ptsd Statement Of Case (Soc)

[Jaina Bledsoe]

had my DRO hearing 2 months ago and recieved an SOC letter a few days ago. Feel it is some sort of progress because after 2 years the VA finally "concedes your in-service stressor". However, the obstacle remains on tying it to the diagnosis. VA outsourced examiner spent 40 minutes and linked PTSD/MDD/BPD as co-morbid disorders originating in childhood, based on questioning that focused on prior service factors (3 years physical abuse, article 15 in basic training, 3 day hospitalization for situational depression 2 years prior to a sexual assault (the conceded in-service stressor). Also, the suicide attempts (2) and subsequent issues of sleep, irritability, paranioa, etc after the assault were used to reinforce this diagnosis. I am not to pleased with symptoms AFTER the assault being used to reinforce that dx, but you can't question a PhD with the VA without looking like a malcontent or somehow feeling like you are supporting a misdiagnosis/inflated diagnosis of BPD.

My question is....

What should I do from here? The VA has already denied my request for a re-evaluation, and nobody at the VA appear to be willing to look at flight physicals (with psych evals), performance records, service school performance, awards, etc. prior to the assault in an effort to disprove the BPD discharge I was given after 9 years of service. the real kicker is that 1 month prior to discharge everything checked out OK while attempting an early out. Not to mention the 2 suicide attempts prompted an MEB for "adjustment disorder" related to other stressors which occured simultaneously with the assault. No mention of BPD during that process, but now it feels like the VA wants to change everything to suit their denial. I actually won the fight with the MEB based solely on those very same records of service 2 years prior to the BPD dx that got me out.

ANY ideas would help. I am homeless and have absolutely no income since the VA is recouping my severance pay with the 10% I was awarded for tinnitus in both ears. Therefore, no money for civilian independent opinion. Do I at least have recourse for aggravation even though the thought of letting the BPD dx stand makes me sick to my stomach?

[Jaina Bledsoe]

CARLIE - The SOC reads as follows: On July 29th, 2011 the VARO recieved your request for a reconsideration the recent decision dated April 12, 2011. In that decision the VARO granted eligibility for treatment only with medicalcare for mental health issues, and confirmed the denial of service connection for PTSD. You provided your own statements for reconsideration, a statement from your ex-spouse, and "lay" statements from individuals who have witnessed the severity of your mental health symptoms.

The additional service treatment records document the suicide attempt Feb 22, 1996 in which you exhibited an overdose using the medical of dyphenhydramine. The treatmentnotes state that at the time you were in the midst of Article 15 proceedures (field grade). A diagnosis of adjustment disorder secondary to impending divorce was provided. Based on this additional material evidence, we sent your entire claims file to the Portland VAMC to be reviewed by a VA examiner, and provide an addendum opinion. This examiner was required to review the entire body of evidence, including a previous opinion by VA physician K. Anderson, MD on Jan 17, 2011. Dr. Anderson opined that you have Borderline Personality Disorder with significant symptoms of depression, as well as PTSD secondary to childhood trauma, which is the same stressor that happened while on active duty.

On January 26, 2012 the same VA examiner, Dr. Munoz conducted the examination provided an opinion that concurred with the opinion in 2011 by Dr.

anderson. Dr. Munoz changed his diagnosis to Borderline Personality Disorder with significant symptoms of depression, as well as PTSD secondary to childhood trauma. He opined that "it is less likely than not" the current mental health problems were occured in or was caused by a military service event.

As stated in the rating decision: "Rationale to support this opinion included several factors. The examiner opined that, while the sexual assault that you you suffered in 1996 was during your military service, it was not the cause of mental health disorder since the record contains evidence of other psychological stressors. Furthermore, your reaction to personal stressors was expressed in behavior associated with borderline personality Disorder and not PTSD. In a statement you submitted (which the examiner also reviewed), you contend that a significant part of your trauma is the lack of support you recieved from people in your unit, as well as unprofessional treatment. the examiner agreed that this is unfortunate event, but noted that it does not meet criteria for a PTSD stressor. Both examiners who have reviewed your record have confirmed their belief that you have a diagnosis of PTSD, both also opined that it is due to trauma, horror, and feelings of helplessness you suffered for an extended period of childhood. Dr. Munoz opined that PTSD, major depressive disorder, and Borderline Personality disorder are commonly co-morbid."

