ptsd Ptsd C&p Exam Within Va Clinic Where He Is A Patient.

[Kimmy]

My husband got a call yesterday from a VA person to review the items in his claim. She was in the process of ordering his C&P exams. She told him that the PTSD exam would be in the same clinic at the VA where he currently goes for treatment. Background: He was formally diagnosed in the past year and has attended the 10 week PTSD group sessions, the 6 week Anger Management sessions and is now in one on one counseling with his doctor who he is pretty comfortable with. He was in college thru VocRehab as a result of service connected bilateral knee injuries. However, he has had to drop out because problems with focus & memory, panic attacks and other anxiety issues all related to PTSD. For the other exams she said he would get the QTC info thru the mail. He got so worked up after this that he had a terrible panic attack last night. He said his mind was racing just thinking that all of a sudden his claim was moving. Quick change is hard for him.

We are thinking that is a good thing that he is going to his same clinic (less stress for him) since they have plenty of documentation on him. Any thoughts?

Edited August 21, 2014 by Kimmy (see edit history)

[georgiapapa]

In my opinion, this should work in his favor. If the examining doctor has any additional questions or needs further clarification after the C & P exam, they could probably confer with his regular clinical doctor. Unless the clinical doctor thinks he is faking his PTSD symptoms, he should be alright. Just my opinion.

[Navy04]

Sounds like a good thing to me.

[Berta]

"He was in college thru VocRehab as a result of service connected bilateral knee injuries. However, he has had to drop out because problems with focus & memory, panic attacks and other anxiety issues all related to PTSD. "

If this is documented by his Voc Rehab counselor, this is good evidence for future TDIU.

[Kimmy]

Yes, Berta - it is documented by the VocRehab counselor. I will keep you guys posted. Thanks for all of the encouragement and support.

[Berta]

Make sure VA has that Voc Rehab info Kimmy.

I realized after continuing my husband's claim for higher rating of his PTSD ,pending when he died ,that the VA Voc Rehab records are not part of the VA medical records at all.

I dont think I even mentioned them to VA because at that time the Voc Rehab Counselor had written to him that his NSC stroke prevented further Voc Rehab. His other evidence warranted a posthumous 100% P & T award for PTSD.

But in 2012 I proved his NSC stroke was a 1151 stroke and they awarded for that under 1151 , but forgot about 15 more months of the 100% and I have a claim pending on that presently.

VA pays 100% for 6 months for major CVAs, SC, or 1151, but then rates the residuals.

Along with SSA records, Voc Rehab records,(by then I had obtained them and sent them to VA) student loan waiver, etc etc. the evidence reveals that he was P & T at 100% due to the stroke from 1992, up until his death 12 tears later.

100% 1151 awards, if in addition to direct SC 100% awards ,which he had, require a separate compensation benefit for the 1151 disability.

And regardless of any VA rating, if the evidence warrants TDIU or 100% , VA should grant it.

My husband was only 30% SC for PTSD when he died.

It added up to about 230% SC plus SMC S after he died.

The VA could not rate his DMII from AO at all, or pay for it because they never diagnosed or treated it. But they did award it as contributing to his death.

I don't care about the lack of rating or retro on that because that was the only award that gave me some Peace over his wrongful death.

Edited August 22, 2014 by Berta (see edit history)

[Kimmy]

What document would he get back from the VocRehab counselor? Right now I think he just has emails back and forth with her acknowledging his issues. What should he ask for?

[Berta]

If VA Voc Rehab finds their program is unfeasible for any veteran ,solely due to their SC conditions, then that veteran is not vocationally able to be rehabilitated and is therefore unemployable. (TDIU)

I think sometimes Voc Rehab doesn't clearly spell out that it is the veteran's SCs that hinder their VocRehab ability..

But the emails you have sound like they probably make this clear as due to his issues (all SCs I assume) and that is good documentation.(the VA emails) in my opinion.

[Kimmy]

OK thanks for the clarification Berta. I am gonna get those emails printed.

[Kimmy]

Berta - Hubby talked to his VR counselor today and he will meet with her this week. She said she will end his VocRehab for school and give him something in writing to document his reasons for leaving the program when they meet. Thanks so much for your timely advice. Things are moving along better than planned. Hadit.com is a wonderful place to share wisdom!!! Thanks again.

[Gastone]

Kimmy; I was just awarded TDIU at DRO informal hearing 06/27/14. Been 90% SC since 70% PTSD award 2011. DRO said the Voc Rehab Denial Letter stating I was not currently eligible to continue the program due to the severity of my SC conditions, seal the deal. That Denial letter removes any questions regarding your current ability to obtain "Gainful Employment." Income above 1 person poverty level of approx $14,000.00 per year is the current VA income threshold for IU. This letter must be forwarded to the VRO handling your claim, fax it and mail it Cert Mail-Return Receipt.

