Question Of Nexus

[Josephine]

Is this why the BVA may be questioning my nexus?

6. Dr. P. should be contacted and asked to provide the basis for his diagnosis of

the veteran, and whether he has any medical training or expertise in treating

or evaluating psychiatric disability.

Letter 1 by Dr. P. April 5, 2004

Department of Veterans Affairs:Re:

To whom it may concern:

______ has been a patient of mine since August 1979.

At the time of her initial presentation her major problem was chronic anxiety/depression. She reports a (five year history) of psychiatric care.

She recently has applied for disability benefits to the Department of Veterans Affairs by reason of her prior time in military service with the Navy 1963/1964

Her ongoing request for disability benefits center on whether or not her anxiety/depression is related to her prior time in service.

She has been granted entitlement to non-service pension.

I have a copy of her U.S. medical records, I also have a copy of a letter documenting an honorable discharge by reason of unsuitability, dated April 7, 1964. This time reflects the fact that she did have emotional problems while in service and had been referred for psychiatric consultation by a board certified psychiatrist.

It is my considered medical opinion that her subsequent problems with anxiety/depression have been of a magnitude to adversely affect her overall health and result in disability. It is also my considered medical opinion those problems had their origin during the time of military service.

I urge reconsideration of a decision for service connected disability by reason of her chronic anxiety with depression.

I just noticed this typing error, it should read (fifteen year).

Letter 2 by Dr. P. April 28, 2006

To whom it may concern:

The above is currently undergoing an appeal process with The board of Veterans Affairs.

This letter is written as an addendum to previously written letters dated April 5, 2004, in regards to her current appeal with the Department of Veterans Affairs.

The basis for my previous noted diagnosis of this veteran was based on knowledge of personal interactions, history taking and physical examinations going back to 1979. I am aware of the fact by reviewing all the military records of the veteran that the patient was treated with Librium and Caffergot while in the military service. 1964, presumptively for treatment of anxiety and depression and associated headaches, by Dr. BCC, followed by two psychiatric consultations thus leading to her early discharge.

The veteran has been on anti-anxiety medication from 1967 to date thus make it plausible that I am correct. I have maintained all of the veteran's civilian records from 1965 to date and all of her military records to date.

As I have previously stated, It is my considered medical opinion that her subsequent problems with anxiety/depression have been of a significant magnitude to adversely affect her overall health and result in disability.

I have no specific training in Psychiatry, but I have the usual level of expertise that would be expected in an internist, board certified, in 1976 and actively practicing internal medicine since that time.

I graduated from the University of Florida Medical School in 1973, was board certified in internal medicine in 1976 and have remained in active practice since that time.

Sincerely,

J.M. P

7. After the above development has been completed, the veteran's claims file

should returned to the board of VA psychiatrists who participated in the

April 2005 examination for clarification of the provided opinion. They should be

requested to review the record and reconcile their opinion as to etiology in

light of the evidence added since their examination of the veteran, including the

May 2005 statement of Dr. B C. C and the January 2006 statement of

Dr. M P.

This is why my claims file is at the Medical Center on the Male Psychiarist desk to follow this section of the remand.

To my knowledge, there is to be no further examination.

Thanks,

Josephine

Edited October 22, 2006 by Josephine

[Berta]

I am not sure I understand the question of nexus---

Although a doctor can attest to the treatment and diagnosis of a condition,and they can support a nexus by mentioning what stressors the veteran reported but an actual nexus still has to be proven in most cases.

This is why the BVA, in the remand, asked for clarification on the incident involving Doris.I believe they were looking for any nexus that could be proven.

Anything that caused inservice anxiety or depression is the nexus (link) to service.

It could be an inservice auto accident, harrassment, sexual trauma, combat events, any one of many things.

Witnessing the death of another serviceperson could certainly be a stressor and this is why I think they (BVA)asked for more information on the pool incident with Doris.

Any evidence of highly abusive treatment inservice is a stressor.

But the VA always wants proof of the stressor unless it is a combat stressor consistent with DD 214 awards or the combat MOS, etc.

[Josephine]

I am not sure I understand the question of nexus---

Although a doctor can attest to the treatment and diagnosis of a condition,and they can support a nexus by mentioning what stressors the veteran reported but an actual nexus still has to be proven in most cases.

This is why the BVA, in the remand, asked for clarification on the incident involving Doris.I believe they were looking for any nexus that could be proven.

Anything that caused inservice anxiety or depression is the nexus (link) to service.

It could be an inservice auto accident, harrassment, sexual trauma, combat events, any one of many things.

Witnessing the death of another serviceperson could certainly be a stressor and this is why I think they (BVA)asked for more information on the pool incident with Doris.

Any evidence of highly abusive treatment inservice is a stressor.

