Axis 1 - Anxiety Disorder Not Otherwise Specified

[Josephine]

This claim of mine is over whelming me.

I know everyone is tired of hearing about my claim.

I just can't let them beat me out of my benefits.

I had my first C&P with a diagnosis of Generalized anxiety disorder with a more likely than not.

5 Months later a Board of Two Psychaitrist - Axis 1 - Anxiety disorder not otherwise specified

Decision- nothing bothered her in service.

Paragrah before the decision - she was taking librium and caffergot in service.

This to me is not a plausible statement. Why would I have been taking two coded drugs.

What are they saying about me with the Not Otherwise Specified??

I could wring that DRO niece of mine by the neck for not helping me.

I hope that she eventually makes it to the Appeals Court as she would like.

Thanks,

Josephine

[Hoppy]

Josephine,

Hang in their. They are just confused. You need new and stronger evidence that takes into account the entire history of your claim. One thing that is true is that if the VA does little to explain to you what they do not like about your claim. In reading the write up you posted I think that the doctor on the first C&P did not either have the proper evidence or maybe he did not write it up properly. It says you were in treatment for forty years. And that you were unable to hold employment. You say you have 40 years worth of reports. You do not say that you submitted these reports or took them to the C&P appointment with you. I get the felling that the DRO thought that the history given by the C&P examiner was based on your subjective opinion. I could be wrong. The VA can not accept your opinion as evidence. This is what I would rather the report say. The veteran brought to the appointment treatment notes from various doctors over the last forty years. Additionally, the veteran brought an earnings statement from the Social Security administration showing little or no income since 1983. I have seen this type of statement in treatment notes that were used in successful claims.

Do not tell these people what you go through. SHOW THEM THE REPORTS and make sure they write that you have the evidence. Submit the 40 year history of treatment and the Social Security income statement to the RO. Do not tell them about it. I would take the Board report to a VA psychologist and tell them to write a report that the assessment that you received that you had no problem in the military is a factual error based on the fact that you were taking meds in the military. Do not argue with these guys based on your opinion. Get a shrink to agree with you and send the shrink’s reports to the RO. I have seen this tactic work for other veterans. If you do not have the finances available, use VA shrinks (more on VA shrinks later). Additionally, your argument that the board report did not mention the logic behind their decision is valid. If you can get them to give weight to the first C&P you should prevail. They might not do this at the RO because they already cited the board of two. Appeal it to the BVA or anybody else. I know veterans who won claims with less evidence than you have at the BVA level. I know veterans who won claims without ever being prescribed pysch meds in the military. I agree that the meds are a key issue in your claim This is my humble non professional opinion.

If you did not submit the forty year history previously or the SSI income statement do so ASAP. I would put on the statement that this new information only confirms previous statements that you made that were not given weight and that it is technically supportive evidence, not new evidence. This is what I would do if it were my claim. This is only my advice. Get your SO on board if you can. Personally, I would be leery of an SO who did not tell you to do this. My SO made me do all this stuff. He was a good SO and worked as a rating specialist for the VA for twenty years and knew what it took to win claims. My first SO was an idiot and did not tell me to do this stuff. I had twenty six years worth of treatment notes at VA hospitals that I did not take to appointments or exams. The reports were lost for five years. When I finally got them I changed SO's and won my claim.

I know your frustration. I had my own 8.5 years battle with the VA. I had a slam dunk claim for a medical condition and the VA screwed it up for 8.5 years. They did get it right. I was basically homeless for 7 years living on a 24 foot boat. I lived on General relief welfare for six month until my SSI came through. I lived on 750.00 a month for six years. The entire time I knew I had a valid claim for 100%. I had been terminated from a really nice, high paying job working for one of the nicest cities in the world (Beverly Hills CA.) They fired me and ran me out of town when they found out I had a life threatening vascular disease. My own attorney pulled me out of voc rehab and told me I could not work under labor law.

These guys do not award service connection until it jumps off the page at them. The doctor’s reports are the key. That is why I tell folks to get reports from current treating physicians. Treating physicians lay the ground work. Then the C&P guys will conform to the opinion of the treating physician or the C&P will not be given weight. If you think that you can win a claim by filing a claim and seeing a shrink one or two times during your life time it will be difficult to win. The C&P examiners need treating physician’s workups. Without them they can only make decisions on little information. Then they make lots of mistakes.

Psych diagnoses can be difficult to make. Many conditions take years to develop. Multiple diagnoses with each new examiner are common.

Patrick worked on C&P's. I have associated on a daily basis with at least 20 veterans who are service connected for PTSD, anxiety disorders etc. I was a veteran’s outreach counsellor in college and have kept in contact with many veterans.

