ptsd Ptsd - Va Does Not Recognize Private Diagnosis

[Apple]

I was Diagnosed with severe PTSD with panic disorder, social/work impairment and personality disorder one year ago by a private psychologist. <br style="mso-special-character:line-break"> <br style="mso-special-character:line-break">

I have been unable to work since that time due to PTSD and other medical conditions. Although I have been suffering with the symptoms of PTSD, for a long time, and out of the service since 1999, I have just recently filed a claim with the VA for my PTSD.

I had my C&P examfor PTSD in March. It went as such:

I was greeted with a typical 'how are you' when meeting the examiner. Then, the examiner said that he thought I was an army vet, to which I stated "no, I was Navy". The examiner asked a variety of questions, including "do you have a stressor"? - to which I responded "yes". Note: the examiner never asked me to elaborate on my stressor during this exam. After approximately 110 minutes with the examiner, the exam concluded.

I requested and obtained a copy of the C&P exam by mail a few weeks later. I noted that the answers I gave were not those that the examiner recorded, but were mostly the opposite to the answers I gave during the exam. The C&P examiner's results stated that I do not have PTSD because I do not meet the DSM IV criteria for a PTSD diagnosis. However, my daily condition supports nearly all the affects and symptoms of PTSD, and my private psychologist confirms this in his diagnosis.

Although I was not involved in direct gunfire, I am a combat vet, and have several stressors that were considered life threatening.

My questions:

1) Will not having a diagnosis of PTSD by the C&P examiner stop my claim for PTSD regardless of the supporting evidence?

2) Seeing that I was given a C&P exam for PTSD, does that mean that my stressor was accepted?

3) Does branch of service stressor play a role in whether one is diagnosed for PTSD by the VA? If so, how?

4) Is it possible to get another C&P exam for PTSD before my claim moves to the next stage?

This C&P exam has me believing that the examiner failed to look at private medical records, and made everything up. I sure don't want a denial based upon a bogus C&P exam.

Thoughts..

Apples

[Tbird]

New Regulations on PTSD Claims

http://www.va.gov/ptsd_qa.pdf

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 timeconsuming requirement where the claimed stressor is related to “fear of hostile military 2

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 3

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-bycase 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.

[Papa]

Tbird- Thanks for the post. Hope you cut and pasted this, it would take me a month of Sundays to have typed this out

Apple, only a suggestion, but contact your Vet Center. Talk to them, and they might be able to help you. Also, why not go to your local VA medical facility and tell them you need to see a mental health professional. You need something or someone to counteract the VA shrinks findings.

Papa

[Apple]

<br />Most of the post here talk about only a VA Doctor can Dx PTSD, and this is totally wrong.  But, I don't think the VA  even likes it when their own Doctor Dx Vets with PTSD.  I had a VA Doctor Dx me with PTSD, and about a year later decided that I needed to be re-evaluated, and we know it is not for an increase, well the second VA Doctor's Dx was even more compiling then the first.  It was not what the VA wanted to see, I guess that is why I have been waiting since Oct 2010.  <br /><br />Apple,  do not give up.  These people here are wonderful.<br /><br />Papa<br />

<br /><br /><br />

Thanks for the encouragement. I was suprised by the statements in the examiner's report. The examiner seemed to avoid questions that would support my diagnosis, then changed my response to nearly all of the symptoms. I could hardly believe it. I don't plan giving up on this claim if I am denied.

[Apple]

Carlie,

The private psychologist who diagnosed my PTSD was shown copies of SMRs which included diagnosis as well as actual event records, evaluations and awards from my military service. My medical records support a PTSD diagnosis per DSM IV, and I was given a nexus relating my diagsosis to the injuries and events that occurred in service. In service events can be verified through both ship's logs and historical events in the news. My evaluation verify. I don't want to get specific about one of my stressors, but it is as obvious to the VA as being in direct gunfire, and is listed among the top stressors in PTSD. Lack of stressor questions by the examiner and statement that I do not have a stressor is why I believe that my records were not adequately reviewed. I believe that the stressor was not a problem. Until proven wrong, I believe that the examiner either failed to obtain the required information from my service records or did not feel like going through the motions of getting it from the source.

Edited July 13, 2011 by Apple

[Apple]

Thanks Tbird,

Your post about the new presuptive was helpful. I appear to meet all requirements with the exception of a VA diagnosis.

[Apple]

&lt;br /&gt;Tbird- Thanks for the post.  Hope you cut and pasted this, it would take me a month of Sundays to have typed this out &lt;img src='http://www.hadit.com/forums/public/style_emoticons/default/biggrin.gif' class='bbc_emoticon' alt='<img src='http://www.hadit.com/forums/public/style_emoticons/default/biggrin.gif' class='bbc_emoticon' alt='' />' /&gt;&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;Apple,  only a suggestion, but contact your Vet Center.  Talk to them, and they might be able to help you.  Also, why not go to your local VA medical facility and tell them you need to see a mental health professional.  You need something or someone to counteract the VA shrinks findings.&lt;br /&gt;&lt;br /&gt;Papa&lt;br /&gt;

&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;

Thanks. I will be doing what you have suggested during my next appointment.

Edited July 13, 2011 by Apple