How screwed am I in dealing with the VA after retirement?

[vet2018]

BLUF: Retiring in a few weeks, just got AD medical records including mental health which I started seeing a few months ago for anxiety-type symptoms and concerns of recurrence of PTSD-type symptoms experienced after a rough deployment around 10 years ago that I never sought help for. I'm concerned that my psychologist, who has apparently has painted me as a hypochondriac, has screwed me over dealing with the VA going forward because they will now downplay all future interactions as being "in my head." Is this a valid concern?

I apologize for the length below, but I'm pretty pissed right now.

In the records for this psychologist I find repeated diagnosis of "Other Specified Anxiety Disorder (Insufficient symptoms)" and the below statements. (this same type of statement is generally repeated across multiple visits)

Quote

He appears overly concerns with the potential of psychologically decompensating in the future. His symptoms are not well characterized by an Illness Disorder at this time, since he appears to be responsive to feedback on negative medical findings. It is likely phase of life factors are exacerbating his anxiety symptoms (i.e. retirement, wife’s declining health, and father’s terminal illness). Moderate emotional impairments have been observed with no significant occupational impairments.

I'm pretty pissed right now over the statement of "no significant occupational impairments" when I've clearly stated to the psychologist over many months that I have had significant difficulty focusing on tasks, difficulty remaining motivated, etc. I'm basically on terminal leave the past two months but during that time have had extreme difficulty organizing most things in my life. My wife is very ill, I myself just received a diagnosis of a rare potentially very debilitating disease 2 weeks ago, and we were caught in a four-car wreck on the freeway the following day (five minutes away from a pre-surgery consult for my wife where we expect multiple complications) that has left us living on pain relievers and muscle relaxers since then, our stress level is through the roof, and the therapist has been told all of this but made no mention of it in the clinical notes at all. Only statements that I am overly focused on getting ill -- which was in a sense true as I was very worried about "numerous unexplained symptoms" for many months until I finally got the diagnosis (through an objective test by a specialist that clearly demonstrated the illness) two weeks ago that tied all these symptoms together. It turns out that I have a disorder of part of my nervous system that affects multiple systems in the body in different ways, so someone not familiar with the disorder can think the patient is presenting with numerous symptoms with no cause, hence it must be mental.

Bottom line is this therapist has painted a picture of me as a hypochondriac who has no work impairment at all, despite a significant recent medical diagnosis and repeated statements that I have significant difficulty with tasks at home. For example, I have repeatedly said that our house is a mess and I have not been able to get organized enough to complete projects at home to simply clean up. I can't stand it around here but never do anything about it. She just wrote from one visit "He was assisted in exploring cognitions that perpetuate procrastination." I have no hobbies, no desire to do much of anything, I just sit all weekend and make my wife miserable. I've told her this repeatedly and as recently as today and the notes she wrote from today are quoted above. Maybe I wasn't clear enough to her but she has expressed at least some sympathy so I thought she understood what I said.

Also I have repeatedly tried to discuss concerns I had regarding severe stress after my deployment, but she has apparently characterized that as "marital strife" when I clearly told her the strife was caused by my inability to deal with my deployment emotionally and taking anger out on my wife. I've told her I was constantly having flashbacks for five years after my deployment, constantly obsessing over loss of friends and what I could have done differently, etc. None of that is mentioned. In fact, the one time I was able to spend some time talking about deployment experiences a few months ago she finally stopped me and said "Whoa, we need to take a different approach next time and avoid that."

I feel that I've made a terrible mistake in trusting this therapist. My initial concern entering therapy was a fear that I did not properly deal with my deployment and that I could return to my previous condition which alternated between complete detachment and rage. I never spoke to a therapist at the time despite my wife begging me to. Now that I tried to talk to someone I find out that those concerns are completely ignored and I am instead painted as a hypochondriac. Because of that I am concerned the VA will treat me as a "problem patient" going forward and automatically discount any concerns I have as "mental" instead of potentially medical.

How realistic is my concern? Thanks.