I often tell folks not to wait for a C&P and do not depend on C&P exams. Rely on your treating physicians to write the reports. I won my claim for a medical condition without ever having a C&P. I know veterans who have won psych claims for anxiety disorders and read all their treating physicians reports. They were treated at VA hospitals and the VA shrinks were very supportive. There were problems. However, with repetitious appointments and resolutions of the problems the veterans prevailed. The types of problems that occurred included; interns writing mis information and omitting important information from military treatment notes. The problem was incompetence not a wilful desire to shoot down the claims.

Edited September 14, 2006 by Hoppy

[Josephine]

Josephine,

Hang in their. They are just confused. You need new and stronger evidence that takes into account the entire history of your claim. One thing that is true is that if the VA does little to explain to you what they do not like about your claim. In reading the write up you posted I think that the doctor on the first C&P did not either have the proper evidence or maybe he did not write it up properly. It says you were in treatment for forty years. And that you were unable to hold employment. You say you have 40 years worth of reports. You do not say that you submitted these reports or took them to the C&P appointment with you. I get the felling that the DRO thought that the history given by the C&P examiner was based on your subjective opinion. I could be wrong. The VA can not accept your opinion as evidence. This is what I would rather the report say. The veteran brought to the appointment treatment notes from various doctors over the last forty years. Additionally, the veteran brought an earnings statement from the Social Security administration showing little or no income since 1983. I have seen this type of statement in treatment notes that were used in successful claims.

Do not tell these people what you go through. SHOW THEM THE REPORTS and make sure they write that you have the evidence. Submit the 40 year history of treatment and the Social Security income statement to the RO. Do not tell them about it. I would take the Board report to a VA psychologist and tell them to write a report that the assessment that you received that you had no problem in the military is a factual error based on the fact that you were taking meds in the military. Do not argue with these guys based on your opinion. Get a shrink to agree with you and send the shrink’s reports to the RO. I have seen this tactic work for other veterans. If you do not have the finances available, use VA shrinks (more on VA shrinks later). Additionally, your argument that the board report did not mention the logic behind their decision is valid. If you can get them to give weight to the first C&P you should prevail. They might not do this at the RO because they already cited the board of two. Appeal it to the BVA or anybody else. I know veterans who won claims with less evidence than you have at the BVA level. I know veterans who won claims without ever being prescribed pysch meds in the military. I agree that the meds are a key issue in your claim This is my humble non professional opinion.

If you did not submit the forty year history previously or the SSI income statement do so ASAP. I would put on the statement that this new information only confirms previous statements that you made that were not given weight and that it is technically supportive evidence, not new evidence. This is what I would do if it were my claim. This is only my advice. Get your SO on board if you can. Personally, I would be leery of an SO who did not tell you to do this. My SO made me do all this stuff. He was a good SO and worked as a rating specialist for the VA for twenty years and knew what it took to win claims. My first SO was an idiot and did not tell me to do this stuff. I had twenty six years worth of treatment notes at VA hospitals that I did not take to appointments or exams. The reports were lost for five years. When I finally got them I changed SO's and won my claim.

I know your frustration. I had my own 8.5 years battle with the VA. I had a slam dunk claim for a medical condition and the VA screwed it up for 8.5 years. They did get it right. I was basically homeless for 7 years living on a 24 foot boat. I lived on General relief welfare for six month until my SSI came through. I lived on 750.00 a month for six years. The entire time I knew I had a valid claim for 100%. I had been terminated from a really nice, high paying job working for one of the nicest cities in the world (Beverly Hills CA.) They fired me and ran me out of town when they found out I had a life threatening vascular disease. My own attorney pulled me out of voc rehab and told me I could not work under labor law.

These guys do not award service connection until it jumps off the page at them. The doctor’s reports are the key. That is why I tell folks to get reports from current treating physicians. Treating physicians lay the ground work. Then the C&P guys will conform to the opinion of the treating physician or the C&P will not be given weight. If you think that you can win a claim by filing a claim and seeing a shrink one or two times during your life time it will be difficult to win. The C&P examiners need treating physician’s workups. Without them they can only make decisions on little information. Then they make lots of mistakes.

Psych diagnoses can be difficult to make. Many conditions take years to develop. Multiple diagnoses with each new examiner are common.

Patrick worked on C&P's. I have associated on a daily basis with at least 20 veterans who are service connected for PTSD, anxiety disorders etc. I was a veteran’s outreach counsellor in college and have kept in contact with many veterans.

