1991 for Panic Disorder was no picnic either but I look at PTSD Vets who do not have boiler plate evidence joust with VA for years and become distressed.

What also annoys me is that the VA sits on evidence that could help Veterans cause someone does not want to pay.

So until I see that the VA is kinder and gentler I still maintain that many Veterans have trouble should file separate claims for PTSD and also for co-morbid conditions such as depression or anxiety disorders which come with PTSD for most. Just my opinion.

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I understand what you are saying pete,but you know as well as i do that we as veterans don't have any control over va,that's the reason we have to understand va rules, to be able to help our fellow veterans,to get what we all deserve.On the new rule the only thing change, is the instressor,for instant if you was vietnam veteran and, your mos was a cook,clerk, or mechanic and you seen a lot of enemy soldiers killed outside your camp and this cause you to have ptsd and you sumbit ,form 21-0781 (Statement in support of claim for service connection for Post-traumatic stress disorder) and you are a cook,clerk or mechainc,va could not vertiy your inservice,because va would say you was not a combat veteran and your claim will be denied , under the new rule if you was ln the area where the enemy soldiers was killed,va would vertify that you was in that area,this is where the do or doubt come in and when it is just as much postive as negative it goes to the veteran.If you been diagnose with ptsd,the VA psychiatrist,or psychologist have to corroborate your ptsd with your inservice stressor. I hope this make sense.

mobie16r

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  • HadIt.com Elder

I say file on any mental condition you have evidence for and don't just pursue PTSD. I have a bad feeling that it is going to get harder to get PTSD claims and other MH claims as well. You have to look at what the VA is actually doing and not what they say. You know the VA sees this tidal wave coming at them. They want to get out from under anyway they can. Allowing the VA to be the last word on PTSD DX is going to be murder. These doctors will get the word to not dx PTSD and they will just leave the vet twisting in the PD wind.

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I foresee that possibility too John.

It has shades of the Norma Perez memo suggesting a PTSD diagnosis should be downplayed.

There was such a broohaha over that in light of Shreddergate , and the memo ( email forget )was released to the public but who knows what is going on now in the inner sanctum of the VA as they consider the stats they estimated on the cost of the new IHD regs?

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I guess one more post will not hurt:) After, reading all these posts, I'm getting more and more nervous about my upcoming C&P PTSD exam. I'm currently rated at 30 percent. My doctor was contracted by the VA. This doctor is very respected here in San Antonio, and has seen many many vets for PTSD. Now, the VA wants to do a C&P!! Why do I think that I'm about to get the old shaft. I know that they are not doing this to increase it.

Papa

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Does the clinical record show your PTSD has increased in it's disabling affects to you?

What I mean by that is have you had any hospitalizations for PTSD since getting the 30%?

Has VA changed your PTSD meds to stronger dosage or different type of med due to PTSD problems?

Have you had any work related or legal problems due to the PTSD?

Do you have a significant other who can give the VA testimony as to your increase in PTSD problems?

Have you applied for and been rejected by Voc Rehab solely due to your SC?

Do you consistently participate in Vet Center groups and/or VA psyche therapy?

Does your PTSD shrink thoroughly document your appointments?

Have you accessed the Rating schedule to see how your medical evidence would warrant a higher rating?

Are you still employed?

The C & P exam might go OK- get a copy of the actual results when they are completed and you will have a leg up as to how they will decide the claim.

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Berta,

Thank you for the great advice. I do have a major issue with going or even asking the VA for help. I did the financial thing and was told that I made too much money to qualify for medical care at the VA. I retired because my PTSD was affecting my work. I did not need a shrink to tell me that. BTW, my wife and I where in your area of NY a few weeks ago, we where on an Amtrak train from Chicago.

papa

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Berta,

Thank you for the great advice. I do have a major issue with going or even asking the VA for help. I did the financial thing and was told that I made too much money to qualify for medical care at the VA. I retired because my PTSD was affecting my work. I did not need a shrink to tell me that. BTW, my wife and I where in your area of NY a few weeks ago, we where on an Amtrak train from Chicago.

papa

Papa,

I just read your post, and understand completely what you are saying. I just want to make sure, though, that you are aware that you don't have to do a financial assessment for full VA medical care if you are 50% disabled. You are entitled to all medical treatment and medicines with no copay due to your service connected rating. If you're not taking advantage of it, you might want to give it some thought. Good luck with the C&P exam. I was just notified that I am scheduled for one in about 2 weeks myself.

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Papa, are you saying that you're already 30% SC disabled, but the VA won't let you into the VA Healthcare system? You're SC for PTSD and they won't let you use VA mental health services or healthcare because you make too much money? How can that be?

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Hedgey,

I have never claimed to be brightest star in the sky. Most of this is my fault, and no one else. I have finally contacted the VA PTSD unit at the VA hospital here in San Antonio. I have also started to wear my Vietnam Veteran's cap, again. BTW, there is a financial assessment that the VA has, and it will tell you whether or not you qualify for care. But, then, I get a letter that says I qualify for cat. B. Never could find out what cat. B is or means.

papa

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Papa,

I'm assuming your 50% disability rating is for service connected conditions. If so, according to the health care enrollment form (1010EZ) instructions, you are not required to complete a financial disclosure. The instructions state:

Section V - Financial Disclosure: ONLY NSC and 0% NONCOMPENSABLE SERVICE-CONNECTED

VETERANS MUST COMPLETE THIS SECTION TO DETERMINE ELIGIBILITY AND COPAY

RESPONSIBILITIES IF THEY ARE NOT:

· a former Prisoner of War or;

· in receipt of a Purple Heart or;

· a recently discharged Combat Veteran or;

· discharged for a disability incurred or aggravated in the line of duty or;

· receiving VA service-connected disability compensation or;

· receiving VA pension or;

· in receipt of Medicaid benefits

Sometimes, the people you speak with at the VAMC or clinic are not really aware of the requirements, and they will tell you that you have to fill out all parts of the form. Anyway, this is just for information purposes. I hope it might help you down the road.

