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    • Exams that were being sent strictly to contractors before, due to VAMCs not being open, are starting to be routed back to VAMCs. This is going forward from last Friday- not sure if prior scheduled exams will be re-created for VAMC vs vendor.
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sphynix06

Bad PTSD/MST C&P...HELP!!!

Question

Hello all.

I had a c&p exam for my ptsd/mst claim on 1/19/17 at the VA Outpatient center in Fort Worth and just got the results back today. I was quite shocked by the notes. I feel that the c&p psychologist did not review the merits of my case properly and just opined hat I was exaggerating my symptoms based on a 15 question "MENT" test which consisted of me differentiating between happy, angry and sad faces. She also asked me to remember 5 items after 5 minutes (which she gave me the answer after I couldn't remember 2 of them). She asked me nothing about my symptoms or about the events of the trauma. She picked what parts of my VA medical records she included in the report (i.e., sleep disturbance). I feel like I have been shafted. She is basically refuting the diagnosis given by my TWO VA psychiatrists, VA psychologist and my VA social worker.

I waited over 25 years to file my sexual assault claim due to me being extremely embarrassed and unable to bring myself to talk about the events that occurred while I served as a submariner in the Navy. The assault happened in 1988; back before don't ask, don't tell. Needless to say I was traumatized and afraid of being kicked out. Nonetheless, I was medically discharged a year later due to asthma brought on by anxiety and panic attacks while onboard my duty station.

So, now I am at the point where I am finally seeking help and I spend 20 minutes with a c&p psychologist who seems to be indifferent about my condition. I almost feel like I should have just retreat back to my home in silence instead of being treated like a liar!!!

What can I do about this?

Here is my c&p exam:

 LOCAL TITLE: COMP & PEN MENTAL HEALTH/PSYCHOLOGY EXAM           STANDARD TITLE: PSYCHOLOGY C & P EXAMINATION CONSULT            DATE OF NOTE: JAN 19, 2017@09:30     ENTRY DATE: JAN 19, 2017@11:27:37            AUTHOR: 

EXP COSIGNER:                                URGENCY:                            STATUS: COMPLETED                    
 Initial Post Traumatic Stress Disorder (PTSD)                        Disability Benefits Questionnaire                         * Internal VA or DoD Use Only *
  Name of patient/Veteran:                                      

SECTION I:  

1. Diagnostic Summary  

Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation?   

[ ] Yes   [X] No       

2. Current Diagnoses     

a. Mental Disorder Diagnosis #1: No Diagnosis          

Comments, if any: Psychological Testing
 A test of response bias specifically related to PTSD symptoms was administered to the veteran during this examination to assess the              credibility of his self-report. The name of this measure is withheld in this report in order to protect the integrity of the test. This test was specifically standardized on a sample of veterans applying for financial remuneration for a claim of disability resulting from PTSD. The veteran's score on this test was significantly above the established cutoff, indicating that his performance was not consistent with persons diagnosed with PTSD but was consistent with the test performances of disability claimants simulating symptoms of PTSD. As such, there is reason to suspect symptom exaggeration and a response style indicative of attempts to portray himself as worse off than he actually may be with regard to              PTSD symptoms. Based on the Veteran's scores, additional testing was performed to further evaluate the possibility of overreporting or exaggeration of mental health symptoms.
             

A second test of response bias was given that was specifically designed to assess the credibility of reported psychopathology symptoms of response bias related to mental illness. Each item on this test was designed to evaluate constructs and behaviors useful in identifying overreporting. This test was developed and validated using both simulation and known-groups designs to identify individuals attempting to overreport symptoms of mental illness. In addition, the validity of this exam has been generalized across various racial/ethnic groups, genders and settings. The Veteran's total score on this measure was above the cutoff, indicating that his responses were not consistent with persons diagnosed with any mental illness. In addition, the Veteran's scores on this interview indicate that his behavior was inconsistent with his reported symptoms and he endorsed very extreme and uncommon symptoms, symptom combinations that are both unlikely and inconsistent with              common mood and psychotic disorders, and  he had a tendency to endorse severe and unusual psychotic symptoms. He also endorsed an unusual course of illness that is inconsistent with the course of  most psychiatric disorders recognized in clinical practice.
             

It is possible that the veteran suffers from a mental illness. However, I am ethically unable to provide a diagnosis at this time given the veteran's response pattern of overreporting on three objective, reliable and valid psychological tests. Providing a diagnosis would require this examiner to resort to mere speculation  and would violate the American Psychological Association's (APA) Ethical Principles of Psychologists and Code of Conduct.             


 b. Medical diagnoses relevant to the understanding or management of the  Mental Health Disorder (to include TBI):

Deferred to a physician
 

3. Differentiation of symptoms   

a. Does the Veteran have more than one mental disorder diagnosed?      

[ ] Yes   [X] No          

c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?      