As far as the place of his C&P, the examiner isn't going to be one of his treating clinicians. It will be a Psychiatrist or a PHD Psychologist either VA or Contract employee. They will complete a PTSD DBQ as requested by the VRO Rating Dept. You might want to review the 38 CFR 4 rating for what ever level of compensation you think your husband is entitled to. You can pull up the PTSD DBQ on-line. He needs to be fully prepared.

Good Luck

Semper Fi

Gastone

[Kimmy]

Thank you Gaston. Ok he pulled the ptsd dbq last night. He will be fully prepared.

[Kimmy]

Update: PTSD C&P was this week. The C&P exam was NOT on the mental clinic but in the C&P office at the VA hospital. The examiner was a VA employee who is a combat vet himself. He said that he refused to ask my husband any questions about the stressor event because that is undue stress on my husband and he got that information from his treatment records. He had my husbands treatment records up and said he had read everything in the record for the past 12 months of treatment at the VA. He wanted to know more about my husbands current challenges. The Doc wanted to talk about the isolation, nightmares, panic attacks, unability to work and go to school. My husband not worked in over 3 years and has been in VocRehab but had to drop out of that because of concentration and memory problems. The Doc took lots of notes.

Then the visit switched and became more like treatment/therapy than the C&P assessment. He talked to me about the things I can do to help my husband. Then he sent a referral in for Cognitive Behavioral Therapy (CBT) for my husband. He also recommended some medications that may he helpful for the nightmares and anxiety and sent in a referral for that. By the time we got home, we got a call for mental health to set up the CBT to start in October. Has anyone every had referrals for additional treatment made during the C&P exam? We didn't know what to make of it. We came prepared to prove my husbands case but it seems that the records spoke for itself.

He said he was going to get the forms done by COB the day of the visit and get it send back to the region office asap. Now we wait.

[georgiapapa]

It is refreshing to hear about VA employees like the examiner who conducted your husband's C & P. Sounds like he was truly concerned about your husband and he actually took the initiative to try to help your husband. I would be surprised if the examiner's report does not fully support your husband's claim.

Good luck to you and your husband. Please express my thanks to your husband for his service.

[Fco75th25div]

Kimmy ....../ It would not surprise me if your husband got 100% Excellent Job. kept us posted on the award.. Send in to the RO additional evidence showing the medication order. That should and will be considered by the claims/rater handling your husbands case !

[HenryS]

I agree - you definitely got one of the good guys.

You might even want to write a letter to the Medical Center Director praising the examiner. But ask the examiner first, because some nasty management types have a habit of turning a positive into a negative.

Manager: "What?! You delivered treatment services during a C&P exam? That violates Grand Poobah Directive 2634(b)(3)! You will receive an admonishment for this serious error."

C&P Psychologist: "When I have a vet in my office who needs some advice and encouragement to receive the help he deserves, and I have time to offer it to him, I'm not just going to sit on my ass and do nothing because of some bureaucratic b--l s--t.

Manager: "And now I am going to write up a Report of Contact because you used foul language with your superior--that's insubordination!"

C&P Psychologist: "If you feel that castigating me for helping a veteran will help you get your next promotion, go right ahead boss. You're the one that has to live in your skin." (Walks away).

At least that's my fantasy of how I wish more of these conversations would go...

Henry

Henry

[Berta]

I will never forget a SOC I got many many years ago that quoted the C & P examiner and had his name in the SOC.I called him right up and started to give him hell.

I was upset because,in order to deny my 1151 claim, he had opined that the veteran's sudden death could have been due to a fatal overdose of cocaine.

I asked the C & P doctor how he could say that because, due to fact that my husband was an organ donor ,right after his death a full toxicology was done within results of his 6 pages autopsy.

"What autopsy!" the C & P doctor said. Here the VARO had deliberately withheld it from him.

The year later I ended up calling a top cardio VA doc in DC who VAOGC had gotten to opine against my FTCA issues.

This doctor said the same thing'''What Autopsy!"...actually she screamed into the phone. She was livid.

Neither this VA doctor ,requested by the OGC to opine on my FTCA charges, nor the General Counsel, nor the 1151 C & P examiner had been given my most critical piece of evidence.....a 6 page autopsy and full toxicology report.

In testimony I gave to H VAC years ago I enclosed copies of 53 tracking slips of evidence my RO had ignored for 14 years at that point.,to include not one but twelve submissions of this critical autopsy.

In 2003 I called up the C & P doctor in the SOC and we had a long talk. We had both realized , because I had called him long ago, that decent VA doctors who want to do a fair C & P can be prevented from doing that by the RO powers that be...if all of the evidence is not given to them. This is why we ask here sometimes to see the Evidence List,when VA denies a claim.

And I learned many times in my years as a claimant, it is always the good stuff they withhold from the examiners.

