ptsd What the significant of the term "Secondary"?

[Big Country]

Fellow Veterans,

Question:  Which is more solid?  PTSD is secondary to Dysthymic Disorder or Dysthymic Disorder is Secondary to PTSD?  What's the significant value of the term "Secondary" in regards to your rating?  I'm looking for the terminology for my Nexus Letter.  Please help!  Any help would be much appreciated.

Thanks

 

Big Country

[Vync]

Hey Big Country,
Well, actually it could be either way. That is up to your doctor to confirm. You would start with the issue that is currently service connected and the additional condition would be deemed secondary to that, along with medical rationale.

I'm not a doctor, but it would go something like this: "The veteran has a long history of treatment for his service connected lumbar spine condition. This condition causes chronic and acute pain and he is unable to dress himself, drive, or attend to household chores, which results in chronic depression. His chronic depression is more likely than not due to the lumbar spine condition." Look up nexus letter or IMO examples here on Hadit for better statements.

Please keep in mind that when it comes to mental health ratings, you could be diagnosed with several conditions, but you will only receive a single rating due to the pyramiding rule. It is possible to be service connected for multiple types of mental health diagnosis, but in the end your actual rating percentage would be based on the symptoms of how it impacts your life and ability to function, per the table below:

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#se38.1.4_1130

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

I hope this helps!

 

[Big Country]

Thanks VYNC,

This is most helpful.

[Guest]

I agree with Vync, for the nexus statement but I think the real problem would be how the veteran actually file his/her  claim.  In my limited experience I found that the best way to file a secondary claim is not to use the word secondary.  I will use Vync, example.  I request to be service connected for depression cause by or as a result of my already service connected lumbar spine condition or something like I request to be service connected for depression associated to my already service connected lumbar spine condition. IMHO, this way VA "should" not be too confused. I have won several claims this way. Others may chime in and have different ways but this is how I won a few claims. You will still need a medical opinion with a good medical rationale but this should help.

[Buck52]

Here ya go Buddy

Example of a Nexus Letter

DATE ____________

Reference: (Veteran's name) ____________

SS# ____________________         VA File #____________________

To Whom It May Concern,

I am Dr. ____________. I am board certified to practice in my specialty. My credentials are included. I have been asked to write a statement in support of the afore mentioned veterans claim.

I have personally reviewed his medical history. (Name the Documents) I have also reviewed and have noted the circumstances and events of his military service in the years ____________ (Event or Events claimed as the cause of the condition) while he served during his military service. (List dates of service)

Mr. ___________ is a patient under my care since (enter Date). His diagnosis is _____________ (Name the Condition).

I am familiar with his history and have examined Mr.____________ often while he has been under my care. (Specify Lab Work, X-rays, Etc.)

Mr.____________ has no other known risk factors that may have precipitated his current condition.

After a review of the pertinent records it is my professional opinion that it is at least as likely as not that Mr. ____________'s condition is a direct result of his (Event) as due to his military service. (Choose the degree of likelihood with which you can concur - "at least as likely as not", "more than likely", or "highly likely")

In my personal experience and in the medical literature it is known (Give a rationale).

Signed,

Dr. ____________
(List credentials and contact information)

Please understand that the VA often uses credentials to assign probative value to the nexus letter.
While the nexus letter must be brief as possible it should be as detailed and complete as the circumstances dictate.

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