[ ] Yes   [X] No   [ ] Not shown in records reviewed          

4. Occupational and social impairment   

a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one)       [X] No mental disorder diagnosis
 b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social       impairment indicated above is caused by each mental disorder? 

[ ] Yes   [ ] No   [X] No other mental disorder has been diagnosed          

c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI?      

[ ] Yes   [ ] No   [X] No diagnosis of TBI                                         

SECTION II:                                                

Clinical Findings:              

1. Evidence Review

Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA)    [X] CPRS

2. History   

a. Relevant Social/Marital/Family history (pre-military, military, and post-military):         

Family - Veteran was raised in a "normal" environment by his mother. "I wasn't that close to my father." Veteran has two brothers and two sisters. Veteran's mother was a kindergarten teacher and his father was a "mobile home constructor". Veteran denied any childhood medical/mental health problems. Veteran denied a family history of mental illness.
         

Marital - Veteran has never been married. His last relationship ended around October of 2016 due to his "agitation." "She wanted to talk about stuff and I didn't want to discuss issues with her." Veteran has three sons (ages 16, 20 and 22). "My oldest two sons I don't really talk to since    they're gone-one is overseas and the other I think moved up North. I call them every now and then and try to reach them but I hardly get in          contact with them. I have a close relationship with my youngest son. He keeps me going."
 

Social - "I had a lot of friends growing up but over the years they sort of fell to the wayside. I had friends going into the military and in boot camp but after sub school I stayed to myself. I had some associates but I didn't want to make any friends after sub school. Currently I have a few associates but I wouldn't call them friends." Prior to the military, the veteran enjoyed running track, playing football, singing in the choir and being in the art club ("I was the cartoonist for the school paper."), science and chess club. "During the military I didn't have any activities other than working on my rating. After I got out I got into oil painting, swimming, cycling and home renovation. I can no longer cycle or swim because of my back and respiratory issues. I haven't attended church in three years and my mother is now a pastor."             

b. Relevant Occupational and Educational history (pre-military, military, and post-military):

Educational - Veteran earned a Bachelor's Degree in Electrical Engineering in 1995  and a Master's Degree in Biomed Engineering in 2009. Veteran informed that he was a good student and denied a history of suspensions, expulsions or learning problems.
         

Occupational - Veteran's job history prior to the military includes custodian and lawn care (self-employed). Veteran serve in the Navy from July 13, 1987- May 16,1989. Veteran was a college student from 1990-1997 and 2004-2009. Since being discharged from the military the veteran has worked as an RF engineer/consultant (1997-2004: "I got into an argument with my supervisor because he always wanted to include me on projects he was working on and I thought that was inappropriate. I thought he had an interest in me even though he didn't say it outright. He wanted to go out and do stuff outside of work hours."); and bioengineer/prosthetic designer for the Department of Commerce (2010-March of 2016: "I got in  several arguments because of space and eventually withdrew and stopped producing. I had to share a small space with a coworker and he was constantly rolling back in his chair asking me questions and tapping me on the shoulder so it finally came to a head.").
         

Occupational problems reported include poor social interaction ("Shouting at people and avoiding contact with guys in the office. I worked better with females."), difficulty concentrating ("Because I was focused on not being in a vulnerable position. I missed deadlines or didn't finish tasks because I couldn't focus. I asked to have my own office but you can't have one as a junior engineer."), difficulty following instructions ("If men tried to get close to me because it reminded me of sub school and the threat of not being advanced or promoted."), forgetfulness, and increased absenteeism ("In 2015 I couldn't deal with the office so I started working from home but my supervisor didn't want me to sever myself from the office totally. I had anxiety about going back and sharing an office with another male. I felt better working by myself because I was more productive.").

In regards to reprimands, the veteran informed that he was written up for poor work performance, absenteeism, being AWOL and conflicts with his officemate. "The conflicts with my officemate led to me being fired."   Veteran informed that he has applied for one job since being fired.          When asked if he was a productive and reliable employee he stated, "As long as I was alone and no one was being touchy with me."
Veteran denied the following occupational problems: assignment of different duties and tardiness
         

An October 5, 2016 MH OUTPT NOTE states, "He is unemployed and uses income from renting rooms to pay living expenses."
         

An October 5, 2016 MH Attending note states, "Lost his last job as a biomedical engineer in March 2016 after "tussling" with an older man in his office who would repeatedly come up behind him and touch/pat his shoulders which reminded him of his Navy experience...Owns home and rents out rooms for income."             

c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military):          Mental Health Veteran began mental health treatment at the North Texas VA in August of 2016 and is compliant with his medication regimen of risperidone, prazosin and sertraline despite feeling "groggy and spaced-out." Veteran denied a history of psychiatric hospitalizations.
         

