ptsd Would This Be Considered A Diagnosis?

[kate7772]

Working on getting an official VA diagnosis for my husband's PTSD claim that was recently denied.

This is what the denial said:

"We concede you experienced a stressful event in service or fear of hostile military or terrorist activity while in Vietnam."

"Your VA 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:"

Then it goes on to list the professionals qualified to diagnose. The attached medical notes from Myhealthyvet are of an evaluation done by a VA Clinical Psychologist which appears to be one of the ones listed in the denial (licensed clinical Psychologist. The Psychologist that performed the attached evaluation has a PSYD after his name. The evaluation was ordered to rule out cognitive problems but he did a depression test and PTSD evaluation. Would this not be a valid diagnosis? And, if not, what does he need to say?

Thanks

Kate

Document - clinical psych eval - Created Dec 14, 2014.pdf

[Philip Rogers]

It looks like they failed to make the diagnosis, by stating "PTSD suggested." Another example of the VA screwing the vet. jmo

pr

[Berta]

Can you attach the denial here...as to the reasons and bases part?

Copy C file # etc prior to scanning it.

[Gastone]

Kate: I think the VA stipulates that only a DX by the C&P examiner determines if a PTSD rating will be awarded. The NEW VA PTSD C&P rules require that only a DR. Psychiatrist or a Specially trained Psychologist with a "PHD" can do the C&P. These C&P Specialists will consider other medical opinions but they don't have to concur. As long as they didn't make a CUE error, your going to have a difficult time with the VA. I don't think this your going to get a quick reversal but send in all the Medical DX's you have. Possibly a piece of New & Material Evidence that wasn't available to the Rater at time of decision will trigger an Automatic VARO Review by a Senior Rater or a Decision Review Officer.

Semper Fi

Gastone

[john999]

That was a pathetic exam. They tip toed around you PTSD DX but did say you were severely depressed. If you can get 10-30% for any MH condition then you can get a IME to boost it up. Your exam was so inconsistent and confusing I really think that you will get 30 because they admit severe depression, but your wife says you have been jumpy all your life. Don't bring her any more to exams. Not her fault she just does not believe she is dealing with Satan. If your depression is SC you should get 100%. It says severe depression.

John

[Berta]

I dont see the the Mississippi Scale for Combat-Related PTSD (M-PTSD)

listed there in the testing list.

The MSCR PTSD is different from the MMPI.

[broncovet]

Yes, he diagnosed you with PTSD, and said the criteria are met using DSM.

In my humble opinion, the VA wont be able to deny this, tho, expect them to try. For a disabity percentage for PTSD, you need to look at the criteria which have been posted here multiple times. The grey area there is Suicidal ideations, which is a big deal in your percentages since SI are present ONLY in the 70% and 100% categories.

quoting your exam:

DIAGNOSIS:

PTSD

Major Depressive Disorder

/es/

CLINICAL PSYCHOLOGIST

Signed: 06/25/2014 16:14

Receipt Acknowledged By:

06/26/2014 09:43 /es/, LISW-S

CLINICAL SOCIAL WORKER

06/26/2014 11:50 /es/

CLINICAL NURSE SPECIALIST

Date/Time: 19 Jun 2014 @ 1450

Note Title: MENTAL HEALTH DIAGNOSTIC STUDY NOTE

Location:

Signed By:

Co-signed By:

Date/Time Signed: 23 Jun 2014 @ 1546

PTSD Checklist M ---

SCALE RAW

DSM-IV PTSD Criteria B IS met

DSM-IV PTSD Criteria C IS met

DSM-IV PTSD Criteria D IS met

*** PTSD Diagnosis IS SUGGESTED

[kate7772]

Kate: I think the VA stipulates that only a DX by the C&P examiner determines if a PTSD rating will be awarded. The NEW VA PTSD C&P rules require that only a DR. Psychiatrist or a Specially trained Psychologist with a "PHD" can do the C&P. These C&P Specialists will consider other medical opinions but they don't have to concur. As long as they didn't make a CUE error, your going to have a difficult time with the VA. I don't think this your going to get a quick reversal but send in all the Medical DX's you have. Possibly a piece of New & Material Evidence that wasn't available to the Rater at time of decision will trigger an Automatic VARO Review by a Senior Rater or a Decision Review Officer.

