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PTSD Denied NSC - Schizophrenia NSC

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VietnamVetSis

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ZERO Rating Decision received!  

  1. "The previous denial of service connection for PTSD is confirmed and continued.  The evidence does not show a current diagnosed disability".  
  2. "The previous denial of service connection for schizophrenia, residual type, competent is confirmed and continued.  The evidence does not show an event, disease or injury in service.  Your service treatment records do not contain complaints, treatment, or diagnosis for this condition.  The evidence does not support a change in our prior decision.  Therefore we are confirming the previous denial of this claim.

Doesn't being WIA with purple heart from grenade booby trap show an event and injury in service?   Furthermore, they made no mention of Agent Orange disabilities claimed (hypertension, ischemic heart disease, etc) even after I responded to 8 of their questions on this disability.   

They did concede 50% schizophrenia NSC as well as INCOMPETENT requiring my brother to engage me as Fiduciary.  Also gave him 40% combined for osteoarthritis and muscle strain SC for his wounds in arm, heel, and knee.   At least he'll get this money.   But I am utterly flabbergasted and discouraged that they would deny him the major PTSD and Schizophrenia claims.   Guess I'll be taking to higher authority now --- Berta, Bronco, anyone ?

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Hi Mark,

Thank you so much for responding.   He does not have a current treating psychiatrist.   Following a 1978 suicide attempt and subsequent hospitalization at a psych ward for 30 days - the psych ward doctor issued a diagnosis of schizophrenia - paranoid type.  After some bizarre behavior by my brother in years that followed, he was an outpatient treatment at county mental health center on and off and attending physician wrote diagnosis in 1983 of " schizophreniform episode with depressive symptoms" .  This medical evidence was submitted with his original claim in 1982 and his request to re-open claim in 2015.  He was not treated for any mental illness while in service / Vietnam.   At his recent C&P exam (last month) the attending VA examiner diagnosed him as still being schizophrenic and they issued a 50% rating -- but the rating indicates NSC.

I will request a copy of his C&P exam from last month immediately -- thank you for pointing me to the form.  I have contacted several psychiatrists in the area to examine him and complete a "DBQ" to show nexus to his Vietnam trauma and they won't even return my calls.   My personal opinion as his sibling (I'm a former banker - certainly not a doctor) is that immediately upon return from Vietnam he had PTSD (burning his uniform, anti-social, startled behavior, etc) and this evolved into schizophrenia, culminating with a suicide attempt.

Symptoms are still there -- just under the surface - because I take care of everything for him down to covering his rent shortage, co-signing for his apartment, buying his clothes and (meager) furnishings, etc.      

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4 hours ago, VietnamVetSis said:

Hi Mark,Thank you so much for responding.   He does not have a current treating psychiatrist.  

You are most welcome. :o)

Does he refuse psych treatment? Schizophrenia is a serious illness, but patients can often enjoy substantial improvement with treatment. With the NSC 50% rating for schizophrenia, he can receive free treatment at a VAMC or VA outpatient clinic. 

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Following a 1978 suicide attempt and subsequent hospitalization at a psych ward for 30 days - the psych ward doctor issued a diagnosis of schizophrenia - paranoid type.  ... He was not treated for any mental illness while in service / Vietnam.

When was he discharged? @THOMAS89031's point about continuity of symptoms is an important one. I've done several C&P exams with vets who were not diagnosed with schizophrenia in service but who began to manifest symptoms shortly after service. Schizophrenia usually starts with prodromal symptoms before progressing to the full-blown disorder, so if those symptoms can be identified as beginning during military service, and then continuity of symptoms can be demonstrated, then the veteran should be service-connected. (Of course, the ultimate decision is up to VBA or the BVA, as you know.)

He might very well also suffer from PTSD, but it will help to see what the C&P examiner said about that. Yes, being wounded by an explosive booby trap is certainly a traumatic stressor. It sounds like they are not disputing that fact, but are instead saying that he is not displaying PTSD symptoms (or not many) currently. 

Quote

I have contacted several psychiatrists in the area to examine him and complete a "DBQ" to show nexus to his Vietnam trauma and they won't even return my calls.

You really need a psychiatrist or psychologist with experience conducting C&P exams, otherwise they won't know what kind of information VBA needs to determine service connection. Also, keep in mind that when a doctor completes a DBQ, he or she is declaring him or herself to be an expert witness, offering an expert witness opinion in a federal legal proceeding. Consequently, psychologists and psychiatrists who know what they are doing will devote sufficient time to conduct a thorough, evidence-based evaluation, and write a cogent report to support their diagnosis and opinion(s). So, you're talking at least 5, and as many as 10 hours for a good evaluation and report. At anywhere from $150 to $300 per hour (psychiatrists usually charge more), you're looking at $750 to $3000 for a well-written, persuasive report. 

A potentially effective, but less expensive option is a "report critique", in which the psychologist or psychiatrist reviews all the relevant records, and then critiques the C&P exam report, pointing out deficiencies particularly with regard to following established VA guidance for C&P exams, and professional standards for such evaluations. Such a critique can support a request for reconsideration and a new C&P exam. If granted, the critique puts the new C&P examiner on notice that they better conduct a thorough, evidence-based evaluation consistent with VA guidance and relevant professional standards ... because you (and your experts) are watching. :ph34r:

Keep us posted! 

