ptsd Guidance request on C&P exam - PTSD, hearing loss, and tinnitus

[rvance313]

OIF vet here.  Like many, I currently struggle with the daily affects of past war zone experiences.  I initially submitted a claim back in 2010 but was denied.  Frustrated, I gave up on it and chose to deal with my struggles on my own.  Following advice I was given, last year (March 2015), I submitted an intent to file a new claim.  I have been following ebenefits to make sure if the ball is dropped, it is not on my end.  Recently, my claim was moved from the "gathering of evidence" phase to the "preparation for decision" phase and about a week later was changed back to "gathering of evidence".  None of this concerns me, as I know the process takes some time but from what I understand, I should be expecting something in the mail soon informing me of dates for my C&P exam(s).  This leads to my purpose for writing this; I have heard/read horror stories about how vets seemingly have been totally screwed out of the compensation and help they deserve due to the ridiculous results from their C&P exam.  I am simply trying to have my proverbial "T's" crossed and "I's" dotted when my exam date comes and also help all other vets that may be worrying about this same issue.  What I mean by this is, I would like to know if there are things that I should avoid saying/doing or is there anything that anyone has thought hindered their ability to get the desired results from their exam, etc.  Under no circumstances will I lie about my experiences or my conditions but I would like to ensure I do not screw myself using improper wording or something of that sort (as I have seen the VA has done to many vets).  

[rootbeer22]

rvance313:

The best advice I was given is to learn as much about the VA disability process as possible so you can go thru this and other Veteran Forums for the similar contentions that you may have? Learn about Range of Motion (ROM) and how pain factors into your CP Exams and what you should do during those exams. I also learned to ensure that you are very clear at what you are claiming from the start and this may eliminate a lot of heartburn down stream in the process. For instance, as I was inexperienced, a VSO helped me with listing my initial contentions which was a mistake for me. For instance, I have bad "prostatitis" for many years and it was clearly within my service medical records. However, she listed it as "groin pain" as a contention that was later denied. Mainly, because it was not listed very specific and a specific diagnosis code, it was denied -I believe for that reason? When I said to her, "I read that contentions need to be very specific" and she said, "Don't worry, the VBA Rater will figure this all out for you anyway"--infamous last words?  As a result, I learned not to rely so much on a VSO who may or may not know their jobs well? Also, you have to make it as easy as possible for the VBA  rater to rate your claims by providing the best evidence and injury linkage to your service  that you can in the form of medical records, & showing a continuing chronic condition. Also, if your medical records are incomplete, then you should get buddy statements from  those that were there when you were injured. Also, try to review the VA DBQ Questionnaires, that correspond to your Contentions - &  CP Exams that they are going review for your case and claim. That way you get a sense of the questions that the CP doctor is going to ask so you have an idea beforehand of how to respond. Many Vets get nervous the first time they have a CP exam and don't always respond with the information that is in their heads? Most of the information can be found in the hadit.com & ASKNOD forums and from people like Berta & Asknod (among many others) (whom are all amazing for advice). Granted, the VA Disability process is very complex and many Vets have negative experience along the way. But if you can read, the average person can figure a lot of it themselves.

But even with negatively, you can't let it sour you or put you into a defensive position to just give up? Many do and blame others for their misfortune with their claims outcomes? But I feel you (Vets) only lose when you (they) give up and I'm glad you came back. I honesty get the complaints because I've had CP exams that I felt betrayed by the doctor and staff leaving things off of the final exam that hurt my ratings and resulted in a lower rating. For instance, I have heart issues and was granted  only 10% for Hypertensive Heart Disease after a long battle. But, it would have been rated 20% if they had listed my complaints about my chest pains and the use of nitro for my angina? Those issues are listed all over my service medical records and I put it on the pre-exam forms that I was sent. But it was ignored? Anyway, I tell Vets that in many cases it's just the "Luck of the Draw" whom does your CP exams but it has a big impact of what they list. Also, you are very right about honesty because it's the best policy for everything in life -not just VA claims. But, just like going into battle, the better trained and prepared that you are, the better the outcome of your claims will be. Also, if you hit an obstacle, have a plan B & C, but learn, learn and learn all you can about the VA Disability process from forums like Hadit.com so that when they throw you a curve ball on a claim, you'll know how to react. As a matter of fact, I'm working on my first Notice of Disagreement or NOD and I'm applying everything that I just spoke about in this post.

Anyway, I wish you Good Luck and Godspeed- Rootbeer22 

[Mark D Worthen PsyD]

I list the following resources on my website (PTSDexams.com). The first two links are articles (posts) I wrote, published on my site:

Advice for Veterans – VA PTSD Compensation and Pension Exam – Advice for veterans who have filed a VA disability benefits claim for posttraumatic stress disorder (PTSD), and have been scheduled for a Compensation and Pension examination (C&P exam).

Advice for Veterans – PTSD Military Sexual Trauma (MST) C&P Exams – Suggestions for MST survivors to file a successful claim for VA disability compensation benefits, although much of the information applies to veterans disability benefits claims in general.

What to Expect at Your C&P Exam – Well-written article for veterans that explains what you can expect at your C&P exam and how to prepare. 

What to Expect at Your C&P Exam (Video) – A 5-minute video produced by the Department of Veterans Affairs that describes what veterans can expect at their C&P exam.

Exam Tips from a Veterans Law Attorney – Check out lawyer Chris Attig’s 10 Tips to Help You Keep the C&P Exam in Perspective. He offers excellent advice from a legal perspective, which is entirely consistent with the suggestions I provide from a psychologist’s perspective.

[Berta]

Mark, have you ever seen a high GAF score successfully challenged?

Although VA does not depend on GAF anymore, it was a controlling factor in many of their past PTSD decisions.

 

 

[Berta]

Mark, have you ever seen a high GAF score successfully challenged?

Although VA does not depend on GAF anymore, it was a controlling factor in many of their past PTSD decisions.

 

 

[Berta]

I think I managed to answer my own question ,in a way....apparently a GAF can change over time.

I just went to the BVA and notice GAF scores had changed in a few older decisions regarding PTSD. over time ..when VA depended on GAF a lot.

I forgot too that my husband's went from 34 to 26.

But I don't think it can be challenged ,however ,if the veteran is deceased and only one GAF score had been determined prior to their death and the decision was not appealed.

 

 

Edited May 27, 2016 by Berta

[Mark D Worthen PsyD]

On 5/27/2016 at 8:26 AM, Berta said:

Mark, have you ever seen a high GAF score successfully challenged?

Although VA does not depend on GAF anymore, it was a controlling factor in many of their past PTSD decisions.

 

 

I apologize @Berta, I somehow missed your post. 

You're right, Global Assessment of Functioning (GAF) scores are no longer part of the DSM, although I still saw them mentioned by RSVRs (raters) and ALJs (BVA judges) through 2016. 

The GAF is a unreliable and only modestly valid measure of functional impairment. (I'm using these terms in the scientific, not legal, sense. See: Reliability and validity.)

We discussed the problems with the GAF in this journal article, on page 205:

Worthen, M. D. & Moering, R. G. (2011). A practical guide to conducting VA compensation and pension exams for PTSD and other mental disorders. Psychological Injury and Law, 4(3-4), 187-216. doi:10.1007/s12207-011- 9115-2 | http://bit.ly/ptsd-exams