ptsd Wife And Caregiver Of Totally Disabled Vet

[Caregiverjc]

My husband is a Vietnam vet. He applied for PTSD 3 years ago and has been denied. He appealed, had another exam about a year ago, still waiting to heal. We are sure that they chalk his PTSD to his other condition. A little history: Over 20 years ago my husband was in an accident and suffered a severe brain injury. The catastrophic injury has left him in a wheelchair and I have to take full care of him. He has severe short term memory problems and needs help with every daily existence. He has no VA benefits because of the, I think 2003 law change about qualifying. I think he can qualify for housebound but not sure. My question is should he wait until we hear about the PTSD claim or start a new claim in the other direction. I would like some advice on what to do and where to start. This is all new for me and my husband isn't able to help. If anyone can help I so would appreciate it.

[Berta]

Yes, you are right, the veteran hiself must request a copy of any VA medical opinions himself-from the VAMC where the C & P was done or from QTC bu I understand QTC doesn't release these oinions until the claim is resolved?????

I hope someone clarifies that here.

You gave good advise and the veteran does need a POA -maybe I jumped the gun on a lawyer because this claim is unusual to me-knowing the veteran certainly was exposed to stressors, yet the MH doc said he didnt seem to have enough' symptoms' consistent with a PTSD diagnosis.

These are some detailed BVA decisions that show how VA can separate brain trauma residuals from PTSD:

http://www.va.gov/vetapp10/Files6/1045937.txt

The veteran had been given a complete neurological exam

“Revised DC 8045 states that there are three main areas of

dysfunction that may result from TBI and have profound effects on

functioning: cognitive (which is common in varying degrees after

TBI), emotional/behavioral, and physical. Each of these areas of

dysfunction may require evaluation. 38 C.F.R. § 4.124a, DC 8045

(2010).”

The cognitive functioning element is “common to TBI” as the decision states but not necessarily to PTSD at all.

The decision goes on to state:

“Cognitive impairment is defined as decreased memory,

concentration, attention, and executive functions of the brain.

Executive functions are goal setting, speed of information

processing, planning, organizing, prioritizing, self-monitoring,

problem solving, judgment, decision making, spontaneity, and

flexibility in changing actions when they are not productive.

Not all of these brain functions may be affected in a given

individual with cognitive impairment, and some functions may be

affected more severely than others. In a given individual,

symptoms may fluctuate in severity from day to day. Evaluate

cognitive impairment under the table titled "Evaluation of

Cognitive Impairment and Other Residuals of TBI Not Otherwise

Classified." Id.”

http://www.va.gov/vetapp11/Files4/1139650.txt

Is also a similar case but other cases are problematic.

This veteran claimed both PTSD and cognitive disorder.The cognitive disorder was service connected but the PTSD appeal was dismissed.

http://www.va.gov/vetapp11/Files5/1141117.txt

Another case might help:

in part:

“The Veteran's service treatment records show that he injured his head during an incident in December 1995 when a stove exploded upon lighting. He received extensive treatment for burn residuals to his face and left hand following the accident. He received extensive treatment for burn residuals to his face and left hand following the accident.

In February 2008, the Veteran was referred to the VA neuropsychiatric clinic after reporting memory and cognitive problems in addition to a history of a head injury. The Veteran indicated that he had started noticing memory problems about one year earlier. He also reported having chronic fatigue, sleep disorders, and poor concentration. The examiner described the December 1995 injury as a loss of consciousness incident, and there were many other incidences of altered consciousness reported as being due to work as a combat engineer. Clinical testing revealed several cognitive defects. The examiner believed that the Veteran had mild cognitive defects due to the prior head injuries, but indicated that was able to cope prior to the onset of depressive and anxiety type psychiatric symptoms. He diagnosed the Veteran with an unspecified cognitive disorder.

The Veteran underwent another VA neuropsychiatric evaluation in July 2009. He reported similar symptoms to those he described during the prior examination. The examiner noted the Veteran's military history involving the injury in December 1995 and his exposure to explosive devices. Cognitive testing revealed several mild deficits. The examiner concluded that the December 1995 incident was a mild TBI and diagnosed the Veteran with a mild unspecified cognitive disorder with minimal changes during the past year. The examiner commented that the present cognitive symptoms seemed to be secondary to TBI residuals. However, he indicated that individuals with mild TBI may recover in a few years and noted that the Veteran's history was significant for a reaction to anthrax vaccination. The examiner also recommended further evaluation to determine the medical cause of excessive fatigue before further cognitive remediation resumes.”

