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]

That is great HowIWish....thank you for helping him.

This is a BVA case that supports what I meant about the CIB, yet multiple diagnoses:

.

http://www.va.gov/vetapp05/files1/0502776.txt

He was represented by NVLSP ---the best pro bono vets law firm we have.

His claim for PTSD generated a 1996 rating decision denial.

He appealed and 2 years later the BVA denied ( 2 years---things went faster in those days)

He appealed to the CAVC who dismissed the case for lack of jusrisdiction…1999.

He appealed with the Federal District Court,who in 2002 reversed the CAVC dismissal.

In 2003 the VA OGC and NVLSP filed a JM  for the CAVC to vacate and remand the case back to the BVA.

The decision then states:

“That

same month, the CAVC issued an Order vacating and remanding

the November 1998 Board decision. 

 

The appeal is REMANDED to the RO via the Appeals Management

Center (AMC), in Washington, DC.  VA will notify you if

further action is required on your part.”

 

The remand in part states: 

 

"The veteran argues that he has PTSD as a result of his

service in the Republic of Vietnam.  He has argued that he

participated in combat, and he is shown to have been awarded

the Combat Infantryman Badge (CIB).  The veteran is therefore

shown to have participated in combat, and his statements and

testimony regarding the claimed stressors must therefore be

accepted to the extent that they are consistent with the

circumstances, conditions, and hardships of his service.  See

38 U.S.C.A. § 1154(b) (West 2002). 

 

However, the claims file contains a significant amount of

conflicting medical evidence as to whether the veteran has

PTSD.  See generally Gilpin v. West, 155 F.3d 1353 (Fed. Cir.

1998) (holding that under 38 U.S.C.A. § 1110, an appellant

must submit proof of a presently existing disability

resulting from service in order to merit an award of

compensation).  In this regard, it appears that the

development of this claim has been stalled by the appellate

process.  Specifically, a review of the claims file shows

that the veteran was most recently afforded a VA PTSD

examination over six years ago, in December 1997.  Since that

time, VA hospital and outpatient treatment reports, dated

between 1998 and 1999, have been associated with the claims

file.  These reports show treatment for psychiatric symptoms,

and they contain inconsistent diagnoses that included PTSD,

schizophrenia, and atypical depression.  VA's fulfillment of

the statutory duty to assist requires a thorough and

contemporaneous examination which takes into account the

records of prior medical treatment, so that the evaluation of

the claimed disability will be a fully informed one.  Green

v. Derwinski, 1 Vet. App. 121 (1991).  Under the

circumstances, the Board concludes that a remand is required

for the scheduling of VA examinations.  With regard to the

examinations to be scheduled, the Board notes that it does

not appear that the veteran has ever received psychological

testing.  On remand, VA psychiatric and psychological

evaluations based on examination and review of the entire

record are in order.  See Littke v. Derwinski, 1 Vet. App. 90

(1990).  Finally, the Board notes that the claims file does

not contain any medical evidence dated after 1999.  On

remand, the RO should attempt to obtain all records of

psychiatric treatment dated after 1999. 

 

Accordingly, the Board has no alternative but to defer

further appellate consideration and this case is REMANDED to

the RO via the AMC for the following actions:

 

1.  The RO should ask the veteran to

provide the names and addresses of all

medical care providers who have provided

treatment for psychiatric symptoms since

1999 (i.e., since the most recent medical

evidence of record), which are not

currently associated with the claims

file.  After securing any necessary

releases, the RO should obtain these

records. 

 

2.  The veteran should be afforded VA

psychiatric and psychological

evaluations, to assess the nature and

etiology of all psychiatric disability

present and the proper diagnoses thereof,

specifically to include whether post-

traumatic stress disorder is present. 

All necessary tests should be conducted. 

The psychological evaluation should

include the MMPI-II, and any related or

additional evaluative tests necessary to

best evaluate the nature of any mental

condition, and better assess the

appropriateness of any diagnosis

assigned.  The claims folder with a copy

of this remand must be made available to

the examiners for review in association

with their examinations. 

 

3.  The RO should then readjudicate the

issue on appeal. If the determination

remains unfavorable to the appellant, he

should be provided with a supplemental

statement of the case (SSOC) that

addresses all relevant actions taken on

the claims for benefits, to include a

summary of the evidence and applicable

law and regulations considered. The

appellant should be given an opportunity

to respond to the SSOC   “ etc etc etc

 

http://www.va.gov/vetapp05/files1/0502776.txt

 

I have no idea of the remand outcome.

