ptsd C&p Results Don't Look Good.

[kate7772]

Looks like my husband's claim for PTSD will be denied. He was diagnosed in Jan. 2914 through VA. Their Psychologist and Psychiatrist concurred on the diagnosis. Has been receiving therapy through PTSD counselor at VA since diagnosis. Counselor says he is a "mess." Severe PTSD and major depressive disorder.

Now the examiner says my husband's problems are the result of his physical health (kidney disease) that was diagnosed two years ago. It's true that the ### really hit the fan at that time with PTSD symptoms becoming more severe. His counselor explained the reason for this is because he had to cut his work schedule to less than 1/2 time and has more time to dwell on things. Counselor said this is a common occurrence with PTSD.

The C&P results have not been posted on Myhealthevet yet; DAV rep gave us this info. I know we will need to wait for the official rating but looks like a long process is in front of us and my husband has very severe and worsening issues at work as a result of the symptoms.

Do you think contacting the VA secretary would help?

Thanks

Kate

[Berta]

Kate, we have a had a good discussion here on Clemons V Shinseki, which could possibly help your husband.

Can you scan and attach the denial? (Cover C file etc) as we would need to read the Reasons and Basis part and the Evidence list to see if Clemons, and even maybe Barr V. Nicholson could help the claim.

Edited December 18, 2014 by Berta

[kate7772]

Kate, we have a had a good discussion here on Clemons V Shinseki, which could possibly help your husband.Can you scan and attach the denial? (Cover C file etc) as we would need to read the Reasons and Basis part and the Evidence list to see if Clemons, and even maybe Barr V. Nicholson could help the claim.

Will do that later today. Did you see the Psychologists notes I posted in another thread the other day? It seems to be a diagnosis with good notes explaining everything. Also, last week his NP set up a consult with a VA psychiatrist who said Assessment: PTSD and then added. "Veteran is has been and is being treated for PTSD."

[Berta]

Do you mean this C & P thread?

f not please tell me where that is posted.

I have been baffled by this entire claim.

But this stood out to me:

" He recounted events from Vietnam as they were scripted and

rehearsed while given the appearance of the importance that he not miss any

detail to this provider."

That is a red flag to C & P MH docs.That was also a red flag when any new combat vet came into the Vet Center I worked at.

I am not suggesting he was not truthful.But that hurt his C & P exam.

As Navy4life correctly observed:

"Towards the end is what also concerns me b/c the examiner gave no respond for:

3) Stressors - NONE? that is not good - I had several"

Someone suggested an IMO but that will not be accepted by VA on PTSD claims anymore.

You stated:

"Don't have an independent doctor but all the symptoms and stressors are recorded in his VA treatment records as well as the diagnosis and treatment. He also submitted a stressor statement when the claim was filed." (stressors recorded in VA med recs does not mean they are proven stressors.)

"He did send info in with the stressor statement pertaining to the events, news articles, etc. and his paperwork shows he was there. He has been working with the PTSD counselor on dealing with the stressors. They are mentioned on Myhealthevet."

"He did send in a lot of info from online including the declassified accounts of the incidents."

That helps prove a stressor but did he prove his MOS put him there at the time of any of these incidents?

You said the denial states the VA had conceded his stressors....?

I am baffled because of 30 years plus experience with PTSD vets, particularly Vietnam combat veterans.....I have never seen a situation like this.

"Also, last week his NP set up a consult with a VA psychiatrist who said Assessment: PTSD and then added. "Veteran is has been and is being treated for PTSD."

That could be good documentation...if the VA Psychiatrist gave a strong rationale that the veteran Has PTSD and that it is due to his service in Vietnam.

Do you have a copy of that entire PTSD assessment? What a VA doc says is meaningless to VA unless they document it.

The other C & P states:

"3) Stressors - NONE"

It is quite possible that the stressors your husband related to the examiner did not raise to the level of how VA defines a stressor.

I had given you a link to how VA defines a Stressor, in the past threads.

You stated in November here:

"Will try to get an evaluation from the psychologist that my husband's NP referred him to for ruling out other cognitive issues. He did test my husband and indicated he agreed with the PTSD diagnosis and the symptoms being as a result of it but apparently we need more, probably a DBQ."

Is that the same exam I referred to above? Or is this a new one?

Navy4Life gave you some excellent advise in the past threads here. I read over everyone of these posts again..many times... because I dont get this at all..

In Nov 21 here you stated:

"He did send info in with the stressor statement pertaining to the events, news articles, etc. and his paperwork shows he was there. He has been working with the PTSD counselor on dealing with the stressors. They are mentioned on Myhealthevet."