But the VA always wants proof of the stressor unless it is a combat stressor consistent with DD 214 awards or the combat MOS, etc.

Berta,

If the Psychiatrist in service refuse to write down what you are saying, then you are just up the creek without a paddle.

My buddy letter failed to write down about my personality. Of course she wouldn't be qualifed anyway.

She was just present with the swimming pool and with Doris and with the Physicians in D. C.

She isn't a doctor. I haven't seen J in 23 years.

I believe that you are saying, She needed to be a doctor to be of any benefit.

The question still remains" Why Was Dr. C. giving me Cafferfot and Librium in Service?

I really don't know what happened to Doris? She was lying on the right side of the pool, when I was ordered to leave.

I was so busy fighting for my own life and this wasn't a one time thing either. I guess that is why I had that Psycho flash back as Wings called it, when the Psychaitrist ask me about the pool. I went to the beach one year and stayed in the hotel, with a sofa in front of the sliding glass door, for fear of the pool below.

At least when this is all said and done, I know that there was a Dr. M at the Va. that believed what I was saying.

Thanks,

Josephine

Edited October 22, 2006 by Josephine

[Berta]

"She was just present with the swimming pool and with Doris and with the Physicians in D. C.

She isn't a doctor. I haven't seen J in 23 years.

I believe that you are saying, She needed to be a doctor to be of any benefit"

No- Josephine- she didnt need to be a doctor at all-

the VA looks for eye witness accounts, preferably notarized statements with the "buddy" stating their full name,address, and anything to show they served with the veteran's unit and did witness any stressful account.

The above statement that she was present at these incidents would satisfy that she witnessed them if she gave details as to when and where and how she was present too-in a

unit exercise or whatever put her there with you and that she too witnessed this stressful event.

A vet I helped locally got in touch with a buddy through his unit web site.. The "buddy" stated he was present at the same stressful incident, gave his unit etc-and service dates, to show VA his was certainly with the veteran at the time and place of the incident, and ironically the buddy gets PTSD SC comp for the very same incident and told the VA his c file number to check this if they needed to.

He notarized the statement and gave the VA his home phone and cell phone and email addy to verify this with him if they needed to.

He also added a very detailed account of the incident which was just like what the vet had put into his stressor letter.

The vet I helped got PTSD service connected due mainly to this buddy statement.

Eye witness accounts that are notarized and give details and put the eye witness when and where the veteran claiming the stressor was are very helpful and also proof , in most cases, of a stressor.

The BVA remand-it seemed to me was looking for more information on the death of the veteran 'Doris' and I believe I mentioned some time back that her picture would be in your basic training graduation book

and it would give her last name and could be verified.Anyone who served in your unit would probably remember this incident.

I only mention this as the BVA did and it seemed that they wanted some verification of this incident which would be a very stressful one for anyone who knew of it.

"In a letter directed to President Bush, and received into the

file in August 2005, the veteran, referring to episodes in

service where she almost drowned, stated that a woman with

whom she trained, "Doris," did drown. The veteran should

be asked if she can provide any further information as to

Doris' last name, and the approximate date and location where

the alleged drowning took place, so that this event can be

confirmed. "

They mention this again in the remand- and this -in my opinion- is the main stressor that the BVA wanted confirmed-

If the statement you have from the woman you mention- "j"- states all this and she was an eye witness -and the details that the BVA mentioned as to time and place, last name etc- anything else that would help-

can be given to the VA-they can verify this as a valid stressor and that would satisfy the stressor element of your claim.

Did she notarize and detail her statement? If not it would not be too late to support this stressor by reaching her again.

This would be the nexus or link to your service.

Service connection -if not proven by combat awards, involves

1. documentaed current diagnosed disability

2. proof of inservice event that caused the disability.(the nexus)

On remands I feel that the veteran should do whatever they can to give the VA what the BVA has remanded for.

Some stuff a remand leaves up to the RO but it sure pays to carefully go over any remand for all the things that are missing.

Edited October 22, 2006 by Berta

[Josephine]

Did she notarize and detail her statement? If not it would not be too late to support this stressor by reaching her again.

This would be the nexus or link to your service.

Service connection -if not proven by combat awards, involves

1. documentaed current diagnosed disability

2. proof of inservice event that caused the disability.(the nexus)

On remands I feel that the veteran should do whatever they can to give the VA what the BVA has remanded for.

Some stuff a remand leaves up to the RO but it sure pays to carefully go over any remand for all the things that are missing.

The two medical psychiatrist discounted her as an eye witness, as she didn't state my personality.

She gave her name, service number, phone number and address. She did not notarize the letter, as no one said for her to. I turned this letter into the R. O and it does have a date stamp on it.

DR. M acknowledged the letter and referenced her in his C&P of More Likely than Not.

I noticed the BVA did not mention her letter.