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Papa, I'm the dim bulb in the box around here. I thought that because I was able to get healthcare without a means test when I was only 10%, it meant that that was true for everyone else who was at least 10%. I never paid attention to the eligibility requirements that JustPLS posted (thanks!).

I was discharged because of my disability, that's why they never made me do a means test.... duh. Even dumber, Papa, was that I didn't pay attention to my eligibility and didn't use the care for nearly 25 years. DUH!!!!

You shine, Papa!!

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I don't think the problem is with us, but with the way the VA displays its information. I read one place that I had to do a means test, but years later run across another page said I did not have to because I had a service connected disability. I have called and emailed my local PTSD VA outpatient clinic for help for over a week, nothing. I did visit the local Vet Center, and the head guy is nutter then me.

Papa

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  • HadIt.com Elder

The unstated "conflict of interest" reasoning is that come review for raise time, a VA treating doctor who "service connects" something with a medical records statement is not acting in their own "self interest".

I firmly believe that the VA must give their doctors some written direction that tells them how to evade and avoid making such statements.

It is possible to sometimes get a VA doctor to write such things, when they "are to be used" for "non VA" purposes (SSDI, etc.) Usually Non VA forms are provided by SSA or possibly an insurance company.

Once filled out, particularly the SSA/SSDI forms, they can be used as evidence in a VA case, such as an appeal proceeding.

None on my VA doctors would help write me a nexus letter. I used to ask them..

(I also asked a few VA doctors to help me by writing a nexus).. I also told VA surgeons where I was injured when they asked me what my injuries were.. and where I got them..

I had to go pay an outside specialist to write an IMO and it was $1,600

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  • HadIt.com Elder

To the best of my knowledge, the net worth/financial statements only need to be filled out by those veterans who might qualify for pension/free care based upon low income.

In the past, the VA did restrict enrollment of veterans who did not fall below financial limits, and who had no service connected disabilities.

Basically, the VA was forced into enrolling veterans anyway, due to a combination of the veterans "drug act", and the desire of the VA to increase the number of "enrolled" veterans.

Enrollment was/is not a requirement for obtaining drugs from the VA. The VA can "review" an outside doctors prescriptions, and then a VA doctor writes internal VA prescriptions.

( I did have VA Clinics at various times ask for a financial statement, and told them no, since it was not required and not in my interest to do so.)

Never give the government or anybody else any more information than you must.

In my state, normal prescriptions expire on the average of every six months.

When the VA supplies prescriptions, they tend to meet the six month requirement by scheduling an appointment, or on paper, having the VA doctor "review and renew" the prescription.

"Review and renew" is often used for drugs that are long term treatment for chronic conditions. IHD and Diabetes are prime examples.

Without such a statement showing net worth/income below the limits, the VA will usually charge "Co-Pay", and may even do so for drugs and treatment that is associated with a service connected

problem. (Make a mistake in the VA's favor, if you make one at all.) When questioned, the stock initial answer is that "It must be adjucated".

Currently, the VA is charging veterans co-pay for drugs and possibly treatment for "presumptive" conditions.

How prevalent this is seems to be something the VA doesn't want to talk about.

This is in direct conflict with the laws concerning presumptives. Basically, when something is given presumptive status, the VA is to regard it as service connected, unless they can prove otherwise.

The law on presumptives also severely limits the ways that the VA might prove otherwise.

As a result, the VA has no authority under the law to charge a veteran for drugs or treatment associated with a presumptive, unless the VA can prove that the condition is not service connected.

Papa,

I'm assuming your 50% disability rating is for service connected conditions. If so, according to the health care enrollment form (1010EZ) instructions, you are not required to complete a financial disclosure. The instructions state:

Section V - Financial Disclosure: ONLY NSC and 0% NONCOMPENSABLE SERVICE-CONNECTED

VETERANS MUST COMPLETE THIS SECTION TO DETERMINE ELIGIBILITY AND COPAY

RESPONSIBILITIES IF THEY ARE NOT:

· a former Prisoner of War or;

· in receipt of a Purple Heart or;

· a recently discharged Combat Veteran or;

· discharged for a disability incurred or aggravated in the line of duty or;

· receiving VA service-connected disability compensation or;

· receiving VA pension or;

· in receipt of Medicaid benefits

Sometimes, the people you speak with at the VAMC or clinic are not really aware of the requirements, and they will tell you that you have to fill out all parts of the form. Anyway, this is just for information purposes. I hope it might help you down the road.

Edited by Chuck75 (see edit history)
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F...I should of filed like 39 years ago...I put this away for so long....I am EXHAUSTED AND DRAINED just from dipping into this PTSD forum....I see I got a long, hard journey ahead of me...who the heck do these VA psychs think they are...BTW, I have a VAMC (initial physical) appointment Tuesday (but been inpatient/outpatient, mental, some years ago) and am pushing myself to open up a horrible can of squirming worms....

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