How Can C&p N.p. Give Non-Medical Report/opinion

[acesup]

Hi, long time since I've posted here. I got shot down in March, denied on all counts, and I've not been handling it so well. But, it is better, and I refuse to quit.

I got in some trouble when I was in the Air Force. I believe it is because of the onset back then of possibly depression/chronic pain disorder and Obstructive Sleep Apnea. (OSA was unknown to the medical community back then, so was Chronic Pain Disorder, but my SMR's cite many of the symptoms that would lead to those diagnoses.)

The C&P N.P. shrew, in her report, began it with a long review of my disciplinary problems while on active duty. She wrote it in a way that would make me look awful, right off the bat, to anyone reading the report.

Personally, this seems unethical to me. I never saw where the VARO requested a recap of my personal conduct record, I thought they simply requested a medical examination/review.

I know we're talking about a VA N.P., but even for one of those, this just seems wrong.

For the record, I received an Honorable Discharge, and was told at the time it was for hardship, but much later I learned that some quack Psychiatrist (whom I never saw) and my C.O. had actually discharged me as "unable to adapt", claiming I exhibited symptoms of several disorders, hence a diagnosis of "Personality Disorder N.O.S.". He claimed that I said if I didn't get out I would "just keep getting into fights". Only fight I ever got into was with a punk who poured hot coffee on me.

Edited October 30, 2011 by acesup

[carlie]

I got shot down in March, denied on all counts, and I've not been handling it so well.

acesup,

What exactly is stated in the Reasons and Bases Section of the Rating Decision ?

[acesup]

Hi, thanks for the responses.

I got into trouble for AWOL; an article 15, then a court martial the second time.

After I had been in the Air Force for a few months, there were some awful things going on in my family; worst was the fact that my father went missing (as it were, he stayed missing for 19 years, long story). Added to that I learned, while in tech school, that my stepfather was physically abusing my youngest sister and brother, and there was reason to believe that sexual abuse was also part of it.

There were some other things going on too, I won't dredge it all up.

Bottom line, I asked for and was denied leave of absence or discharge for hardship, and I went AWOL. Twice. I was busted, fined, served two months in lockup, and went through retraining group. The family problems had only gotten worse, and I was having a number of issues (physical injury and depression) so I once again requested a hardship discharge. I was told that it was approved. A month or so later, I was called to Squadron HQ and told to pack my stuff and process out.

That was 1974.

I am 50% SC for the back injury and for residuals of hepatits (which was determined to be a gift from processing out exams, either medical or dental.)

I was diagnosed with depression while active duty. My SMR's show complaints of headaches, nervousness, depression, fatigue, sleeplessness, etc.

I filed in 2007 for some issues including OSA and depression and/or other associated mental disorder. I had some strong nexus opinions, but the NON-SPECIALIST, NON-BOARD CERTIFIED IN ANYTHING Nurse Practitioner shot down the OSA and other stuff. The C&P psych confirmed my diagnosis of long-term depression, and added a dx of Chronic Pain Disorder, but then said that while it was possibly related to service, it also was possibly not, therefore it was not due to SC. Funny, her words seem to say "at least as likely as not", but then she says not likely. Kind of contradictory, but it was good enough for the VARO to say no.

I will likely be hiring a NOVA lawyer for my appeal soon.

[Hoppy]

I agree with Carlie that we need to hear what the denial said.

I had some strong nexus opinions, but the NON-SPECIALIST, NON-BOARD CERTIFIED IN ANYTHING Nurse Practitioner shot down the OSA and other stuff.

Were your nexus opinions from specialists? What were their credentials? Did they treat you?

You were diagnosed with a Personality disorder in 1974 under diagnostic criteria of the DSM II. I have had no problem getting these old DSM II diagnoses thrown in the trash. The problem is that you need to develop a replacement diagnosis based on the symptoms of record at the time you were in the military. This often requires multiple notations of symptoms noted in a clinical setting. If there is very little in your records to go on the doctors will say there was insufficient records to form an opinion.

