ptsd 50% Ptsd, How To Get And Increase ?

[Wjason777]

In 2011 I’ve been diagnosed with PTSD, and was granted 50%. I’m currently being seen at the local VA and is currently taking meds. In the last 8 months I’ve been really having trouble, my condition has gotten worst and it seems like my meds haven’t been working. I have and appointment this month with my psychologist. What do I need to do and what do i need in order to get and increase for my condition? How can I get my condition to get listed as permanently? I see on Ebenefits that I’m schedule for an Review on Nov 2016 and that my condition is not listed as permanently.

Edited February 10, 2015 by Wjason777

[georgiapapa]

Basically that is correct. An IME is one conducted by a doctor who does not work for the VA, either directly or through contract.

[ArNG11]

Do you know what an IME/IMO means? You need to get one. You don't want to rely just on the VA to get an increase for your established PTSD claim. I was just 30% when I got a couple of IME's for an increase. It cost me maybe $300 bucks. I got TDIU P&T due to the IME I got from a psychiatrist that used to work for the VA in Tampa. These doctors exist in every larger city.

They often work with SSDI lawyers who refer their clients to them to help win their claims. It is much harder these days to get private psychiatrists to treat you via medicare or insurance.

The insurance industry has been allowed to not pay for out-patient mental health care. Despite new laws to bring equity between physical and mental/emotional treatment it is not happening. My private shrinks no longer take Blue Cross due to changes BC/BS made to create such a burden on the doctors that they will simply not accept the insurance. Medicare only pays for 50% of allowable charge for mental health treatment. Why are they allowed to get away with this? Fortunately, I have other ways of getting this treatment paid for even though I see a VA shrink. If I need a medical opinion I can get one from doctors who have treated me for years. Depending just on the VA for anything is a big mistake IMO.

A one or two time visit to an IME doctor should not cost that much considering what you stand to get if you win your claim.

I agree, two or three arrows are better than one. Statements from professional aquantiances and experts in the field with verifiable credentials will make your case stronger.

[Wjason777]

Do you know what an IME/IMO means? You need to get one. You don't want to rely just on the VA to get an increase for your established PTSD claim. I was just 30% when I got a couple of IME's for an increase. It cost me maybe $300 bucks. I got TDIU P&T due to the IME I got from a psychiatrist that used to work for the VA in Tampa. These doctors exist in every larger city.

They often work with SSDI lawyers who refer their clients to them to help win their claims. It is much harder these days to get private psychiatrists to treat you via medicare or insurance.

The insurance industry has been allowed to not pay for out-patient mental health care. Despite new laws to bring equity between physical and mental/emotional treatment it is not happening. My private shrinks no longer take Blue Cross due to changes BC/BS made to create such a burden on the doctors that they will simply not accept the insurance. Medicare only pays for 50% of allowable charge for mental health treatment. Why are they allowed to get away with this? Fortunately, I have other ways of getting this treatment paid for even though I see a VA shrink. If I need a medical opinion I can get one from doctors who have treated me for years. Depending just on the VA for anything is a big mistake IMO.

 

A one or two time visit to an IME doctor should not cost that much considering what you stand to get if you win your claim.

Just a quick update and some questions

Today I was seen by licensed clinical social worker (LCSW) outside the VA using my own personal insurance. She doesn't have a problem with filling out the VA form 21 for me. But its going to take about 3 visits ( 3 weeks) which is not a problem with me. How ever being that she is a LCSW  how seriously would the VA take her in support of a PTSD claim for and increase? I wasn't too sure on that being that she isn't a Psychiatrist. So just to make sure i made a appointment with a actual psychiatrist today also, he also doesn't have a problem filling out a the VA form and writing at statement ($220).

My worries is when the VA actually looks at the Form from which ever i decide to use, is that going to be enough evidence for and increase being that those doctors are not my  current doctor at the VA? I guess what im trying to say is out of the 3 doctors who would carry the  most weight?  If its the outside doctors, would a form 21 and a written statement be enough?

 

[USMC_VET]

Just remember as well, and this is not the same as the VSO speech of "dont ask for more they could take it away".  But whenever you ask for an increase, you are not really asking for an increase, you are asking for he VA to look at your records and then what new evidence you have and then rate you based on that.  If you dont provide good, quality, authoratative evidence and leave any opening for them to say "you got better" they will attempt to reduce you.  i went through this just recently.  was my own fault.  I didnt do what i said above and provide good evidence.  So what im trying to say is, go for it, get what you deserve, but do it right.

From reading your last post I would do the following.

1) DBQ and IME Report from Psychologist. 

2) Sworn Declarations from yourself, wife and others if possible.

3) Copies of all medication history, if its through the VA they have access to it.  With all of my claims any evidence from VA medical records I make copies of and submit that as well. It makes it easy for them and it makes sure that they DO SEE the evidence they already have access to.  Always make your claims and evidence submission barney style.

4) If your doctor has exam notes regarding specific visits since your 50% rating that has indicated a increase in the severity of symptoms send those in as well.  redact (black out) any information not pertinent to the claim. 

5) Do not sign any release of medical information, ever.  some may disagree but this is why i do the leg work for the VA i want them to see whats pertinent to the claim and not give them carte blanche to look through my private medical records and find one comment taken out of context by my doc and use that to deny me or worse.