The C & P doc and I not only had a good talk about the VA ...we knew the cocaine statement was not his fault, and he also agreed with the claim I had re-opened but could not opine on it because ,he laughed when he said this,

I had knocked down 2 of his C & Ps already.

It is always good to hear of positive experiences with VA C & P doctors.

It probably happens more then we know.

But it is lousy C & P exams that cause denials and perhaps endless remands.

And we probably don't know what kind of VA pressure some C & P docs are under to go against the claim.

[Kimmy]

C&P Results: Since this exam a few weeks ago, hubby was referred and has seen the psychiatrist and has been prescribed Prozosin and Zoloft. We mentioned these new developments in my statement in support of claim and hubby mentions on his PTSD form. All of the most recent info is in myhealtevet so I hope the claims reviewer reads all of that activity before making the decision. He marked the 30% level but he mentions all of the symptoms and he even mentions the inability to work. I pray that all of this is taken into consideration. Any thoughts?

1. Diagnostic Summary

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

Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria

based on today's evaluation?

[X] Yes [ ] No

2. Current Diagnoses

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

a. Mental Disorder Diagnosis #1: PTSD

b. Medical diagnoses relevant to the understanding or management of the

Mental Health Disorder (to include TBI): Please refer to the General

Medical Examination report for any medical diagnoses or concerns

3. Differentiation of symptoms

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

a. Does the Veteran have more than one mental disorder diagnosed?

[ ] Yes [X] No

c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?

[ ] Yes [X] No [ ] Not shown in records reviewed

4. 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? (Check only

one)

[X] Occupational and social impairment with occasional decrease in work

efficiency and intermittent periods of inability to perform

occupational tasks, although generally functioning satisfactorily,

with normal routine behavior, self-care and conversation

b. For the indicated level of occupational and social impairment, is it

possible to differentiate what portion of the occupational and social

impairment indicated above is caused by each mental disorder?

[ ] Yes [ ] No [X] No other mental disorder has been diagnosed

c. If a diagnosis of TBI exists, is it possible to differentiate what

portion

of the occupational and social impairment indicated above is caused by

the

TBI?

[ ] Yes [ ] No [X] No diagnosis of TBI

SECTION II:

-----------

Clinical Findings:

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

1. Evidence review

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

In order to provide an accurate medical opinion, the Veteran's claims

folder

must be reviewed.

a. Medical record review:

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

Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed?

[X] Yes [ ] No

Was the Veteran's VA claims file (hard copy paper C-file) reviewed?

[ ] Yes [X] No

If yes, list any records that were reviewed but were not included in the

Veteran's VA claims file:

If no, check all records reviewed:

[X] Military service treatment records

[X] Military service personnel records

[X] Military enlistment examination

[X] Military separation examination

[ ] Military post-deployment questionnaire

[X] Department of Defense Form 214 Separation Documents

[X] Veterans Health Administration medical records (VA treatment

records)

[ ] Civilian medical records

[ ] Interviews with collateral witnesses (family and others who have

known the Veteran before and after military service)

[ ] No records were reviewed

[ ] Other:

b. Was pertinent information from collateral sources reviewed?

[ ] Yes [X] No

2. History

----------

a. Relevant Social/Marital/Family history (pre-military, military, and

post-military):

Veteran reported being raised in an intact family with no history of

abuse/neglect. He completed HS and some college. Veteran is married

with 2 children.

b. Relevant Occupational and Educational history (pre-military, military,

and

post-military):

family mental health (pre-military, military, and post-military):

Veteran has participated in the PTSD Recovery Group at the XXXX

VAMC. He is currently doing individual therapy at the XXXX VAMC

with xxxx

.

3. Stressors

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

Describe one or more specific stressor event(s) the Veteran considers

traumatic (may be pre-military, military, or post-military):

a. Stressor #1: Veteran reported

being involved in firefights while deployed

Does this stressor meet Criterion A (i.e., is it adequate to support

the diagnosis of PTSD)?

[X] Yes [ ] No

Is the stressor related to the Veteran's fear of hostile military

or

terrorist activity?

[X] Yes [ ] No

Is the stressor related to personal assault, e.g. military sexual

trauma?

[ ] Yes [X] No

b. Stressor #2: Veteran reported seeing fellow soldiers killed as well as

seeing dead Iraqi soldiers

Does this stressor meet Criterion A (i.e., is it adequate to support

the diagnosis of PTSD)?

[X] Yes [ ] No

Is the stressor related to the Veteran's fear of hostile military

or

terrorist activity?

[X] Yes [ ] No

Is the stressor related to personal assault, e.g. military sexual

trauma?