An October 12, 2016 SLEEP TELEPHONE NOTE states, "I called the patient and explained their sleep test results in detail. I explained him that  the study did not show significant sleep apnea despite his sleeping on his back. He is unable to sleep on his side due to his shoulder          problems...Encouraged the patient to lose weight."
         

A November 2, 2016 MH PTSD INDIVIDUAL NOTE states, "Veteran believes that gay men are going to hurt him. He also informed worker that  he has experienced a lot of fear and worry this Halloween with people who are transgender, to the point that he is not sleeping for fear they          will break into his home. Veteran is worried that he may have to "barricade" his home with bars on  the windows."
         

A November 3, 2016 MH Attending Note states, "Updates that since last  appt, his GF ended their relationship, "she said I was over agitated."    Last week, he describes an incident at a restaurant when a transgendered person was standing by him, he turned and saw the person,
 got so upset that he ran out of the restaurant and vomited.  Since last week has felt progressively worse.  "It's harder to tell which people          to stay aware from.. it's a whole new ballgame with transgendered [people]...I don't know who my enemy is."  He states he needs to set a          perimeter on his house, put bars on his windows/doors, and update his security alarm.  Reports poor sleep, gets out of bed 3-4x/night to          check doors/windows and frequency of NMs has increased. Appetite is low. Feels that he cannot focus, "I'm constantly thinking how to avoid     these people."  Reports hearing male voices talking outside of his windows so he fears they will break in (reason for "setting perimeter"). When he is in public he has thoughts of "I need to get them before they get me" when he passes male strangers.  Has not had any violence but does say he has had verbal arguments (told someone in the Wal-Mart line to back up and they argued with him, for example)...+ MST in Navy- unwanted taunts, suggestive remarks and genital contact and kissing from supervisor."                    

A December 5, 2016 MH ATTENDING NOTE states, "Updates writer that he has spent ~$3000 since last visit adding bars to the outside of his first floor home window and installing a security system with cameras. Reports he still plans to add more cameras to monitor his roof because "maybe someday deterred by the barricade downstairs might want to get in up there."  Reports vague AH of hearing footsteps on his second floor when he is down on the first floor.  Denies hearing voices from  upstairs or outside his window like he endorsed last visit.  Reports nighttime is the hardest for him because "that's when they are outside...the enemy, the transsexuals."  Denies actually seeing anyone outside of his house at night.  Reports he is comfortable with certain people coming up to his house, like the mailman, but states he is not comfortable when strangers come up.  States he is not aggressive but tells them to go away.  Does not take his gun with him to the front door.  States he now feels better with his house more protected.  Is able to watch movies and enjoy them during the day.  His security system is on his phone app and he checks it every 3 hours.  At night he "secures the perimeter" every 2 hours, has an alarm set."             

d. Relevant Legal and Behavioral history (pre-military, military, and post-military):         

Behavioral - "In 2005 I grabbed a guy that was dressed like a female. We were meeting for a date but his profile said he was a female. Two months ago a person behind me in line was transgender. I pushed him to the side and ran outside."
         

Legal - Veteran denied a history of legal problems.             

e. Relevant Substance abuse history (pre-military, military, and  post-military):         

Substance Abuse - Veteran denied a history of substance abuse.             

f. Other, if any:       No response provided.          

3. Stressors    

Describe one or more specific stressor event(s) the Veteran considers    traumatic (may be pre-military, military, or post-military):       

a. Stressor #1: MST February-April of 1988:

CPRS states, "A male teacher began touching him during class and stepped over lines trying to get too close that made him feel very uncomfortable. Veteran says there was never genital contact because there was touching and kissing on the part of the instructor." Veteran's stressor statement states, "One trainer would come up behind me and massage my shoulders. He also grabbed my waist and pressed himself against me. I could feel his erect penis against my buttocks. He also made sexual innuendos and jokes. He also asked me if my nipples were hard because I was glad to see him. He then said, 'I bet you have a nice sized tool'. He then touched my left nipple and kissed my neck. When I confronted him he stated that if I didn't cooperate, I may not pass through with my classmates. He then grabbed my crotch and said, 'Pass or no pass. You make the determination.' My relationship with my long time high school sweetheart ended that summer (June of 1988) because I withdrew fro the relationship and was too ashamed to confide in her." Please note that this last statement is in contrast to the statement provided by his former girlfriend who stated that the veteran "mentioned that a sexual assault happened to him during training that changed him and that he needed time to work through it."                   

Does this stressor meet Criterion A (i.e., is it adequate to support  the diagnosis of PTSD)?         

[X] Yes  [ ] No                   

Is the stressor related to the Veteran's fear of hostile military or terrorist activity?         

[ ] Yes  [X] No                   

Is the stressor related to personal assault, e.g. military sexual trauma?         