Both of the VA examiners did review all aspects of your records (as well as your statement), "lay" statements, all of the military treatment and opined that the symptoms from which you suffer are a result of Borderline Personality disorder. VA is unable to provide compensation for benefits for Borderline personality disorder because it is a congenital disorder. (38 CFR 4.9)

During the hearing at the VARO, testimony was taken that repeated the documented facts related to this appeal. The evidence is material, but it does not show that any further development or VA examination are required. As of the date of this decision, the VARO has not recieved any additional evidence, which is material to this appeal.

according to this regulation, service connection for PTSD requires medical evidence diagnosing the condition in accordance with $ sec. 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occured. If a PTSD claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroberate the veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, MH counselling centers, hospitals, or physicians; pregnancy tests or tests for STD's; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifyable cause; or unexplained economic or social behavior changes. VA will not deny a PTSD claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the veterans service records or evidence of behaviour changes may constitute credible supporting evidence or advise VA of potential sources of such evidence. VA may submit any evidence that it recieves to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occured. (38 CFR 3.304(f))

The VARO has conceded your in-service stressor, but the medical specialists have not linked the diagnosis to that specific event. they believe that your PTSD is related to your childhood abuse. In the lay statements, your own statements and testimony, document that the current PTSD did not surface until roughly 2000. During active duty, the specialists have stated your mental health problems were your diagnosed Personality disorder.

The VARO has followed the duty to assist requirements of the law. The VA letters informed you what was needed to develop the claim, requested any sources of evidence that we would have obtained, and requested a VA examination and addendum opinions based on additional material evidence. (38 CFR 3.159) During the hearing, you stated that you have been recieving counselling at the Vets Center, but believe that this evidence is personal, and should be kept private from the VARO. If you change your mind, the VARO will obtain copies of theses records in support of your appeal, or you can furnish a copy of the records to DAV and they can submit them as evidence.

This current decision has been completed using the DRO de novo review process. this means that the same evidence that was used in the rating decisions that denied service connection were readjudicated as if those rating decisions had not been completed. (38 CFR 3.2600)

Yes I have applied for SSDI, but they have already denied 2x stating my symptoms are not severe enough to prevent working.

I was in a Grant Per diem program the last 8 months but am being removed now. I was dealing with harassment and intimidation from another tenant (not in a VA program) that went on for 4 months. I attempted to resolve the issue with management, letters from therapists describing PTSD aggravation, etc to no avail. 2 weeks ago there was yet another confrontation and I drew a knife to defend myself / keep this individual at bay (he would get in my face). that ended my involvement with the program. I have filed a complaint with the VA OIG as I am not the only veteran who has had these issues, which are not intervened upon by management. The VA program had delegated these issue to be resolved by a non-profit organization that manages properties, but fails to reengage when this management company fails. In essence, they delegate authority and behave as if the responsibility is delegated as well. I have complained to the OIG for a "systemic veteran safety issue", argueing that the safety of veterans in its program is not a responsibility that can be safely delegated to an outside agency which repeatedly fails in addressing or resolving safety issues.

[Ethan'sGrandma]