 

The claim was filed in 1995 or 1996

There was no question that the vet had been in combat and was awarded the CIB.

The problem that made this take almost ten years ,and even longer for the remand, was the conflicting medical diagnoses.

There is nothing further at the BVA since ,for that docket #, He might have won on remand, or maybe even given up, or -like too many Vietnam vets, he might even have died...

I am proud of the work you are doing to help your husband.

 

 

[Buck52]

HowIWish

I had read something about the difference between PTSD & Bipolar

I got this off '' get well''web site

The Relationship between Bipolar Disorder and PTSD

Studies have found that anywhere between 11% to 39% of bipolar patients also meet criteria for PTSD. It is not entirely surprising that high rates of PTSD are found among people with bipolar disorder, as many people with bipolar also have a history of traumatic exposure. Traumatic exposure may be more likely to occur during a manic episode when a person with bipolar disorder is more likely to make risky or impulsive decisions.

In addition to being a risk factor for the development of PTSD, traumatic exposure during childhood, such as childhood physical or sexual abuse, may also be risk factors for the development of bipolar disorder.

The Effect of PTSD Among People with Bipolar Disorder

Having PTSD along with bipolar disorder can have a major negative impact on your life.

[HowIWish]

Buck, thank you. I need to find some more medical studies about that!

I can tell you from first hand experience that the symptoms that go along with PTSD compound bipolar so much. He can be having a really good day, or couple of days, and all it takes is getting stuck in a big crowd, or a really loud noise, and you know what that means for someone with PTSD. But when you have bipolar as well, it can trigger weeks of mania or dysphoric mania. Usually for him it's dysphoric mania, which is unbelievably bad. Most doctors agree that dysphoric mania is the worst part of bipolar, and definitely the most dangerous. The suicide rate for bipolar is 20% as it is. But add in PTSD and it terrifies me.

When he's in a dysphoric mania and in a psychosis, he obsesses about suicide. I never even knew. I knew he would disappear for a week or two and live in his car, but he always kept his suicidal thought to himself until right before his hospitalization. I think it had gotten so bad, and he was so scared, he finally admitted how bad it was.

When a police officer is sitting in his cruiser for hours at a time literally staring down the barrel of his service gun staring at the bullet in the chamber... Well, that's just awful. And knowing my husband has been going through this for years without any help or support... And when he finally is begging for help and the VA is doing this.

When he's in his right mind he is so scared of what he could do when he's not. He wants to watch our kids grow up. We need him. And to be totally honest, the fact that the VA is doing this is making him so much worse. I'm partially doing as much as I am because cognitively he just can't. If I wasn't fighting on his behalf he would have already quit. He thanks me every day for staying and helping him. But another reason I'm doing this for him is to shelter him somewhat from the harshness of what's actually happening with the Va. He knows everything, but knowing it is totally different from having to read and re-read the lies, listen to the phone recordings, and take notes on everything going on. 

It's just too much for him. It's too much for me, but I can keep going, so I am. And I won't stop. The path may keep changing, but we're not stopping.

 

[HowIWish]

I know I write a lot, but at least I can get it all out here. At home I have to keep it all together and there's nobody to really talk to. Thank you for at least being a place I can unload.

[HowIWish]

I'm working on some research for all of this VA stuff, but I forgot to tell you guys my favorite part of my husband's chart. His inpatient psychiatrist diagnosed ME with a personality disorder as well! :) 

She said that my personality disorder exacerbates his, and is the root of his issues, and then she even went a step further... she said that she suspected BOTH of his parents had personality disorders also. Paranoid personality disorder for his parents. She didn't specify which one I had. 

She spoke to me 3 times on the phone, once just to ask me to drop my complaint about her, and she saw me in person twice. My in-laws she has never met or spoken to. 

The VA has such amazing psychiatrists that they can diagnose people telepathically, without ever having said a word to them!!! But only with personality disorders....   ;)

It's funny, but only if others see the absurdity of it. It actually scares me that there are workers at the VA that would read his chart and buy it without questioning the integrity of a doctor that would write things like that in a patient's chart.

[Buck52]

We're all hoping and praying  President elect Trump  will stop this non-sense  or craziness within the VA & things get 100% better for every veteran and his/her spouse.