[X] Yes  [ ] No                       

If yes, please describe the markers that may substantiate the stressor. Veteran's treatment records, buddy statement and stressor                statement were reviewed. However, there are no markers in the veteran's STRs or personnel records which the VBA has confirmed.                   

4. PTSD Diagnostic Criteria 

No response provided.
   

5. Symptoms    

No response provided.       

6. Behavioral Observations   

MENTAL STATUS EXAM - Appearance, Behavior, and Speech Veteran's appearance and dress were appropriate for the exam. His speech was normal in rate and tone. Veteran's response to the evaluation was guarded but engaged. Rapport was easily established with the Veteran who put forth a conscientious effort to answer all questions to the best of his ability.
   

Thought Process - There was no evidence of loose associations, flight of ideas, circumstantial, or tangential thought process. Veteran completed similarities and interpreted  proverbs accurately.
   

Thought Content - Veteran denied having any obsessions or suicidal/homicidal ideations. However, delusions regarding the security of his home and transgenders were reported. "Transgenders are trying to get back at me because I grabbed the transgender that I was supposed to go on a date with. His profile said he was female. I have to hone in and decipher whether someone is male or female because my initial problems came with my sexual assault in training so I've distanced myself from males who are the enemy. The transgender caught me off guard and now they're trying to trick me. It's a whole new ball game."
   

Perceptual Abnormalities - "I keep hearing my instructors voice in my head. Especially if I get around someone who has to make choices that involve me. I keep hearing 'pass or no pass' which is what he said to me. I hear a human voice outside my windows. When I go look there's nothing there so I don't know if they've run away or what. That's why I put up security cameras."
   

Mood and Affect - Veteran's mood was "indifferent" and his affect was flat.
   

Sensorium and Cognition - Sensorium was clear. Veteran was oriented to time, place and person. Immediate memory was good as he was able to repeat five of seven numbers forward and six of seven numbers in backwards sequence. Recent memory was fair as he recalled two of three items after five minutes. Remote memory was  fair as he recalled the names of the last three presidents, the name of his high school, his youngest son's birthday, and his first job. Veteran was unable to recall the name of his elementary or junior high school nor his siblings or two oldest sons birthdays. In regards to concentration, Veteran spelled world forward and backwards and completed simple mathematics, serials    3's, and serial 7's. His intelligence appeared to be average.

Judgment and Insight - Veteran's insight is good as he understands the outcome of his behavior and the choices he makes. His judgment is impaired but he informed that he would return a library book to the library if found, pull over for the police, and return a wallet he found to the owner.

 7. Other symptoms  

Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above?      

[ ] Yes   [X] No          

8. Competency  

Is the Veteran capable of managing his or her financial affairs?      

[X] Yes   [ ] No          

9. Remarks, (including any testing results) if any     

Financial: "My brother pays any bills that I can't pay online."      
   

NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's    application.
 

 

Edited by sphynix06
to remove my name

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sphynix06,

Welcome to hadit. I am so sorry for your pain.  I can only imagine what you went through.

I just had repressed memories explode in my head this past weekend. 

DADT was new or not even, so I was more afraid of getting kicked out than I was of anyone finding out what happened.  So I spent the last 22 years living a life based on a lie that I told myself so many times that it became my truth.

No one knows what happened. I've only just reached out for help, for MST, this week.  I have mentioned it here, on my own thread(what constitutes MST?) and I sent a secure message to my VA MH provider. I do have an appointment with them this Monday coming, but might not make it.  So I called the BH unit at my VAMC, this morning, and left a call back message/voicemail with the MST social worker.  No return call yet, but I will call again in a few minutes...

Andyman

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Well, yes this sounds like a bad  C and P exam. You should dispute it ASAP.  Your examiner stated "no diagnosis".  This is a deal breaker for your claim.  But, dont be alarmed..  VA often hires docs that give c an p exams favorable to them.  You just need something to refute it.  You may already have it..with your current VA docs.  

Chris Attig has written about something called, "develop to deny".  VA is not supposed to do this.  If they have competent docs with a diagnosis, and a nexus, then they should not need a c and p exam.  When they order one to try to deny you, that is "developing to deny".  You may need an attorney involved.  

You can challenge the competency of the examiner.  Does the examiner have experience and or training in treating MST?  It the examiner has no experience/training in treating PTSD/MST, then you can ask that this exam is thrown out.  

Order your cfile, and read it.  Did your docs diagnose and treat you for PTSD/MST?  You dont need a half dozen diagnosis, one should suffice.  

Did your docs state, to the effect, that your (PTSD/MST) was "at least as likely as not" due to

(event(s) that occured in service).  With PTSD, you need to document a "stressor".  (That means something happened triggering your PTSD..such as seing someone blown up, or something, like, for example, handling dead bodies)  If you are claiming MST, you should have documentation of an "in service event".  Hopefully you reported the event(s) and were treated in service.  

