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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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    • The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



      Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.



      Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.



      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



      At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.



      NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.



      ------



      Example for 2020 using the same disability rating



      1998 - Initially Service Connected @ 10%



      RESULT: Service Connection Protected in 2008



      RESULT: 10% Protected from reduction in 2018 (20 years)



      2020 - Service Connection Increased @ 30%



      RESULT: 30% is Protected from reduction in 2040 (20 years)
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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.

      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.
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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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I have submitted my NOD and I am in touch with a representative from DAV who is assisting me in obtaining a IMO. 

I requested a DRO review on my NOD.  I am waiting to see what happens. I'm sure it will be a long process. 

 

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Throw everything at them and something will stick.

The balance of the examiners denial is in equipoise. The exam states that these conditions exist, that others also exist, and that it cannot be determined if any of them contributed to PTSD, but she did certify that you have PTSD via MST, not in dispute. Also not in dispute or even addressed in if the MST in service even aggravated a pre-existing condition, if it existed. Did you give them anything on previous sexual assaults or harassment before you joined? They MUST have reasonable facts to go by, not just speculation by the examiner that you have gone through sexual trauma before the MST.


To me, that is equipoise, and you should get the benefit of the doubt. Ramp, reconsideration. Write your lay statement to claim this as equipoise. Every other thing is still in reserve, including the competency of the examiner. Do the easy part first. The examiner does not make claim decisions, the RO does that. If they goof, and they do very often, you get BS results. This is one of the BS results.

 

also...

 

go back through your VA MH records with a fine tooth comb. Look at what the Psych notes say, and if the psych you are seeing has made notes on MST causes in your file. ... That would give you ammo to push this over the mark.

Edited by pwrslm

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I did not have any previous assaults.  I will go back and look through my records but I can't think of anything. 

 

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So it has been a while since I have responded to this post, was waiting to hear back from VA.  Sent for a higher level review and was ultimately denied.  I will submit my claim for appeal to the BVA.  Just getting my thoughts together. 

 

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I am sorry that you are going through this but please don't give up. VA in their ways deny veterans for little or no reason at all because they know some veterans won't appeal or wait too long to appeal then the veteran has to re-open his/her claim and start all over again.

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    • The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



      Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.



      Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.



      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



      At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.



      NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.



      ------



      Example for 2020 using the same disability rating



      1998 - Initially Service Connected @ 10%



      RESULT: Service Connection Protected in 2008



      RESULT: 10% Protected from reduction in 2018 (20 years)



      2020 - Service Connection Increased @ 30%



      RESULT: 30% is Protected from reduction in 2040 (20 years)
      • 4 replies
    • Wonderful news way to hang in. I hope this gives you some well deserved peace. 
    • If HadIt.com has helped you or you believe in it’s mission then please donate even $1 helps. I hope HadIt.com has provided $1’s worth of help to you. Imagine waking up and there is no HadIt.com it could happen and that is why I’m asking for your help now.



       



      Our traffic is going up and so are our expenses, however revenues have gone down and so I am reaching out to you to see if you can help me keep Hadit.com up and running.
      • 4 replies
    • 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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