hypertension My First C&p Examination By Va. Psychologist Phd.

[Josephine]

Hi Friends,

This is my first C&P examination. Perhaps someone can learn from my mistakes.

Thanks as always,

Josephine

TITLE COMPENSATION & PENSION EXAM

AUTHOR M, C OCT 18, 2004

REVIEW OF MEDICAL RECORDS: The Veteran’s claims File was reviewed.

MEDICAL HISTORY: Mrs. __ is a 60-year old married white female in military service from March 1963 to May 1964. Medical problems include a history of TIA, hypertension, rheumatic heart disease, hypothyroidism, orthostatic hypotension, and inner ear problems.

PSYCHIATRIC HISTORY: the veteran was seen today regarding possible service – connection for anxiety and depression. She has a long history of anxiety and depression. She reports that she had no psychiatric difficulties whatsoever prior to military service. The C- File contains records related to her honorable discharge due to unsuitability regarding emotional difficulties, primarily being emotionally immature and being dissatisfied with the navy and inability to adjust to navy environment. Prior to this discharge she had two psychiatric evaluations in 1964, one of which basically indicated she was rather dissatisfied with the navy, and diagnosed no psychiatric illness. Second was similar, describing general dissatisfaction and reduction in performance in responsibilities. They suggested longstanding personality traits of emotional immaturity, dependence, and instability. She was recommended for discharge in 1964.

The veteran reports that a Dr.C --- prescribed Librium while in the service, though in the few service records that were seen this medication was not seen. However a letter from a friend in service does indicate she was on anti-anxiety medication during her service time.

An examination request dates her psychiatric treatment back only to 1978, through her C- file contains records as far back as 1967, describing how she “stays nervous” and that Librium was prescribed.

She has been on Valium for many, many years, which she reports does help some. She has been to counselors, psychiatrist and currently gets her medicine through her primary care provider. She reports that she went for help prior to even 1967, though was not put on medications in 1965 due to her pregnancy.

The veteran also reports being on Elavil some time between 1971 and 1973, prescribed by a Dr. Kibbe. Records also indicate a history on being on Mellaril years ago.

She is currently not seeing a psychiatrist or counselor, and again gets her medicine through her primary care doctor.

She has not worked since 1983, secondary to her high levels of anxiety and depression. She has been married since 1965 and reports a good relationship with her husband. They have two daughters and six grandchildren with whom she gets along with well. She has a good relationship with family, as well as a number of friends. She tries to stay active, engaging in things such as internet, some visiting with others, collecting dolls and antiques, and going to yard sales.

She describes symptoms to include extremely high anxiety and periods of depression ever since her time in the service.

She reports another number of stressors while in the service. When she was in the navy, she reports that in basic training she was unable to swim and was very frequently thrown into the pool in an effort to help her learn how to swim, and did not seek to take her out until she was nearly drowning. Another time she describes being pushed off the high dive. Again, these events are also noted by a letter from the veteran’s friend who was in the navy with her by the name of J xxxxxx.

The veteran reports that she reported this mistreatment to the psychiatrist, though apparently this is not documented in the psychiatric reports. She also describes being physically mistreated by a doctor by being grabbed by the neck and was so scared that she urinated.

MENTAL STATUS EXAMINATION: The veteran presented with extreme levels of anxiety and appeared very distraught. She also appeared very depressed and frustrated.

Her hands were visibly wet with sweat, and at times she became somewhat tearful.

There was no impairment of thought processes or communication, nor were there any delusions or hallucinations.

Behavior and eye contact were appropriate.

She reported no homicidal thoughts. She reports rare occasional suicidal ideation about once every two years, though without any intent whatsoever to act on such thoughts. She is not presently suicidal. She does adequately with personal hygiene and basic activities of living, and was fully oriented. She denies memory impairment or obsessive - compulsive behavior.

Speech was within normal limits. The veteran reports symptoms indicative of panic attacks approximately once per week with a rapid heartbeat, hyperventilation, intense fear, desire to escape, sweating, trembling and feeling cold. The veteran reports daily feelings of depression with sadness, crying spells, low self-esteem, impaired appetite, and irritability.