Jaina,

It's apparent that the docs are not giving any validity to your PTSD due to any military trauma, only relating to your childhood. The note you posted on here seems contradictory in that on one hand, they are saying BPD is the issue, but on the other hand, PTSD has been diagnosed, but not relating it to service. Then, they are not assigning your present symptoms to PTSD by what is written, but to BPD. Have you looked over the notes from your treating providers to note what is showing on their notes regarding symptoms? We know VA has access to that stuff, but it doesn't mean they're going to read it, so many times we have to point it out if something has been "missed" from the record. It looks like they are saying criteria for PTSD has not been met, except for the pre-military time, not assigning any to aggravation for during military time. I am thinking this is having to do with whatever symptoms you are having that are being noted by the providers, outside of whatever BPD symptoms they are noting. Some of the symptoms can overlap with PTSD, but that seems to be where the differences may not be being noted. I am assuming you are familiar with the criteria for PTSD as well as for BPD, but it may be in your best interest to review them to see if they are matching what has been noted by you to the providers and what the providers have noted for you that actually applies to you. Do you have copies of Vet Center notes? If so, is there something there that may help? Did you complete your statements and VA Form 21-0178a with assistance from your VSO? I'm asking because I notice in the VA letter that they mention that a lot...your lay statements. I noticed from my own claim that many things I would say would then get twisted, misconstrued, or whatever, so sticking to what is as evidence, as documented, then summarizing for them helped me. Re: SSDI...you say you've been denied twice. Was that on two separate applications, or is that based on denial on reconsideration, then at hearing level? Did SSA send you for their own consultative exam, or did they base their decision on what you already have as evidence? Did you have an attorney for their process? For SSA, a good attorney can assist in developing the claim. Is your SSDI claim done and over with, or do you still have appeal time left? You've come this far, so I hope you continue and with much success...

[Jaina Bledsoe]

Jaina,

It's apparent that the docs are not giving any validity to your PTSD due to any military trauma, only relating to your childhood. The note you posted on here seems contradictory in that on one hand, they are saying BPD is the issue, but on the other hand, PTSD has been diagnosed, but not relating it to service. Then, they are not assigning your present symptoms to PTSD by what is written, but to BPD. Have you looked over the notes from your treating providers to note what is showing on their notes regarding symptoms? We know VA has access to that stuff, but it doesn't mean they're going to read it, so many times we have to point it out if something has been "missed" from the record. It looks like they are saying criteria for PTSD has not been met, except for the pre-military time, not assigning any to aggravation for during military time. I am thinking this is having to do with whatever symptoms you are having that are being noted by the providers, outside of whatever BPD symptoms they are noting. Some of the symptoms can overlap with PTSD, but that seems to be where the differences may not be being noted. I am assuming you are familiar with the criteria for PTSD as well as for BPD, but it may be in your best interest to review them to see if they are matching what has been noted by you to the providers and what the providers have noted for you that actually applies to you. Do you have copies of Vet Center notes? If so, is there something there that may help? Did you complete your statements and VA Form 21-0178a with assistance from your VSO? I'm asking because I notice in the VA letter that they mention that a lot...your lay statements. I noticed from my own claim that many things I would say would then get twisted, misconstrued, or whatever, so sticking to what is as evidence, as documented, then summarizing for them helped me. Re: SSDI...you say you've been denied twice. Was that on two separate applications, or is that based on denial on reconsideration, then at hearing level? Did SSA send you for their own consultative exam, or did they base their decision on what you already have as evidence? Did you have an attorney for their process? For SSA, a good attorney can assist in developing the claim. Is your SSDI claim done and over with, or do you still have appeal time left? You've come this far, so I hope you continue and with much success...

I have complete copies and will be drafting a response in the coming weeks. I will post a copy of what I write to the BVA here. My dx is there, my stressor is there. All I need to do is link the two. The C&P examiner did NOT list my personell records in his evaluation, therefore a substantial basis of my arguement will be that his diagnosis would be incomplete since the "performance and behavioral changes" were the crux of my establishment of the stressor... which has been conceded. The fact that this DR is attempting to rewrite dx from doctors who saw me at the time is also a point I will argue. hopefully effectively.

SSDI is basing their denial on VA records, but they have not disclosed what records, whole or in part, they have reviewed. Despite the C&P difficulties, my S&I impairment has been listed as high and highly unlikely i would be able to work. GAF at the C&P was 23 - barely above blithering idiot. NO, the SS has NOT sent me to any exams, only constantly innundated me with questionaires over and over. I have a SS rep, but he does not appear very active. I have already signed a compensation agreement with him so I will not change at this time. The 2 denials so far are for same claim. an appeal hearing is in the works... ~1 year from now

I won't be online very much after tonight, as I am leaving the housing at which I access the internet. I will occassionally be able to access the internet via friends homes, but that will be hit or miss.