I often tell folks not to wait for a C&P and do not depend on C&P exams. Rely on your treating physicians to write the reports. I won my claim for a medical condition without ever having a C&P. I know veterans who have won psych claims for anxiety disorders and read all their treating physicians reports. They were treated at VA hospitals and the VA shrinks were very supportive. There were problems. However, with repetitious appointments and resolutions of the problems the veterans prevailed. The types of problems that occurred included; interns writing mis information and omitting important information from military treatment notes. The problem was incompetence not a wilful desire to shoot down the claims.

Edited September 14, 2006 by Josephine

[Josephine]

Hoppy,

Edited September 14, 2006 by Josephine

[Josephine]

Hoppy,

I am expecting a new C&P examination from The Appeals Management Center.

If this should happen, I will definitely take all of my medical records, which all state diagnosis of acute to chronic anxiety.

My first C&P was held a little strange, for the examiner and myself were at a disadvantage.

No, I did not take my 40 years of treatment records, but did take my buddy letter.

When I got there, the first thing the doctor said. Miss, I can't help you.

I ask him why? He stated that the VA has asked him to evaulate me for an acquired psychiatric disorder, but they ask him from 1978 to date. I ask him then , " where are my private medical records from 1965 to date?

He ask If I had a copy of them and I told him yes, but that the Va had a copy also, because I had seen them at the Va.

This poor young doctor spent one hour of his time, finding my medical records. He went from year to year, until he located them all hidden in my claims file.

In his C&P, he stated that he had read the entire claims file and the question they posed to him was incorrect. He stated that " Why do you only want an evaluation from 1978 to date, when I have all of the veterans treatment records from 1965 to date"?

The second C&P was no more than an examination to get rid of me. There was just too much falsifying my medical records to even consider it as a C&P.

They should have never stated that I had 3 children when I have only two and that my medical records stated this, when they changed the records.

If this lady Psychiatrist, doesn't get her examination thrown out, I will definitely turn her over to The Board of Medicine, for I do think that she is in a safe haven at the Va. , but her Virginia state license can be addressed, by the Commonwealth of Virgina.

I will never allow any doctor to change my medical records to make me what they would like for me to be.

Her lies are slander and nothing else.

If she hadn't lied about my treating physician in service and stated that he gave me librium for a headache and that the command issued my discharge for bad behavior, I would have never contacted him to write me a letter to what really happened in service.

Dr. C. was there and he knew it all. He started my early discharge for medical reasons only.

My treating physician may be an internist, but after 30 years of treatment of my anxiety and other illness, I do believe that he can hold his own with those two psychiatirst.

By the way, I called my niece the DRO and she did tell me that the Anxiety not otherwise specified was payable , that the laws had been changed some time back.

I guess that she is telling the truth on this one?

I have a problem being a Sensitive 6 file with my file in the state of West Virgina and my living in Virginia. Most employees of the Va. can not open the file and that darn toll free number takes me back to Virginia.

I have never been able to speak to the ones that were calling the shots in West Virginia

If I receive another C&P from The Management Center in Washington as directed by the BVA, then I shall take all of my medical records with me. The letter from Dr. C. and the 3 letters from my treating Internist.

I know that it is unual to have an internist treat anxiety, but it just happened that way.

I have medical records of private psychiatrist, but he is far better than they were.

Thanks so much for placing so much into helping me with this claim.

Believe me, another examination, and I will be prepared.

Thanks bunches!!

Josephine

Edited September 18, 2006 by Josephine

[Hoppy]

Josephine,

It does seem that so far you have been the victim of administrative errors rather than a ploy by adjudication to shoot you down. The C&P examiner being limited to evaluate from 1976 sounds like a problem. That does not mean that you will not run into examiners with hidden agendas. And it does not mean that the administrative errors were not intentional either. These types of people will mess up your claim. You have the right idea to hit them with a complaint to the doctors licensing agency. If you had the time and wanted to really cause problems you might want to try and find out why the RO asked for a medical opinion from 1976. The problem is that the RO folks probably have way more protections than the doctors.

The entire subject of administrative errors and adjudicators manipulating evidence is the subject of a post I have been thinking about for over a month. I will probably type it up soon. In my case I was awarded service connection for angioedema by the RO and never submitted any additional evidence other than a medical report showing that the original denial was based on a fraudulent or grossly incompetent determination that my angioedema was the result of post service employment.

The problem with the interpretation that the lithium was prescribed for a headache does shoot down what I consider to be a very strong point in your case. That being that you were prescribed psych meds in the military. However, being prescribed psych meds is not a requirement. I have read cases where veterans were service connected for psych condition 15 years after discharge. The only in service symptoms noted were for a condition called somatization. Somatization according to the DSM IV TR can be used to replace the requirement of “sadness” when making the diagnosis of a major depressive episode. The veteran was discharged for a personality disorder and there was no record of psych meds. Also, there was no post service treatment for 15 years. I am also familiar with other similar cases.

