ptsd Advice On My Nod For Bva

[Swarthy]

here is my letter so far:

I would like to file a Notice of Disagreement with the
Statement of Case denying my claim for an acquired psychiatric condition to
include PTSD.

The VA has from the outset recharacterized my claim of PTSD
as one of depression and as secondary, Alcohol Abuse. I have to believe this is
done in the best interest of my claim. I have never claimed that
depression/dysthymia was caused by service, though it had its onset in service.
And I am positive that my duty on the psych ward played a part. I also have
never claimed that my substance abuse was caused by service. I believe I did
that to myself. Current research into PTSD does shows that depression,
substance abuse and homelessness, specifically in veterans, can be linked to
PTSD. Research also indicates that presentations of Borderline Personality and
Antisocial Personality disorders are frequently seen in cases of PTSD.



The SOC states “While the veteran has
furnished statements dealing with possible stressors for a diagnosis of post-traumatic
stress disorder, the examiner did not furnish a diagnosis of post-traumatic
stress disorder.”

It is possible the examiner did not diagnose PTSD because the
exam/DBQ I was given was for Mental Disorders (other than PTSD and eating
disorders). I would like to bring to your attention that the assault is noted
in my STR by Master Chief Creel on 1/9/95

The SOC states “The
two reported personality disorders given by VA providers include borderline
personality disorder and sociopathic (now called antisocial) personality
disorder and a personality disorder by definition existed prior to service.”

Also according to the DSM-IV definition, “Personality
disorders represent a long-standing pattern of problematic behaviors, thoughts,
and feelings that often start in adolescence or early adulthood.”

I experienced none of these until my billet on the psych ward and certainly
after the attack. I have also enclosed a letter from my first wife describing her
knowledge of how I was. And you have a letter from my second wife of how I became.

The initial ‘impressions’ and ‘rule out’ diagnoses of personality
disorder from providers have to be considered that at the time (just coming off
the street, withdrawing, etc.) I was in bad shape and sometimes suicidal (I was
once put on a “hold”). I was typically using alcohol and drugs after the
military to distract/numb my thoughts away from my constant ruminations about
my experiences on the psych unit and at times a fear of being assaulted again.

Regarding the sociopath/antisocial diagnosis: This was given
as the result of one 30 minute visit with a doctor who, it is my understanding,
no longer works for the VA. During this visit I was upset about the hepatitis C
diagnosis he had just given me and I asked him to confirm it with the lab. He
chuckled at this and chuckled again with the person on the phone in the lab. Also
during the exam when I listed all the places I had lived (such as Berkeley, Ca,
Flagstaff, AZ) and he replied, “All you people end up in those places.” I got
the impression he meant ‘you people’ to mean homeless alcoholics. When I left
his office I asked the front desk not to schedule me with him again and the
secretary’s response was, “Don’t worry. He’s out of here in a month.”

In my experience when working and treating sociopathic/anti-social
personality disorders they did not respond well to structure as stated in the
SOC. Other personality disorders may but definitely not those particular
disorders.



I feel the current examiner erroneously “cherry picked” from intake diagnoses I
received when I entered into drug and alcohol treatments. The (again initial
impression) diagnosis of ‘Personality Disorder NOS’ given by Dr. Soman was removed
very soon in my treatment with him. Also, none of my VA discharge notes
list personality disorder as a diagnosis or problem. Additionally, the first
C&P examiner gave “No Diagnosis” for Axis II. And in service psychiatric testing
(1/29/1992) showed no personality disorder- in fact, the examiner stated, “No psychiatric
disorders were noted”. I feel this satisfies a presumption of soundness.

I have cleaned up and feel much better emotionally but the
symptoms of PTSD have definitely become amplified and at times have seriously
hindered my attempts to settle into a normal life and be around normal people.
I am currently working on this and have been in treatment for ‘Complex PTSD’
since

Also, I am service connected and currently treated for a sleep disorder noted
as “severe” in my STR on 1/24/95 and a severed nerve. I feel that this, the
current C&P exam note and my current treatment and diagnoses satisfies the
evidence of a continuing disability. To me, it seems as if the symptoms are
compensated but not the cause.