She reports having hope, but is but is often pessimistic. She reports high levels of anxiety every moment of the day with anxious, nervous feelings, inability to relax, excessive worry, and the above – mentioned physical symptoms of sweating. She has some mild impulse control difficulties resulting in verbal anger outburst, as well as occasionally becoming so angry and frustrated that she kicks holes in her walls at times.

Sleep is somewhat impaired, as she complains of getting only five or six hours of sleep per night due to early morning wakening, though indicates that such amount of sleep does not severely negatively impact her. She denies any alcohol and drug problems.

The veteran indicates a high level of anxiety that is often triggered by certain cues that remind her of military experiences. For example, she has, since the military service, been extremely frightened and avoidant of water, especially pools. She even tends to avoid the large tub in her home, instead choosing the smaller one. She reports heightened anxiety around doctors and is fearful of heights.

DIAGNOSIS: anxiety disorder, not otherwise specified, with depression.

SUMMARY AND CONCULSION: this veteran clearly has a very long history of anxiety with depression, and currently during this examination, warrants such a diagnosis due to the above- mentioned symptoms.

It appears that her diagnosis is not what is in question, according to the examination request.

The main question appears to be “ Does the veteran have a chronic acquired psychiatric disorder which began in service?”

Based on the evidence to be discussed next, this examiner’s opinion is that it is as least as likely as not that the veteran’s anxiety and depression was caused by a result of her military service.

The evidence reviewed in this case was the entire Claims file, though, in particular, there are records indicating that she was diagnosed with anxiety and prescribed Librium in 1967, whereas the examination request initially stated that her psychiatric treatment dated from 1979, according to the form.

In addition, the veteran reports no medication treatment prior to that in 1965 when evaluated, due to her pregnancy, which is plausible. Given the closeness of her treatment to her military service (compared to 1978), this makes it more likely than not she had been having problems in 1964, as well.

The veteran’s friend from the navy was in with her also provided a letter describing how the veteran was anxious and on medication for” nerves” while in the service. The veteran who wrote the letter, Jxxx also describes some of the abusive and stressful conditions that they endured, which could certainly contribute to such anxiety states.

In addition, the veteran’s current fear of heights and water could also certainly be tied to such experiences. Of course, it is recognized that such experiences are not proven, though this veteran’s friend does corroborate them.

In addition, the veteran had two psychiatric referrals within a short period of time in March 1964.

Given this fact, it makes it more likely than not that she had some kind of psychiatric difficulty while in the service, and she was judged to be unsuitable for service.

It is unclear why, despite the veteran’s report of telling of her stressors, that they were not documented.

The veteran also has indicated no childhood psychiatric difficulties again making the beginning of her troubles dating to service more likely.

Signed

C. M.

PhD

Clinical Psychologist

Edited December 30, 2006 by Josephine

[john999]

Josephine

That is a perfect C&P exam for service connection. What is wrong with it? Is this the exam the VA ignored? When did you have this exam because service connection should be established on or around that time or when you filed the new evidence or appeal.

[Josephine]

Josephine

That is a perfect C&P exam for service connection. What is wrong with it? Is this the exam the VA ignored? When did you have this exam because service connection should be established on or around that time or when you filed the new evidence or appeal.

John,

I received this from the DRO

10-07-2004 - The Decision Review Officer ( DRO) has completed a preliminary review of your file and has determined that, based on the evidence currently of record, your claim cannot be granted. This is not the DRO's final decision. We are sending you this Statement of the Case so that you can better understand your appeal. An examination is being scheduled at the Va. Medical Center. The Va. Medical Center will notify you about the date and time to report for the examination.

The DRO also sent me a Form - 9 with this Statement of the Case. I had 60 days to turn it back in.

I received a denial for anxiety with depression in the same statement of Case.

The DRO also re-opened the claim for " Acquired Psychiatric Disorder" with the new and material evidence. (The Psychiatric Records from the Archives)

This C&P was October 18, 2004. I waited for an answer and had to turn in the form - 9.

I turned it in November 30. 2004.

5 Months later I had the Board Examination with the notice from the Medical Center - Reminder of your clinic appointment.

Yes, the answer to your question, this one was ignored.

I feel that the second C&P was seeking a denial, as that is exactly what the R.O received.

