ptsd Filing and SMR questions

[HowIWish]

Let me start off with saying this:

I understand now how some might have thought when I asked my question about a hospitalization at the Va helping my husband get his disability I was trying to game the system or something. I didn't mean it that way at all. Back then (it feels like a lifetime ago) I saw my husband completely falling apart and I was being told by friends and family that he needed to be hospitalized. I saw it coming, and I was naive how the mental health system worked. My thought was that if he needed to be hospitalized anyway, that using the VA would help the situation in its entirety.

Yes, I was very wrong. I had read how amazing the VA's PTSD programs were, and I guess I figured getting him into the Va system then would sort of kill two birds with one stone. He could start getting help in a place he felt more comfortable by being around other vets, he could get the hospitalization he needed for much less than $2,000 a day (the price of the private hospital he had his outpatient care at) and he could go ahead and be in the VA system.

Well, if you've read my other posts you know nothing good came out of his 18 day stay at our local VAMC. It's been a nightmare ever since and keeps getting worse.

Sorry if I sound defensive. Being married to a man (whom I love very much) that has major paranoia issues has kind of made me this way. His paranoia tends to focus on me... I'm poisoning him, I'm holding him hostage, and on and on... Sometimes he has good days, and other days I spend most of my time trying to convince him I'm not working with Barrack Obama to have him put in a straight jacket. 

 

Anyway- on to my current questions! First, my husband's FDC was ready to file, we were just waiting for his SMRs. They finally came today and I was so excited. But there are NO medical records in the envelope. There is also no records pertaining to his deployment. It is basically just his enlistment paperwork, his security clearance paperwork, and his discharge papers.

On the ebenefits site where we put in his paperwork, it says the VA can get all of his medical records from DoD hospitals. Should we go ahead and file and let the VA get those records? The website says it can still be submitted as an FDC and they have access to those records. That's my first question.

My second question has to do with his ongoing care at the VAMC. This past week they told him he is now ineligible for all care and they canceled everything. They refuse to give us anything in writing, but they have canceled every single appointment he had, including his support groups. They say it's because he makes to much money. But he was already enrolled and paying co-pays! 

I've read everything I can find, and he is completely eligible for care. We were fine with paying the copays for now. The first week of February his income will be dropping by 2/3's, and then he was going to file a hardship and then they said we wouldn't have the copays anymore. 

We we really need to file his claim. The faster we file the faster (hopefully) he can be service connected and we won't have to worry about them cutting his Health benefits. Would you guys just go ahead and file now without the rest of the SMRs? There isn't going to be anything in there to really help a whole lo anyway. He didn't have any mental health issues while enlisted. Nothing became an issue until a little while after his discharge. His deployment was towards the end of his enlistment.

Also, what's the best way to fight them canceling his health benefits? The VA flagged him as a high suicide risk for 60 days of "Enhanced care," and now they're refusing him ALL care! It seems we should have something in writing so we can file an appeal, but nobody will even tell us who made this decision. This all happened yesterday, and this coming week is Christmas. I'm thinking we need to go to the VA in person Monday or Tuesday and get some explanations. 

One more thing- my husband had a PTSD screening because his outpatient psychologist was trying to get him into the 8 week inpatient PTSD program. While inpatient his psychiatrist said he did not have PTSD. That's a crock because every single professional he has seen outside of the VA has said he undoubtedly has PTSD and it is greatly complicating his other MH issues. But that does us no good with the VA. So he had this PTSD screening at the request of his VA psychologist who has been trying to get him further help within the VA. The PTSD screen doesn't say anything. He was denied getting into the program, and his psychologist told him that she has been told to make sure not to chart any diagnosis in his chart. It's just frustrating. Isn't the point of a PTSD screening to see if he has it? 

Oh well, forward we go! As always, any help is extremely appreciated. This site is invaluable. I have learned more here than anywhere else! 

 

[Berta]

This is the VA FDC criteria:

http://www.benefits.va.gov/fdc/

Personally if I were you , I would have your husband obtain buddy statements  from the buddies you mentioned here because VA gives weight to probative eye witness accounts and I assume that is what you mean about what they told you he 'had to do":

" I didn't even know how bad until he was in the hospital and a few of his combat buddies contacted me concerned about him. He had kept it all to himself, but they filled me in on how bad it really was and some of things my husband had to do. He was a machine gunner and had to kill some people that were shooting at them from rooftops more than once. I knew he had been shot at, but I didn't know he had killed anyone until recently. "

And send that evidence along with the VA claim.

I think I already gave you the criteria for buddy statements.

 

 

 

[Berta]

Just to add..... I understand the CIB should denote stressors but it is the DX that is in question.

Va will review all of his VA medical records....which they have, but they will need his private records as well.

Do you have copies of them to file with the FDC?

You stated here: --------------------------------

"my husband had a PTSD screening because his outpatient psychologist was trying to get him into the 8 week inpatient PTSD program. While inpatient his psychiatrist said he did not have PTSD. That's a crock because every single professional he has seen outside of the VA has said he undoubtedly has PTSD and it is greatly complicating his other MH issues. But that does us no good with the VA. So he had this PTSD screening at the request of his VA psychologist who has been trying to get him further help within the VA. The PTSD screen doesn't say anything. He was denied getting into the program, and his psychologist told him that she has been told to make sure not to chart any diagnosis in his chart. It's just frustrating. Isn't the point of a PTSD screening to see if he has it?"