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Sorry you got a bad exam. seems later on in the exam they contradict the diagnoses. I would def contact the patient advocate at the facility you had your exam at and file a complaint.

If it is any help to ease your mind there is tons of legal VBA precedent that is in your favor based solely on the fact of multiple diagnoses and your story being consistent. if you go to the VBA website and search past cases and search MST you can find lots of cases that were found in favor of the veteran do to this.

 

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Sorry to hear that.

Edited by kent101

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Update:

I received my award/denial letter today which granted 30% for asthma and denied ptsd, sleep apnea, headaches, chronic fatigue and all my other conditions claimed as secondary to ptsd.

PTSD

In response to the ptsd denial, my VSO is putting together a response in the form of a CUE because the rater failed to consider my behavioral change while in service as evidence to support my mst. Surprisingly, the very reason my claim was denied was because there was nothing in my service records pointing to the mst; not because of the non-diagnosis and disparaging c&p exam. The rater examined the claim as if it was a standard ptsd instead of ptsd due to mst.

To help with my fight I am seeking the assistance of an outside vet friendly psychologist (Dr. Valette) to write an imo.($2k) So, that would make 3 mental health professional giving me a diagnosis that refutes the report of the c&p examiner. I am not sure if I should submit the imo along with the CUE or wait until the decision comes back. I am trying to avoid negating my $2k new material evidence in case the examiner denies it again. Thoughts??

Sleep Apnea

In response to the sleep apnea denial, I called the c&p examiner and asked for reconsideration because his report stated that asthma and sleep apnea are in no way related. I shared with him several articles which stated otherwise and also shared several BVA cases which granted sleep apnea as secondary to asthma. He told me that no one in the fort worth office has ever granted service connection for sleep apnea as secondary to asthma, but that I should refile and request service connection for asthma aggravating the sleep apnea. Huh??? isn't that still a connection in itself? Nonetheless, he stated that he would think about amending his notes to opine that my sleep apnea is at least as likely as not aggravated by my service connected asthma. If he does do this then I won't have to get an imo for the sleep apnea, but I am not to optimistic about his follow through.

 My headaches and chronic fatigue is claimed secondary to sleep apnea so I will have to refile those one I get connected for the sleep apnea.

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    • By USMC_VET
      A little background first on this specific claim to provide greater context for the readers.
      I had no idea that i had OSA until i got married and through the years my wife has told me about how i would snore really loud, stop breathing at night, choke, etc. pretty standard stuff for anyone that has it.  I had buddies in the Marine Corps who told me the same thing after our first deployment, but i had always chocked it up to my dad snored so i snored, the stopping breathing thing was weird but i was 18/19 so your health isnt a primary concern and BAS is only for bones sticking out.  I got out in 2006 and didnt make a claim for OSA until 2016.  First i talked to my primary care then was referred to a VA pulmonologist. He ordered a sleep study and the VA fumbled it sending me to a private facility and did a in home test. When the results came back i saw in my VA health record the Pulmonologist was terse with his message saying he wanting a in facility sleep study so a month later i did mine at the VA overnight.  I was diagnosed with Mild OSA and given a CPAP.
      When the CPAP arrived i spent a month trying to get it to work but every morning it would show only 45-60 minutes of time.  I have nightmares at night, some i remember some i dont but would rip off the mask or when i woke up would be so worked up i didnt put it back on.  I do cycles of trying it for awhile and stopping for awhile, giving it a chance because my wife is worried about the OSA and its health effects. 
      My claim history was this, as i stated i made my first claim in 2016 and was denied.  I reopened the claim (when that was still an option in 2018) and was denied again.  What i submitted was bascially the VA medical record showing that i had it, that i was ordered a CPAP and sworn statements by myself, my wife and buddies in the Corps that stated they saw symptoms in 2003-2006.  I had NO nexus or medical proof that it began in service
      I made a mistake in 2019 when it was denied again and NEVER filed a NOD as i kindof gave up when that and other new claims for increases were denied, but I DID make a intent to file back in July 2019.  I was out of the VA regulation changes loop and didnt know that they had gotten rid of reopening and moved to the Supplemental evidence route so in February through April i decided to really focus on making a quality claim since my 2016/2018 claims were more shot in the dark hoping that the VA would just grant it.  I went to specialists in the field for the claims i was making and got updated diagnosis of symptoms and effects, got my sworn statements (which in my opinion has more 'umph' than a buddy statement) more detailed in terms of observed symptoms, timelines and effects upon my life as well as i went out and got two IMO's. The first IMO was for PTSD from Dr. Elaine Tripi in Michigan whos IMO got the VA to drop their attempt to reduce my rating in 2015/2016 (and i suspect it was because her IMO made a case for an increased rating). In that IMO she detailed my history, current symptoms, etc as well as opined on how my PTSD affected my OSA symptoms and how it interfered with its treatment.  I also got a IMO from Dr. Anaise who wrote a lengthy (near 50 pages) on how my OSA is aggravated by Tinnitus and PTSD and interferes with my ability to go to sleep, stay asleep and interferes with my treatment.  
      When i submitted the claim (reopen was still available as an option on ebenfits) my new claims, increase and "reopen" were all lumped together as one big claim and sent off in April. As a sidenote whenever i send my claim i do so through ebenefits as well as fax AND send CERTIFIED MAIL WITH RETURN RECEIPT. i keep a copy of the USPS receipt with tracking, Cert Mail receipt and the return receipt and staple that together with my hard copy claim evidence in a folder for each claim ive ever made.  The VA has a way of "losing" evidence and if you ONLY submit via ebenefits, regular mail and/or fax you cant prove they received it per say.  This DOESNT mean they wont pretend they didnt get it but what it does is allows you to prove upon appeal that YES you did send it in the time window necessary for your claim AND that they did receive it because the return receipt shows Jim VArep did in fact get it on such and such day. So if you get denied its really important to look at your cfile after to see what evidence the rater actually looked at and if they dont have ALL the evidence in that file you can appeal on those grounds in conjunction with more evidence if necessary that X doctors exam or IMO proves your case, wasnt considered AND the VA had received it.
      So a few weeks after i submitted it, the VA sent me the normal letter stating they had received my claim for X,Y,Z  New & increased claims but i didnt see anythign about OSA which was weird.  a week later i got a letter from the VA saying that my claims for OSA were not new, had been denied previously and were not on appeal and gave me a list of options. I chose Supplemental Evidence since the IMO's were "new evidence"  to be considered and met the criteria and it had been over a year since my denial so i couldnt submit a NOD and get the backdated effective date.  This was my fault. One i gave up in 2019 and didnt file a NOD to hold my place and Two i didnt keep up to date with new VA regs regarding reopened claims, etc.

