ptsd Not Sure Where To Turn

[Jay]

I have been on this site for a while but new to posting. I am 90% disabled for PTSD and Bipolar II Mixed and currently going through a hard time. In the past I was turned down for TDIU and SSD because nothing in my records stated I couldn't work just my condition is guarded. I have no place in the area to get an IMO since I live in the booneys. My VA treating doctor and social worker have recently wrote short letters that may or may not help my case. They were reluctant to do so. I just left my last job because stress and panic it caused me on the job due to my PTSD. I was wondering if I can (appropriate) to share my two letters and get oppinions on how it may help or not help my case? The letters are about a half a page put together. I've been able to get employment but not maintain it. Thanks.

[Jay]

Would a letter stating I am catastrophically disabled by the VA help for TDIU and SSD?

[cooter]

I would definitely say so.

DEFINITION OF CATASTROPHICALLY DISABLED

1. Catastrophically disabled (CD) means to have a permanent severely disabling injury, disorder, or disease that compromises the ability to carry out the activities of daily living (ADL) to such a degree that the individual requires personal or mechanical assistance to leave home or bed or requires constant supervision to avoid physical harm to self or others.

2. A veteran may meet the initial CD requirement by a:

a. Clinical evaluation of the patient’s medical records that documents that the patient previously met the criteria set forth in following paragraph 3 and continues to meet such criteria (permanently), or would continue to meet such criteria (permanently) without the continuation of on-going treatment; or

b. Current medical examination that documents that the patient meets the criteria set forth in following paragraph 3 and will continue to meet them, or would continue to meet such criteria (permanently) without the continuation of on-going treatment.

3. This definition is met if an individual has been found, by the Chief of Staff (or equivalent clinical official) at the Department of Veterans Affairs (VA) facility where the individual was examined, to have a permanent condition specified in following subparagraphs 3a, 3b, or 3c:

a. One of the permanent diagnoses found on website: http://vaww.va.gov/v...01/report01.htm (see “View CD Diagnoses”).

<H1 style="MARGIN: 0in 0in 0pt">OR </H1>b. A condition resulting from two of the International Classification of Diseases, 9^th Edition, Clinical Modification (ICD-9-CM) procedure codes, or associated V codes when available, or Current Procedural Terminology (CPT) codes provided the two amputation procedures were not on the same limb. These codes can be found at the following website: http://vaww.va.gov/v...01/report01.htm (see “View CD Diagnoses”).

<H1 style="MARGIN: 0in 0in 0pt">OR </H1>c. One of the following permanent conditions:

(1) Dependent in three or more ADLs; i.e., eating, dressing, bathing, toileting, transferring, incontinence of bowel and/or bladder, with at least three of the dependencies being permanent with a score of 1, using the Katz scale. NOTE: The Katz Index of ADL assigns a maximum of 18 points across all six ADLs. The most dependent rating on each ADL is a 1, and an intermediate functional limitation is a rating of 2, with independence rated as 3. To be catastrophically disabled, the veteran must have a rating of 1 on a minimum of three permanent ADLs. For example, a veteran dependent in all ADLs would have a total Katz score of 6. VHA DIRECTIVE 2004-067 CORRCETED COPY November 22, 2004 A-2

Similarly, a veteran dependent in three ADLs and needing less assistance in three other ADLs would score 9.

(2) A score of 10 or lower using the Folstein Mini-Mental State Examination (MMSE). NOTE: The MMSE has a maximum assignment of 30 points across eleven measures. A score of less than 10 is consistent with severe cognitive impairment. To qualify for CD status, there must be documentation in addition to the MMSE score of 10 or lower, showing that the patient has a permanent cognitive impairment. To show that the impairment is permanent, the reversible causes of cognitive impairment need to be ruled out. A common example is a delirious patient who may score very badly on the MMSE, but improve once the source of delirium is treated. It is also important for evaluators to remember that a low MMSE score by itself is not diagnostic (i.e., it is not specifically diagnostic of dementia), but it is an indication of cognitive impairment that warrants further evaluation.