The veteran appears to have symptoms of a personality disorder and her anxiety with depression did not begin or worsen during service.

R.O ruling - We place our weight with the Psychiatrist, because they are Psychaitrist.

I sure hope that someone learns from my mistakes.

Thanks,

Josephine

Edited December 30, 2006 by Josephine

[john999]

Is your BVA claim still alive on this matter? You should have gotten the benefit of doubt on that first C&P exam. I believe that the DRO must have been afraid of a retro payments issue because your C&P was good enough for service connection. You do need to get out of your RO because you had a good claim as I read the C&P exam. What did your second C&P say? You and Terry Higgins have something to talk about being that your local VARO seems hell bent on denying you service connection. Where exactly is your claim at now? Did you ever appeal your character of discharge? Sometimes the RO just decides they are not going to grant service connection no matter what evidence you show them. That sounds like what you have here.

[Josephine]

Is your BVA claim still alive on this matter? You should have gotten the benefit of doubt on that first C&P exam. I believe that the DRO must have been afraid of a retro payments issue because your C&P was good enough for service connection. You do need to get out of your RO because you had a good claim as I read the C&P exam. What did your second C&P say? You and Terry Higgins have something to talk about being that your local VARO seems hell bent on denying you service connection. Where exactly is your claim at now? Did you ever appeal your character of discharge? Sometimes the RO just decides they are not going to grant service connection no matter what evidence you show them. That sounds like what you have here.

John999,

Yes, my file went before the BVA and was remanded to the AMC in Washington. D. C. The Va hid my medical records from Dr. Muxxx - on that first C&P. He hunted for a hour to locate them in my file.

The second C&P is the one with the Board of Two, by means of HypXXXX. I will type for you just a tad of it. This may answer the pension disability.

MEDICAL HISTORY Mrs ___ is a 60 - year old white female married un-employed nursing assistance who was referred to a board of two psychiatrist as part of her appeals process for a service- connected disability claim. she served in the Navy from March 15, 1963, as a hospital corpsman. She allleges that her chronic anxiety and depression with headaches began while on active duty. Her first claim was filed in 1978 and was denied. A second claim filed on 2002 was also denied. She was awarded 100% non -service connection disability for anxiety and depression, but was denied due to excessive income.

She completes the exam with changing of military and private medical records.

She refused to put down that I saw Dr. J psychiatrist for nervousness, headaches and irrability.

She put down that I saw him for headaches only.

Same for the Board Certified Psychiatrist. She changed his records also.

She changed all of my private medical records.

I have ask for a complete investigation by the AMC concerning her changing my private medical records.

Her conclusion. Axis 1 - Anxiety Disorder not otherwide specific

Axis 2 - borderline personality

Axis V - GAF - 40

Mrs XXXX symptoms are primarily consistent with a personality disorder. it does not appear that MrsXXX developed a chronic Psychiatric disability while on active duty.

She was separated from the navy because of " Unsuitability" related to her dissatisfaction with the service and several incidents, which she considered indicative of abuse.

Her entrance and Exit psysical make no mention whatsoever of any psychiatric symptoms.

It is the finding of this Board that the veterans anxiety disorder was not caused or worsened by her time in service.

Bingo- No benefits!

Thanks Josephine

Edited December 30, 2006 by Josephine

[john999]

Josephine

You do need a IMO to send to the VA to tilt the benefit of doubt in your favor. Otherwise you may get the benefit of the doubt, but you may not based on two C&P exams that come to different conclusions. I think you should get the benefit of the doubt, anyway, but you want to make your claim so solid that you don't spend the rest of your life fighting this thing.

[Josephine]

John999,

My husband is going to help me get all of my papers together on Monday, so that he can make copies for me, and overnight them.

The firm has agreed to have my IMO for me in three weeks after receipt.

I sure hope this time that the rating board at the AMC is telling the truth, that I am to be rated in February.

I may need the assistance of their lawyers on staff also.

I am fighting the sytem and it is time for it to stop. The BVA knew when they sent my file back to the two psychiatrist that they would not change their minds.

I will not allow Dr. L to slander me to badly.

I posted this C&P on line, just in case someone out there had a postive examination and was sent for another one for same illness, to be on guard.

Thanks to all of you,

Josephine