“The Board finds the current evidence sufficient to warrant a grant of service connection for TBI. The Veteran's service treatment records document a head injury, and the Board has no reason to doubt the credibility of the Veteran's reports of working near explosive devices, as his military occupational specialty was listed as a combat engineer while serving in Iraq. In addition, the February 2008 and July 2009 VA neuropsychiatric reports both indicate that the Veteran currently experiences some cognitive impairment related to those incidents in service. “

and

“The Veteran has been diagnosed as having PTSD by a VA psychologist based upon reports of stressful experiences involving fear of hostile military activity...”

(His PTSD claim fell under the new PTSD criteria)

“Subject to the provision governing the award of monetary benefits, service connection for PTSD is granted.

Subject to the provision governing the award of monetary benefits, service connection for a traumatic brain injury is granted. “

from:

http://www.va.gov/vetapp11/Files3/1120557.txt

I am very stunned at the VA's denial of PTSD in Caregiverjc's husband's case.

It is possible he was unwilling to reveal some symptoms or even underplay them during the PTSD C & P.

As I understand it they are awaiting for a decision as this is on appeal.

Caregiver stated ina prior post:

"My husband did go to VA for a couple of years for counseling and group meetings. The VA counselor agreed he has PTSD."

I wonder if the VA even considered those records.

I am concerned that this veteran might not have received proper neuropsychiatric testing at all.

[carlie]

Yes, you are right, the veteran hiself must request a copy of any VA medical opinions himself-from the VAMC where the C & P was done or from QTC bu I understand QTC doesn't release these oinions until the claim is resolved?????

I hope someone clarifies that here.

[/quote

When an exams is done at a VAMC - right then it becomes a part of the claimants medical records

and ROI can much more easily, provide a copy to the claimant.

When an exam is done at a contracted examiners office (like QTC) that is owned by the VARO -

VBA department and not automatically a part of the vets medical records.

EDITING TO ADD :

After the VARO has used your QTC exam to make a decision - I hear that it THEN becomes

a part of the claimants c-file - and you can get a copy at that time.

This is my basic understanding of this issue.

[Berta]

Thanks Carlie- I just found the neuro tests I referred to here as to what VA gave my husband:

Weschler,

The Hand test,

Shipley Institute of Living Scale,

MMPI combat related

Trails Mosing Parts A & B

Hooper Visual Organzation VOT

MCMI, (Millon Clinical Multiaxail Inventory test)

Memory scale Form I

The results write up clearly indicate these were tests to evaluate PTSD as separate from traumatic brain residuals of stroke.

Also did the VA rate and give a percentage as NSC to his Brain trauma in the past decision?

Cognitive impairment is rated by VA in 10 separate facets with each facet being rated numerically

on a five point scale.

The 2011 edition of the VBM points out that the TBI ratings are within 4.1242 under DC 8045.

Your husbands residuals of the accident as far as cognitive imp[airment and other factors could have masked the PTSD to some degree during a C & P exam but without proper neuro testing it seems VA's point is , in spite of his established stressors, somehow an accident 'cured' the PTSD .

You need him to request a full copy of all of his medical records to include any MRI findings (this might have been done by another hospital when he had the accident and those private records should be obtained too.) and the VA records should include copies of the results of any neuropsychiatric tests they did.

I hope you continue to pursue this claim because their rationale as to the lack of enough symptoms of PTSD seemed preposterous to me.

Did he ever have performance appraisals at past jobs or any run ins with the law prior to the accident or maybe even a past divorce that could have been symptomatic of his PTSD?

[Capt.]

Hello Caregiver,

Berta,,, has given you some great advise. I agree with her , you are almost forced to get a lawyer to really proceed much further. You have a denial letter and now the appeals process is all that is left for you to use. I am also going to remind you of the time line problems that you need to watch and try to act within. Your husbands retro dates do become important and the VA is counting on you just going away because of frustration. Berta said you might have to get tough and thats what its going to take. I think a POA as Boxer and Berta brought up is very necessary , but you are getting into the appeals process that will need more and an experienced VA lawyer is invaluable as most of us have already found out.

I would also say that you may need a IMO so to counterpunch your VA examiners report. Berta is very well oriented in the is department and your claim mirrors alot of what she has already been thru. I am a big believer in IMOs. Though expensive as a rule, they are a must in being able to squash the detrimental opinions of the VA or QTC examiners. Remember that QTC is a HIRED GUN...... they are hired to try and save money for the VA. No they are not fair and most QTC exams will be fault riddled as most of our folks can atest to. That is what an IMO is for and utilized. You may want to consider it an investment. Money out up front to pay for a good IMO , but return upon the award granted later and the retro from the Earliest Effective Date will put a smile on your face.

