Request Advice On Mental Health Disorder Claim

[georgiapapa]

I am thinking about filing a mental health disorder claim but I want to make sure my claim has a chance of success and also make sure I am not filing it prematurely.

Since October 2011 I have had a claim pending for AO Multiple Myeloma and peripheral neuropathy secondary to multiple myeloma. As a result of anxiety from my cancer diagnosis, I have also been going to a VA psychologist and a psychiatric NP since the summer of last year. I am currently on medication for anxiety.

After viewing some of the comments on hadit about anxiety and depression secondary to service connected disabilities, I decided to request copies of my VA mental health records to see if a claim may be justified.

Some of the comments in my records include the following:

"axis I - adjustment disorder with mixed anxiety and depressed mood (ICD-9-CM 309.28) primary."

"adjustment disorder with anxiety secondary to medical condition - multiple myeloma."

"sleep disorder."

"nightmares"

"status: fair, continues to struggle emotionally."

"anxious mood"

"withdrawn"

"anticipatory anxiety"

"hopeless and helplessness"

"labile"

"anxious, depressed"

"memory deficiencies"

My Axis V - GAF scores range from 45 to 58 with most in the mid 50s.

Last August I had back to back appointments on the same day with my psychologist and psychiatric NP. During these appointments, my psychologist gave me a GAF of 45 and the NP gave me a GAF of 58. This was my lowest and highest on the same date. I can't figure this out.

I believe the information I received justifies a mental health disorder claim but I would like input from others familiar with claims for mental health disorders.

QUESTION: Since I am in the middle of a claim for multiple myeloma, should I wait and make sure it is approved before filing a claim for the mental health disorder or should I make it part of my pending claim for multiple myeloma?

I really hate to do anything to delay the processing of my current claim but I would also prefer not to delay the effective date of my mental health disorder claim if it is approved.

Your input would be appreciated.

Thanks...Georgiapapa

[georgiapapa]

Sharon & Donna,

I appreciate your suggestions. If anyone else has any thoughts on the effective date issues brought up by Donna, please let me know.

Georgiapapa.

[Berta]

“Other than my multiple myeloma, neuropathy and anxiety disorder, I don't think I have anything else that I could service connect unless it is conditions related to the contaminated water at Camp Lejeune when I was there in 68, 69 and 70. “

How are you trying to get the PN Sced?

That was the point John was making.

Although Peripheral Neuropathy is an AO presumptive,the actual PN regs and criteria are very difficult for any vet these days to succeed in a PN claim due to the wording of the actual regulation.

“VA presumes Veterans' acute and subacute peripheral neuropathy is related to their exposure to Agent Orange or other herbicides during military service when:

• 
  It appears within one year of exposure to Agent Orange to a degree of at least 10 percent disabling by VA’s rating regulations, and
  
• 
  It is temporary and resolves within two years. “
  

from: http://www.publichealth.va.gov/exposures/agentorange/conditions/peripheral_neuropathy.asp

But it is a well know complication of DMII and ,with medical evidence of the link from DM to the PN, VA will SC it.

If you feel your Camp Lejeune experience caused you any disability-by all means file the claim.

and more info here at hadit. I call these the “Bad Water” vets as compared to the Blue/Brown Water vets.

First LeJeune Bad Water award.

My husband was at Le Jeune sometime from 1964-1968 USMC and of course Danang ,Vietnam July 65-Jul 66, Ist MarDiv, Ist Amphibious Tractor Battalion.

[georgiapapa]

Berta,

My claim for peripheral neuropathy is claimed only as secondary to my multiple myeloma. I have had neuropathy in my toes for several years. In 2009, the neuropathy began spreading into the rest of my feet. My neurologist conducted EMG tests, Nerve Conduction Studies and several blood tests. At that time my neuropathy was considered moderate. The same neurologist also discovered myeloma protein in my blood and referred me to a oncologist who discovered my myeloma. In the fall of 2011, my neuropathy began progressing up into my legs. My neuropathy pain also increased and I started taking gabapentin. I had additional EMG tests, Nerve Conduction Studies and CT myelogram tests in 2011. My neuropathy was then considered severe in my feet and legs.