Edited July 11, 2012 by Jaina Bledsoe

[carlie]

CARLIE - The SOC reads as follows:

On July 29th, 2011 the VARO recieved your request for a reconsideration the recent decision dated April 12, 2011.

In that decision the VARO granted eligibility for treatment only with medicalcare for mental health issues, and confirmed the denial of service connection for PTSD. You provided your own statements for reconsideration, a statement from your ex-spouse, and "lay" statements from individuals who have witnessed the severity of your mental health symptoms.

J - The April 12,2011 rating decision, stated exactly what and all in the Reasons and Bases Section regarding

the claim for PTSD?

If you have already posted it please put the link for it here.

The additional service treatment records document the suicide attempt Feb 22, 1996 in which you exhibited an overdose using the medical of dyphenhydramine. The treatmentnotes state that at the time you were in the midst of Article 15 proceedures (field grade). A diagnosis of adjustment disorder secondary to impending divorce was provided. Based on this additional material evidence, we sent your entire claims file to the Portland VAMC to be reviewed by a VA examiner, and provide an addendum opinion. This examiner was required to review the entire body of evidence, including a previous opinion by VA physician K. Anderson, MD on Jan 17, 2011. Dr. Anderson opined that you have Borderline Personality Disorder with significant symptoms of depression, as well as PTSD secondary to childhood trauma, which is the same stressor that happened while on active duty.

On January 26, 2012 the same VA examiner, Dr. Munoz conducted the examination provided an opinion that concurred with the opinion in 2011 by Dr.

anderson. Dr. Munoz changed his diagnosis to Borderline Personality Disorder with significant symptoms of depression, as well as PTSD secondary to childhood trauma. He opined that "it is less likely than not" the current mental health problems were occured in or was caused by a military service event.

As stated in the rating decision: "Rationale to support this opinion included several factors. The examiner opined that, while the sexual assault that you you suffered in 1996 was during your military service, it was not the cause of mental health disorder since the record contains evidence of other psychological stressors. Furthermore, your reaction to personal stressors was expressed in behavior associated with borderline personality Disorder and not PTSD. In a statement you submitted (which the examiner also reviewed), you contend that a significant part of your trauma is the lack of support you recieved from people in your unit, as well as unprofessional treatment. the examiner agreed that this is unfortunate event, but noted that it does not meet criteria for a PTSD stressor. Both examiners who have reviewed your record have confirmed their belief that you have a diagnosis of PTSD, both also opined that it is due to trauma, horror, and feelings of helplessness you suffered for an extended period of childhood. Dr. Munoz opined that PTSD, major depressive disorder, and Borderline Personality disorder are commonly co-morbid."

J - is "which is the same stressor that happened while on active duty" actually stated word for word in the SOC?

Is there anything in the SOC or prior decision that states whether either Dr Anderson or Dr Munoz considered or provided

any opinion on whether or not XYZ during active duty, AGGRAVATED mental health issues from childhood trauma ?

Have you gotten copies of both of these examinations and gone thru them to compare against the prior

decision and this SOC for accuracy? Many times a VBA decision maker will only quote a part of what is said

and negate the part that would support a grant for SC of the issue.

Both of the VA examiners did review all aspects of your records (as well as your statement), "lay" statements, all of the military treatment and opined that the symptoms from which you suffer are a result of Borderline Personality disorder. VA is unable to provide compensation for benefits for Borderline personality disorder because it is a congenital disorder. (38 CFR 4.9)

During the hearing at the VARO, testimony was taken that repeated the documented facts related to this appeal. The evidence is material, but it does not show that any further development or VA examination are required. As of the date of this decision, the VARO has not recieved any additional evidence, which is material to this appeal.

according to this regulation, service connection for PTSD requires medical evidence diagnosing the condition in accordance with $ sec. 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occured. If a PTSD claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroberate the veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, MH counselling centers, hospitals, or physicians; pregnancy tests or tests for STD's; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifyable cause; or unexplained economic or social behavior changes. VA will not deny a PTSD claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the veterans service records or evidence of behaviour changes may constitute credible supporting evidence or advise VA of potential sources of such evidence. VA may submit any evidence that it recieves to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occured. (38 CFR 3.304(f))

The VARO has conceded your in-service stressor, but the medical specialists have not linked the diagnosis to that specific event. they believe that your PTSD is related to your childhood abuse. In the lay statements, your own statements and testimony, document that the current PTSD did not surface until roughly 2000. During active duty, the specialists have stated your mental health problems were your diagnosed Personality disorder.