The symptoms noted in the military need to be linked to a current service connectable mental condition by a qualified clinician. If you get an opinion from a MD the VA will rebut you with an MD. If you get a psychiatrist then the VA will need to rebut you with a psychiatrist. Phd's or other staff working under the supervision of a Phd can also write reports. Check with your service officer or VA regs, to get a list of required qualifications.

It would be best if the clinician making the link provided an independent medical opinion (IMO).An IMO is based solely on a review of all records including military and any records since the military. The clinician must say that the opinion is based on the records including your service records and current records and that you were either not interviewed by the doctor or that statements you made during his interview were not used to make the linkage between in service symptoms and your current diagnosis.

You need to find a qualified clinician who will work with you. There reports must be written in a proper format and based on records acceptable to the VA. Check the IMO link on hadit for more information.

If they send you to another C&P and they try to continue the personality disorder diagnosis this will require more of an effort. I have been able to get current diagnoses of personality disorder diagnoses thrown in the trash even when they were made by forensic psychiatrists the VA contract with for the opinion. The current criteria for making a retrospective diagnosis of a personality disorder when the individual exhibits symptoms of other mood and anxiety disorders in very difficult to establish.

I know of at least 10 veterans who have posted on hadit in the last fifteen years who were discharged in the 70's with a personality disorder who were able to establish another service connectable mental condition including John999.

I have been able to use VA treating clinicians to write the reports. However, it is hit and miss. Many VA clinicians will not get involved in the review of old records and writing

reports for compensation.

Do you have depression secondary to your back condition?

Edited October 31, 2011 by Hoppy

[71M10]

Greetings,

It sounds like the NP read the medical statement from the psychiatrist that was used to Chapter you on a personality disorder. If you were chaptered for a personality disorder, then the litany of your behavior is very much medical evidence. You seem to be spitting fire and brimstone at her, but you havn't indicated with any specificity the credentials of those that issued your "strong nexus opinions". In reading your postings you indicated these things started "a few months" after joining the Air Force and you cited Tech school as a starting point. Did you complete training? How many years (or months) of service medical records are available to back up a diagnosis of these in-service chronic medical problems? Just about anyone in Initial entry training at some point could be diagnossed with depression. Did the doctors that wrote your medical opinions address/overturn the personality disorder diagnosis? It seems to me until you have medical evidence and a direct opinion overturning that personality disorder diagnosis you arn't going to get much traction on your other Mental Health claims.

You seem very angry, but being angry oftentimes doesn't help the situation. Give the members here on the board some more detail and we might be able to provide some more targeted advice.

Best regards,

[john999]

I think your best bet would be to ask for secondary depression/pain disorder based on your SC back condition to get you to TDIU. You do this with an IMO as Hoppy said. After almost 40 years this is probably the only way to get it. What Chapter was your discharge? Was it for a PD or result of courts martial? Did you get an honorable discharge? You can have a PD diagnosis and have depression or even a psychotic or neurotic disorder superimposed on it. Start with what you already have in the bag and expand from there.

[EricHughes]

I think your best bet would be to ask for secondary depression/pain disorder based on your SC back condition to get you to TDIU. You do this with an IMO as Hoppy said. After almost 40 years this is probably the only way to get it. What Chapter was your discharge? Was it for a PD or result of courts martial? Did you get an honorable discharge? You can have a PD diagnosis and have depression or even a psychotic or neurotic disorder superimposed on it. Start with what you already have in the bag and expand from there.

Your particular situation screams for the help of a NOVA advocate. It will require a lot of time to properly develop, and the NOVA advocates typically have smaller case loads than a NSO from a veteran's service organization. Thus, they have the ability to provide the time and attention your case requires.

What I think John is getting at is that you need to EITHER show that the pattern of depression continued since active duty. Or that the current depression is related to a service connected condition. It will be easier to show a secondary cause at this time. However, if your depression is recurrent and part of a continued pattern of recurrence that started while on active service -as in a bi-polar- diagnosis then you could get direct service connection. One thing to consider is do you have any service records that are new and material to your claim? If you do, a good advocate can get the VA to get an earlier effective date. One place to look is to request via FOIA the daily desk logs for the dates surrounding your AWOL, and Court Marshal. They may have evidence in them that are not part of the VA record that can drasticlly help you. Your advocate should have info on how to request them.