Edited August 7, 2018 by vet2018

[Buck52]

You may want to look up your Diagnostic Code they have you given you?

check these 

General Rating Formula for Mental Disorders

   Rating

Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.100%

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships.70%

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.50

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).30

Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.10

A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.0

9520   Anorexia nervosa

9521   Bulimia nervosa

Rating Formula for Eating Disorders

   Rating

Self-induced weight loss to less than 80 percent of expected minimum weight, with incapacitating episodes of at least six weeks total duration per year, and requiring hospitalization more than twice a year for parenteral nutrition or tube feeding.100

Self-induced weight loss to less than 85 percent of expected minimum weight with incapacitating episodes of six or more weeks total duration per year.60%

Self-induced weight loss to less than 85 percent of expected minimum weight with incapacitating episodes of more than two but less than six weeks total duration per year.30%

Binge eating followed by self-induced vomiting or other measures to prevent weight gain, or resistance to weight gain even when below expected minimum weight, with diagnosis of an eating disorder and incapacitating episodes of up to two weeks total duration per year.10%

Binge eating followed by self-induced vomiting or other measures to prevent weight gain, or resistance to weight gain even when below expected minimum weight, with diagnosis of an eating disorder but without incapacitating episodes.0%

Note 1: An incapacitating episode is a period during which bed rest and treatment by a physician are required.

Note 2: Ratings under diagnostic codes 9201 to 9440 will be evaluated using the General Rating Formula for Mental Disorders. Ratings under diagnostic codes 9520 and 9521 will be evaluated using the General Rating Formula for Eating Disorders.

(Authority: 38 U.S.C. 1155)

[79 FR 45100, Aug. 4, 2014]

[vetquest]

Yes your therapist might have made things hard for you.  What you need to do is get some C&P's completed and see what they say about you.  I was discharged at the convenience of the government and my medical C&P cited hypochondria.  My mental health C&P was not much better.  It was eight years before the VA rendered a diagnosis of PTSD. 

What you might do in the mean time is start seeing a therapist on the outside and see what they have to say about you.  You may get two different stories and the benefit of the doubt is supposed to go to the veteran.  Anxiety disorder is not so bad as long as it is marked service connected, PTSD is an anxiety disorder but it can only be diagnosised by VA C&P's.  The good news is that if you have had a deployment that went bad and you lost friends this could be considered as a nexus for PTSD.  Get some buddy statements from others that were there before you lose contact with them.

Get into the VA system and get some C&P's completed and go from there.

[broncovet]

No.  Do not concern yourself with what this doctor said.  Ignore it.  Here is what you do need for service connection, and none of it involves the blessing of your active duty doctor.  

1.  CURRENT DIAGNOSIS.  Go to a VA doc and read his exam report  to see if you have a current diagnosis of a mental health disorder.   Tell him if you think you may be depressed, PTSD, etc, etc.   

2.  In service event or aggravation.  With PTSD, this is called a "stressor".

3.  Nexus, or doctors opinion that 1 and 2 are related.  

     Check your medical file to see if you have a stressor or in service event documented.  That will be a problem, which may be solved if you were a combat Vet..its pretty much presumed its stressful to be shot at.  

     If you are seeking benefits dont delay past a year from your exit from service, for multiple reasons.  Apply before a year.

     Here is part of the reason why.  Ok, you had a pre service physical.  Now, if you get diagnosed with a malady AFTER service, its presumed you got that malady in service, provided that, you apply within a year of getting out.  

Edited August 7, 2018 by broncovet
add more

[vet2018]

Thanks all for the responses. I apologize for the length of these rants but it's a lot to get off my chest and I want to make sure I go through the process correctly for my family's sake.

@Buck52 the DSM-5 diagnostic code is F41.8, here's a link with more info about it: http://seniorcarepsychological.com/other-specified-anxiety-disorder-symptoms-and-related-dsm-5-diagnosis/

