ptsd Ptsd C&p: Surprising To Say The Least

[2E151]

I had the PTSD C&P exam today that I've been worrying about for the past couple of weeks. The wife had us on a tight schedule so we made it to the QTC building exactly at the time of the appointment. Needless to say I was a click away from full freak out mode, but I refused to take any medications.

The staff was pleasant, took my paperwork, and the Doctor came out and got me and the wife almost immediately. Super friendly guy, he has a private practice and travels down to my neck of the woods once a week for QTC. I'm so glad he had the "bedside manner" he did, or I would have probably had a nervous breakdown in front of my wife.

The examination was like nothing I expected.

Since this was supposed to be a fully developed claim (initiated the old fashioned way over the phone) the VA obviously didn't have a lot of information to provide him with, but I brought him my 21-0781, the last couple of pages of my Statement in Support of Form (the pages talking about my current conditions), the private tests I had done locally (PAI, MPPI-2,ect) and a couple of other odds and ins.

Walking into his office he said the process had been streamlined recently and that a lot of the pre-military/childhood questions had been phased out. First question was about my childhood, ("Very close-knit family, no problems") second question he asked was I depressed. ("Everyday"), any Anxiety issues ("Through the Roof"), Short Term Memory ("non-existant"), Long Term Memory ("almost as bad") when I told him the dosage of Xanax I get every month from the VA (240 1mg pills a month) I swear his jaw literally dropped.

He asked the wife some pretty specific questions, stating that spouses often catch things a patient might overlook. He actually took the time to sift through my notes, he saw the part where the Cognitive Processing Therapy had made things considerably worse and agreed that it should never be the first method of treatment, that you need to learn how to cope with the symptoms before diving into the problems.

He really didn't proceed how I expected: I expected him to pretty much go down the list on a DBQ. We had some casual talk about the VA in general, life experiences, and such.

Two things blew my mind though:
He told me that he had recieved a formal email via his boss from the VA that he provided more diagnoses for PTSD than any other clinical psychologist employed by QTC in the entire country, and that it needed to be addressed. He asked his boss, "What do you want me to do? Lie?", and of course she said No, and he responded "I just examine them and call them like I see them."

Second, he asked about any substance abuse. I was honest in that I drank like a fish when I was in Mosul, and had recently began self-medicating with alcohol in the evening because of the lack of results from the previous 4 anti-depressents, that I just wanted an hour or two of happiness. He looked me dead in the face and said if your going to self medicate toss the bottles and smoke pot. He said its several times more effective and a fraction as damaging to your health. I was incredulous, me and the wife looked at each other and said if I could find some I would! He said to toss the bottles again and keep your eyes open, this is a military and a college town.

Obviously I have no clue exactly how he wrote things up, I have a positive feeling but we'll just have to see how the RO interprets things. As soon as I can I'm going to try and find out how to get a copy of his exam, the regional office is only 2 hours away.

If your Examiner suggests that might want to take up smoking pot, I can't imagine what he wrote down....

[deanbrt]

My guess is this occurrence may be a bellwether that the VA may be de facto raising the bar for PTSD diagnosis to mitigate the explosion in claims for it.

I think someone posted here that the VA is no longer accepting IMOs for PTSD.

As for noting a history of alcohol or drug use, the following is germane to Social Security but food for thought here. I think you have to be honest, but consider carefully your responses.

http://www.disabilitysecrets.com/can-you-get-disability-with-drug-alcohol-use.html

[carlie]

I was worried about that too, but I when I told him my binge drinking occured in service during when my stressors occured he just kinda of dismissed it with a wave of his hand

It's considered self medicating - I would not worry unless it kept you from

taking care of your life and finances (or was the cause of a secondary disability)-

then they may try to put incompetent to handle VBA benefits, down the road.

JMHO

[deanbrt]

"Claimants whose disabling conditions are psychiatric or emotional in nature (for example, depression or anxiety) will have a harder time proving that their alcohol or drug use is not a contributing factor to their mental impairment. Most psychologists and psychiatrists believe that even moderate alcohol use contributes to depression."

[carlie]

http://www.va.gov/vetapp09/Files3/0920567.txt

"THE ISSUE

Entitlement to an initial disability rating in excess of 50
percent disabling for posttraumatic stress disorder (PTSD),
with alcohol abuse."

"CONCLUSION OF LAW

With resolution of reasonable doubt in favor of the Veteran,
the criteria for a 70 percent initial rating for PTSD with
associated alcohol abuse have been met. 38 U.S.C.A. §§ 1155,
5103, 5103A, 5107 (West 2002 & Supp. 2008); 38 C.F.R.
§§ 3.102, 4.3, 4.7, 4.132, Diagnostic Code 9411 (effective
prior to November 7, 1996); 38 C.F.R. § 4.130; Diagnostic
Code 9411 (2008)."

"The diagnosis was PTSD, along with a history of
substance abuse. The evaluator thought that the Veteran
needs help for PTSD and associated depression and believed
the alcohol was self medicating for his symptoms."

"The Veteran testified at a May 1991 hearing saying he began
drinking in Vietnam and did it to self medicate for
nightmares. He endorsed severe startle reaction, flashbacks,
nightmares, suicidal thought, auditory hallucinations, and
sleep trouble."

