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      Examples:

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



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      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?



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finajones

MST C&P exam contradictory

Question

I recently had my c&p for mst ptsd.  The c&p examiner diagnosed me with ptsd.  The stressor was MST.  Her opinion on the DQB form was MST.  

However, she wrote that she couldn't say without speculation if my stressor contributed to my diagnosis.  The rater sent the exam back to her for clarification saying that she said on the DBQ that attributed my ptsd diagnosis with the MST but her written opinion said something different.  She responded and stated the same thing that she couldn't say without speculating that the stressor caused the ptsd.   

What do I make of this?  

 1. Diagnostic Summary  

   Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria    based on today's evaluation?    [X] Yes   [ ] No           ICD code:  F43.10        

  2. Current Diagnoses      a. Mental Disorder Diagnosis #1: PTSD           ICD code: F43.10
    b. Medical diagnoses relevant to the understanding or management of the       mental health disorder (to include TBI): none identified
    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   [ ] No   [X] 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] Occupational and social impairment with reduced reliability and productivity
    b. For the indicated occupational and social impairment, is it possible to       differentiate which impairment is caused by each mental disorder?       [ ] Yes   [ ] No   [X] Not Applicable (N/A)           c. If a diagnosis of TBI exists, is it possible to differentiate which       occupational and social impairment indicated above is caused by the TBI?       [ ] Yes   [ ] No   [X] Not Applicable (N/A) 

              SECTION II:        

Clinical Findings:  

1. Evidence Review    Evidence reviewed (check all that apply):        [X] VA e-folder    [X] CPRS
 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: Veteran repors verbal harrassment at her unit from 2004-2006   and being sexually assaulted in 2006          
          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                        If no, explain:                reported MST 

    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.                
 4. PTSD Diagnostic Criteria   

Note: Please check criteria used for establishing the current PTSD diagnosis.    Do NOT mark symptoms below that are clearly not attributable to the Criterion
 A stressor/PTSD.  Instead, overlapping symptoms clearly attributable to other    things should be noted under #7 - Other symptoms.  The diagnostic criteria    for PTSD, referred to as Criterion A-H, are from the Diagnostic and    Statistical Manual of Mental Disorders, 5th edition (DSM-5). 

Criterion (A) Exposure to actual or threatened a) death, b) serious injury,    c) sexual violence, in one or more of the following ways:  

                                    [X] Directly experiencing the traumatic event(s)

Criterion (B) Presence of (one or more) of the following intrusion symptoms  associated with the traumatic event(s), beginning after the  traumatic event(s) occurred:                                       [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).                   [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).    [X] Intense or prolonged psychological distress at exposure to  internal or external cues that symbolize or resemble an   aspect of the traumatic event(s).

 Criterion (C) Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred,  as evidenced by one or both of the following:                         [X] Avoidance of or efforts to avoid external reminders  (people, places, conversations, activities, objects,  situations) that arouse distressing memories, thoughts, or                       feelings about or closely associated with the traumatic  event(s).
Criterion (D) Negative alterations in cognitions and mood associated with  the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of  the following:

[X] Persistent, distorted cognitions about the cause or   consequences of the traumatic event(s) that lead the  individual to blame himself/herself or others.   [X] Markedly diminished interest or participation in  significant activities.   [X] Feelings of detachment or estrangement from others.

Criterion (E) Marked alterations in arousal and reactivity associated with  the traumatic event(s), beginning or worsening after the  traumatic event(s) occurred, as evidenced by two (or more) of  the following:   [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance.   [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

Criterion (F)                          [X] Duration of the disturbance (Criteria B, C, D, and E) is  more than 1 month.
Criterion (G)                          [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important  areas of functioning. Criterion (H)      

[X] The disturbance is not attributable to the physiological                       effects of a substance (e.g., medication, alcohol) or                       another medical condition.
Criterion (I)  Which stressor(s) contributed to the Veteran's PTSD  diagnosis?:    [X] Stressor #1
5. Symptoms    ----------    For VA rating purposes, check all symptoms that actively apply to the 

