What's your opinion, light at the end of the tunnel or not?

[Bigkevo44]

I finally received a hard copy of my recent C&P exam. I had to travel to the actual VAMC in DC to retrieve it even though I submitted a paper request about a month ago. Anyway, here are the results… Please tell me what you think my chances of receiving a favorable rating are. My claim was remanded back to the VARO by the BVA for further development and a C&P exam. Here are the results…

 

ICD code: 309.28 (F43.23)

Mental Disorder: Adjustment Disorder with Mixed Anxiety and Depressed Mood

Under #3 Occupational and social impairment
[X] Occupational and social impairment with reduced reliability and productivity is checked

For VA rating purposes, check all symptoms that apply to the Veteran’s diagnosis:

[X] Depressed mood
[X] Anxiety
[X] Suspiciousness
[X] Chronic sleep impairment
[X] Mild memory loss, such as forgetting names, directions or recent events
[X] Impaired judgement
[X] Disturbances of motivation and mood
[X] Difficulty in establishing and maintaining work and social relationships
[X} Difficulty in adapting to stressful circumstances including work or a work like setting
[X] Impaired impulse control such as unprovoked irritability with periods of violence

Remarks: The diagnosis obtained was based on the criteria contained in the Diagnostic and Statistical Manual of Mental Disorders -5 (DSM-5)

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ]

a.       The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness.

b.       Based on this examination and veteran’s current symptoms described in the examination report, the veteran meets diagnostic criteria for Adjustment Disorder with Mixed Anxiety and Depressed Mood (with alcohol use) as outlined in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Therefore, the current diagnosis is at least as likely as not related to the veteran’s fear of being deployed to the Gulf War during his Active Reserve Duty Training in 1990.

Thanks in advance for all your help and advice.

[Bigkevo44]

Okay thanks again for your insight. It still scares me a little that the C & P doc focused on the secondary claim and practically disregarded the Camp Lejeune part.

[Berta]

I respectfully disagree with any chance of service connection at this point.

Unless your SMrs were thoroughly reviewed by the examiner and  the PTSD diagnosis had more rationale to it ,as within those STRs,and maybe there is more to the exam results that are not posted here..

In June I replied to your other topic with the Camp LeJuene presumptives

http://community.hadit.com/topic/67266-camp-lejeune-horror-story/

and the fact that illnesses not on this presumptive list will need a strong medical nexus.

 

You will need an IMO/IME  (Independent Medical Opinion/Exam) that has a full medical rationale that your MH issues are solely due to the contaminated water at Camp LeJuene, with no other etiology.The IMO/IME criteria is here at hadit and needs to be followed to the letter.

I am baffled by the examiner's logic as to PTSD.

 

When PTSD is diagnosed after July 2010 (the new PTSD regs came out then) they are applied to post 2010 claims and if there is any reason to consider other causation for PTSD , then the claim is developed further on that level.

This BVA case reveals the 2010 PTSD criteria. I have posted that regulation here many times and need to re post it, it is hard to find. Basically this is it:

http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp00/files2/0010597.txt

"Fear of hostile military or terrorist activity" means that a Veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, such as exposure to an improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the Veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror.  Id.

/ The Veteran's lay testimony may establish the occurrence of the claimed in-service stressor where the stressor claimed by the Veteran is related to the Veteran's fear of hostile military or terrorist activity, the claimed stressor is consistent with the places, types, and circumstances of the Veteran's service, and a VA psychiatrist or psychologist, or one with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and the Veteran's symptoms are related to the claimed stressor, as long as there is no clear and convincing evidence to the contrary.  38 C.F.R. § 3.304(f)(3)."

I think the C & P doctor focused on ‘fear of’ in these regulations but never read the rest of the regulation.

But again maybe there waqs something in your SMRs that supports her diagnosis and opinion regarding 'fear of'

deployment.

Can you give us the Docket Number of the Remand?

 

 

[Buck52]

Ms berta

I don't think the stressors for his PTSD ''fear of deployment'' to an hostile enemy territory  VA will not accept?

However from this veterans cause from drinking the camp Lejeune contaminated waters, cause by his IN SERVICE of a VA diagnosed of the ''Neurobehavioral Effects''

My mistake here I assumed this veteran had this VA Diagnose of Neurobehavioral Effects''

instead he is Diagnosed with 

ICD code: 309.28 (F43.23)

Mental Disorder: Adjustment Disorder with Mixed Anxiety and Depressed Mood

“Veteran also reported that he was stationed at Camp Lejeune in 1986 for training. A correspondence statement in the veteran’s medical records indicate that he was stationed in the Warehouse Unit (3051) for training (ACDUTRA). As a result, he reported that he qualified for the Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012. Veteran reported that he suffers from Neurobehavioral Effects.” Veterans mental health symptoms started approximately nine years after he was stationed at Camp Lejeune. While medical records indicate treatment for a mental disorder, no evidence is provided supporting a causal link between the veteran’s mental disorder and exposure to contaminated water while stationed at Camp Lejeune in 1986. Veteran’s medical records have been reviewed and an opinion cannot be rendered without resorting to speculation regarding whether the veteran’s mental health symptoms are related to being stationed at Camp Lejeune in 1986.

 

So I looked up the ''Neurobehavioral Effects'' and it does state that  because he was contaminated with the Camp Lejeune water contamination  it is presumptive fact that his symptoms from the contaminated waters.

However no Diagnose for it?

Edited July 13, 2016 by Buck52

[Berta]

'Neurobehavioral Effects' is a ball park statement and not a diagnosis.

An IMO/IMO doctor can determine what Neurobehavioral effects a vet has but would need a strong medical rationale ,surely supported by strong citations from Neuro asbtracts,and maybe even an MRI, to opine that the specific affects -which the doctor would have to identify, as diagnoses ,from this veteran's records , are solely due to the chemicals this vet was exposed to at Camp LeJuene in the water.  And give a very strong medical rationale for the opinion.

http://www.nap.edu/read/2141/chapter/11    A detailed read on MANY 'neurobehavioral' possible diagnoses.

My husband had at least three of them, PTSD, Organic Brain disease, and dementia.USMC

 

 

 

[Buck52]

Roger that Ms berta!

I don't know what to say now..other than what you mention  to get an IMO/IME and hope to get a rational statement from qualified Dr

 Veteran’s medical records have been reviewed and an opinion cannot be rendered without resorting to speculation regarding whether the veteran’s mental health symptoms are related to being stationed at Camp Lejeune in 1986.

 

[Bigkevo44]

Ok thanks for the input. Looks like I will pursue the IMO route to connect the water to my condition.