Dr. ---- in his C&P note states that I
experience “Social and occupational
impairment due to mild or transient symptoms which decrease work efficiency and
ability to perform occupational tasks only during periods of significant
stress, or; symptoms controlled by medication” I feel this is accurate.

[carlie]

Yes the nerve was severed during the attack and likewise the sleep disorder and "behavioral problems" showed up after the assault.

The whole time my claim has been for PTSD,

I don't know why the RO will not pay attention to the PTSD diagnoses. In the SOC they state it is because the examiner failed to diagnose it.

They recharacterize it as for depression (which is what I was treated for in service)

I seem to have to fight the PD diagnosis because that is the reason they list for the denial.

its like I'm playing checkers and they are playing chess:)

Since you were treated on active duty for depression,

"They recharacterize it as for depression (which is what I was treated for in service)"

That's the issue I would have submitted a claim for SC of.

IMO - Personally I don't care if they compensate me for PTSD / MDD / Depression -

whatever they want to call it Mental Health wise -

just provide my SC and comp, and I will leave them alone : - )

[FormerMember]

Just a minor legal point- A SOC is followed by a Form 9 to complete the substantive appeal. A NOD, on the other hand, is filed in conjunction with a disagreement with a decision. You have 60 days to submit new evidence a la 38 CFR 3.156(b) in order to provoke a SSOC or a grant. This is covered by 38 CFR 19.31. VA is in the habit of filing the claim in the circular receptacle if you fail to perfect the substantive appeal. Since it will take them a year to review this, best to submit new evidence as well as the Form 9 and hash it out without losing the claim due to failure to complete the substantive portion. See also VAOPGCPREC 9-97 for guidance.Best of luck.

[john999]

New evidence in the form of a IMO for depression would help since you were treated for and DX'ed for depresssion in service.

[Swarthy]

"I wouldn't be fighting against the PD as much as I would be fighting to

SC the PTSD."

I know! That is what my original claim was for. Taking your comment (quoted above) I went back and looked through my C&P's i see that both examiners state that my "Depression was not caused by service."

I am changing my NOD to ask that my claim be 'reorganized' or 're considered' in regards to my original claim for PTSD since all the evidence I submitted and my current treatment is for PTSD. I never claimed any depresson came from service, but that it was one of my symptoms from PTSD. I think they assumed that since I was treated in service for dysthymia that my claim was for depression. But none of my evidence confirms that.

[carlie]

Also,

I just took note of your topic title.

Advice On My Nod For Bva

Is the above correct or, are you actually preparing this as a NOD to a VARO decision

that was adjudicated less than one year ago ?

Also, I agree with john999.

I would take my SMR/STR's to a private MH pedigree or perhaps

one at the Vet Center, and see what they might be able to write

to help support the claim.

JMHO

[Swarthy]

I was just informed that one does not submit a NOD to a SOC. Only a Form 9.

Would this be okay to send a long with it:

My claim has gone way off course. Since I was treated on
active duty for symptoms of depression it is logical that the Regional Office would
add depression to my claim, But, I have never claimed that problem is service
related, I don’t know what it is from.

There have been many contentions added to my claim
and appear to complicated it. My claim since 2008 has been for PTSD

This is evident by the final analysis of my 2 C&P
examinations. In 2012: “depression nor his substance abuse were the result of
his military service”. And in 2008 “presently
deny any problems with depression, therefore there is no apparent link between
his current problems and events from active duty.”

Also, in communication from The Regional Office on January 23,2012 a letter was sent says “we are working on your
claim for: acquired psychiatric condition to include depression and ethanol
abuse” Another letter dated July 12, 2012 states that it is unclear if I am claiming
PTSD.

I am aware that I am to blame and I apologize for my part in
the mix ups.. In the decision dated September 25, 2008 it says,” we requested
information concerning your in service stressor on December 27, 2007 and again
on February 19, 2008, to date we have not received a response from you.”

This is not easy. Again I avoid the situation in the 2008
C&P note that reads, “he denies that he was ever physically harmed or
attacked while working on the psych units.” This was easy to avoid since my
attack happened at a train station.

