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  • 14 Questions about VA Disability Compensation Benefits Claims

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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Most Common VA Disabilities Claimed for Compensation:   

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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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Question

Hey there and thanks in advance for your time. My main question is how much weight is given to comments? The Checkmarked Impairment would indicate up to 50% - but the comments seem to read more like 70%. Would appreciate your thoughts on where you think this might land. Sorry for it being so long, stripped out as much as I could.

SECTION I:

a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)? [x ] Yes [ ] No

Diagnosis #1: Major Depression, single episode, moderate to severe ICD code: 296.22

Indicate the Axis category: [x ] Axis I [ ] Axis II

Comments, if any:The veteran's Major Depression is more likely than not secondary to her musculoskeletal condition and chronic pain from her service connected lumbarsacral/cervical strain and knee condition. She has had worsening of her pain conditions over time to the point that it has significantly interfered with her ability to care for her own needs and participate in activities which she previously enjoyed. This eventually led to depression. Clinical records clearly indicate that her depression is felt to be due to her medical conditions and chronic pain. There is a clear association between the severity of her depression and the severity of her pain and physical limitations.

b. Axis III - medical diagnoses:

ACTIVE PROBLEM

Low back strain

Arthritis of spine

Degeneration of intervertebral disc

Arthritis of knee

Chondromalacia of patella

Derangement of meniscus

Premature beats (SNOMED CT 29717002)

Paresthesia (SNOMED CT 91019004)

Paresthesia of foot (SNOMED CT 309087008)

Chronic constipation (SNOMED CT 236069009)

Esophagitis (SNOMED CT 16761005)

Neck pain (SNOMED CT 81680005)

Rectal hemorrhage (SNOMED CT 12063002)

Nausea (SNOMED CT 422587007)

Lumbar disc prolapse with radiculopathy (SNOMED CT 202735001)

Major Depressive, Single Episode

Chronic Low Back Pain (ICD-9-CM 724.2)

Bursitis/Tendonitis

Stomatitis, Aphthous * (ICD-9-CM 528.2)

Rosacea * (ICD-9-CM 695.3)

Migraine with Aura, without mention of intractable Migraine without mention of

Syncope * (ICD-9-CM 780.2)

Other specified cardiac dysrhythmias

Graves' Disease * (ICD-9-CM 242.00)

Endometriosis * (ICD-9-CM 617.9/617.0)

Pain in joint involving lower leg (ICD-9-CM 719.46)

c. Axis IV - Psychosocial and Environmental Problems (describe, if any): unemployment; chronic mental health symptoms, chronic pain, financial concerns, limited social supports; numerous medical conditions

d. Axis V - Current global assessment of functioning (GAF) score: 52 mconsistent with recent GAF (52 on 10-25-13)

Comments, if any: Veteran has moderate to serious difficulty with depression and anxiety; she has intermittent passive suicidal ideation; she has poor motivation and chronic problems with energy/concentration/focus/distractibility/interest /hoplessness/helplessness. She is social withdrawn and periodically does not leave her house for extended periods at a time. She becomes frustrated over her need for her husband to act as a caretaker. She is unable to attend to a number of ADLs, but is not neglectful of hygiene or appearance. She has frequent anxiety attacks but no panic attacks or violence. No impulsivity. She has withdrawn from activities that she previously enjoyed and frequently avoids family and friends. She has lost a number of friends due to social withdrawal. She endorses irritability and poor frustration tolerance.

3. Occupational and social impairment

-------------------------------------

a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses?

[x ] Occupational and social impairment with reduced reliability and productivity

c. Relevant Mental Health history

MENTAL HEALTH HISTORY: No h/o mental health treatment in childhood, adolescence or during the military. SMR are negative for mental health treatment. She reports being resistant to mental health treatment and having a long history of aversion to psychotropic medications. She was therefore very resistant to referral to mental health services.

She first participating in behavioral health medicine at the VA in 2012 where she got limited treatment for chronic headaches. She was referred to mental health after having a "breakdown". She was first seen in November 2012 at which time she was diagnosed with major depression.

Clinical records endorse her depression as being due to her chronic pain from her service-connected conditions. She has a history of being a very strong and independent woman who has great difficulty dealing with being dependent on others for basic care. This has greatly added to her depression over time. She is seen every 2-3 months for medication management and weekly to biweekly for individual therapy. On her current medication of Remeron 15 mg q.h.s. and temazepam 22.5 mg q.h.s. There is no history of inpatient psychiatric admissions, substance abuse treatment\problems or suicide attempts.