 

I have attached the a file that outlines how to submit a claim and gather/submit evidence.  ignore the first part that goes over how to apply for compensation via ebenefits.

 

you will find the sworn declaration template (regarding #2 on my list) these hold more weight than simple statments from yourself or wifes because those statements are not under penalty of perjury while a sworn declaration is, thus holds more weight. 

Also pay particular attention to making sure that you have a good evidence list cover page of what you are sending in and send it shotgun style via fax, upload ebenefits AND most importantly Certified Mail w/ Return Receipt.  If you are close enough hand deliver as well to the VARO and make sure they notarize the evidence, if they wont do all of it have htem notarize at the very lease the evidence list cover page.

 

HADIT UPLOAD EVIDENCE HOW TO.pdf

[USMC_VET]

Forgot to mention...

With medications.  Make sure that you always keep those up to date with refills. 

If you have a 30 day supply even if you forgot some days and wont need the refill until next week vs this week when the 30 days is over, refill it.  I set calendar reminders in my phone to do this.  The VA has denied claims since there were gaps in peoples medication history which they took as getting better.

 

Why?

Because they way they look at it, and in my opinion its not without merit, if your condition is bad enough to warrant Medication X and you dont take it for periods of time then you must not really need it and thus be getting better.  While i do say it does have some merit, it does not take into effect, especially with mental health issues, the fact that people forget and those of us with memory problems, forget often.  not because we dont need it, its just part of the condition.

 

[OEF 21B]

Hi Wjason777,

Here's what I just submitted for an increase for my current 50% PTSD rating on the 17th of August 2015.  I didn't include copies of the actual notes since the VA should be able to pull them up.  I just listed the date and the major symptoms noted in each Dr.'s treatment notes.  Hopefully I'll either get an increased rating based on the treatment notes, or will have a PTSD C&P scheduled.  E-Benefits is showing "RVSR for opinion exam" so I'll probably get a PTSD C&P date in the mail....

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

I request an increase rating for my service connected PTSD from 50% to 70% based on increased symptoms as noted in 4.130 Schedule of ratings - mental disorders 9440.

My request is based on treatment notes from Dr. xxxxx, Staff Psychologist, and Dr. xxxxxxx, Staff Physician, VA Outpatient Clinic, xxxxxxxxx.

Date                 Treating Doctor        Noted Symptom(s)
28 Jan 2013     Dr. xxxx                    Stress at Work; disturbing dreams
16 Apr 2013     Dr. xxxx                    Lack of intimacy, lack of connection with daughters
                                                         Supervisor questioning treatment
17 Jun 2013     Dr. xxxxxx               Social Avoidance
09 Oct 2013     Dr. xxxxxx               Continued social anxiety and social avoidance
09 Jan 2014     Dr. xxxxxx               Patient doing fairly well, current meds helpful
27 Oct 2014     Dr. xxxxxx               A lot of social avoidance, occasional problems
                                                        with irritability, sexual side effects, solitary activities
02 Feb 2015     Dr.xxxxxx               Patient doing well with increase in meds, sexual
                                                        side effects
06 May 2015     Dr. xxxxxx             Having problems over last 1-2 months, more sleep
                                                       disturbance, nightmares, anxiety and hyper-         
                                                       vigilance as well as more withdrawal
16 Jul 2015     Dr. xxxxxxx             Some sleep disturbance and low energy, low
                                                       motivation
07 Aug 2015     Dr. xxxxxx            Nightmares, social anxiety, irritability at home
                                                      adding Gabapentin for anxiety/irritability

The VA treatment notes show occupational and social impairment, with deficiencies in most areas such as work and family relations due to impaired impulse control (unprovoked irritability), difficulty in adapting to stressful circumstances including work, or a work like setting; and inability to establish and maintain effective relationships.

History of Condition:

I started treatment at the xxxxxx     VA Outpatient Clinic in 2010.  My staff Psychiatrist is Dr. xxxxxx, and my staff psychiatrist is Dr. xxxxxxx.  I have completed the PTSD Basics class, the Nightmare group, and attend the weekly OEF/OIF drop-in group.  My symptoms have mainly consisted of social anxiety, social avoidance, hyper-vigilance, and sleep/nightmare issues.  Dr. xxxxxx has changed my medications numerous times in order to help minimize the sexual side effects of my treatment medications. 

I started having issues with impaired impulse control(unprovoked irritability) with my family and co-workers around the fall of 2014.  Dr. xxxxxx has been treating the unprovoked irritability with various medications since then and recently this month increased my current medication (Duloxetine) from 60mg a day to 120mg a day and added a new medication (Gabapentin, 900 mg a day) to help with anxiety/irritability.

The unprovoked irritability has caused occupational and social impairment with my work and family relations.  I am having almost daily panic attacks and keep a bottle of Alprazolam with me at all times.  My family is afraid to be around me out of fear that I will "blow up".  I keep to my self at work and try to minimize all contact with my co-workers in order to avoid any "problems" that could get me fired.

Based on the treatment notes and the history of my treatment with the xxxxxxx VA Outpatient Clinic, I submit that I am exhibiting occupational and social impairment, with deficiencies in most areas such as work and family relations due to impaired impulse control (unprovoked irritability), difficulty in adapting to stressful circumstances including work, or a work like setting; and inability to establish and maintain effective relationships.

The overall evidence record shows that the severity of my PTSD most closely approximates the criteria for a higher evaluation of 70%.