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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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lotzaspotz

Reminder that your exam starts in the waiting room lobby

Question

I was reviewing 2015 BVA decisions regarding the New Orleans RO, and came across the following.  I'm on a tablet and can't cut and paste the section, but scroll down to the second paragraph above the "Order" section.  You'll find that this veteran's carriage and demeanor when she was called from the waiting room found its way into her C & P exam report and then into the BVA decision.

http://www.va.gov/vetapp15/Files2/1512277.txt

Always remember, your exam starts the moment you enter the exam facility.  If you're there for a spine exam, your posture in the chair you're seated in, in the lobby, may very well be noted.  There's plenty of literature on exams here at hadit, but I thought it would be useful to remind everyone that the exam begins upon entering the facility, not when entering the examination room.

Edited by lotzaspotz
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Lotz,

 

Thanks for the info and you are so correct. I tell this to Vets all the time to always remember that the VA is looking at us the minute we are no longer Active and become Vets!!!

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In this particular veteran's case, the remand resulted from some extra effort put forward by the BVA, luckily.  I guess the RO expected her to show up for the exam showing visual cues of the obvious effects of incapacitating migraines in that moment.  Instead, she tried to act like a person whose turn came up to be seen at the DMV.  Note the statement about her wearing sunglasses, that she wore them in the examination room and suddenly complained of pain from the light.  Left unsaid in the decision was whether she wore them in the lobby while she waited, and if the examiner asked her if she experienced pain from the light in the lobby when she was waiting to be called.  

 

 

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The crazy one here, This somewhat happened to me but I would say that C & P exams starts when the veteran pulls up in the parking lot. In one of my exams it was mention about my dark glasses given to me by VA.  My glasses are polarized tented and the stay dark all the time. It was hot that day and when I pulled up to the parking lot and got out of my car my glasses got foggy and I had to take them off to wipe them so I could see and I put them back on. When I went in to see the doctor he commented on my glasses and that they were dark and did I where them all the time and the fact that it was hot that day and it would be best to stay in. No statement ended up in my rating but I believe that when a veteran has an exam, he/she is watched at the earliest point for the VA doctor to come to a conclusion before the veteran ever see the doctor.

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What's the saying, Pete, "It ain't paranoia if they're REALLY after you!"

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This exact thing did happen to me at a C&P exam.  I went to the exam quite a few years ago.  Me and the exam doctor did not get on well at all.  I was  an excitable boy in those days.  To justify him screwing me in his exam the doctor said that my demeanor changed from the time I was in the waiting room to the time I was in the exam.  This was a doctor who maintained that since I had a degree in psychology this was proof that I was faking my C&P for mental health issues.  The upshot was an appeal that I won based on a biased exam.

If your exam is for a bad foot and you use a cane then you better be using it from the time you get out of your car at the VA until you get back in to go home.  All the rest pertains as well.  I have had VA C&P exam doctors say such outrageous things to me about veterans.  Many of these doctors are jaded and cynical people who have zero respect for veterans and believe most of us are free loaders and game players.  You can't give them an inch or any excuse to screw you because many will do it just for spite.  You know every few decades some administration decides that most veterans on disability are faking and just getting free ride at taxpayers expense.   This happened in the 1980's .   It will probably happen again when we get an administration that wants to cut taxes and cut growth of entitlements.  No matter what the politicos say about honoring vets they will cut your throat to save a dime.

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               neutralized.  This event would meet DSM?five trauma criteria for PTSD.
               Other VA notes also refer to the veteran being next to a man who 
      almost committed suicide, but a sergeant apparently prevented it.  This would
               also not meet trauma criteria as nothing actually happened.  There was
               no trauma witnessed, and the veteran himself was not in significant
               threat. The veteran today said he really wanted to have a career in 
      the USMC, but also noted that the reason he actually got out was due to a
               Reduction In Force at that time.  
               