4 months ago she endorsed passive suicidal ideation.

She continues to endorse chronic difficulties with hopelessness, helplessness, worthlessness, and guilt. She has chronic difficulties with "need for control", excessive worry, racing thoughts, feeling like a burden, social withdrawal, irritability, poor frustration tolerance and emotional detachment.

d. Relevant Legal and Behavioral history (pre-military, military, and post-military): No history of DUIs, arrest or time in jail. She is at risk for foreclosure due to losing her source of income. She continues to endorse social withdrawal, emotional detachment, irritability and poor frustration tolerance. There is no history of assault or violence.

e. Relevant Substance abuse history (pre-military, military, and post-military): ETOH: Never problematic; she thinks a glass of wine per month. Drugs: Never. Smoking: In her teens

3. Symptoms

-----------

For VA purposes, check all symptoms that apply to the Veteran's diagnoses:

[x ] Depressed mood

[x ] Anxiety

[x] Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively

[X ] Chronic sleep impairment

[x ] Mild memory loss, such as forgetting names, directions or recent

events

[X ] Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks

[x ] Flattened affect

[x ] Disturbances of motivation and mood

[x ] Difficulty in establishing and maintaining effective work and social relationships

[x ] Difficulty in adapting to stressful circumstances, including work or a worklike setting

[x ] Inability to establish and maintain effective relationships

4. Other symptoms

-----------------

Does the Veteran have any other symptoms attributable to mental disorders that are not listed above?

[x ] Yes [ ] No

If yes, describe:social withdrawl; frequent hopelessness/helplessness; chronic problems with energy/concentration/focus; ruminating thoughts; excessive worry; her need for control; social withdrawal; emotional attachment; frequent sense of worthlessness and guilt; black and white thinking

5. Competency

-------------

Is the Veteran capable of managing his or her financial affairs?

[x ] Yes [ ] No

6. Remarks, if any:

-------------------

The following gives added information reading the Veteran's employability for both sedentary and physical employment based on her mental health symptoms. Veteran is considered fully capable of managing funds in her own best interest.

Her ability to understand and follow instructions is considered mildly impaired.

Her ability to retain instructions as well as sustain concentration to perform simple tasks is considered markedly impaired. Her ability to sustain concentration to task persistence and pace is considered markedly impaired. Her ability to respond appropriately to coworkers, supervisors, or the general public is considered moderately to markedly impaired. Her ability to respond appropriately to changes in the work setting is considered markedly impaired.

Her ability to accept supervision is considered mildly impaired. Her ability to accept criticism is considered mildly impaired. Her ability to be flexible in the work setting is considered markedly impaired. Her ability to work in groups is considered moderately impaired. Her ability for impulse control in the work setting is considered moderately impaired. The veteran has poor stress tolerance and is easily overwhelmed and exhausted. For example, she was very exhausted by the end of her to our assessment.

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Thanks for your WAG, Carlie - appreciate your taking the time to read it. All comes down to that impairment checkmark most of the time, eh?

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I agree with carlie, but I would say boarderline to 70%. Are you working?

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Not working. Wheelchair bound. Essentially housebound. Lucky to have my husband of 27 years (also former Marine) taking care of me. I haven't been able to work since 2010 - was (very) recently approved for SSDI, mostly due to service connected issues, so that was a huge help. I've been service connected since my exit physical in 1990 and never knew it until I came to the VA for the first time in 2011 when I could no longer afford private health care. Didn't even know I could receive disability compensation.

I really appreciate you guys here - this site was extremely helpful as I built my claim, and now it helps me pass the time with folks in similar boats. People who understand, and are supportive of each other. I don't post much, but I lurk quite a bit when I'm stuck in bed or on the couch.

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If you don't mind me asking. What is your SC broken down in percentage/condition and is there anything else you are applying for other than your MH claim?

Get your private psych Dr to fill out the disability Benefit Questionaire below. It's a good form to use as it addresses the symptoms of the rating chart.

General Rating Formula for Mental Disorders:

Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name (100%)

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships (70%)

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships (50%)

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events) (30%)

Occupational and social 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 continuous medication (10%)

A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication (0%)

http://www.vba.va.gov/pubs/forms/VBA-21-0960P-2-ARE.pdf

Edited by Dot09

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