The VARO has followed the duty to assist requirements of the law. The VA letters informed you what was needed to develop the claim, requested any sources of evidence that we would have obtained, and requested a VA examination and addendum opinions based on additional material evidence. (38 CFR 3.159) During the hearing, you stated that you have been recieving counselling at the Vets Center, but believe that this evidence is personal, and should be kept private from the VARO. If you change your mind, the VARO will obtain copies of theses records in support of your appeal, or you can furnish a copy of the records to DAV and they can submit them as evidence.

J - I feel you are going to need a written opinion from a mental health provider that counters these two doc's -

that at least states something to the effect that even tho you have co-morbid mental health conditions,

you do have a diagnosis of PTSD and that it is more / as likely as not, that the event/s that happened on

active duty, aggravated mental health issues from childhood.

This doc will need to include full medical rationale to support their opinion.

This is absolutely what you need and nothing else, they are pretty much telling you that in the above.

If you can submit this - the decision maker should apply the BOD and grant the issue as SC'd.

I have no idea what is contained in your Vet Center records - but the Vet Center usually does not turn over

copies of their records to the VARO anyways. In ALL cases I've dealt with - the providers at the Vet Centers

compose a treatment summary letter for the VARO.

I feel it MAY not have been a good decision on your part, to force exclusion of Vet Center evidence to be

considered and factored into the decision.

This current decision has been completed using the DRO de novo review process. this means that the same evidence that was used in the rating decisions that denied service connection were readjudicated as if those rating decisions had not been completed. (38 CFR 3.2600)

Yes I have applied for SSDI, but they have already denied 2x stating my symptoms are not severe enough to prevent working.

I was in a Grant Per diem program the last 8 months but am being removed now. I was dealing with harassment and intimidation from another tenant (not in a VA program) that went on for 4 months. I attempted to resolve the issue with management, letters from therapists describing PTSD aggravation, etc to no avail. 2 weeks ago there was yet another confrontation and I drew a knife to defend myself / keep this individual at bay (he would get in my face). that ended my involvement with the program.

J - who is the therapist mentioned above. Have they provided any opinion for your VBA claim ?

When someone attempts to do you personal harm, not harassment or intimidation. but harm -

I personally wouldn't waste time and energy with any hopes that "management" will help,

I call the po-po and right then.

carlie

I have filed a complaint with the VA OIG as I am not the only veteran who has had these issues, which are not intervened upon by management. The VA program had delegated these issue to be resolved by a non-profit organization that manages properties, but fails to reengage when this management company fails. In essence, they delegate authority and behave as if the responsibility is delegated as well. I have complained to the OIG for a "systemic veteran safety issue", argueing that the safety of veterans in its program is not a responsibility that can be safely delegated to an outside agency which repeatedly fails in addressing or resolving safety issues.

[Jaina Bledsoe]

As mentioned, here is my upcoming response...draft version:

Dear Claims Department,

This statement is in response to a Statement of the Case you sent dated June 21^st, 2012 for a decision reached on a De Novo Review dated April 24^th, 2012 at the Portland VA Regional Office. I appreciate the time and effort that have been put forth in this process by your office and the many medical specialists involved. However, I still believe my claim of service connected PTSD is still very much warranted and valid, and that evidence exists to support that belief versus Preexisting Borderline Personality Disorder.

I ask that a service connection for PTSD rated at 70% or higher per your rating schedule be awarded. The basis of this rating is supported by the evidence while in service and the medical opinion of Dr. Munoz dated November 23^rd, 2010. I also ask that Major Depressive Disorder be accepted as a secondary injury to PTSD and rated according to prescribed standards. It should be noted that this statement includes a request for RECONSIDERATION.