She was with me in boot camp, corps school and D. C. She saw it all and she wrote it all. Those shrinks said that she did not address my personality. She wasn't witnessing my personality only the events as they happened.

They can check her service records and see that she took an overdose of my medication and was taken to the dispensary by the M.P.'S.

I gave the the Va. the letter and envelope, by DR. C. He gave me those coded drugs for a reason. I have only spoke to him twiced in 42 years. He thought that I was already drawing benefits at discharge.

I shall assume that they called him, he isn't difficult to locate at the Mayo Clinic in Minn.

This is a mess and a maze and I will never win it.

I figure the two Psychiatrist will come up with some cock and bull story and it will be over. I am tired of all of this. Dr. C. has offered to go as far as I need him to , but it seems hopeless.

I have the drugs and the symtoms in my sick bay records and no diagnosis.

Thanks for answering me,

Josephine

[Hoppy]

Josephine,

The question still remains" Why Was Dr. C. giving me Cafferfot and Librium in Service?

This is long. However, I do address your question with my experiences.

There is more than one way to win a claim like yours. I had very similar situations. Life threatening stressor and several visits to military shrinks. I was discharged for emotionally unstable personality disorder. The life threatening attack was reported to the barracks MAA. However, no report was taken by the MAA. The MAA thought it was a funny joke. I woke up from a sound sleep and could not breath for 2+ minutes. Someone in the barracks filled my mouth with shaving cream. I am a mouth breather and have an airway disease. The shaving cream caused a laryngeal spasm, AKA dry drowning. Laryngeal spasms kill 1000’s of people every year. My airway condition makes me susceptible to laryngeal spasms. I developed a sleep disorder and could not sleep in a barracks. I moved off base. A military doctor thought that I appeared anxious and referred me to a shrink. I did not ask to see the shrink. The shrink said I had a personality disorder and recommended a discharge to my CO. Instead I was sent to mess duty for three months. For the next nine I returned to work as an ejection seat mechanic. My CO sent me to mess duty because he was pissed that he heard about my problems from a doctor rather than me talking to him. Also he thought that punishment would do me some good and help me get over my problems.

The problem was that I had a disease that in 1968 was called “angioneurotic edema”. It was listed in the DSM III as a psychiatric condition. The dispensary doctor kept telling me I was crazy. After I was discharged the AMA dropped the diagnosis of “angioneurotic edema” from the DSM. The disease is now called angioedema. It is a medical condition. My CO could have sent me to mess duty for three years and it would not have “cured” me.

I had three workups by military shrinks. All said personality disorder. I took these reports to a VA psychiatrist and had her review the SMR and write a report. She tore the military shrinks apart. It was very easy because all the symptoms and history taken by the military shrinks did not have anything to do with a personality disorder and specifically supported the fact that I had been attacked in the barracks. She gave me a multiple diagnosis of PTSD due to life threatening night time attack and anxiety disorder due to a chronic life threatening medical condition called angioedema. And anxiety disorder that clearly was the result of military service. The DRO sent me to a C&P. The C&P supported the diagnosis of anxiety disorder clearly the result of military service and chronic life threatening angioedema that was already service connected. Technically I was re-diagnosed with an anxiety disorder based on the symptoms noted in the three reports written by military shrinks.

The RO totally ignored the PTSD diagnosis because there was no police report. They could not separate the expected lifestyle changes caused by a chronic life threatening medical condition from excessive anxiety associated with an anxiety disorder caused by the medical condition and the anxiety disorder that started in the military and pre dated the onset of life threatening angioedema. Since there were no valid diagnoses that pointed to a non military etiology and all diagnosis were the result of service and a medical condition that was already service connected. The final determination was “Angioedema with anxiety 70%”. I have other SC’d conditions

All this to explain that you are on the right track with the question you asked about the medications prescribed to you in the military. In my opinion, the events in the military are not the issue. The RO is trying to resolve the case based on a verifiable stressor. Get them their info if you can. However, in my opinion, the treatment notes from the military shrinks must be re interpreted as being part of a condition that affects you today and is not a personality disorder.

My question was who is DR C. If he was a military doctor what diagnosis did he put in the SMR if not a military doctor do you have his notes and what do they say. One problem that I ran into was that several of the doctors in the military refused to put the diagnosis of “angioneurotic edema” in my file. I had several dispensary notes that showed that I came to sick call with no explanation as to why I was there. They said it would cause a problem for promotions later in my career. Fortunately, two weeks before my discharge I saw a specialist who made the diagnosis in his report and prescribed the same medications that have been prescribed for the last 35 years for angioedema. My first record of post service treatment was 7 years after discharge. Without that diagnosis and the medications prescribed two weeks before my discharge every SO I talked to said I would have never been service connected. Additionally, I would have had a serious non service related cause of anxiety and any anxiety condition would also have not been service connected.