At first, my neurologist and orthopaedic doctor thought the neuropathy was caused by spinal stenosis but the CT myelogram indicated I did not have any significant stenosis. After reviewing all of the diagnostic tests and my other medical records from my orthopaedic doctors, oncologist and primary care doctor and doing some research of the medical literature available; my neurologist concluded that my neuropathy was caused by my multiple myeloma disease. One of my two oncologists also agreed with my neurologist's conclusion. I asked my neurologist if he would put his conclusion in writing and follow a format necessary for a successful claim with the VA. He agreed and I provided him with the information provided on the hadit website for IMOs. He provided me with a detailed IMO which concluded with the following sentence: "Considering every possible sound medical etiology/principle, to at least the 50% level of probability, I am of the opinion that the patient's symmetrical distal polyneuropathy of his lower extremities is more likely than not secondary to his currently diagnosed dysproteinemia/smoldering multiple myeloma disease."

As to the bad water at Camp Lejeune, I am currently researching to see if any of my other issues may have been caused by the bad water. My unit was housed in the area where water was provided by the Hadnot Point water treatment plant. I have found info on veterans who have filed claims for multiple myeloma and peripheral neuropathy due to exposure to the contaminated water but since I am already pursuing claims on these issues as a result of my agent orange exposure, I don't think I need to file a duplicate claim for these issues.

Berta, any additional thoughts or suggestions or you have would be appreciated.

Thanks Georgiapapa...

[georgiapapa]

Berta,

Forgive me for being a little slow but it just hit me as to what you and John are trying to tell me. To make sure I am now clear on this, are you and John saying that my claim for peripheral neuropathy will not even be considered along with my multiple myeloma claim? It sounds like I will have to wait until my multiple myeloma claim is approved and then file another claim for peripheral neuropathy secondary to multiple myeloma. Is this correct? If so, should I withdraw my claim for peripheral neuropathy at this time and refile later?

NOTE: For what it is worth, my oncologist considers my peripheral neuropathy as a symptom caused by my multiple myeloma and has reclassified me from asymptomatic multiple myeloma to symptomatic multiple myeloma.

How can I clean this mess up?

Georgiapapa...

[Berta]

No mess at all!! Thanks for that response as I sure learned something important from you today!!!!

If the doctor documents this in writing to VA or within the med recs VA has (dont know if this is VA or private doctor):

"For what it is worth, my oncologist considers my peripheral neuropathy as a symptom caused by my multiple myeloma and has reclassified me from asymptomatic multiple myeloma to symptomatic multiple myeloma."

witha brief medical rationale,then that is Golden as to PN as secondary.

I found a similiar case at the BVA:

http://www.va.gov/vetapp/wraper_bva.asp?file=/vetapp10/Files2/1018384.txt

This BVA case not only shows how the C & P doctors can make things difficult for vets with classifications of multiple myeloma but also how there could be an association between MM and PN.

T^HANK YOU!!! I had no idea whatsoever that PN could be secondary to this disability.

[georgiapapa]

Berta,

My neurologist and oncologists are all private doctors. All of them have been in practice for over twenty years and they have great credentials. The only specialists I use at the VA are for my mental health issues.

On September 19, 2010, you cited the same BVA case to me in a reply to a question I had about filing a claim for smoldering multiple myeloma. This is a great case and I actually submitted a copy of the case as part of my evidence in my recent claim for multiple myeloma and peripheral neuropathy. I thought the facts in this case were similar to my situation.

Do you think I need to make any changes in my current claim or leave it like it is? I am still not clear on this.

I know you are one of the most knowledgeable members on this web site and when you speak I listen. However, my scrambled brain doesn't always properly process the information I receive. At times I have problems concentrating and staying focused on what I am doing.

Your expertise is appreciated.

Thanks...Georgiapapa