The reports you have in the military can not be ignored and the personality disorder diagnosis in my opinion must be re-evaluated. That is because under the DSM III the requirements for making the diagnosis were very vague. When they wrote the DSM IV they dropped several personality disorders due to the vagueness. They also stiffed the requirements for making the diagnosis of other personality disorders.

When preparing for your next C&P focus on the weak points of your claim. There was another veteran on the board who had a problem because the VA ignored a psych diagnosis made by an MD who had a general practice. At one time I filed a PTSD due to aggravated assault claim. My SO was of the opinion that I needed to get opinions from either psychiatrists or PhD’s in clinical psychology. He also told me to get them from VA doctors.

If the treatment reports you have are from private M.D.’s and these doctors prescribed psych meds make sure you have the notes showing the meds. Also, I tell people to get reports from treating physician because you can actually ask the doctor to write things in the report that you think are important. Additionally, the treating doctor can write what they want since they are the doctor. I did this in my PTSD claim and got specific issues addressed that other wise the doctor might not have detailed in the report.

In your case a long history of treatment for anxiety should be sufficient no matter if the doctor is an M.D. or the head of the Mental Health Department at a VA hospital. However, this time make sure they either note that the psych meds were specifically for anxiety and not a headache and also that the symptoms noted in the military were consistent with an anxiety disorder and indicates the onset of the current anxiety disorder irrespective of whether or not the meds in the military were for headaches.

Also, have a treating physician review the 40 year history of the M.D.s who treated you and note that they concur that such treatment was for chronic anxiety that is related to the emotionally unstable reaction that occurred in the military and was mis diagnosed. I actually asked and got a VA shrink to write in my treatment notes that the diagnosis of personality disorder made in the military was based on superficial and inadequate history and testing. Furthermore, the activities and statements noted in the military medical reports indicate a diagnosis of an anxiety disorder and PTSD that onset in the military.

When I went to the DRO on my PTSD claim he scheduled a C&P with the head of the mental health clinic at the VA hospital. They scheduled the C&P because I had multiple diagnoses of PTSD due to assault and PTSD due to a chronic life threatening medical condition. It really did not matter because the assault happened in the military and the medical condition was already service connected. The DRO was confused because a SSI shrink said I had schizo affective disorder. The DRO wanted to make sure that there was not another condition confusing the issues.

In my conversation with the C&P examiner I specifically referred the examiner to the details that I specifically asked the treating physician to put in the reports. Something I did in the C&P worked. The C&P examiner threw out the SSI diagnosis and wrote a report that allowed no room for the denial of a secondary psych condition to my angioedema. The funny thing is that I am not sure exactly what was going through the DRO’s head. I was service connected 100% for angioedema without a specific diagnosis of the secondary psych condition cited by the DRO.

One of the problems is that I got one of the treating doctors to write that the life style mandated by a medically prescribed plan to manage the angioedema mimicked a psychiatric condition with a GAF of 40. I had a service connected medical condition that mimicked a psych condition and I had a psych condition. As I was leaving the DRO’s office I told him about this situation and that there was no way any shrink could unravel any intertwined symptoms of the psych condition and the medically prescribed plan to manage a life threatening disease that was already service connected. I let him know that I was appealing any denial all the way to federal court. I also told him that lost a very good job working for the City of Beverly Hills and I have not worked in ten years because my attorney told I could not work under labor law, I was tired of arguing with lawyers. I told him I was done and he could put a fork in me. I told him if he thought I could work he needed to get reports from lawyers not doctor because it’s the lawyers who are telling me I can not work. It took 8 years to get to see this DRO. I went into the room exercising great restraint. I am sure that it was obvious that I was really pissed and loaded for bear. It might come down to a bigger fight than you want. You just have to prepare well and cover all the angles.

[Josephine]

Josephine,

It does seem that so far you have been the victim of administrative errors rather than a ploy by adjudication to shoot you down. The C&P examiner being limited to evaluate from 1976 sounds like a problem. That does not mean that you will not run into examiners with hidden agendas. And it does not mean that the administrative errors were not intentional either. These types of people will mess up your claim. You have the right idea to hit them with a complaint to the doctors licensing agency. If you had the time and wanted to really cause problems you might want to try and find out why the RO asked for a medical opinion from 1976. The problem is that the RO folks probably have way more protections than the doctors.