      Since that supplemental claim was received on 4/24/20 (todays date is 6/18/20) I have had two psych exams and two records reviews through QTC (private company the VA contracts to do DBQ/exams).  The first pysch exam was related to my request for an increase for PTSD back in April and in May i had a NP contact me who was reviewing my med records for OSA and had follow up questions regarding my condition both current and past.  In that conversation i talked about how i never went to go get checked because i never knew what OSA was at that time, thought it was normal to snore, etc., how BAS is frowned upon in the Marines for things like that, my history with it since i got out up to now and how my nightmares make me rip off the CPAP at night.  I did ask her if she had seen my imo, other evidence and she said no JUST my medical record.  I know examiners arent raters and all but I find it weird that VA will deny IMO's as valid if they dont "review veterans entire file" but will accept something from a examiner if its negative when only their VA med file is shared.  Its great advice to always bring your evidence with you to a exam but given the current COVID situation ALL of my exams thus far have been telephone or video. I asked her what the exam was specifically for or what they asked her to examine and she said it was basically whether or not my OSA was service connected and occured in service. I do believe it was but i was making the claim as SECONDARY to PTSD and/or Tinnitus as an aggravation which she was unaware of. I fired off some angry messages via the IRIS system to the VA regarding this (no idea if they got included in my record or reached a rater since the only response i got was "thank you for contact us heres how to make a new claim").  
      Within the last 3 weeks i had a 3rd & 4th "exam". The third was a MD who was reviewing my records as well and asked alot of the same questions, she was also unaware this was a secondary claim for aggravation and had seen no evidence submitted or my entire file so i went through it with her again.  The 4th exam was another psych interview which i was told was to examine my secondary claims to OSA, but knowing the VA i knew it was basically another review of my ENTIRE PTSD claim ive had as well.  Vets should be aware that even if a exam is about something specific any evidence or statements made that can negatively effect an existing general disability & will be held against you.  This was quite clear when he just asked about current PTSD symptoms and never ONCE asked about my OSA, etc. So i had to bring that up myself. 

      VA.gov check claims hasnt been updated since a week after my claim submission. my OSA claim has said "we dont know your status" even now and my other new/increased claim stopped after "request for more information" (i.e. requesting new QTC exams).  So ever few days i check that as well as ebenefits to see if any of the DBQ's show up in my blue button (none have but im guessing because QTC doesnt have to update the way in house VA does).
      Finally today i see on my disabilities list that OSA was granted secondary to PTSD for 50% bringing me to 90% with an effective date of 4/24/20.  I know that this ISNT the same as a letter from the VA but i know someone who is a VA rater who has been giving me updates on my record so im 99% certain this ebenfits update is accurate.  
       
