Depression as secondary

[Andyman73]

Hello all,

I got a phone call at the end of work yesterday afternoon, can I come down for a C&P exam on Tuesday, the 3rd of November...what is this for...my claim for depression, yes I will be there.

Anyone go through an exam for depression as secondary to chronic pain?  Or even just depression, that can give me some pointers?  What should I not mention, besides life before my service? How much detail should I give?  Should I mention my night sweats, and nightmares along with my chronic sleep impairment?  How long will this type of exam take? 1 hour, 2 hours, or longer?

Semper Fi.

Andyman.

[USMC_VET]

You will need to do 2 things.

1) Connect your depression to the chronic pain as the cause, or you can also claim it as aggravating it, that you have depression but your pain makes the depression worse than it would have been.

2) That your depression is ratable.

 

To connect it to the chronic pain you need to show the rater that before you had chronic pain you had no issues with depression, or if it was present that it was a 2, and now its a 5, etc. 

Be honest, but if you never had issues with depression before if they ask about your history, have you ever gotten "down" before or did you ever have the "blues" etc. 

I would give as much detail as possible.  focus on two things, how the chronic pain (which i am assuming is SC already) has caused your depression, and that you are depressed BECAUSE of the pain, that is what gets you down.  Focus on how the depression affects your life with your friends, loved ones AND WORK. 

 

look at the 38 CFR for mental health disorders, this is how they will rate your depression.  pick out the things that pertain to you and MAKE SURE YOU FOCUS ON THOSE THINGS MORE THAN OTHERS WHEN DESCRIBING YOUR SYMPTOMS.

General Rating Formula for Mental Disorders

	Rating
Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.	100
Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.	70
Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.	50
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).	30
Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.	10
A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.	0

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[Okichewy1]

Just had this done and approved.  I claimed anxiety and depression due to chronic pain in my knee and shoulder (both S/C).  I started seeing a LCSW (Licensed Clinical Social Worker) after my Primary care doctor stated that I had anxiety.  The LCWS said I had depression and anxiety due to medical issues and chronic pain.  I submitted my claim, had to do a MH C&P exam.  Was approved for 30% for Somatic Symptom Disorder (Formerly Chronic Pain Syndrome).  If you feel you have depression due to your pain, get it checked out and then go from there.

[Buck52]

Andyman

when the examiner ask questions  just answer honestly as you can and go into details bout how its effecting your life &  on some questions just be more specific and go into detail more.  USMC_VET right on  check out those CFR's mental health disorders and the symptoms .

try not to stumble & look off like your thinking what to say with your answers ... Although sometimes being depressed we have speech difficulty don't let that worry you it should help you..

you will do okay buddy

Good Luck

 

.............Buck

[Andyman73]

On the quick over view of the above chart(thanks USMC_VET!) It looks like I would fall squarely in the 50, with a few in the 70% range.  Should I take some notes along to ensure I cover some issues, or no?  How much detail do I give about my sleep issues, or suicide ideation, and so on?

When I asked my MH therapist about the chronic pain connection he was quite vocal about it, saying that chronic pain most definitely leads to and or worsens depression.  And he does have me DXd with MDD, reoccurring.  I've been dealing with pain since late 1992, would that qualify as chronic?  I believe 2 of my SCDs are actually listed with pain in the terminology.

Also, how long should I expect to be in the exam, I've got nothing else going on that day, just curious, is all.

Thanks, guys,

Semper Fi.

Andyman

 

[USMC_VET]

What i now do for my C&P is i write up a long overview in sworn declaration format of my symptoms and all the big and little things i want them to know and have noted in the exam.  I submit that to the evidence intake center stating that i will be presenting this to the examiner for my compensation and pension exam on XX/XX/XXXX in the exact format that has been submitted as evidence, etc.  I have 3 copies.  One that goes to evidence intake center, 1 that goes to examiner and one that i hold myself.  THis way i dont forget things, which i HAVE DONE ON EVERY SINGLE C&P I HAVE BEEN IN!

This way the evidence is there and submitted and the VA "knows" the examiner got this copy.  not a silver bullet but this way if you have to go to appeals you can dispute the exam "the examiner noted that i did not have pain that interferred with gainful employment, however as noted in the sworn declaration dated 1/1/2015 that was submitted ot the examiner the day of the Compensation and Pension Examination on 1/3/2015 i specifically noted in three paragraphs how this pain has interfered with my ability to work, missed days of work as well as had sever decreased productivity...etc...etc."

Alot of the "tricks" for an initial claim as far as submitting evidence the proper way, etc is not so much "this will guarantee a good outcome the first time" thing, its more of covering your butt in cas eyou have to appeal.  hopefully you wont, but this all helps.

But in the very least write down things, tell the examiner you have a list of things you wanted to talk about and wrote them down becuase you have problems remembering things and get flustered easy, etc.

The exam can last a short or long time, i have heard of 4+ hours for PTSD mentla health evals, have never been to a C&P for depression, just ptsd, so i cant say definitively.  will really depend on the examiner and how they view your claim, etc.

[Andyman73]

USMC_VET,

Ok, thanks, I will write a list of talking points.  I only just got my evidence package mailed off on Monday, should be there tomorrow.  Talk about cutting it close!  But then again, I only requested this exam on the 9th of this month!

I sent them STRs starting from the beginning, to the end, covering 6 yrs, where I was seen for pain.  Also, where I had sinusitis and IBS with stress and sleep impairment mentioned, an episode of angina(chest pain?) where they mentioned my stress level. I high lighted the dates, the issue(pain) and what med was prescribed.  Then I included a list of pain meds prescribed by VA over the years since.  And lastly my most recent MH notes where my doc has my current DX and his notes.  And I wrote a decent statement in support of claim.  I tried to keep it short and sweet, not wanting to overwhelm them with a novella.

Should I tell the examiner that I will be sending a copy(or already have sent) to the claims intake center as additional evidence, to ensure the examiner enters the correct info on the exam?

And yes, I forget something every time, too.  I asked one examiner a few questions, not related to the exam, after it was over, and that ungrateful Vet/VA employee wrote them in his exam notes, but in a negative light.  Which I then mentioned when I wrote up a statement in support of claim for a following contention.

Semper Fi.

Andyman