The facts in your SOC dated June 21^st, 2012 which I feel are in error or need to be applied to the law more closely are as follows:

● §3.102 (CURRENT) Reasonable Doubt.

I believe that service records prior to my assault, particularly those in my 201 personnel file, provides a significant amount of “positive evidence” contrary to a diagnosis of Borderline Personality Disorder or any other pre-service condition. I also believe that responses, symptoms, and developed issues after my assault constitute “probable results of such known hardships”.

● §3.159 (05/08) Department of Veterans Affairs assistance in developing claims.

The Department of Veterans Affairs has been extremely helpful in retrieving missing records, ensuring they are present in the claims file, and to the best of my knowledge reviewing all given evidence. However, I have significant concern that independent examiners Dr. Munoz and Dr. Andersen have either not had or missed reviewing evidence that would support §3.102 above. In the Veterans Administrations duty to assist, it should be reasonably interpreted to include ensuring ALL pertinent evidence is adequately reviewed and cited in an examination. Both examiners have listed evidence reviewed. Both examiners have failed to list evidence from my personnel file other than a DD-214. Since the establishment of my in service stressor relied almost exclusively on changes in behavior, performance, and development of issues that did not exist or did not exist to nearly such an extreme degree prior to 1996, it is reasonable to expect the same evidence should be reviewed by both examiners. This evidence is accepted under §3.304(f), paragraph 4 and should be included, reviewed, and cited when conducting a diagnostic evaluation. Any and all lay statements submitted to the Department of Veterans Affairs should also be reviewed by both examiners since it covers both periods prior to and after the assault in 1996. It is my belief that all this evidence would have been extremely helpful to the examiners at the time of diagnosis.

● 38 U.S.C. 5103A©

Paragraph (4(i)) states “In a claim for disability compensation, VA will provide a medical examination or obtain a medical opinion based upon a review of the evidence of record if VA determines it is necessary to decide a claim.” Since it is reasonable to assume that the Veterans Administration reviewed lay statements, personnel records, and medical records when it determined conceding my in service stressor was warranted the same evidence should be available to the examiners the Veterans Administration chose.

● §3.2600 Review of benefit claims decisions.

Paragraph (a) states that “The reviewer will consider all evidence of record and applicable law, and will give no deference to the decision being reviewed.” Paragraph © states that “The reviewer may conduct whatever development he or she considers necessary to resolve disagreements in the Notice of Disagreement, consistent with applicable law.” It is reasonable to assert that the reviewer does not have the authority or expertise to address what is arguably a misdiagnosis by the examiners based on a lack of knowledge or indifference to evidence supporting a reasonable doubt. Therefore further development, either by independent 3^rd party examination as requested during the hearing or a further review by the original examiners, could and likely should have be conducted.

● §3.303 Principles relating to service connection.

Paragraph (a) states that “Service connection connotes many factors but basically it means that the facts, supported by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. This may be accomplished by affirmatively showing inception or aggravation during service or through the application of statutory presumptions. Each disabling condition shown by a veteran's service records, or for which he seeks a service connection must be considered on the basis of the places, types and circumstances of his service as shown by service records, the official history of each organization in which he served, his medical records and all pertinent medical and lay evidence. Determinations as to service connection will be based on review of the entire evidence of record, with due consideration to the policy of the Department of Veterans Affairs to administer the law under a broad and liberal interpretation consistent with the facts in each individual case.”

This CFR supports the relevance of the contents of my personnel file prior to the assault in 1996. The “circumstances of his service” should reasonably include the character of my service for the 6 years, 8 months prior to my assault as well as the character of my service in the Korean Peninsula.

Paragraph © states “In the field of mental disorders, personality disorders which are characterized by developmental defects or pathological trends in the personality structure manifested by a lifelong pattern of action or behavior, chronic psychoneurosis of long duration or other psychiatric symptomology shown to have existed prior to service with the same manifestations during service, which were the basis of the service diagnosis will be accepted as showing pre-service origin.”

This CFR alludes to a “lifelong pattern of action or behavior”. This in itself is significant in that in order for one to believe this was preexisting, or existing at all for that matter, a pattern should have been existent prior to the assault to the same degree as after. The evidence in my personnel file does not support this belief or this diagnosis.