I didn’t want to tell anyone of the assault and certainly
that I have ‘problems’ from it. I figured it was my own issue, and something I
could ignore until it went away. Going so far as to accept the consequences in
service of Non Judicial Punishment in the form of 30 days restriction and loss
of a months pay for several Unauthorized Absences due to my sleep disorder.
Thinking that my problems were self-induced even when a sleep test revealed “severe”
sleep disturbance and likely could have gotten me out of the NJP. I only
revealed the assault later when I was unable to do a push up at Physical
Readiness Testing due to my severed nerve. This shows how much I desired to
keep it covered up.

My STRs and evidence of letters from a former co-worker and supervisor
show that I exhibited many of the symptomology form Manual M21-1:

“Evidence that might indicate such a stressor as lay
statements describing episodes of depression; panic attacks or anxiety
but no identifiable reasons for the episodes; visits to medical clinics
without a specific ailment; evidence of substance abuse; and increased
disregard for military or civilian authority.
The Manual also lists behaviors such as requests for change of military
occupational specialty (MOS) or duty assignment, increased use or abuse of
leave, changes in performance and performance evaluations, increased use
of over-the-counter medications, unexplained economic or social behavior
changes, and breakup of a primary relationship as possibly indicative
of a personal assault, provided that such changes occurred at the time of the
incident. The Court has also held that
the provisions in M21-1, Part III, 5.14©, which address PTSD claims based on
personal assault, are substantive rules that are the equivalent of VA
regulations and binding on VA. Y.R. v.
West, 11 Vet. App. 393, 398-99 (1998); Patton, 12 Vet. App. at 272.



My attempt to compartmentalize my response to the assault likely predicated my
divorce. I have enclosed my enlistment Report of Medical History and a letter from_____ (My ‘Primary

relationship’ that broke up) as proof of prior
functioning and that homelessness and Drug addiction were very out of character.

The current C&P examiner gives a different scenario for my
success in the military, and this shows how far my claim has drifted. On the
surface, the examiner’s statement that “in many cases individuals with
personality disorders function better in a structured military environment.” On
the surface this devalues my service and success.

Reagarding PD, it needs to be noted that VA treatment
records of hospital discharge diagnoses to substantiate doubt that a personality
disorder exists in my case:

Bay Pines Progress Note dated 8/29/01 lists “Axis II
Deferred”

Menlo Park VAMC Discharge Summary dated 3/25/03 lists “Axis II Deferred”

Battle Creek VAMC Discharge Summary dated 12/22/03 lists “Axis II No Diagnosis”

Sheridan VAMC Discharge addendum dated 12/03/09 “Axis II Deferred”

Current Psychiatric Progress Note dated: 6/22/12 lists “Axis II – Personality
Disorders: None”

|and even the diagnosis received in service by Dr. Soman was ruled out as a
problem.

The SOC states, the examiner notes that the “vet reported that while he was in the
military he was encouraged to get out because of his personality disorder and
limited ability to handle stress”

This is mischaracterized and needs to be clarified. In
service, I had approached my Leading Petty Officer on the unit to tell him I
was becoming very stressed by the job, getting depressed and that I was
thinking about getting out. His reply was simply, “You could always get out on
a personality disorder.” I was not “encouraged” to get out.

The LPO’s statement has to be put in context. On the unit
there were bona fide personality disorders but if you wanted out of your
enlistment and were committed to it to a degree that keeping you in would be harmful
to you (as in getting yourself admitted to the Psych ward), you could be given a
“character” diagnoses. If you were on a 2 year enlistment you were given
“Adjustment Disorder/”Failure to Adapt” if you were on a four year enlistment,
you were given the generic Personality Disorder NOS. This enabled the service member
to seek separation from service.

As the examiner noted, I have cleaned up and feel much
better emotionally but the symptoms of PTSD have definitely become amplified
and at times hinder attempts to settle into a normal life and be around normal
people. This is why I submitted a claim for PTSD.

I am service connected and currently treated for a sleep
disorder and a severed nerve. To me, it seems as if I am service connected for
the symptoms but not the cause.

Thank you,

Edited February 18, 2013 by Swarthy