               
         b. Relevant Occupational and Educational history (pre-military, military, 
      and
            post-military):
               This veteran has had a number of past mental health evaluations here 
      at
               the VA.  Please see the 12/16/2011 psychology evaluation, the 4/272012
               psychiatry intake, and the 10/17/2016 psychology mental health
               treatment plan for details of his history.

      Vet reported today that he has had mental health treatment in the
               private sector starting about 2003/2004 regarding ADHD and was placed
               on Adderal as well as a number of antidepressants.

               He started here at the VAMC in 2011, dealing with issues of ADHD,
               Depression and Anxiety (particularly Social Anxiety). He has seen
               psychiatry, psychology and social work at various times since then, up
               until the preseent. 

               He also had Neuropsychological testing on 10/14/2011 regarding an ADHD
               eval.

               Psychiatry records indicate medication has not been all that effective
               regarding his depression and social anxiety. 
               He currently is treated with Adderal for ADHD and recently was
               (re)started on escitalopram.

               He has also been in and out of psychotherapy for the above conditions. 


               This examiner notes that the previous evaluations noted above assessed
               for PTSD but indicated he did not meet criteria.

               Those evaluations also indicated that the veteran's depression
               condition really worsened in recent years following the breakup of his
               long-term relationship about five or six years ago, though a little 
      bit before that there was some increased depression.  Furthermore, those
               evaluations also indicate the veteran has felt that he always has
               tended to be rather anxious and depressed with low self-esteem.  The
               records indicate a history of a very strict and harsh, verbally
               abusive, father as well as a history of being bullied in school, 
      though did not get any mental health services.  Curiously, VA social work
               notes from more recent times such as 5/18/2017, seem to describe the
               social anxiety as being caused by or started in the military, related
               to harsh treatment by a corporal.  This is not likely accurate given
               the previous treatment notes described in the first paragraph above
               that indicate a long history of this type of feeling even in his 
      youth, as well as more recent onset/worsening of symptoms just a few years 
      ago following the relationship breakup.
               
               
         d. Relevant Legal and Behavioral history (pre-military, military, and
            post-military):
               This veteran has had a number of past mental health evaluations here 
      at the VA.  Please see the 12/16/2011 psychology evaluation, the 4/272012
               psychiatry intake, and the 10/17/2016 psychology mental health
               treatment plan for details of his history.

               None
               
               
         e. Relevant Substance abuse history (pre-military, military, and
            post-military):
               This veteran has had a number of past mental health evaluations here 
      at the VA.  Please see the 12/16/2011 psychology evaluation, the 4/272012
               psychiatry intake, and the 10/17/2016 psychology mental health
               treatment plan for details of his history.

               None.
               
               
         f. Other, if any:
               n/a
               
               
         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: Small arms fire and mortar battle in Gulf War
         
               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 Criterion 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 Criterion 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 violence, 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] No criterion in this section met.

            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] No criterion in this section met.

            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] No criterion in this section met.

            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] No criterion in this section met.

            Criterion F:
            
                        [X] No criterion in this section met.

            Criterion G:
            
                        [X] No criterion in this section met.

            Criterion H:
            
                        [X] No criterion in this section met.

            Criterion I: Which stressor(s) contributed to the Veteran's PTSD
                         diagnosis?:
                         No response provided.
                         
         5. Symptoms
         -----------
         For VA rating purposes, check all symptoms that actively apply to the
         Veteran's diagnoses:
         
            [X] Depressed mood
            [X] Anxiety
            [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
         --------------------------
         The veteran's affect was broad, though mood appeared dysphoric and anxious.
         He was quite talkative and animated at times.  He was polite and 
      cooperative.
         Eye contact and behavior were normal.

         7. Other symptoms
         -----------------
         Does the Veteran have any other symptoms attributable to PTSD (and other
         mental disorders) that are not listed above?
            [X] Yes   [ ] No
            
                If yes, describe:
                   The veteran has a history of attention deficit/hyperactivity
                   disorder (ADHD), inattentive type.  Please see the DSM?five as well
                   as the neuropsychological testing from 10/14/2011 for details of
                   such symptoms.
                   