Paragraph (d) states “Post service initial diagnosis of disease. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. Presumptive periods are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. The presumptive provisions of the statute and Department of Veterans Affairs regulations implementing them are intended as liberalizations applicable when the evidence would not warrant service connection without their aid.”

“All the evidence, including that pertinent to service” again supports my belief that for a true, accurate, and justifiable diagnosis to be done my personnel file information should be reviewed and cited by both examiners. The only evidence cited by both examiners was that which could be used to support a diagnosis that would prevent establishing a service connection. Furthermore, diagnoses by competent and accredited professionals while actually in service diagnose an “adjustment disorder”. An adjustment disorder is an excessive reaction to stress, and is more closely related to PTSD than a Borderline Personality Disorder. It is my belief that the only reason PTSD was not diagnosed post assault was the disassociation of the event. I also believe that if I had been able to convey this information at the time, the DSM-IV would have supported a diagnosis of PTSD secondary to sexual assault. Neither VA examiner addressed the issue of disassociative amnesia (Psychogenic Amnesia) and the possibility other stressors coinciding with the time of the assault became a “fall back” explanation for the behaviors, symptoms, and issues that developed. There was also no mention of what effect a sudden reintegration of that memory could have, under a very closely mirrored situation at the time. As they stand currently, both VA diagnoses attempt to “change” the diagnoses of the professionals who spent significantly more time with me, and viewed my behaviors and symptoms directly immediately after the assault.

The first diagnosis of Borderline Personality Disorder appears just prior to discharge, and only then to facilitate the removal from service I had been seeking a month prior due to severity of issues that developed in 1996. At the time it was an extremely expedient method to salvage an honorable career and escape the reprisals I had endured by supervisors for months. The detail of this diagnosis itself is minimal at best and was supported wholly by events, behaviors, and issues that developed after the assault in 1996.

● §3.304(a), (b), and © Direct service connection; wartime and peacetime.

Paragraph (b) states “The veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakeable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service. Only such conditions as are recorded in examination reports are to be considered as noted.”

An entrance exam conducted July 19^th, 1988 and a subsequent Class ONE Flight Physical dated August 10, 1992 support a presumption of sound condition prior to the assault in 1996. It should be noted that a detailed psychological examination is standard for any Class ONE Flight Physical (Required with Warrant Flight School applications) and is not arbitrarily passed. Borderline Personality Disorder, in any degree, would be cause for exclusion. I received a “SAT” or satisfactory rating. Furthermore, symptoms of “”Frequent trouble sleeping” and “Depression or excessive worry” and “Attempted suicide” were never previously checked on Standard Form 93 (Report of Medical History) until I sought an early out opportunity January 12^th, 1998. This was more than one month prior to receiving a diagnosis of Borderline Personality Disorder, resulting in a Chapter 5-13 Discharge.

[Federal Register: May 4, 2005 (Volume 70, Number 85)]

[Rules and Regulations]

[Page 23027-23029]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr04my05-3]

The effect OF this new interpretation is to establish different standards to govern for disabilities that were noted at entry into service and those that were not. If a disability was not noted at entry into service, VA will apply the presumption OF Sound condition under 38 U.S.C. 1111. If VA fails to establish either that the disability existed prior to service or that it was not aggravated by service, the presumption OF Sound condition will govern and the disability will be considered to have been incurred in service if all other requirements for service connection are established. In such cases, the presumption OF aggravation in 38 U.S.C. 1153 will not apply because VA will presume that the veteran entered service in Sound condition. On the other hand, if a condition was noted at entry into service, VA will consider the claim with respect to the presumption OF aggravation in section 1153.

