ptsd CP conducted without veteran.

[MOMO68]

Sorry for the long post but need some insight. I filed a claim IU in June 2015. I looked at my my healthvet file and found this. It states a CP Exam but I was not present as I read further it was seem like a medical opinion from a CP Exam I had in December of last year. Can someone take a look at it and give some insight into what the outcome may be? 

This is an addendum to Dr. ??? PTSD C&P evaluation of 12/12/2014, Per VBA request of 11/24/2015. Dr. ???is no longer available to complete the addendum so it was assigned to this writer. The relevant portion of form 2507 is copied below: Please have examiner ?????. provide an addendum to the examination he or she conducted on the Veteran on 12//1/2/2014. Please provide the following clarification: Please state whether or not the Veteran's service connected post traumatic stress disorder precludes her from physical or sedentary employment. DBQ PSYCH PTSD Review: Please review the Veteran's electronic folder in VBMS and state that it was reviewed in your report. The Veteran is service connected for post traumatic stress disorder (also claimed as sleep disturbances) which is currently evaluated at 70%. Please evaluate for the current level of severity of the Veteran's service connected disability. If the diagnosis rendered is different from the disability for which the Veteran is service connected, please indicate whether the Veteran's current diagnosis is a progression of the service connected disability or the original diagnosis was in error. 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. Additional remarks for the examiner: Veteran is claiming TDIU as a result of her service connected post traumatic stress disorder disability as well as several nonservice connected disabilities. ***Please comment on the effect of the Veteran's service connected disabilities on his or her ability to function in an occupational environment and describe any identified functional limitations. Please refrain from opining on if the veteran is unemployable or employable; instead focus and reflect on the functional impairments and how these impairments impacts occupational and employment activities. This addendum is based upon the veteran's condition around the time of Dr. ??? evaluation, determined to the best of this writer's ability, based upon his report and available contemporary documentation in the medical record. Her condition may have worsened in the ensuing 50 weeks. CPRS records indicate that this veteran was suffering from Recurrent Major Depression around the time of Dr.???? evaluation, and had been at least sporadically since 2006. She was also diagnosed with prolonged bereavement. The severity of the MDD had been rated as Mild to Moderate about 3 weeks before Dr. ???? saw her. Thus, it would have been appropriate for a MH evaluator to attempt to determine what portion of the veteran's reported level of occupational and social impairment was due to the PTSD, to the Bereavement, and to the MDD. An attempt to do so post hoc is complicated by the fact that the veteran was and apparently still is experiencing auditory and visual hallucinations that have variously been described as depressive phenomena, and as feaures of unresolved bereavement over her sister's sudden death in 2006. Because the treating psychiatrist opined that "[Anti-psychotic medication will not be prescribed because] her AVH [Auditory/Visual Hallucinations] are comforting and associated with bereavement," writer will not consider those as being contributory to veteran's reported level of social/occupational impairment. Conservatively estimating that 20% of the reported impairment can be attributed to MDD, which appears not to be service-connected, writer will review reported PTSD symptoms in attempting to opine whether these in and of themselves would have impacted employment.  Veteran was found to be somewhat withdrawn, and to be emotionally isolated from others. She had irritability, problems with concentration, and sleep disturbance. She had anxiety, suspiciousness, disturbance of motivation and mood, problems establishing relationships, and poor tolerance for stress. She avoided thinking about her trauma. These symptoms would have been expected to affect employability in that veteran would have been expected to have difficulty working in an environment that was stressful, put her in contact with large numbers of others, and put more than moderate demands on her ability to concentrate and remain alert. She would not do well in a situation within which she was expected to take initiative or to self-motivate. However, sedentary occupations within a low-stress, low social contact environment, with modest productivity demands, probably would not have been precluded by the PTSD symptoms mentioned above. Furthermore, even jobs that are modestly physically demanding would not have been precluded solely by the PTSD symptoms, albeit of course there were other, potentially limiting non-psychiatric impairments present as well. Writer opines that her capacity to work in an environment optimized for her PTSD symptoms would have been moderately impaired but not absolutely precluded.

Edited December 5, 2015 by MOMO68

[broncovet]

Something is either not making sense here, or I am getting old, or both.  

You were apparently denied by the RO, I guess, because the exam was inadequate.   So far, I am with you.  

So, you reopened under 3.156 new and material evidence, and, apparently got a new C and P exam?

And your reopening was denied, as apparently VA felt you had no new evidence?  Anyway, I suggest:

1.  Get a copy of the new exam: Did it answer the questions (1. Did they opine whether or not SC conditions prevent you from SGE?)

2.  Get a copy of the rest of your cfile.  Were these questions answered in other exams?  

3.  Please post the "reasons and bases" for denials.   The "threshold" for reopening is low.

Try reading this and see if it makes sense to you:

http://www.purpleheart.org/ServiceProgram/Training2011/T-1%20Imp%20%20court%20case%20N&Ml%20Evidence.pdf

 

[MOMO68]

New cp didn't answer SGE. just PTSD has gotten worse. The claim was an FDC for IU (new) and increase for PTSD/MST. I submitted.claim with VOC rehab infeasible letter but RO is stating this is not new material and evidence. My last IU claim did not have letter. I have sent for cfile before I appeal.

 

 

 

 

[Navy04]

Sorry to hear what you are going thru. I would just reopen the Denied Claim and go in there with the Letter in hand, and new evidence. Have you been seeking MH care thru the VA? If so then I do not see what is the hold up. Do you currently work?  Good luck and keep us posted

[MOMO68]

Thanks Navy04. I have been receiving MH treatment from VA for about 3 years. I am currently unemployed. Denial letter states records and forms never received when I know they were received.

Can some of the moderators answer a question. What is best a DRO Review, Appeal or could I submit a CUE?