"ORDER

A rating of 70 percent, but no more, for PTSD with associated
alcohol abuse is granted, subject to the laws and regulations
governing the award of monetary benefits from initial
entitlement."

[deanbrt]

Here is the full article from which I referenced. Obviously it is directed toward claims at another government agency, that being Social Security. Any good workman's compensation attorney will tell you one of a company's first line of defense for claims of work related depression and anxiety is if they can show substance abuse on the part of the employee. Does this mean all are denied? No. Certainly some are successful depending on the circumstances, as the article notes.

It is a question of risk to me. You might notice the statement about even moderate alcohol use as a cause of depression and anxiety. Moderate implies one or two drinks a day. You might remember the VA asks the question "how many drinks do you take a day" with some frequency I see no purpose in volunteering that one goes down to the Legion and has five or six beers with friends. That one goes there in the afternoon and has a couple of beers as a social outlet with friends is enough, in my estiomation. To be redundant, it is a question of unnecessary risk to me. My opinion.

Can You Get Disability If You've Used Alcohol Or Drugs?

If your condition would improve if you quit drinking or using drugs, you won't be able to get Social Security disability benefits or SSI.

Sometimes the Social Security Administration (SSA) can use the fact that you drink or use drugs as a reason to deny your claim. In other cases, however, it is possible to get disability benefits even if you drink or use drugs. Whether or not the SSA can deny your claim on the basis of alcohol or drug use depends on the nature of the medical condition for which you're applying.

Is Alcohol or Drug Use a Contributing Factor to the Impairment?

Whether your drug or alcohol use will affect a claimant's eligibility for disability benefits hinges on whether it contributes to your disabling medical condition. If a claimant's drug or alcohol abuse is deemed a material contributing factor to a medical impairment, that claimant will not win disability benefits. Materiality is determined by asking this question: Is the medical condition for which the claimant alleges disability exacerbated (made worse) -- or even caused -- by alcohol or drug use? If the answer is yes, the claimant's drug or alcohol use may be considered material to the alleged impairment, and the claimant may be found ineligible to receive disability benefits. This evaluation is called a drug and alcohol abuse (DAA) determination.

Will the Impairment Improve Without Alcohol or Drugs?

The SSA will ask the question, "If the applicant quits drinking or using drugs, will the applicant's medical condition improve?" To use an example, if a claimant has seizures, and the records indicate substance abuse, a claims examiner or judge (depending on the level the claim is at) will question what role is played by the claimant's use of substances. If an SSA medical consultant was of the opinion that a claimant's seizure condition would medically improve if the substance use or abuse came to an end, then the substance use or abuse would be labeled as material to the seizure condition. As a result, the claimant could not be awarded benefits on the basis of seizure disorder. If, however, the conclusion was made that the claimant's frequency of seizures would continue regardless of whether or not the alcohol or drug use was discontinued, such use would be considered immaterial---in other words, irrelevant.

What If the DAA Caused the Impairment?

It doesn't matter whether past alcohol or drug abuse caused the medical condition. Here's another example. A claimant applies for Social Security disability based on liver dysfunction and alcoholic hepatitis. The claimant has a history of alcohol abuse, some of it recent. Will the alcohol abuse harm the claimant's disability case? It depends on whether or not it is currently material or immaterial to his condition. It doesn't matter whether the alcohol abuse caused the liver damage in the first place.

What matters is whether the disabling condition would disappear if the claimant stopped drinking. If the claimant's liver damage is so pronounced that ceasing alcohol use completely would make no difference to the claimant's medical condition, then alcohol abuse would be considered immaterial, or irrelevant, to the case. If, however, ceasing the use of alcohol would result in medical improvement, alcohol abuse would be deemed material to the disability case, and the claim would be denied.

It's Difficult for Applicants With Mental Conditions to Prove Immateriality

Claimants whose disabling conditions are psychiatric or emotional in nature (for example, depression or anxiety) will have a harder time proving that their alcohol or drug use is not a contributing factor to their mental impairment. Most psychologists and psychiatrists believe that even moderate alcohol use contributes to depression.

Claimants for Social Security disability who have a history of alcohol or drug abuse but who are not currently using substances should carefully review their medical records before they file for disability. Often, medical doctors and mental health professionals will indicate "suspected use" in their treatment notes, and these indications, proven or otherwise, can have a damaging effect on a disability claim. For more information, see our article on admitting alcohol or drug use.

Representative Payees

If you win your claim for disability but the SSA believes you are still abusing alcohol or drugs, the SSA will require that you have a representative payee and will refer you to a substance abuse treatment program. The SSA will send your disability check to the representative payee, who is in charge of doling out money to you and paying bills for you, and preventing you from spending money on your addiction. The representative payee can be a friend, family member, or orgaization. person that you trust such as a parent or it can be a qualified organization. Learn more about representative payees.

Learn whether you can get disability due to a past or present alcohol addiction or drug habit.

Updated by: Beth Laurence, J.D.

[deanbrt]

I should have written moderate drinking is defined as MORE than one or two drinks a day.