Did he send in any buddy statements? Is his "paperwork" directly from his SMRs, or Unit history explaining how his initial MOS "Postal" I believe you called it, put him into close proximity to hostile fire'''etc etc , as the new 2010 PTSD regs state??

Why was he working on the stressors with the PTSD counselor ,in November, when the C & P exam in November stated he revealed "none" during the exam.?

As you can tell I have many questions...but please dont feel you have to answer any of them.

I sure hope you can attach the denial here.I think something important is missing here...

How can the VA concede stressors , as you said they did in the denial, when the C & P above says "None"....I am quite concerned about that. I have never seen anything like that before.

BUT then again you have the DAV , his stressers were conceded in the denial , and the DAV rep is fully aware of Clemons V Shinseki and Barr V Nicholson (I hope)and will surely advise you how those regulations should be applied to the next step of the claim.....

[kate7772]

Do you mean this C & P thread?

f not please tell me where that is posted.

This one:

I have been baffled by this entire claim.

But this stood out to me:

" He recounted events from Vietnam as they were scripted and

rehearsed while given the appearance of the importance that he not miss any

detail to this provider."

That is a red flag to C & P MH docs.That was also a red flag when any new combat vet came into the Vet Center I worked at.

I am not suggesting he was not truthful.But that hurt his C & P exam.

I realize it hurt the exam. I was there and also can see where he appeared rehearsed. He was in some respect. He had just come off of 10 weeks of therapy where the therapist went over and over the events of his service and how he felt about them. And, since he is suffering from some cognitive functioning, and was told it was very important to let the examiner know everything and to not hold anything back, he kept going over and over everything in his mind before the exam. So, it pretty much followed that he worked hard to try and tell him everything. The truly sad thing about this whole thing is that my husband is the most totally honest person I know. Now, to have this questioned, he feels very invalidated, in much the same way he felt when returning from Vietnam to the chants of "baby killer" and being bombarded with rotten fruit. For years he kept his time in Vietnam buried and lived to him a life of comfortable avoidance. None of this came out until I convinced him to seek treatment, not for PTSD but for anxiety and depression among other issues. In all our years of marriage, we had not talked about it and I never would of dreamed that he had suicidal thoughts until it came out in therapy. We had never considered PTSD and had only thought of it in terms of something affecting veterans of later wars. The VA was the one who gave him that diagnosis. Now, since the C&P I see him retreating back into the place he lived for all those years and attempting to close up that box he had opened.

As Navy4life correctly observed:

"Towards the end is what also concerns me b/c the examiner gave no respond for:

3) Stressors - NONE? that is not good - I had several"

The C&P examiner decided he did not have PTSD and apparently therefore he could not have stressors.

Someone suggested an IMO but that will not be accepted by VA on PTSD claims anymore.

You stated:

"Don't have an independent doctor but all the symptoms and stressors are recorded in his VA treatment records as well as the diagnosis and treatment. He also submitted a stressor statement when the claim was filed." (stressors recorded in VA med recs does not mean they are proven stressors.)

"He did send info in with the stressor statement pertaining to the events, news articles, etc. and his paperwork shows he was there. He has been working with the PTSD counselor on dealing with the stressors. They are mentioned on Myhealthevet."

"He did send in a lot of info from online including the declassified accounts of the incidents."

That helps prove a stressor but did he prove his MOS put him there at the time of any of these incidents?

You said the denial states the VA had conceded his stressors....?

I am baffled because of 30 years plus experience with PTSD vets, particularly Vietnam combat veterans.....I have never seen a situation like this.

"Also, last week his NP set up a consult with a VA psychiatrist who said Assessment: PTSD and then added. "Veteran is has been and is being treated for PTSD."

That could be good documentation...if the VA Psychiatrist gave a strong rationale that the veteran Has PTSD and that it is due to his service in Vietnam.

Do you have a copy of that entire PTSD assessment? What a VA doc says is meaningless to VA unless they document it.

The other C & P states:

"3) Stressors - NONE"

It is quite possible that the stressors your husband related to the examiner did not raise to the level of how VA defines a stressor.

I had given you a link to how VA defines a Stressor, in the past threads.

You stated in November here:

"Will try to get an evaluation from the psychologist that my husband's NP referred him to for ruling out other cognitive issues. He did test my husband and indicated he agreed with the PTSD diagnosis and the symptoms being as a result of it but apparently we need more, probably a DBQ."