         8. Competency
         -------------
         Is the Veteran capable of managing his or her financial affairs?
            [X] Yes   [ ] No
            
         9. Remarks, (including any testing results) if any
         --------------------------------------------------
            The exam request form states/asks:

            "Exams on this request: 
            DBQ INITIAL PTSD

            ** Status of request: 
            Pending, reported to MAS
            
      --------------------------------------------------------------------------
            ------



            DBQ PSYCH PTSD Initial
            _________________________________________________________________________

            The following contentions need to be examined:

            PTSD
            Active duty service dates:
            Branch: Marine Corps
            EOD: 08/02/1988
            RAD: 08/01/1992

            DBQ PSYCH PTSD Initial:
            Please review the Veteran's electronic folder in VBMS and state that it 
            was reviewed in your report.

            MEDICAL OPINION REQUEST
            TYPE OF MEDICAL OPINION REQUESTED: Direct service connection
            OPINION: Direct service connection

            Does the Veteran have a diagnosis of (a) PTSD that is at least as likely 
            as not (50 percent or greater probability) incurred in or caused by (the) 

            Combat Action Ribbon during service?

            Rationale must be provided in the appropriate section. Your review is not 

            limited to the evidence identified on this request form, or tabbed in the 

            claims folder. If an examination or additional testing is required, 
            obtain them prior to rendering your opinion.

            POTENTIALLY RELEVANT EVIDENCE:


            NOTE:  Your (examiner) review of the record is NOT restricted to the 
            evidence listed below.  This list is provided in an effort to assist the 
            examiner in locating potentially relevant evidence.

            Tab A (DD Form 214 in VBMS): TAB A- CAR COMBAT ACTION RIBBON IN DESERT 
            STORM AND DESERT SHIELD  dated 06/27/2017

            If more than one mental disorder is diagnosed please comment on their 
            relationship to one another and, if possible, please state which symptoms 
            are attributed to each disorder.

            If your examination determines that the Veteran does not have diagnosis 
            of PTSD and you diagnose another mental disorder, please provide an 
            opinion as to whether it is at least as likely as not that the Veteran's 
            diagnosed mental disorder is a result of an in-service stressor related 
            event."


            ------?????????

            As noted above, this veteran does not appear to meet criteria for PTSD,
            lacking sufficient number, frequency, and severity of symptoms to warrant
            such a diagnosis.  The veteran does have depression and anxiety (mainly
            social anxiety) and ADHD conditions described above, though it is this
            examiner's opinion that they are less likely due to, caused by, or
            incurred during military service for the reasons noted above.

            Today, the veteran denied any delusions or hallucinations.  There are no
            panic attacks and no OCD.  He denied any suicidal or homicidal ideation.
            He says that he knows if he were ever to kill himself, it would hurt his
            mother significantly and he would did not want to do that.  He does 
      report frequently being in a low, sad and depressed mood.  He reported crying
            spells, decreased hope, low self-esteem, feeling easily overwhelmed,
            feeling "stuck" and self critical.  He described feeling depressed over
            various regrets he has in his life.  He also reported a lot of anxiety.
            Some of this is regarding his current life situation including financial
            difficulties, though a lot also appears to be related to socially related
            anxiety feelings.  He feels others judge and evaluate him in a negative
            manner.  He feels he just does not measure up and worries when others are
            looking at him, that they are thinking negative thoughts or critical
            thoughts about him.  This also creates not only emotional anxiety, but
            also physical symptoms such as nausea.  Regarding PTSD issues, the 
      veteran says he has sometimes dreamt that he is in the US Marine Corps but is out
            of shape.  He reported no recent issues with any actual trauma related
            nightmares.  He also says he has negatively dreamed recently about his
            most recent ex-girlfriend (from five years ago).  The veteran did not
            describe upsetting intrusive trauma memories nor severe distress at any
            particular cues.  The veteran does not appear to actually meet criteria
            for HYPERvigilance.  He seemed to deny his issues with anxiety around
            people have to do with actual fear for his physical safety.  This
            avoidance of people and public has to do more with worrying about their
            judging him.  He reports when driving he is aware of other cars and where
            people are around him, though this does not appear to be related to 
      trauma or represent any PTSD.  The veteran seems to describe having no real set
            sleep schedule and he will go to sleep at widely varying times.  He says
            he has some difficulty falling asleep but once he is asleep, he will 
      sleep for as long as 12-16 hours.  This may be related to his nonservice related
           anxiety/depression condition and his negative coping strategy of
            avoidance.
       
      NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application.
      XXXXXXXXX XXXXXX,
      PhD Clinical Psychologist
    • By chomperjones
      Ok guys and gals, im back after a few months with more information.
      So for a little background, my effective date is 12/12/16. It moved to prep for decision in 2 weeks and stayed there for a few months. 
      then it went back to gathering evidence, at which time i recieved a phone call scheduling me for an exam on march 25.
      10 minutes later they called back saying i could come in for an exam tomorrow (which was march 1st).
      I  attended my c&p exam for bipolar/depression- and the examiner concluded the exam by telling me to go directly to MH because im not mentally healthy or stable.
      I have the results from ROI, i scanned them, and posted them online below.
      I am currently 80% disabled, none of which are MH related :-( (illness consumed my life beginning midway through my 4 years on AD)
      I know im crazy in the head, and this report only makes me feel worse about myself. please dont judge me, im receiving treatment as we speak.
      part1: 

       
      part2: 

       
      part3: 

       
      part4: 

       
      part5: 

       
      part6: 

       
      part7: 

       
      part8: 

       
       
    • By Gatorintel
      So after five years of receiving my disability payments at 100%, the VA scheduled me for a reevaluation on my lower back degenerative disc disease, L4-S1.  My other disabilities had already been given P and T, so I wasn't reevaluated on those.
       The doctor today did the measurement so quick that there is no way he could have line-up the measurement tool for an accurint reading.  
      I am concerned that I will be given a lower rating on my back flexation.  I have been regularly seen at the VA for PT on my back and have been scheduled for injections to reduce the pain.  I have had an MRI as recent as two months ago that says my degenerative discs have not improved, but they have not gotten markably worse.  
      I would like to know if anyone has had their back rating reduced based on maybe a 10 degree improvement in flexation, but that the flexation brings me to the 20% rating vs the 40% rating.  I am not sure if the VA regional office will say a 10% increase is a marked improvement and lower my rating.  
      Any comments will help my monkey mind on this particular subject.
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    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
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    • Exams that were being sent strictly to contractors before, due to VAMCs not being open, are starting to be routed back to VAMCs. This is going forward from last Friday- not sure if prior scheduled exams will be re-created for VAMC vs vendor.
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    • Mere speculation in your VA C and P exam

      M21-1, Part III, Subpart iv, Chapter 3, Section D – Examination Reports III.iv.3.D.2.r. Examiner Statements that an Opinion Would be Speculative Pay careful attention to any conclusion by the examiner that an opinion could not be provided without resorting to mere speculation (or any similar language to that effect). VA may only accept a medical examiner’s … Continue reading
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    • A favor please - just changed servers so if you have a moment...
      A favor please - just changed servers so if you have a moment go to https://www.hadit.com I'd like to see how the server handles a lot of traffic. So if you have a moment click the link and i can see how things are going on the back end.
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    • It's time to ask for help from the community. If you can help with a gift it would be very appreciated.

      Fund HadIt.com Veteran to Veteran LLC


      Give a financial gift to help with the upkeep of HadIt.com. HadIt.com is NOT a non profit. Gifts are not tax deductible, they are just gifts. 
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