@vetquest Sorry to hear about your delays. That seems to be a common theme. Unfortunately I'm not really in a position to get buddy statements. I'm in the Air Force and it was a very weird deployment situation. They deploy us as individuals to fill slots, not as a unit, and this particular deployment had me (an IT guy) deploying (with a few days' notice -- surprise) into a very small (~60 people) mashup unit of infantry and civil affairs types (Army + AF + Navy) and a small Navy EOD team (even a couple Marine ETTs) on our own on a tiny FOB responsible for an entire province in far east Afghanistan during the runup to the Taliban resurgence. Instead of comm I was put in with the S3 in a TOC that basically only had 3 people in it (S2, S3, and me) because we were so undermanned and I had no prior experience in this type of operating environment at all. (I literally went from cubicle farms doing help desk tickets to coordinating all aspects of a FOB on a daily basis) It turned out I was able to hold my own at it pretty well after I got adjusted to it, and in a lot of ways I enjoyed it and miss the hell out of it but once it was over I returned to my unit stateside. Since I didn't deploy with anyone from my unit there's no one to really reach out to about the things that happened over there. We got shot at/rocketed/mortared and it was my job to help coordinate defense, coordinate air support and medevac when our folks went out and got in TICs, etc. But there isn't anything that says "you got shot at" in particular, so I'm not sure what would be useful for that. I do have helmet cam footage of combat from some of the guys who went out but I wasn't out with them, I was on the other end of the radio making sure they got out in one piece. Usually. I went out some but never got in a TIC while out. Was on the phone with my wife when we came under heavy mortar fire once, that sucked. I do have an ARCOM from Task Force Spartan (10th Mountain) but it is generic.

@broncovet are you saying at the C&P I should explicitly state that I think I have PTSD? My therapist has stated in the notes that I do NOT have PTSD because I said my issues from the deployment have lessened to the point that the issues are "rare." But to me that simply meant that it isn't affecting my life on a constant basis. I still however have feelings of guilt/etc (especially over one friend's death that I feel I could have done more to prevent but probably couldn't -- he was amputated waist down by an IED just outside our FOB -- first daisy-chain IED in eastern theater -- and I was on watch and initiated the response to get them back in safely) but do not have hypervigilance and flashbacks like I did back then. My issue is that I simply forced myself to deal with the issues but don't feel I ever properly processed them, I just buried them over time, and I'm concerned they will come back again. I get fairly nervous even typing up what I did above. My wife did write a lay statement describing how I changed after the deployment, detachment/rage, etc that I was considering giving to my current active duty psychologist but now I'm glad I didn't, since I'm concerned it would be dismissed. I was considering taking that (along with my wife) to my C&P after I file my claim. (we see our VSO next week to start the claim process)

In hindsight I wish I had gone to the local vet center which my wife had urged me to do back then, but I was worried about a diagnosis somehow affecting my clearance (TS) which would harm my career. Now I want to get it on my record but it seems too late, and because I "dealt with it" on my own my therapist seems to be giving testimony against me. And now that I have a serious medical diagnosis I want to research it and understand it as much as possible, but that comes across as "obsessing" over it which is frustrating again.

This morning I had an unrelated appointment with my primary care provider and at that time just unloaded about feeling overwhelmed with everything we are dealing with. (my multiple medical issues, wife medical + pending surgery that stopped her heart before, career change, etc) It finally came to a head yesterday (before I even read my record) when I reached a point where the only way I relaxed was to just finally stop caring about anything, which is a dangerous road to go down. PCM agreed we are dealing with a lot, said she had noticed me deteriorating over several months, was very concerned and offered to hand me off to a psychologist, but then she called my psychologist and came back and said she was told it was "just an adjustment issue" and that there was nothing to be concerned about. So I feel blown off. I was offered an appointment with a behavioral health specialist which I took, just so I can go on record somehow. I was given a PHQ-9 and GAD-7 which I basically maxed out but don't know if they will take it seriously since I was in the psychologist's office yesterday answering similar questions with lower scores, because I try to present as trying to improve. But now I'm not sure how to effectively demonstrate that I am concerned about real issues.

I have asked my wife if she is willing to come with me to the BHOP appointment so she can report what she has observed and experienced and she is very willing. Beyond that I'm not sure what would turn this situation around. I feel like I went way off track in this therapy process and don't know how to get back on track now.

Sorry for the ranting, this is just very frustrating.

Edited August 8, 2018 by vet2018

[Buck52]

 This may or may not give you an answer to your questions, but it may give you some insight as to what you maybe up against.

You need to request a different therapist , just say the one you have now is ok but we just don't click....they will understand. and ask the therapist for a new evaluation for mental disorder's.

A VA Phy Doc  or qualified Dr can evaluate  you  even a LCSW S-3 or S-4 under the care of a qualified Dr can do the evaluation. 