Is that the same exam I referred to above? Or is this a new one?

The one I linked to above.

Navy4Life gave you some excellent advise in the past threads here. I read over everyone of these posts again..many times... because I dont get this at all..

In Nov 21 here you stated:

"He did send info in with the stressor statement pertaining to the events, news articles, etc. and his paperwork shows he was there. He has been working with the PTSD counselor on dealing with the stressors. They are mentioned on Myhealthevet."

Did he send in any buddy statements? Is his "paperwork" directly from his SMRs, or Unit history explaining how his initial MOS "Postal" I believe you called it, put him into close proximity to hostile fire'''etc etc , as the new 2010 PTSD regs state??

His main MOS was Infantry with Postal a secondary because he could type. He was out in the field with the engineers.

Why was he working on the stressors with the PTSD counselor ,in November, when the C & P exam in November stated he revealed "none" during the exam.?

He had been seeing the PTSD therapist since April on a weekly basis, going over his stressors and dealing with how they have been affecting his life. I don't know where the examiner got that he had none. My husband was a shaking mess during the exam as he recounted them. The examiner stated that he could understand how those events could cause him distress and they certainly would be a lot to deal with.

As you can tell I have many questions...but please dont feel you have to answer any of them.

I sure hope you can attach the denial here.I think something important is missing here...

How can the VA concede stressors , as you said they did in the denial, when the C & P above says "None"....I am quite concerned about that. I have never seen anything like that before.

BUT then again you have the DAV , his stressers were conceded in the denial , and the DAV rep is fully aware of Clemons V Shinseki and Barr V Nicholson (I hope)and will surely advise you how those regulations should be applied to the next step of the claim.....

We have a Psychiatrist diagnosis of PTSD in the records from July 2014 (before the C&P) and another Psychiatrist from Dec. 2014. Both VA employees. These were brief and maybe not explanatory enough but the first one was never mentioned, although in the records. The Psychologists notes state a diagnosis of PTSD and goes into more detail, including symptoms, stressors and reasoning. This was in the records before the C&P and rating but never mentioned. We met with a DAV service officer today and he said this was not in the list of evidence VA reviewed.

These were all with the qualifications VA said were needed in their denial letter.

The DAV rep filed a reconsideration today with reasoning that the C&P was not complete and some documents were not considered in the rating, although available. He asked for another C&P.

Here is this denial with the PTSD part in its entirety (very short.) Couldn't get the scanning right so copied and pasted.

3. Service connection for post traumatic stress disorder (previously claimed as irritability,

nervousness, and anxiety).

Rating Decision dated September 19, 2013, denied service connection for irritability,

nervousness and anxiety, since your service treatment records do not contain complaints,

treatment, or diagnosis for this condition, and the evidence did not show a current diagnosed

disability. You were notified of this decision by letter dated September 20, 2013. We received

additional evidence for consideration.

We concede you experienced a stressful event in service or fear of hostile military or terrorist

activity while in Vietnam.

Your VAMC Cleveland treatment records show you've been diagnosed with post traumatic stress

disorder by a clinical social worker and a clinical nurse specialist.

In order to conduct an initial examination for mental disorders, the examiner must meet one of

the following criteria: a board-certified or board-eligible psychiatrist; a licensed doctorate-level

psychologist; a doctorate-level mental health provider under the close supervision of a boardcertified

or board-eligible psychiatrist or licensed doctorate-level psychologist. a psychity

resident under close supervision of a board-certified or board-eligible psychiatrist or licensed

doctorate-level psychologist; or a clinical or counseling psychologist completing a one-year

internship or residency (for purposes of a doctorate-level degree) under close supervision of

a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist. Your

diagnosis of post traumatic stress disorder by a clinical social worker and a clinical nurse

specialist was sufficient to schedule you for a VA examination. However, we cannot grant

service connection for a mental disability diagnosed by a clinical social worker or a clinical

nurse specialist.

VA examination shows you do not currently meet the criteria for a diagnosis of post traumatic

stress disorder.

The previous denial of service connection for post traumatic stress disorder (previously claimed

as irritability, nervousness, and anxiety) is confirmed and continued, since this disability wasn't

shown during your active service, and the evidence does not show a current diagnosed disability

with a link to your military service.

Edited December 20, 2014 by kate7772

[OhioVSO]

Kate,

I just read the treatment record that you posted ( ). I see the date is June of 2014.

I'm curious, when did he start MH treatment at the CBOC? Was the June appointment his first? Has he had any appointments since?

[rosypalm]

Keep fighting!