The entire subject of administrative errors and adjudicators manipulating evidence is the subject of a post I have been thinking about for over a month. I will probably type it up soon. In my case I was awarded service connection for angioedema by the RO and never submitted any additional evidence other than a medical report showing that the original denial was based on a fraudulent or grossly incompetent determination that my angioedema was the result of post service employment.

The problem with the interpretation that the lithium was prescribed for a headache does shoot down what I consider to be a very strong point in your case. That being that you were prescribed psych meds in the military. However, being prescribed psych meds is not a requirement. I have read cases where veterans were service connected for psych condition 15 years after discharge. The only in service symptoms noted were for a condition called somatization. Somatization according to the DSM IV TR can be used to replace the requirement of “sadness” when making the diagnosis of a major depressive episode. The veteran was discharged for a personality disorder and there was no record of psych meds. Also, there was no post service treatment for 15 years. I am also familiar with other similar cases.

The reports you have in the military can not be ignored and the personality disorder diagnosis in my opinion must be re-evaluated. That is because under the DSM III the requirements for making the diagnosis were very vague. When they wrote the DSM IV they dropped several personality disorders due to the vagueness. They also stiffed the requirements for making the diagnosis of other personality disorders.

When preparing for your next C&P focus on the weak points of your claim. There was another veteran on the board who had a problem because the VA ignored a psych diagnosis made by an MD who had a general practice. At one time I filed a PTSD due to aggravated assault claim. My SO was of the opinion that I needed to get opinions from either psychiatrists or PhD’s in clinical psychology. He also told me to get them from VA doctors.

If the treatment reports you have are from private M.D.’s and these doctors prescribed psych meds make sure you have the notes showing the meds. Also, I tell people to get reports from treating physician because you can actually ask the doctor to write things in the report that you think are important. Additionally, the treating doctor can write what they want since they are the doctor. I did this in my PTSD claim and got specific issues addressed that other wise the doctor might not have detailed in the report.

In your case a long history of treatment for anxiety should be sufficient no matter if the doctor is an M.D. or the head of the Mental Health Department at a VA hospital. However, this time make sure they either note that the psych meds were specifically for anxiety and not a headache and also that the symptoms noted in the military were consistent with an anxiety disorder and indicates the onset of the current anxiety disorder irrespective of whether or not the meds in the military were for headaches.

Also, have a treating physician review the 40 year history of the M.D.s who treated you and note that they concur that such treatment was for chronic anxiety that is related to the emotionally unstable reaction that occurred in the military and was mis diagnosed. I actually asked and got a VA shrink to write in my treatment notes that the diagnosis of personality disorder made in the military was based on superficial and inadequate history and testing. Furthermore, the activities and statements noted in the military medical reports indicate a diagnosis of an anxiety disorder and PTSD that onset in the military.

When I went to the DRO on my PTSD claim he scheduled a C&P with the head of the mental health clinic at the VA hospital. They scheduled the C&P because I had multiple diagnoses of PTSD due to assault and PTSD due to a chronic life threatening medical condition. It really did not matter because the assault happened in the military and the medical condition was already service connected. The DRO was confused because a SSI shrink said I had schizo affective disorder. The DRO wanted to make sure that there was not another condition confusing the issues.

In my conversation with the C&P examiner I specifically referred the examiner to the details that I specifically asked the treating physician to put in the reports. Something I did in the C&P worked. The C&P examiner threw out the SSI diagnosis and wrote a report that allowed no room for the denial of a secondary psych condition to my angioedema. The funny thing is that I am not sure exactly what was going through the DRO’s head. I was service connected 100% for angioedema without a specific diagnosis of the secondary psych condition cited by the DRO.

One of the problems is that I got one of the treating doctors to write that the life style mandated by a medically prescribed plan to manage the angioedema mimicked a psychiatric condition with a GAF of 40. I had a service connected medical condition that mimicked a psych condition and I had a psych condition. As I was leaving the DRO’s office I told him about this situation and that there was no way any shrink could unravel any intertwined symptoms of the psych condition and the medically prescribed plan to manage a life threatening disease that was already service connected. I let him know that I was appealing any denial all the way to federal court. I also told him that lost a very good job working for the City of Beverly Hills and I have not worked in ten years because my attorney told I could not work under labor law, I was tired of arguing with lawyers. I told him I was done and he could put a fork in me. I told him if he thought I could work he needed to get reports from lawyers not doctor because it’s the lawyers who are telling me I can not work. It took 8 years to get to see this DRO. I went into the room exercising great restraint. I am sure that it was obvious that I was really pissed and loaded for bear. It might come down to a bigger fight than you want. You just have to prepare well and cover all the angles.

Edited September 15, 2006 by Josephine