Mental Health C&P

[jlduty]

I had all of my initial C&P exams about 3 weeks ago.  I was not initially scheduled to see a mental health professional.  At the general exam I was asked if I had ever been seen by a mental health professional during my AD service and whether I had ever been depressed.  I answered yes to both.  The examiner recommended to the VA that I have a mental health exam as well.    I received the appointment letter two days ago.

I have never been diagnosed with depression but I did have an evaluation/interview when I was trying to get my chronic pain diagnosed.  I never heard back from the doctor after the evaluation.  However, I have had suicidal thoughts at three different times in my life.  I also went to a therapist through Military One Source when I was going through my divorce.    Well, onto my question I guess, now that I have given a little background information.  I am just wondering what I should expect at my exam next week?  I am not sure what I should even say.  I am not currently struggling at all, however, I can get dark sometimes.  I would like to have a service connection in case I slide back into a bad place in the future.  I am only hoping for a 0%.  Should I add mental condition or depression to my claim or should I wait until my current claim is settled so as not to send it back to the beginning again? Or will this exam be sufficient?  Any advice or insight would be greatly appreciated.     

[Andyman73]

jlduty,

Welcome to Hadit!

Ok, here's the big thing, when you go to the C&P exam for MH, describe everything from your worst day ever. They will downplay your level of MH rating if they can.  Yes, talk about the SI(suicide ideation). Also, keep as much of your responses directly related to your service years, and the years since.  Otherwise they will try to say your issues predate your service.

I too have SI.  I even tried it a few times.  I am currently MDD, as DXd by my VA MH Dr.  But not SC.  Am fighting them on this.  I have a 23+ year history of chronic pain, starting when I fell down stairs during boot camp. 

Since you are already scheduled for your exam, you should file the claim for depression.  That way your EED will be protected.

Others here will chime in with better intel than I can offer.

Semper Fi

[Mark D Worthen PsyD]

On 5/18/2016 at 9:34 AM, jlduty said:

I am just wondering what I should expect at my exam next week?  I am not sure what I should even say.  I am not currently struggling at all, however, I can get dark sometimes.  I would like to have a service connection in case I slide back into a bad place in the future.  I am only hoping for a 0%.  Should I add mental condition or depression to my claim or should I wait until my current claim is settled so as not to send it back to the beginning again? Or will this exam be sufficient?  Any advice or insight would be greatly appreciated.     

I would check with your veterans service officer, but if VBA requested a Mental Disorders C&P exam, that means they will issue a disability determination regarding depression, so it does not seem like you would need to file a Mental Disorders claim. Again, check with your service officer as there may be details or intricacies in your case that would dictate a difference course of action. 

Your goal of establishing SC, even if it is only 0%, is smart. Hopefully you will not suffer from depressive illness in the future. But as the old saying goes, "An ounce of prevention is worth a pound of cure." 

All the Best,

Mark

[Mark D Worthen PsyD]

On 5/18/2016 at 0:06 PM, Andyman73 said:

...when you go to the C&P exam for MH, describe everything from your worst day ever. They will downplay your level of MH rating if they can.

I don't make a habit of disagreeing with Marines, as I value my life and limbs , but I would suggest caution about focusing only on your worst day ever.

I understand where you're coming from Andyman73, as there are some biased, prejudiced, disrespectful C&P psychologists or psychiatrists who tend to discount or minimize a veteran's symptoms and associated functional impairment. IMHO those types should immediately get the boot, and it really pisses me off that they are even allowed near a DBQ. 

On the other hand, if you get a decent examiner, you don't want him or her to think you're exaggerating. Of course, if they ask you to "describe one of your worst days", definitely do so--tell it like it is.

Otherwise, it is usually best to answer the examiner's questions as asked. This will usually mean describing both your history of depression, which will include the worst times, and your current symptoms. 

Keeping a daily symptom diary can really help with providing vivid descriptions of your symptoms and how they limit your life. I write about such a diary on my blog (URL in my signature, below), along with a lot of other advice for PTSD and mental disorder C&P exams. (There is no advertising on my blog, and I do not sell anything.)

All the Best,

Mark

Edited May 20, 2016 by Mark D Worthen PsyD
typo; and added emphasis (italics) to improve clarity of expression

[Gastone]

The MH C & P Psychiatrists and Psychologists PhD are  trained in Forensic MH interviews. The Rating Dept makes a specific request for a VA MH DBQ to be completed. You might want to review the DBQ listed for your condition. Having an idea of the questions to be covered, can take some of the edge off.

As to your "worst day," if you don't discuss it, it won't be considered. Keep in mind, this a FORENSIC EXAM. The Dr will opine as to "over reporting" of symptoms. Your not trying to get over on the VA, so just be yourself, no better no worse. Depending on your issues, the exam could take 1+ hrs, be prepaired.

Who really knows your Head, better than you? Review the 38 CFR 4, based on your answers to the respective DBQ, how do you Rate?

Your "New Meat," "The FNG," forget about that "Hoping for a 0% SC."

Semper Fi

 

[TALON II FE]

I agree with the above from Mark and Gastone, with a word of caution:  I would highly recommend avoiding any topic matter PRIOR to your service.  I think this is what Andy was getting at in part of his post.  Even though there is a qualifier which says that a disability made worse by service should be treated the same as one incurred while in service, in MH rating, this does not seemed to be honored as 'frequently'.  I have seen many Vets run into problems when they started going into childhood, adolescence, etc.  It really is NOT pertinent to the rating, or should it be part of the SC

Keep in mind, this is NOT a medical appointment!  It is more of a legal fact-finding inquiry.  In all honesty, you were enlisted or commissioned being of "sound mind and body", excepting anything found during intake thru MEPS, etc.  Unless they noted issues then, you effectively had "no defect" upon entry into service.  Initially, I failed the depth perception test.  I had just switched to glasses from contacts for the MEPS, so that was the cause.  I later switched to a flying gig from busting my knuckles, passed the depth perception test, no problem.  BUT, if I tried to claim a depth perception issue, I would have a steep hill to climb.  Once you open up that Pandora's box at a C&P, well...it could cause issues.

Please keep in mind, a C&P is NOT treatment!  In treatment, I would recommend baring it all.  You have to put it all out there and deal with it to realize the maximum return from your therapy, BUT I don't believe that a C&P is the place for that.  Stick to what happened in service and since you exited, you will be less likely to incur "unexpected" or "unplanned" results, or a lack of results altogether.

[Andyman73]

Yeah, guess I fumbled the ball a bit, there.

Mark, I wasn't really saying that everyday is your worst day. However if you give a general answer, then something important gets left out. For example, if you say that when you're having a tough day, SI thoughts dance around in your head. Which is in the 70% rating area. But if you say that you're generally depressed all the time, well, the examiner may opine your depression is of a much lesser % degree.  Or, maybe it doesn't matter because your examiner isn't interested.

Like Gastone said, I certainly am not trying to get anything passed/over on the VA. I just want to be treated fairly and given what's due me.  If I go 2 decades without seeking help, because I believed I wasn't eligible, am I to be punished because of it?  Am I less deserving, or less believable? What if I had succeeded with my suicide attempts? It wouldn't matter what anyone thought about me then, or if they believed me at all.

Talon, if your examiner is not interested in your service, and keeps trying to steer the conversation to the time before service, at what point do you, the Vet get to say enough?