       
      The takeaways are this.
      1) Do the damn research and work the claim yourself, no VSO or rep is going to care as much as you do. You care about your case, they have 15,50,100 other vets whos cases they are working and even if they are a great VSO/rep they cant possibly give a crap as much as you do.  dont hope the VA just "gives" you the rating you deserve make it so they cant NOT give it to you with the proper evidence.
      2)IMO's are golden. I know not everybody can afford them, i couldnt per say and had to sell some things to come up with the $500 for Dr. Tripi and $1500 for Dr. Anaise, but they were well worth it, without them i definitely wouldnt have gotten my OSA approved. I think have both a MD stating both the phyiscal and mental nexus and a Psychologist stating the pure mental side gave it a one two punch.  
      3) Along with the IMO go to doctors/specialists in your area and get documented evidence of you issue, ask them to be detailed in the exam notes.  I even emailed a couple time asking the doc (this wasnt for OSA but a different claim, but good general advice) asking them to update the notes to specifically include certain symptoms and effects upon quality of life.  Having this helps alot, combined with IMO's its very difficult for a random NP to override their  findings with one exam or phone interview.  Remember the VA is military based in that the ranking officer rules.  So if you only have a NP (nothing against NP's this is just how the VA works) from a urgent care saying you have OSA caused by PTSD or that your shin splints are 8/10 pain and they have a pulmonologist, MD or specialist say its only 1/0 and doesnt effect guess who wins. If you have two psychologists but yours has great bonafides and background and theirs has only been practicing for 5 years solely at the VA yours wins.  Im not saying dont go to a primary care to document because youll only see a NP all evidence helps but be aware if they pull out a MD who counters that exams findings youre likely to lose. Because they will always want to lean to denial and if their person has more experience or is a specialist that will win over what  you submit. Dont give them an option, and even if they do decide to rule against you, you can make a great appeal based on the fact they sided with their NP over a specialist in the field your making a claim for who knows more.

      4) Never let claims die. Dont make a new claim until your ready to with great evidence (file a intent to file first though to preserve backpay/effective date) If denied make sure you keep a reminder about the NOD date and when you do file a NOD make sure that is certified mail with return receipt to prove you mailed it/VA received it before the deadline, because if you dont and they can make a case it was received 24 hours after the NOD deadline you lost you backpay date and possibly years of backpay.  Now there are situations where claims die but if theres a opportunity to still make it on appeals hire a GOOD (there are alot of crappy ones) appeals attorney and move forward. I know they take 20%+ of your backpay but if you aent comfortable enough to navigate the appeals process its well worth it.  
      5) stay up to date on new VA regs, Hadit is a great source for this you dont want to be like me thinking that certain avenues are still open and they arent. If I had stayed up to date i wouldve been able to file earlier for the OSA and preserve YEARS AND YEARS of backpay now im only going to get 2 months.
      6) I didnt do this for this claim although i should've and kept a diary of when i was using the CPAP, roughly when i ripped it off, data on how long i wore it, frustrations over not being able to wear it, info on my nightmares causing me to rip it off etc.  years of diary entries wouldve been a help. I didnt need it in the end but if you cant afford a IMO things like this can help because theres NO SUCH THING AS TOO MUCH EVIDENCE.  A diary is one of the key things that helped me win my migraines case.  for months prior I kept a diary of my headaches and effects, then transcribed them into ebenefits health diary.  I am not perfect at it but i now write as much as i can as often a i can in this diary about ANY service connected or possibly service connected illness (especially things that could be considered aggravated by a service/possible service connected disability).  That way when you are making a claim or fighting a reduction you can pull out timestamped entries for months/years relating to it and it makes it harder for a rater to think you pulled this out your but last month to make a claim. 
       
      A big thanks to everyone on HADIT.  i did alot of research here through the years to help make my claims better and it worked
      Another big thanks to Dr. Anaise and Dr. Tripi for their outstanding IMO's that helped me win this. 
    • By Ztmiller8
      Hey all,
      First off, love this page it has been extremely helpful! 
      Background: currently at 90% / 70-ptsd, 50-migraines, 10-iritis, 10-tinnitus, and I’m in the running for 100 at the moment. 
      Current day: Was content at 90 but after all these years I have finally come out about my MST when I was in the infantry. Still working stuff out on that end as this is still fresh...
      Anyway, I submitted a claim for sleep apnea because of the MST. I submitted the following: picture of CPAP machine I use in my house, nexus statement from issuing doctor, Nexus statement from other doctor stating the sleep apnea is due to trauma from MST,  copy of sleep study confirming I have sleep apnea from doctor listed above and buddy statements as well as the formal submission paperwork of my MST to three levels of my chain of command, NCO, O3, O5 etc...
      Wrap this all up with a successful expedited hardship approval and you now have me waiting for answers. Well today (a few moments prior to writing this) I found out I am getting a C&P exam for this...I almost feel like this is a slap in the face...I mean how am I to go up to that examiner and explain all this when I literally gave it all to them...
      Has anyone been in my shoes before???
       