[ ] Yes [X] No

4. PTSD Diagnostic Criteria

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

Please check criteria used for establishing the current PTSD diagnosis. Do

NOT mark symptoms below that are clearly not attributable to the Criteria A

stressor/PTSD. Instead, overlapping symptoms clearly attributable to other

things should be noted under #7 - Other symptoms. The diagnostic criteria

for PTSD, referred to as Criteria A-H, are from the Diagnostic and

Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Criterion A: Exposure to actual or threatened a) death, b) serious

injury,

c) sexual violation, in one or more of the following ways:

[X] Directly experiencing the traumatic event(s)

[X] Witnessing, in person, the traumatic event(s) as they occurred to

others

Criterion B: Presence of (one or more) of the following intrusion

symptoms

associated with the traumatic event(s), beginning after the

traumatic event(s) occurred:

[X] Recurrent distressing dreams in which the content and/or affect of

the dream are related to the traumatic event(s).

[X] Marked physiological reactions to internal or external cues that

symbolize or resemble an aspect of the traumatic event(s).

Criterion C: Persistent avoidance of stimuli associated with the

traumatic

event(s), beginning after the traumatic events(s) occurred,

as evidenced by one or both of the following:

[X] Avoidance of or efforts to avoid distressing memories, thoughts,

or

feelings about or closely associated with the traumatic event(s).

[X] Avoidance of or efforts to avoid external reminders (people,

places, conversations, activities, objects, situations) that

arouse

distressing memories, thoughts, or feelings about or closely

associated with the traumatic event(s).

Criterion D: Negative alterations in cognitions and mood associated with

the traumatic event(s), beginning or worsening after the

traumatic event(s) occurred, as evidenced by two (or more)

of

the following:

[X] Markedly diminished interest or participation in significant

activities.

[X] Feelings of detachment or estrangement from others.

[X] Persistent inability to experience positive emotions (e.g.,

inability to experience happiness, satisfaction, or loving

feelings.)

Criterion E: Marked alterations in arousal and reactivity associated with

the traumatic event(s), beginning or worsening after the

traumatic event(s) occurred, as evidenced by two (or more)

of

the following:

[X] Irritable behavior and angry outbursts (with little or no

provocation) typically expressed as verbal or physical aggression

toward people or objects.

[X] Hypervigilance.

[X] Exaggerated startle response.

[X] Problems with concentration.

[X] Sleep disturbance (e.g., difficulty falling or staying asleep or

restless sleep).

Criterion F:

[X] Duration of the disturbance (Criteria B, C, D, and E) is more than

1 month.

Criterion G:

[X] The disturbance causes clinically significant distress or

impairment in social, occupational, or other important areas of

functioning.

Criterion H:

[X] The disturbance is not attributable to the physiological effects

of

a substance (e.g., medication, alcohol) or another medical

condition.

Criterion I: Which stressor(s) contributed to the Veteran's PTSD

diagnosis?:

[X] Stressor #1

[X] Stressor #2

5. Symptoms

-----------

For VA rating purposes, check all symptoms that actively apply to the

Veteran's diagnoses:

[X] Depressed mood

[X] Anxiety

[X] Suspiciousness

[X] Chronic sleep impairment

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

events

[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

6. Behavioral Observations

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

Veteran was alert and oriented x4. Veteran's mood was anxious with flat

affect. Veteran was alert and cooperative, demonstrated good grooming and

hygiene, and made appropriate eye contact. Speech was of normal rate, rhythm

and volume. When discussing traumatic events related to his combat tour the

Veteran became tearful. Veteran denied any current suicidal or homicidal

ideation, intent, or plan during this evaluation. Veteran denied any history

of suicide attempts or psychiatric hospitalizations. Veteran denied any

hallucinations or delusions and has not had any hypo/manic episodes. Veteran

reported independent management of his ADLs.

7. Other symptoms

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

Does the Veteran have any other symptoms attributable to PTSD (and other

mental disorders) that are not listed above?

[ ] Yes [X] No

8. Competency

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

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

[X] Yes [ ] No

9. Remarks, (including any testing results) if any

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

Veteran's C-file/Vista/VBMS/CPRS (as available) were reviewed as well

as

conducting a clinical interview.

It is felt this Veteran's symptoms of PTSD are related to a fear of

hostile military or terrorist activity, the claimed stressor is adequate

for a PTSD diagnosis and his symptoms are related to these stressors.

This

is a combat Veteran who deployed.

Veteran's PTSD is at least as likely as not caused by or a result of his above listed traumatic stressors which occurred while deployed.

He is not working due to feeling overwhelmed with stimuli and "I'm not able to focus on

my school work, because then I feel unsafe". He reported irritability,

increased anger and isolation, as well as poor sleep with nightmares on a consistent basis.

[Navy04]

It looks like he will be granted SC at the 30% level. Good luck and God Bless!!!

[Kimmy]

Thanks US Vet

[Kimmy]

Granted 50%!!!