Semper Fi

Gastone

I will scan in the denial tonight but it was short, only saying they concede the stressors and need a diagnosis by......and one of the ones they listed was Clinical Psychologist with a doctorate level degree. I looked up this Psychologist's credentials and it says doctor of Psychology. I know he said at the end "ptsd suggested" but he also says diagnosis PTSD and depressive disorder and all criteria met along with his testing. Maybe he would have been more thorough but my husband was only referred to him for an opinion to rule out a cognitive disorder. My husband's NP also sent him to a Psychiatrist at the VA last week to review for PTSD in response to the denial. But, his notes were very sparse. He seemed irritated that the raters did not accept the diagnosis from the NP and social worker specializing in PTSD and insisted they were able to diagnose the same as he was. Didn't really say anything on his opinion other than Assessment: PTSD and mentioning the treatment he has had along with the symptoms he is experiencing. Seems like my husband's treatment team wants to help but they just don't seem to understand what the benefits side needs.

[Berta]

I have noticed that more remands are popping up at the BVA regarding claims from Vietnam vets, with PTSD, or a psychiatric disorder,not PTSD but potentially service connectable.

For example this May 2014 remand states:

"All necessary special studies or tests, to include psychological testing and evaluation, such as the Minnesota Multiphasic Personality Inventory, and the Mississippi Scale for Combat-Related PTSD, should be accomplished. "

The BVA makes this important point with a case law citation:

"On appeal, the Board has broaden the PTSD claim on appeal in order to encompass any psychiatric disorder, as instructed in Clemons v. Shinseki, 23 Vet. App. 1 (2009), which held that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record."

http://www.va.gov/vetapp14/Files3/1424336.txt

Their 'broadening' of this appeal is specific to this veteran but Clemons V SHinseki might help you, if you need to formally appeal the denial.

BTW, the vet above was awarded the CIB.

[kate7772]

That was a pathetic exam. They tip toed around you PTSD DX but did say you were severely depressed. If you can get 10-30% for any MH condition then you can get a IME to boost it up. Your exam was so inconsistent and confusing I really think that you will get 30 because they admit severe depression, but your wife says you have been jumpy all your life. Don't bring her any more to exams. Not her fault she just does not believe she is dealing with Satan. If your depression is SC you should get 100%. It says severe depression.

John

I am the wife. I told them he has had problems since I have known him. I have only known him since after the military. It is also in his records that before the military he was very different; social, upbeat, etc. He came back a very different person, avoiding friends, burying himself in long work hours. He seemed more social when I first met him but we met in a bar and he was drinking a lot. Once we married, he traded the drinking for long work hours and he became different. It really accelerated several years ago when he stopped working so much. Edited December 15, 2014 by kate7772 (see edit history)

[kate7772]

Yes, he diagnosed you with PTSD, and said the criteria are met using DSM.

In my humble opinion, the VA wont be able to deny this, tho, expect them to try. For a disabity percentage for PTSD, you need to look at the criteria which have been posted here multiple times. The grey area there is Suicidal ideations, which is a big deal in your percentages since SI are present ONLY in the 70% and 100% categories.

quoting your exam:

DIAGNOSIS:

PTSD

Major Depressive Disorder

/es/

CLINICAL PSYCHOLOGIST

Signed: 06/25/2014 16:14

Receipt Acknowledged By:

06/26/2014 09:43 /es/, LISW-S

CLINICAL SOCIAL WORKER

06/26/2014 11:50 /es/

CLINICAL NURSE SPECIALIST

Date/Time: 19 Jun 2014 @ 1450

Note Title: MENTAL HEALTH DIAGNOSTIC STUDY NOTE

Location:

Signed By:

Co-signed By:

Date/Time Signed: 23 Jun 2014 @ 1546

PTSD Checklist M ---

SCALE RAW

DSM-IV PTSD Criteria B IS met

DSM-IV PTSD Criteria C IS met

DSM-IV PTSD Criteria D IS met

*** PTSD Diagnosis IS SUGGESTED

The suicidal ideation is all through his treatment notes. BTW, I really thought I knew my husband but had no idea about those thoughts until he started treatment. Very scary. I'm a little nervous to leave him alone now. I don't even let him drive anymore because he is so careless.