All the Best,

Mark

 

Edited by Mark D Worthen PsyD
added 'free' so it's now 'free treatment'
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I sure agree with Dr Mark here:

 "It sounds like they are not disputing that fact, but are instead saying that he is not displaying PTSD symptoms (or not many) currently."

When I was a vet center volunteer, I observed many vets who were reluctant to detail their stressors and their symptoms for the VA. And I know at least 3 GSW vets who do not consider their GSWs as  a stressor. (Because they had so many more stressors they felt were worse than that) 

It is quite possible that he is holding back on talking about Vietnam.I know plenty of vets who have hidden their symptoms when they could.

He might have even served with my husband 65-66 out of Danang AB, which he described as a year in Hell on earth.

There are multiple indications of PTSD in observed behaviors and the schizophrenia could be even masking them.

What surprised me when I worked at a vet center is how many vets there, already compensated for PTSD, would tell me things they would never tell the VA. It often takes someone to draw these veterans out.

One vet told me something horrific that could easily have been verified by VA. But he was already getting his proper VA PTSD comp.

I told him I felt he should bring it up with his VA shrink because he suffered from it with flashbacks and nightmares. Sharing and Getting things out in the open makes it so much easier to deal with it.But he said he could never tell his VA shrink about this horrible event because she was a

woman.I reminded him, I am a woman and he had just told it all to me. PTSD has some unique symptoms.

Did the VA give him the Combat related MMPI?

 

 

 

 

 

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to add...

These 2 conditions of PTSD and Schizophrenia can overlap as these cases show.

The medical term is called comorbid conditions.

Mark gave excellent advise…….schizophrenia is a psychosis that falls under the Chronic presumptives, if there is evidence at least of 10% upon discharge. But it all depends on getting all of his records and then obtaining an IMO/IME

 

“FINDINGS OF FACT

 

1.  In 1980, VA amended its regulations to include PTSD.

 

2.  The first communication from the Veteran claiming entitlement to service connection for PTSD is dated April 13, 1995. 

 

3.  The evidence shows the Veteran has had overlapping symptoms of PTSD and schizophrenia since service. 

 

 

CONCLUSION OF LAW

 

The criteria for an effective date of April 13, 1994, for a grant of service connection for PTSD, have been met.  38 U.S.C.A. §§ 5101(a), 5110 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.400 (2011). “

 

http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp12/Files1/1201318.txt

 

“The RO received the veteran's new claim for service

connection for PTSD on October 5, 1992.  As indicated above,

this claim served as the basis for the RO's April 1992 rating

action that granted service connection for PTSD, and

subsequent, October 2002 rating action that also granted

service connection for schizophrenia, and assigned an

effective date of October 5, 1992, for the grant of service

connection for PTSD with schizophrenia."

 

http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp04/Files3/0423610.txt

 

 

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So sorry I've been off this site for a while.   In the meantime, I've requested his C&P exam and from that, will set up psych appointment for 'report critique' as Dr Mark suggests.   At that time, I will also get him a physical for his Agent Orange exposure symptoms.   I will make sure its a Dr versed in the VA .   Any suggestions from HAD IT audience for Doctors in the Northern Virginia area would be extremely appreciated !

On 5/30/2016 at 8:32 AM, Mark D Worthen PsyD said:

What diagnosis does his current treating psychiatrist list? How about mental health treatment in the past--did they diagnose schizophrenia? PTSD? 

When did he first manifest symptoms of schizophrenia? When did he first receive treatment for schizophrenia?

AS I said, he doesn't have a current treating psychiatrist.   C&P examiner said "Schizophrenia, residual type" - 50% - Non Service Connected.   C&P also said no current diagnosis of PTSD.   He tried to commit suicide in 1978 and that was the first treatment for schizophrenia, with an official diagnosis of schizophrenia, paranoid type and manic depressive symptoms.  Hearing voices and hallucinating - the whole 9 yards.

 

On 5/30/2016 at 2:09 PM, Mark D Worthen PsyD said:

Does he refuse psych treatment?

Yes.   I tried to take him back to local community mental health facility several years ago.   They were willing to take him in as outpatient -- he said no, he "already did that".  

On 5/30/2016 at 2:09 PM, Mark D Worthen PsyD said:

When was he discharged?

May of 1970.   

On 5/30/2016 at 7:25 AM, Berta said:

Furthermore, they made no mention of Agent Orange disabilities claimed (hypertension, ischemic heart disease, etc) even after I responded to 8 of their questions on this disability

Berta --- They did send another letter saying they acknowledged that he was claiming these but they must be submitted as new disabilities on Form 526.  When I get the current medical documentation for his hypertension, etc I will do this.

On 5/30/2016 at 7:21 AM, Berta said:

Did the 5103 waiver or anything else from the VA  ask for more specific medical evidence of any claimed AO disabilities?

I have to look in his papers here for the 5103 waiver.   Ebenefits certainly did ask many questions about AO disabilities claimed -- I answered them all.   But except for the hypertension, there is no Service Treatment Record for these -- or any current medical evidence.  So again, I need to get him to a Doctor - post haste.

I feel awful that I have not done this yet.   But really need the current C&P exam to go on.  

 

 

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If he hasn't had an Agent Orange Registry Health Exam for Veterans, it's a good thing to do for medical (treatment) reasons. It is completely separate from the disability compensation process, but the doctor can alert the veteran to conditions that might be related to Agent Orange exposure, for which he could then receive treatment. (If he does not have an earned income, and for other reasons, he is probably eligible for free medical treatment at the VA.)

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