I said this before the med connection is very important to your claim. However, I have seen cases where a veteran was service connected for an acquired psychiatric condition 15 years after being discharged for a personality disorder and no meds were prescribed in the military. It was determined that the in service symptoms were early symptoms of the condition diagnosed 15 years later.

To clarify one other statement you made. You said the claim has been open since 1978 or there about. What is the claim date according to the VA’s computer. The answer to this question could open a whole new area of debate.

Hang in there. Don’t let this run you down. It can do it. They ran me around for 8.5 years. I am surprised I survived.

[Josephine]

To clarify one other statement you made. You said the claim has been open since 1978 or there about. What is the claim date according to the VA’s computer. The answer to this question could open a whole new area of debate.

Hi Hoppy,

What a wonderful person you are.

When I was discharged from service, I was told that I would be giving up any G.I benefits. This is signed a paper to and believed.

Anyway, I filed for Anxiety, Depression and Headaches in 1978 and a counselor sent me a letter - You are not service connected.

I filed again in 2002 - No service connection.

2003 I was granted a pension stating " we find you to be disabled back to 1983. This time, I said no way.

I went to the R. O and demanded to see my records, The more they refused, the more I insisted, until I made a bit of a scene.

They got the file though and I noticed that my Comptency Review Records were not in the file, I ask the counselor and he said that was all the records. I said," Boy the psychiatrist didn't think much of me. Perhaps you could help me locate Dr. C. He said no way, he is most likely retired.

I came home and wrote to the St. Louis Archives and the Psychiatric Records came and a letter from my commanding Officer describing my early discharge.

I turned copies of these in to the R. O in 2004 and within one month, I received a letter that my file was re-opened. Within 3 months, I received a statement of the case stating " This is not the DRO Final Decision, but I am sending you a form 9 to return within 60 days and we are sending you for a C&P for an Acquired Pschiatric Disorder.

The form 9 was turned back into the Va. before the C&P. I just wrote down anything that I could think of, that I had not had a C&P and Etc.

I had the first C&P and was found with the Generalized Anxiety Disorder with a More likely than Not.

Immediately my file was transferred to another state.

5 months later , I had that dumb C&P with those two lying psychaitrist. Nothing bothered her in service.

It was my turning in records never seen by the Va. that opened my claim and I don't know if it is open or closed.

I went to the internet and looked for Dr.B.B C. and I located him and here is a copy of his letter. I turned in a copy of his letter and envelope to the R.O and the Medical Center, due to that hypnotic C&P.

My claims file is now with the two lying Psychiatrist to reconcile their differences and to rationale their decision of me and to read his letter and give the BVA a new opinion.

May 15, 2004

To whom it may concern:

_________ Formerly ---- , has requested that I write documenting my care of her during the period of

February and March, 1964, at the U.S ___ She was an enlisted person and I was a general Medical Officer, practicing at that facility. The question she has asked me to address is whether I helped her obtain a discharge from the Navy.

_____________ has provided from her medical records as well as recent letter to me, which is undated. My evaluation of her on 2/20/64 and a follow up visit on 2 / 27/ 64 are available. Two Psychiatric consultations are also available for review. The first performed on 3/12/64 by DR. J and the second performed by Dr. M. Finally the letter by our C.) recommends an Honorable Discharge by reason of unsuitability. My understanding is that the discharge occurred shortly thereafter.

After phone discussion with ____, I did remember her as an enlisted person at the ______ with whom I had worked on occasion. My workup of 2/20/64 concluded that she had tension versus vascular headaches and I added a tranquilizer to her headache medicine for anxiety. The note from 2/ 27/ 64 documents that the lab test were normal and I recognize my personal shorthand in my notes that I often used for a counseling session. After 40 years I do not remember whether I started the process discharge, but suspect I may have been supportive. She had seen a Navy Psychiatrist on 3/12/64 with no indication of further workup or return. Two weeks later she saw another psychiatrist to whom I frequently referred patients who needed special understanding and sensitivity. While there is no documentation that I referred her, the fact that she saw Dr. M scarcely two weeks after with no worsening of condition does suggest to me that I may have sent her for the evaluation relative to discharge.

Both C H and Dr. M comment on ----- immaturity and that she was uncooperative in her duties. After she reminded me and recalled specific instances. I did recall that she baby - sat in our home on multiple occasions with our two children ages 2 and 1. I know that my wife and I would have not allowed her to stay with the children if there had been any question of her suitability. The ___ staff was close knit and I would have likely been made aware of any poor behavior on ______ part.

While my memory does not allow me confident documentation of my role in her discharge there is circumstantial evidence that her story is credible and I hope that you will give her case every consideration..

BCC M.D.

Edited October 22, 2006 by Josephine