 [X] Depressed mood       [X] Anxiety       [X] Suspiciousness       [X] Panic attacks that occur weekly or less often       [X] Chronic sleep impairment       [X] Disturbances of motivation and mood       [X] Difficulty in establishing and maintaining effective work and social           relationships

 The following contentions need to be examined:       post traumatic stress disorder (PTSD) personal trauma - mental disorders        (related to: PTSD - personal trauma)
       DBQ PSYCH PTSD Initial:
       Please review the Veteran's electronic folder in VBMS and state that it       was        reviewed in your report.
       MEDICAL OPINION REQUEST
       TYPE OF MEDICAL OPINION REQUESTED: Military Sexual Trauma (MST)
       OPINION: Military Sexual Trauma (MST)
 

What the rater sent back to the examiner:

  Please return the exam to the examiner as on the exam she attributed the PTSD diagnosis to the Veterans MST and then in the separate opinion said     differently. Please have the examiner provide an opinion as to whether the     current PTSD diagnosis is at least as likely as not (50 percent or greater     probability) caused by or a result of the in-service MST-related marker(s),     and provide a rationale. Please note that only PTSD can be service connected based on circumstantial marker evidence    *****************************************************************************    *************

What the examiner wrote back:

Veteran's Service Treatment Records document the presence of events that VBA    has identifiend as potential markers for MST prior to the reported incident    as well as following the reported incident. Writer is unable to opine without    resorting to speculation if Veteran's diagnosis of PTSD is at least as likely    as not caused by or a result of the in-service MST-related marker.
    Determining if a MST stressor occurred is a legal issue not a clinical issue.    Writer is not qualified to opine if a specific marker is sufficient evidence    to support a claim of MST or if the absence of a marker is sufficient    evidence to dispute the claim of MST.
 

 

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 Looks like a 70% rating.. just my opinion.

This C&P Examiner can speculate  rather or MST caused/related to your MST PTSD.  with these 4 words

''IS LEAST LIKELY AS NOT''

Make sure this examiner is qualified  to do a PTSD  MST C&P Exam.

Quote from Attorney Chris Attig

'' A medical examiner who states “no conclusion as to etiology or diagnosis can be reached without resorting to speculation” may be obligated to research medical literature; his/her conclusions as to service connection must reflect the limitations of knowledge in the medical community at large and not those of a particular examiner or doctor''

Read what Veteran Attorney  Chris Attig mentions about Speculation  from C&P Examiners

https://www.veteranslawblog.org/veterans-disability-benefits-service-connection-cannot-be-determined-without-resort-to-speculation/

 

Edited by Buck52

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Thanks for the link.  I think she was qualified, she is a VA psychologist and seems to have a lot of training in this area.  I guess I'm just confused by the diagnosis and then the opinion.  Doesn't make a lot of sense to me how are the raters supposed to make a decision when their examiner couldn't.  

 

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Usually if you get a decent rater  one that will read your records and evidence  and this shows to be favorable to you  to make a decision   he will ,  if not then usually he will send it back to the examiner for clarification  and you may get another C&P hopefully with a different examiner.  it is what the rater decides if this examiner don't redo or do as the rater ask  or just deny the claim from lack of information on the examiners part.  if this happens  SEND IN YOUR NOD ASAP. if you have a MST PTSD Diagnose from the VA then you may want to get an IMO/IME from an qualified  Dr opinion.favorable to you.about your condition.

jmo

 

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I will have to wait and see as my claim is pending decision approval.  It has moved quickly since my exam.  I appreciate the information.

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So I got my envelope last night in the mail and my claim was denied.  The reason for denial is that the doctor couldn't opine without resorting to mere speculation.  Does anyone have any advice?  

I'm not sure how she came to that opinion when according to her exam, she diagnosed PTSD and related it to the stressor which was MST.  Doesn't make sense to me.  

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    • https://community.hadit.com/searching-for-va-claims-information-on-hadit.com/

       

      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
      • 3 replies
    • 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.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      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.
      • 2 replies
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      • 7 replies
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