      Thank you all.
    • By ThomasGray
      First off, hello and thank you in advance for any help that can be provided. Also, I apologize if something is not clear, trying my best to keep things concise.
      On Friday, May 15, I received letter from the VA, dated May 11, proposing a rating reduction from 100% to 70% for PTSD. The only evidence for the change listed is Rating Decision - Narrative(17SEP18) and DBQ PSYCH PTSD Review(06MAY20), whereas on my initial decision letter there was an abundance of evidence used. The major takeaway appears that my medical records(both prior to and after the initial rating, also from VA facilities) were not considered in this proposal. Is this normal?  
      I have yet to obtain the most recent C&P as I just received the proposal letter, but intend to attempt on Monday, May 18. Looking at the proposal letter though it seems that examiner didn't check a few specific boxes that were checked on my previous C&P. Other than that the differences appear to be minor. The two lists are as follows: Original C&P Gross impairment in communication Suspiciousness Depressed mood Suicidal ideation Near-continuous depression affecting the ability to function independently, appropriately, and effectively Disturbances of motivation and mood Chronic sleep impairment Near-continuous panic affecting the ability to function independently, appropriately, and effectively Difficulty in understanding complex commands Total occupational and social impairment Panic attacks (weekly) Difficulty in adapting to stressful circumstances Neglect of personal appearance and hygiene Difficulty in adapting to work Inability to establish and maintain effective relationships Flattened effect Panic attacks (less than weekly) Intermittent inability to perform maintenance of minimal personal hygiene Difficulty in adapting to a worklike setting Anxiety Difficulty in establishing and maintaining effective work and social relationships Intermittent inability to perform activities of daily living Gross impairment in thought processes New C&P Forgetting names Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and mood Depressed mood Suicidal Ideation Near-continuous depression affecting the ability to function independently, appropriately, and effectively Disturbances of motivation and mood Mild memory loss Forgetting recent events Chronic sleep impairment Near-continuous panic affecting the ability to function independently, appropriately, and effectively Difficulty in understanding complex commands Panic attacks more than once a week Difficulty in adapting to stressful circumstances Neglect of personal appearance and hygiene Difficulty in adapting to work Inability to establish and maintain effective relationships Impairment of short- and long-term memory Flattened effect Difficulty in adapting to a worklike setting Anxiety Difficulty in establishing and maintaining effective work and social relationships Forgetting directions I bolded the important items not that were not checked on the new c&p which led to the reduction proposal. It seems strange to me that new symptoms were added, however the very specific ones that would've caused the rating to remain the same all disappeared in just 1.5 years even though there is no noted improvement in my actual medical records.  
      What exactly is my next step? I have written a few statements of disagreement contesting the proposed reduction and pulled my VA medical records and will be getting a copy of the new C&P shortly. I have no idea were send the items as it is unclear in the packet. It says I have 30 days for one option and 60 days for the other. I don't think I need a notice of disagreement or start the appeal process as the final decision hasn't been made(this is a poorly worded question)?  
      Can I also request that they consider TDIU if the rating reduction is finalized or will I have to start a new claim for that? Should i send TDIU forms with my statements of disagreement and records?  
      I have been avoiding poking the bear and not filing claims for other conditions, some of which are caused by the various medications they have me taking, should I start filing claims for those as well?  
      And finally, if I do have to file for TDIU separately, should I start the claim now so that the date is saved? Do I submit the claim before or after I receive the final decision on the proposal? Sorry for the long post. I'm lost as to what to do next. It took me over 5 years of being denied before they would actually service connect anything and now this. Thanks again for any help, it is appreciated.
    • By Wise Guy
      I have a current claim for several injuries to include PTSD. I did some research and found out the best way of getting a rating for migraines is to have a diary through the VA of the migraines. For my PTSD which I got diagnosed through the VA in February, I'm taking Doxazosin (Nightmares), Hydroxyzine (Anxiety), and Sertraline (Mental Health). All of the medication causes headaches. However, the Sertraline only causes headaches within the first 2 weeks. I was going to wait until the claim was complete before filing for Migraines because I wanted to already have the rating for PTSD first so I can claim the migraines as secondary. But is there a way to still file for it now to still say it's because of the medication for the PTSD? Which route should I go or is there a better one? And should I talk to my VA counselor/medication doctor to get him to state that my migraines are caused by my PTSD and medications? I heard every time you file for a new claim, then everything gets re evaluated so it would be ideal if there was a way to get everything done now. 
       
      Also, I did get diagnosed through the VA for Sleep Apnea back in February,. So, can I say that the migraines was also caused by the Sleep Apnea?
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      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
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    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

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      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
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    • Exams that were being sent strictly to contractors before, due to VAMCs not being open, are starting to be routed back to VAMCs. This is going forward from last Friday- not sure if prior scheduled exams will be re-created for VAMC vs vendor.
      • 7 replies
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