You may have dealt with these issues back then but as time goes on those issues will arise again and again  this is why were encourage to seek therapy! 

You need to let them know how all of this has effected you and your family,  you don't have to go into detail as what you witness  ,you can say things like you witness death up close & you were in constant fear for your life,.ect,,,ect,,,

The VA MH People know that when a combat Veteran starts to go into detail about what he seen and witness (OVER THERE) they know it is nerve wracking and stressful for the veteran to discuss it and bring back these horrific memory's,  Rather You actually have PTSD , High Anxiety or Depression to Unspecific Mental Disorder.(THEY FIGURE IT OUT)

All you need to do is just state the facts, you can say things like some of the horrific things I witness (OVER THERE) was very upsetting at the time and give some of your symptoms and symptoms your wife has notice  like night mares/ night sweats  change in your behavior , your not the same man you was before you went (OVER THERE)

Never tell a therapist it don't effect you or your issues are rare.....this is very important stuff its serious and could and probably & will effect you the rest of your life.

Only the VA MH clinic Dr's can diagnose PTSD For rating purposes.

They VA needs to re-evaluate  you on the DSM-5 Criteria the VA Uses to access your symptoms & to give you the correct diagnose  to an unspecific mental  disorder?,  they can separate these  by asking you questions and see what your symptoms are and how many and the severity of them. they use a diagnostic manual to let them know how to diagnose you by your symptom's  so your Answers in the Evaluation is very  Important.   just be honest for your sake.

 The VA Rates PTSD By your symptoms 

Again Here is a list of the MH PTSD Ratings by symptoms

General Rating Formula for Mental Disorders

   Rating

Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.100%

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.70%

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.50%

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).30%

Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.10%

A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.0%

 

:Note  you can Rant all you want to , this is frustrating  you got that right  and if a Veteran didn't have PTSD before dealing with the VA He /She will get it......eh!

Good Luck my Friend.

 

 

 

Edited August 8, 2018 by Buck52

[broncovet]

You posted:

Quote

 I still however have feelings of guilt/etc (especially over one friend's death that I feel I could have done more to prevent but probably couldn't -- he was amputated waist down by an IED just outside our FOB -- first daisy-chain IED in eastern theater -- and I was on watch and initiated the response to get them back in safely) but do not have hypervigilance and flashbacks like I did back then. 

This sounds like a "stressor" to me, but then Im not a doctor.  You dont have to be standing next to a friend for it to qualify as a "stressor" for PTSD.  The "stressor" is another name for an "in service event".  Focus on your service connection if you are seeking benefits.  For therapy, I can not do this for you..you will need to seek healing and therapy from God, and from your doctors, so Im addressing your benefits only.  

To reiterate:

You need these 3 things for service connection.  Every thing else is noise:

1.  Current diagnosis.  Not a diagnosis in service.  A diagnosis by a doc now.  This does not have to be made (and usually is not) by your C and P doc.  Any doc.

2.  In service event.  This appears you have one, as you described it.  It has to be pretty scary to have a friend almost blown in half..even if you did not see it personally.  If you lose a loved one, you still feel pain..perhaps even more so..if you were not by their side at their death.  An in service event can not be documented by a doctor at VA who never served with you.  He can not say that he was there when your friend was amputated, as he simply does not know.  Sometimes you need buddy letters for this, but, surely you have this friends name and the VA should be able to verify that your friend suffered an IED explosion in or near your unit.  

3.  Nexus, or doctors statement that your PTSD (or other mental health disorder) is at least as likely as not due to this stressor in service.  

      Your diagnosis does not have to be PTSD.  It can be depression, or other diagnosis.  This diagnosis does not need to be made at a c and p exam.  Often the C and P examiner does not spend enough time with you to really make a diagnosis..he or she often relies upon the diagnosis of another mental health professional.  Are you prescribed any drugs on a daily bases, such as Prozac, Buprioprion, Atavan, and a whole host of others?  If you are taking any of these, it almost certainly means "A" doctor has diagnosed you with one or more mental health disorders, but, you do not always know this.  The doctor may or may not say, "I diagnose you with ........"   Instead, he says, take one of these pills a day and we will see how you feel."