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Secondary Action Required?

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IMEF-Gunny

Question

C&P exam performed, unfavorable, but many contradictions, claim went to prep for decision. I rebutted and shot holes in the Dr's opinion/rationale by quoting/ stating regulations/ laws and bringing up the fact that he changed my diagnosis from that of my local VAMC, said it was pre-existing, but did not address whether it was aggrivated by service.

Claim went back to gathering evidence.request 2 came out, which was a request to the same Dr for an opinion as to aggrivation. Again Dr stood his ground, but clearly contradicted himself. Claim immediately went back to prep for decision.

Again, I rebutted and shot holes in his response, quoting regulations/ laws and quoting past appeals findings in regard to similar cases.

Claim went back to gathering evidence.

Monday, still gathering evidence, but reading requested docs past due. called Peggy, no information needed.

Tuesday my claim moved to prep for decision again and showing new Request  3 - No longer needed, under which it reads Secondary Action Required.

 

Now, I will assume that this , although under the header "Required from You", is an internal request requesting additional oversight from someone.....likely because I'm a pain in the ass that keeps throwing wrenches into the C&P docs babble, quoting regs/ excerpts from VA training manuals and past appeals decisions, and their the Dr clearly (even to a complete idiot like myself) destroys his own arguments with contradictory statements.

So, my question is, from the much more experienced folks here that have spent time in the VA's offices......is the "Secondary Action Needed" likely an internal request for close scrutiny? Peggy said it was saying it needed a second signature, but I'm assuming  not for retro , but for dotting I's and T's?

 

As always, any input is appreciated!

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  • HadIt.com Elder

Gunney

What was their reason to deny?

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Waiting on the official letter, but I'd say......C&P doctor's oppinion that MDD not aggrivated by service. I'll know more in the next 10 days. His latest aggrivation notes are riddled with contradiction.

MEDICAL OPINION SUMMARY

-----------------------

RESTATEMENT OF REQUESTED OPINION:

a. Opinion from general remarks: TYPE OF MEDICAL OPINION REQUESTED:

Aggravation of a pre-existing condition.

OPINION REQUESTED: Aggravation of a pre-existing condition.

The examiner diagnosed major depressive disorder and stated the condition

existed prior to service. We need an aggravation medical opinion.

Was the Veteran's major depressive disorder (which clearly and

unmistakably

existed prior to service) aggravated beyond its natural progression by the

Veteran's service?

The Veteran served in Southwest Asia during the Gulf War and has submitted

stressor statements on VA Forms 21-0781, Statements in Support for Claim for

Service Connection for Post-Traumatic Stress Disorder (PTSD), received June

29 and August 10, 2017. The service treatment records on file show a history

of depression and alcohol use prior to service:************* (2 incidents at age 14 and 16 of minor consumption)

- 12/01/1989, depression and alcohol use

- 12/01/1988, alcohol abuse

Active duty dates are from 11/30/1990 to 04/29/1991.

Rationale must be provided in the appropriate section.

If more than one mental disorder is diagnosed please comment on their

relationship to one another and, if possible, please state which symptoms

are attributed to each disorder.

If your examination determines that the Veteran does not have diagnosis of

PTSD and you diagnose another mental disorder, please provide an opinion as

to whether it is at least as likely as not that the Veteran's diagnosed

mental disorder is a result of an in-service stressor related event.

b. Indicate type of exam for which opinion has been requested: DBQ PTSD

Initial

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR AGGRAVATION OF A

CONDITION THAT EXISTED PRIOR TO SERVICE ]

b. The claimed condition, which clearly and unmistakably existed prior to

service, was not aggravated beyond its natural progression by an in-service

 CONFIDENTIAL Page 7 of 8

event, injury or illness.

c. Rationale: It would be speculation to determine the presence of

aggravation due to any trauma occurring during veteran's military

service. **********so, wouldn't it be speculation to say it wasn't??????

This conclusion is based on the following: 1) Veteran has multiple

established factors increasing the likelihood of depression including

relationship difficulties, early family risk factors********parents divorced at 8 years old, and alcohol abuse. ************(2 incidents at age 14 & 16)

These established factors are likely associated with significant aspects of

veteran's depression. Separating out the portion of depression

attributable to trauma in the presence of these other larger factors would be a

questionable exercise at best. **********Again, if you cannot seperate them then how can you rule that it didn't?

2) The literature to establish a connection

between trauma and depression does not exist in a way that allows

application in this situation. **********so, no literature to disprove aggrivation????

PTSD and Major Depression likely have some level of

concordance (having one diagnosis increases the likelihood of having the

other diagnosis); however, even this literature has not established firm

levels of concordance depending on the severity of trauma, family history,

and other risk factors not to mention the more than 25 years between the

trauma and current functioning such as exists for the veteran. *********NO WHERE in my files, history does anyone or anything say I went 25 years, in the doctor's words "relatively problem free"!!

In addition,

this literature is about diagnosed PTSD, not just a trauma having occurred.

Similarly, there is literature on connection between general stresses and

depression but again not in a manner that allows the assessment of a 25 year

lapse between stress and current depression.********No evidence to 25 years trouble free.....buddy statements from family, friends, work say very differently!!!!

 

3) Veteran's depression is very mild. *********VAMC notes and C&P contradict this sharply.....he bases this on the fact that my MMPI showed lower depressive signs and no malingering

The mildness of the depression suggests that any portion of

depression attributable to aggravation would be very small. Smaller than the accuracy

of current psychological strategies to measure.*********I have yet to make it thru a VA appointment or C&P without breaking down hard!

*************************************************************************

 

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  • HadIt.com Elder

You should not "reopen" your claim since you just got a decision.  You should NOD it and appeal to DRO/BVA to include an IMO that directly takes into account the VA's medical evidence and C&P exam and refutes them with good rational.   If the VA uses one shrink to beat you then you get two on your side as IME/IMO types.  Many civilian shrinks will do this for a pretty small fee.  You just have to find the ones in your community that will do it.  You should not have to pay $2000 for a one or two page letter based on a live exam.  I had four IME's to go from 30% to 70& to TDIU to P&T in the space of about 18 months.    The VA C&P doctor was a resident and my IMO's were board certified specialists.   You just have to stack the evidence higher than them and better quality. I read where C&P doctor says your depression is "very mild".   What does he base this on and what evidence.  Were you examined by a psychiatrist or a psychologist since they mention MMPI.  Shrinks don't even use it anymore only clinical psychologist these days.

 

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He based the "mild" on the MMPI results soley. Psychologist.....There is nothing, anywhere in my files that support the idea of mild depression. Quite the opposite really. He also, cut & pasted parts of VAMC notes.....only the ones that said "doing better on the meds" type appointment notes. He also neglected to mention things that happened in service, like my friend being killed in the Gulf, although he used it to essentially say.....see, depression, not PTSD....it was a sham all the way around.

I also made mistakes.....I let him lead the questioning. He never mentioned stressors.....instead querying me about my friends death, my hatred for Islam, etc. We had discussion of panic attacks when I don a SCBA, like a gas mask, at work and get panic attacks.....he excluded that and marked it "no panic attacks", etc, etc

 

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