ptsd Interesting Movement On Claim

[westcoastlv]

Per EBenefits, there is some new and interesting movement on the claim.

Origianl claim rated last year @ 50% PTSD. My husband and I thought it should be higher, and the DAV suggested filing for an increase, which we did. Then, we decided to file a Reconsideration Request, which stated that if the claim could not be reconsidered, then it should be accepted as a NOD. We faxed it on 10/31/11 (then followed up with certified mail).

I just saw on EBenefits, in the closed claims section, that an Administrative Review was opened on 10/31/11 and closed on 11/14/11. There are no details except it lists all of the documents from the original and increase claims. There is no indication if anything was decided, except that it is now closed and can be appealed.

Has anyone see this before, any indication of what this could mean?

[carlie]

Carlie,

Here are the statements from the Dr's Report, this WAS NOT part of the original claim:

"The examiner (PhD) provides a GAF score of 45 which is used in rating overall psychological, social and occupational functioning of people over 18 years of age, but excludes physical and environmental impairment. Conversely, according to the DSM-IV, a 45 GAF score is supposed to demonstrate serious symptoms OR any serious impairment in social, occupational, or school functioning."

"Therefore it is a gross misrepresentation of the actual facts of Mr. Veteran's case to take the above information and then use it to underrate the severity of Mr. Veteran's service connected PTSD"

"Both the medically qualified C&P Examiner and now myself (another clinically qualified, licensed Psychologist) are in agreement that the SEVERITY of Mr. Veteran's PTSD should be rated at a Global Assessment of Functioning score of 45, 'which is indicative of serious symptoms or serious impairment in social, occupational, or school functioning'. This correlates with the 100% SC disability rating of the General Rating Formula for Mental Disorders."

"Mr. Veteran has not been able to work since 2008 due to the nature, severity and chronicity of his service connected PTSD. He has also been unable to go to school due to the nature, severity and chronicity of his PTSD. This also correlates with the 100% SC disability rating of the General Rating Formula for Mental Disorders."

"After reviewing the current medical records, it is my professional opinion that Mr. Veteran's current condition is "more likely than not" related to the in-service condition. Due to the nature, severity and chronicity of Mr. Veteran's Posttraumatic Stress Disorder (PTSD), it is my professional opinion that he can no longer maintain full-time gainful employment, nor can he sustain effective social relationships. Mr. Veteran's prognosis for improvement remains poor, therefore his disability should be considered to be permanent."

The veteran has the following significant barriers to learning: Emotional barriers: comment: severe, chronic, service connected PTSD.

Also, got a call from the VA C&P Examination office today to make a new C&P appointment. Things seem to be moving very quickly, and now my husband has gotten paranoid that they are trying to take his 50% rating away.

Any thoughts??

wc,

With what I bolded and underlined above - VBA might inferred a claim for IU.

Has a 21-8940 been submitted ?

The mental health providers at the top, apparently do not understand how the VBA

arrives at evaluation percentages.

For VBA - a GAF score alone, will NEVER be all that VBA factors into the percentage of disability assigned.

The GAF score is only one factor that is used.

Here's some research material.

http://www.va.gov/vetapp10/Files4/1039965.txt

A Global Assessment of Functioning (GAF) rating is a scale

reflecting the psychological, social, and occupational

functioning on a hypothetical continuum of mental-health illness.

Richard v. Brown, 9 Vet. App. 266, 267 (1996), (citing Diagnostic

and Statistical Manual of Mental Disorders (4th ed. 1994)). The

Board notes that an examiner's classification of the level of

psychiatric impairment, by words or by a GAF score, is to be

considered, but is not determinative of the percentage rating to

be assigned. VAOPGCPREC 10-95.

- - - - - - - - - -

http://www.va.gov/vetapp10/Files4/1039783.txt

Since the initial grant of service connection, the Veteran has

been assigned GAF scores ranging from 52 to 75, with no

discernable pattern. Of the GAF scores assigned, 4 scores

indicated moderate symptoms or moderate difficulty in social,

occupational or school functioning; 3 scores indicated mild

symptoms or some difficulty in social, occupational, or school

functioning; and 1 score indicated no more than slight impairment

in social, occupational, or school functioning. Although GAF

scores are important in evaluating mental disorders, the Board

must consider all the pertinent evidence of record and set forth

a decision based on the totality of the evidence in accordance

with all applicable legal criteria. See Carpenter, 8 Vet. App.

at 242. Accordingly, an examiner's classification of the level

of psychiatric impairment, by word or by a GAF score, is to be

considered but is not determinative of the percentage VA

disability rating to be assigned; the percentage evaluation is to

be based on all the evidence that bears on occupational and

social impairment. Id.; see also 38 C.F.R. § 4.126 (2008);

VAOPGCPREC 10-95, 60 Fed. Reg. 43186 (1995).

Throughout the pendency of this appeal, the Veteran's PTSD was

marked by occupational and social impairment with reduced

reliability and productivity due to such symptoms as: nervous,

anxious, and/or tense affect; panic attacks; impairment of

memory; disturbances of motivation and mood; difficulty in

establishing and maintaining effective work and social

relationships; paranoia, psychomotor agitation; self-isolation;

low self-esteem; self-critical; low self-worth; feelings of

guilt; feeling compelled to stay busy; hypervigilance; periodic

verbal angry outbursts; intrusive thoughts; nightmares; avoidance

behavior; sleep difficulties; hyper-startle response;

irritability; poor concentration; and agoraphobia. Moreover, the

Veteran was assigned GAF scores that indicated slight to moderate

PTSD symptoms. Based on a longitudinal review of the evidence of

record, the Board finds the symptoms associated with the

Veteran's service-connected PTSD more closely approximated the

criteria for a 50 percent evaluation throughout the pendency of

this appeal. 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411;

Fenderson, 12 Vet. App. at 126. As such, the Board finds that a

50 percent rating for the Veteran's PTSD is warranted throughout

the pendency of this appeal.

- - - - - - - - - -

VBA uses - 38 CFR - Part 4

§ 4.130 Schedule of ratings—mental disorders.

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=e385413526414e4ae4a2ee998623e016&rgn=div8&view=text&node=38:1.0.1.1.5.2.111.73&idno=38

General Rating Formula for Mental Disorders:

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships

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