And within  an older thread you mentioned multiple diagnoses, to include PTSD ,as well as one being Personality disorder  ,I believe....that was the most recent VA diagnosis? 

My point is that buddy statements might help a VA C & P doctor overcome  the Personality Disorder diagnosis and they might consider the private PTSD diagnoses.....Might... or agree medically with any other compensable diagnosis that is claimed....that can be attributed to his service.

 

 

 

 

[Buck52]

I maybe wrong in saying this  but from experience visiting with other Veterans...anytime your in treatment or even at a MH C&P Exam  if the veteran gets emotional in anyway they automatically slap Depression as Dx.  

Even though in my opinion nothing wrong if the veteran gets emotional  they still should rate  the symptoms accordingly  not because a veteran gets emotional.

jmo

[HowIWish]

My husband and I have talked about the buddy letters and he is working on it. I am working on making him a list of things they need to include. He thinks he will have no problem getting at least 3-5 buddy letters, and he could probably get more if need be. He is going to email his old Company Commander who is currently still enlisted and is a Colonel. He thinks he will give him a buddy letter as well.

I'm hoping some of the guys he has maintained the closest contact with will be willing to share their award letters like you had mentioned, Berta. I think they will. The ones that know some of what we are going through are pretty upset with the way the VA is handling this, and I think they will have no problem helping my husband out. 

I also had another thought yesterday. Yes, the inpatient psychiatrist wrote TONS of notes, but I'm thinking we could use that to our advantage. I'm not sure if it will help, but what if I printed out the DSM V criteria for PTSD and then went through her notes and linked her notes with the criteria, showing that in her own words he meets the criteria? It obviously won't fix the entire problem, but it may help. For instance, Criteria C is Avoidance. She has mentioned my husband's avoidance issues many times in her notes. So I just make a list under each criteria of every time she mentioned him meeting that criteria. I can make a list of the date/ time/ line that she made a written note of each specific criteria for PTSD.

Then we have the Stressor covered with his CIB and buddy statements, as well as an easier way for the rater/ C&P examiner to see that in the Psychiatrist's own words he should have been diagnosed with PTSD in the first place.

Also, yes, I have copies of all of my husband's medical records to submit with his claim. He was first diagnosed and treated for PTSD in 2012, the first time he ever went for help. That was initially by his family doctor. He was put on medication, started gaining weight (a side effect of his medication) and about a year later was when he developed OSA and began treatment for that. The weight gain is documented. We have all of his medical and MH records from outside of the VA to submit, and in those records there has never been a question of whether he has PTSD or not. 

 

 

 

[HowIWish]

Buck, from what I've read, I think you're right!

[HowIWish]

Also, he/ we had been seeing a counselor at the VA the past month since he was discharged from inpatient care. Up until last week she was awesome and was trying to help him. She doesn't work for the VA on their payroll, she is working on her Doctorate and is doing her final semester clinical work. But she's assigned to the VA. She had read through his chart and had told us both that she was trying to get him he help he needed for his PTSD. Her opinion was the same as his non-VA practitioners that yes, he has bipolar 1 or possibly schizoaffective disorder (which is a mix of schizophrenia and Bipolar) but that his PTSD was so bad that it was making the psychotic symptoms worse. That if he could get his PTSD under control, his other issues would be easier to control and he could get stable much easier.

She told us both very clearly that she was instructed by the VA not to write any new diagnoses in any of her patient's charts that they hadn't been rated for. I understood this, and it makes sense given how the VA operates. Neither of us had any problem with that. She wanted, and specifically asked me to come to certain appointments with my husband. She's the one that tried to get him into the PTSD 8 week residential program. Last week was his first appointment after he was denied getting into that program, and she wanted me to come.

Last night I was going over his most recent notes in his chart and I found something very wrong. Last week she charted that he had spoken about his dad being physically abusive to his mom during his childhood. Her notes stated that the abuse he witnessed during his childhood could have caused the "trauma symptoms" he now experiences.

My husband never said any such thing, and nothing even related to that was even discussed. My husband says that his dad was never abusive to his mom. He drank and isolated himself in his study, but never even verbally fought with his mom. 

This could have been a mistake. But because of his chart already being chock full of lies and statements from both of us that we're never made, we doubt it.

So now the one professional my husband trusted he no longer does. He plans on calling the counselor next week when she is back in the office and asking her if it was a mistake and to fix it. I'm curious what her response will be.

But now he no longer wants to get any MH treatment at the VA. I don't really blame him.

We will no longer continue to fight for his health benefits at the Dayton VA. If/ once he has a rating, maybe he will go to the Chillicothe VA, but in the meantime we are going to try to find him treatment elsewhere, and hopefully Medicaid.

I do find it very curious that right after she had tried to get him into the residential program and had other VA people involved in his outpatient care that this all happened. Sounds paranoid, but it's only paranoia if there aren't facts to back it up. The VA has just been an ongoing nightmare. All we were hoping for was to get him the raved about PTSD care that we've heard about. Even his non-VA doctors were really hopeful that if the VA would help him get his PTSD symptoms under control, he could get stabilized faster. It really looks like that won't be possible, at least for quite a while.