I would also say that Berta recommended you get copies of these reports if possible. Carlie brings up the QTC problem. If he had a QTC exam then the results are property of the VA Regional Office, and the VBA and will probably require a FOIA to get. However if the examination was by the VAMC ,,,your VA hospital or clinic persay, then you will be able to get your copy as it will become part of your continual medical records. I am currently waiting on decisions and trying to get copies from QTC. I have written my lawyer a note to see what we can do to get the QTC copy from the exams of about 60 days ago. You need to know the results so you can formulate your plan on the next phase of your process of Claims.

Carlie you are exactly right on the ownership of the reports from QTC. Getting copies of them can require much time and patience. I will let our members know more on mine particulars when we get them from QTC.

Berta has given you the example BVA decisions on separating the claims from TBI and PTSD so you have that to give your POA or your lawyer to help them with appeals process. This may be what the IMO doctor will have to address , specifically.

I wish you did not have to go thru all of this and know that you probably have a full plate right now. Thank you for taking care of one our countrys treasures , your Veteran husband and a big thank you to your husband for his service to his country. Above all please remember this is the heart of Hadit . A place to come and be able to properly get your claim to the next level and winning your claim. And most important ,,,,,above all else.....NEVER GIVE UP. God Bless, C.C.

[Berta]

Bill, the problem with a cosly IMO here is -that, if the VA used the new PTSD criteria, they will not accept an independent IMO for a PTSD.

diagnosis.

The good part is that VA might not have considered the prior MH diagnosis of PTSD by VA done by a VA counselor.And would favorably consider that oh appeal. Those records should be coied and sent to the VA if they were never listed as Evidence.

I dont know what the background of the VA counselor was, when compared to the VA doc who opined on this claim, but I found ,working at a vet center with MSWs and VA counserlors as well with my husband's VA PTSD experience,

that many VA counselors understand PTSD far better than some of the other MH providers at VA .

I hope a strong argument with evidence ,if the claim is contined to be denied ,can warrant a better C & P for proper psychiatric testing.

This claim is exactly why NOVA and other vet groups fought this in court as to the IMO prohibition for non VA diagnoses of new PTSD claims.

They lost last week but hopefully they can appeal to a higher court.

I griped as a commenter at the Federal Register over the IMO clause of the new regs, Over 600 others did too, vets, lawyers, vet orgs etc but I guess we didnt gripe enough.And the recent court decision has again taken this right away from PTSD veterans.

The new criteria for PTSD has helped thosands of OPIF OEF vets I am sure, but what about all other vets. It is not fair.

A good vet rep or lawyer can assess this claim with all available medical records to word it to overcome the IMO clause in the new criteria by somehow pressuring VA to re do the C & P exam.

We dont know what the actual exam says.or even if they violated the VCAA here.

Cripes the last C & P they did for my DMII claim got me a PA opinion.When the remand called for a cardio opinion.

When VA says' the examiner' in SOCs -I often wonder if the examiner was a real doctor.

If VA gets these tests done, then the resulting opinion then comes from the VA itself and it could help the claim.

The results of any MRI done as well can help.

I actually used a photo of an autopsied brain years ago and marked the areas of ischemic lesions on the parts that compared to my husband's MRI to support one of my past claims regarding his VA deficits when compared to his PTSD.

[Capt.]

Hello Berta,,,

Thats a good point , and I have forgotten that new ruling. The VA has carefully covered that base with the new guidelines. Well I guess the only thing to do is use the evidence at hand and try to use an "in house" Doc/counselor that would be sympathetic to the issues and the record. This one is going to be hard all the way around and will take some work and alot of patience. Trying to trigger another C an P here is also going to be hard , unless the timelines get long and drawn out and the VARO request one that would be "fresher" to make a decision with. Yes , I remember the battle that NOVA and the Vet Groups were waging and this one really needs to be changed as it is totally unfair. Just think what would happen if ALL claims were not allowed an IMO. OUCH ,,,,,it would be catastrophic to say the least. I am suprised that it is not on the radar for a higher court to rule on its constitutionality and I feel this one is ripe for that avenue. I would wager we have not heard the last on this issue from the Veterans advocates side.

I really don't have an idea on how to get Caregivers propelled further at this point. Berta you have fought this type of battle before so you may have a plan for her.

I wonder if Caregivers husband is suffering from anything else that would be presumptive at this point. At least something that has got a chance. She really has not elaberated on much more than the PTSD issue.

Anyway thanks for reminding me memory loss..... been trying to deal with that too. NEVER GIVE UP. God Bless, C.C.