Response to Cliche Magnet

[Mark D Worthen PsyD]

This is a reply to @Cliche Magnet's post -  PTSD's long term effects. Did you win a decision? For some reason I was not able to reply the usual way (I could not type into the box). 

Incurrence and Continuity
When did you discharge from military service, and when did you first seek mental health treatment? 

If you began to manifest symptoms of a psych disorder during service, and you sought treatment soon after discharge, and you have suffered from that same (or similar) disorder since that time, i.e., you have shown continuity of symptoms, then it is possible that VBA could find that the disorder was incurred during your military service and you are entitled to VA disability benefits. [See: 38 C.F.R. §3.303(a) and (b)].

This principle would apply whether or not your diagnosis is PTSD. In other words, if you manifested some posttraumatic stress symptoms, but not enough to satisfy the DSM-5 diagnostic criteria for the disorder, but all your psych symptoms considered collectively, for example, posttraumatic stress symptoms + depression sx + anxiety sx, do meet diagnostic criteria for another mental disorder, then that mental disorder could be service-connected, 

Service connection for a psych disorder under these incurrence and continuity principles poses some challenges, but I evaluated several veterans over the years who received disability compensation for such conditions. Usually the biggest challenge is that the veteran did not seek treatment until many years after discharge. In those cases, one of the fundamental questions the C&P examiner and the VBA adjudicator have to consider is, "If he had a mental disorder that caused functional disability for all those years, why didn't he seek help?" 

Of course, there are some very legitimate answers to that question, e.g., socialization causing men to avoid seeking help due to the narrow, rigid masculine role identity our society has historically imposed on boys and men; plus an ethos in the military to eschew mental health treatment because others will likely perceive it as a sign of weakness and incompetence.

As an aside, I should mention that if a veteran suffers from psychoses during or shortly after military service, and he or she still has disabling symptoms from the same or similar psychotic disorder, then service connection is covered under a different regulation concerning chronic conditions. [See: C.F.R. 38 §3.307 and §3.309(a)].

PTSD
If you have PTSD due to watching your friend burn to death, and your friend's tragic demise is documented, and your presence on the scene can also be demonstrated via documentation and/or lay testimony, then yes, the PTSD can be service connected. And in that case, a letter from your commander and others would be helpful. 

You could certainly seek an IME (I use the term, IPE, since I am a psychologist ;-), and that is something I do in my private practice, but frankly it costs $1000 or more and you can get a C&P exam for free. If the C&P exam ends up being inadequate and VBA denies service connection, then an IME/IPE would make more sense. Of course, that's just my opinion. You should also see what other knowledgeable people think.

Dual Role Conflict
In general, treating psychologists should not write 'nexus letters' or complete DBQs because doing so constitutes a dual role conflict.

A C&P exam is a forensic mental health evaluation, where the 'client' is VBA, the 'referral questions' are directly related to legal issues, and the goal is to conduct an independent, objective, unbiased evaluation. In terms of the C&P psychologist, he or she is an expert witness, providing expert witness testimony in a federal legal proceeding.

Psychotherapy is a treatment/helping relationship, where you are the client, the referral questions relate to helping you, and the objective is to help you achieve your recovery goals. In terms of the treating psychologist, he or she is providing a healthcare service.

As you can see, the professional relationship between the psychologist and the veteran in these two scenarios are very different. In situations like the one you mentioned, i.e., asking a treating psychologist to write a nexus letter, it's helpful to know that such treating psychologists must be very careful about being in two very different roles at the same time with the same person. Usually it is not a good idea. (See: American Psychological Association's (APA) Ethical Principles of Psychologists and Code of Conduct, Ethical Standards 3.06 and 3.07.

All the Best,

Mark

[Mark D Worthen PsyD]

57 minutes ago, Andyman73 said:

Mark,

I, for one, am thanking God that you are a member here.  I messaged you earlier with a brief rundown on my issue(one of many).

Thank you for giving such thought out opinions and answers that even the lowliest laymen among us(like me) can understand them.

I am one of those men you mentioned earlier, who went far too long, without treatment, for fear of public humiliation. Or, like in my case more specifically, I thought help wasn't there for me, but for those that were in combat or combat arms MOSs. Or experienced non-combat traumatic events, and/or MST. Since I have none of those in my history, I just hid myself away in the darkest corner closet of my mind, never seeking the light of day(help).  Even now, having been in treatment at my VAMC, for a year, have barely opened that closet door. My VA MH doc likes to talk about what's bothering me at the moment, which is all well and good, too.  But that's like washing your car, when it needs a frame off resto-mod to make it right.

Anyway...

Thank you so much @Andyman73. 

Although PTSD garners most of the attention these days, the fact remains that almost as many veterans receive SC for other mental disorders. [The proportion is 59% PTSD and 41% other mental disorders.]

If you haven't already, definitely tell your VA doc what you want and need and how you feel. The more direct you are with your psychologist or psychiatrist, the more you will get out of it. 

All the Best,

Mark

[Andyman73]

I try to talk to him about these things, but it never goes anywhere, and always seems to focus on the here and now. Not that that isn't important, also.  He did tell me, some months ago, that he can tell that I'm not trying to b.s. him, or the VA.  I guess that's something.

I don't know how to tell him that thinking about what I'm feeling, whenever I'm feeling something, in no way shape or form, makes me feel better about what ever.  He tells me that we (Marines have it the worse, in his decades long career) have these computer tapes/files that run in the background, constantly, like the ones that tell us to blink, breathe, heart to beat, and so on.  It comes from how we were broken down and rebuilt during boot camp, and so on.  And it takes a long time, and frequently never happens, to overcome or deactivate those programs.

Sure, that's great and all, but I can't stop how I feel when things happen...good bad or ugly.  I am starting to learn to control my reactions but that doesn't take away the feelings. For the most part, everything that leads to loss of control goes into a bottle and locked away.  It's the only way I can keep from harming myself, or my family, or worse yet, drowning myself at the bottom of a bottle.