(3) A score of 2 or lower on at least four of the thirteen motor items using the Functional Independence Measure (FIM). NOTE: The FIM contains eighteen measures in six domains. The thirteen motor items are in four domains: self-care; sphincter control; transfers; and locomotion. The scores across all these domains range from needing a helper because of complete dependence (score of 1 for total assistance and a score of 2 for maximal assistance), with intermediate scores 3 through 5 for modified independence, to scores 6 or 7 when no helper is needed. To be CD, the veteran must have a score of 2 or lower on at least four permanent conditions of the thirteen motor items using the FIM.

(4) A score of 30 or lower using the Global Assessment of Functioning (GAF). NOTE: The GAF is taken directly from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), p. 32, except that VHA only includes scores from 1 to 100, excluding 0 (insufficient information).

(a) GAF is a 100-point scale divided into ten defined levels, with higher scores indicating a higher overall level of functioning. For example, the Description of the GAF level 21 to 30 is as follows: “Behavior is considerably influenced by delusions or hallucination or serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) or inability to function in almost all areas (e.g., stays in bed all day, no job, no home or no friends).”

(b) GAF is to be used only to reflect psychological, social, and occupational functioning. Impairment in functioning due to physical illness or environmental limitations are not to be taken into consideration in using this scale. The scale rates both functioning and, particularly in the higher ratings, the severity of symptoms due to a mental disorder. Using GAF for documenting the CD may be only done in the context of a mental disorder considered to be of a permanent nature. For example, a patient with a serious suicidal attempt might well rate a score under 30, but generally within a few days or weeks will return to a much higher level both symptomatically and functionally. CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 A-3

4. References

a. Katz S, Downs TD, Cash HR, et al. “Progress in the Development of the Index of ADL,” The Gerontologist. Part I:20;1970.

b. Juva K., Sulkava R., Erkinjuntti T., et al. “Staging the Severity of Dementia: Comparison of Clinical (CDR, DSM III-R), Functional (ADL, IADL) and Cognitive (MMSE) Scales,” Acta Neurologica Scandinavica. 90:293;1994.

c. Folstein MF, Folstein S, McHugh PR. “Mini-mental State: A Practical Method for Grading the Cognitive State of Patients for the Clinician,” Journal of Psychiatric Research. 12:189; 1975. CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 B-1

[Jay]

Thanks cooter for your reply. I will submitted the catastraphoic letter. I also received a letter today stating I am not feasable for employment from Voc Rehab. Can I use this for TDIU and SSD. It mentions after speaking with me the following issues were noted

inability to deal with authority figures which casuses you high anxiety

Difficulties dealing with and managing stressful situations on the job

Concentration issues affecting your job performance and completeing your educational training

PTSD and Bipolar causing you to struggle with social and occupational settings

Uncessful maintaining employment for any period in time and in any setting because of PTSD and Bipolar symptoms; you have not been

able to perform job duties and you continually are assigned different job assignments, have conflicts with coworkers and supervisors etc..

You have had two jobs since moving to _____ and were uncessful retaining them do to your service connected disabilities.

Based on this information, we are unable to find feasible for employment under guideline of Vocational Rehabiltating

Independent living services not needed at this time.

.

Thanks for everyones replies. Not having the complete support of my doctors with regards to writing lengthy supporting letters and no IMO anywhere near I am trying to gather what I do have to make a strong case. So any comments are welcomed and appreciated on how strong a case I may or may not have at this time using the 2 doctor letters, Catastrophic Disabled letter, and now the Voc Rehab lettter.

[cooter]

YES, by all means submit the Voc Rehab letter. Their statement "Based on this information, we are unable to find feasible for employment " is strong evidence you can not work.

Submit this with the other docs to SSA and your claim for TDIU.

I can't remember if you mentioned earlier if you already have a claim in for TDIU or not. If you already did file, make sure the Voc Rehab letter gets in your c:file so it would be considered evidence in the claim.

Coot

[Jay]

Ok so I turned in the two Dr. Letters below, Voc Rehab not feasible employment letter, and the Catastrophically disabled letter since 2009 into the Regional office via my Service Officer all this month. Today I received a chapter 35 DEA dependents pamphlet with a letter about my son and/or daughter may be eligible for these benefits. Does this mean I got the TDIU P&T I requested. I haven't had a C&P but I did have one two years ago that gave me the PTSD at 70%. This seems very fast to get one of these pamphlets already. Comments?

[cooter]

For the moment, all I can say is, it's not a bad sign!

I sure nobody can give you a positive answer if it was granted or not. To early.

Coot