I would also like to note that a Medical Board Report dated April 11^th, 1996 was conducted after a second suicide attempt. The AXIS 1 Diagnosis was “Adjustment Disorder” and the AXIS 2 Diagnosis was “Dependent Personality Traits”. This diagnosis was done after 12 (Twelve) days of in hospital observation, by medical personnel who witnessed my behaviors firsthand, and still is absent a Borderline Personality Disorder diagnosis. I reasonably must question a diagnosis 14 years later based on a 40 minute interview or simple review of medical records, especially when the same personnel records that allowed me to remain in service at that time are not cited in the more recent diagnoses. I assert that the Veterans Administration, through hurried and incomplete diagnoses, has failed in providing “clear and unmistakeable (obvious or manifest) evidence demonstrating that an injury or disease existed prior thereto and was not aggravated by such service.”

Paragraph (b(1)) states “...Determinations should not be based on medical judgment alone as distinguished from accepted medical principles, or on history alone without regard to clinical factors pertinent to the basic character, origin, and development of such injury disease. They should be based on thorough analysis of the evidentiary showing and careful correlation of all material facts, with due regard to accepted medical principles pertaining to the history, manifestations, clinical course, and character of the particular injury or disease or residuals thereof.”

Both evaluations done after filing for Compensation for PTSD address medical opinions of Borderline Personality Disorder, and cite only evidence that supports that diagnosis. Neither evaluation weighs the evidence with the “thorough analysis of the evidentiary showing and careful correlation of all material facts, with due regard to accepted medical principles pertaining to the history, manifestations, clinical course, and character of the particular injury or disease or residuals thereof.” This claim was filed for PTSD secondary to a Military Sexual Assault. It was not filed for Borderline Personality Disorder, PTSD, and Major Depressive Disorder secondary to childhood trauma. The focus of these evaluations should have been to weigh the information against a DSM-IV criterion for PTSD first and foremost. If that was not possible, or could not be supported, it should have been cited exactly why, and only then an alternate diagnosis provided.

Paragraph (b(2) states “History conforming to accepted medical principles should be given due consideration, in conjunction with basic clinical data, and be accorded probative value consistent with accepted medical and evidentiary principles in relation to value consistent with accepted medical evidence relating to incurrence, symptoms and course of the injury or disease, including official and other records made prior to, during or subsequent to service, together with all other lay and medical evidence concerning the inception, development and manifestations of the particular condition will be taken into full account.”

This paragraph supports my claim that evidence should have been weighed against the criteria of PTSD first and foremost, and that all pertinent records should have been cited. Particularly records that would establish a sufficient baseline prior to the assault in 1996. Again, if the evidence did not support a diagnosis of PTSD secondary to personal assault only then should an alternate diagnosis have been provided.

I submit that it would be a fair and just means in resolving this disagreement as follows:

1. 
   Allow and provide a disinterested 3^rd party not affiliated (or under contract) with the Veterans Administration (hereby referred to as “the evaluator”) to conduct an evaluation per the “Department of Veterans Affairs Best Practice Manual for Post Traumatic Stress Disorder (PTSD) Compensation and Pension Examinations” Guidelines. This should also include testing, to rule out or support congenital factors.
   
2. 
   Ensure the evaluator reviews and cites the veteran history as evidenced in the personnel file before, during, and after the assault as well as medical records. Provide an opinion as to whether the service record prior to the assault would be attainable if PTSD was preexisting.
   
3. 
   Ensure the evaluator addresses the issue of psychogenic amnesia, memory loss, and the effect of reintegration of memory.
   
4. 
   Ask the evaluator to address multiple diagnoses of “Adjustment Disorder” in relation to a disassociative memory event, PTSD, and the presence of unrelated stressors. Compare to Borderline Personality Disorder under same guidelines, noting similarities and differences.
   
5. 
   Omit previous evaluations after discharge from military service from the claims file, or instruct the evaluator to disregard them, on the basis they are incomplete for reasons I stated earlier. This will also prevent bias or influence of the 3^rd party.
   
6. 
   Allow me to present my own case (argument) in support of a diagnosis of service connected PTSD secondary to Sexual Assault to the evaluator citing the specific evidence in my claim I feel is relevant.
   
7. 
   Return the claim and the evaluators findings for RECONSIDERATION by the Portland VARO.
   
8. 
   If unable to provide a independent 3^rd party evaluation, consider allowing an addendum with #'s 1-4, and 6-7 to Dr. Munoz, complete with a substantial in-person interview.