How to win 100 P&T for PTSD_MST

[ndy856]

Currently has 70% for PTSD (90% combine with others) but recently put in for 100 (P&T) increase on the PTSD via a claim agent. Are there any lay statement samples out there for a co-worker and spouse to follow? and will another C&P be ordered when the previous one for 70% was only 14 months ago? That exam didn't have the whole picture becasue I was holding back a lot due to fear of being taken away, the examiner made me feel very uncomfortable about the MST, so the goal now is to get to P&T so there will be no more future exams.

Edited June 11, 2019 by ndy856
Need to provide more details

[broncovet]

If you are seeking an "increase" in your mental health ratings, lay statements wont be of use to you.  You already have all 3 Caluza elements (or you would not have gotten your rating).   A doctor will have to document your increase in symptoms, lay evidence will not suffice to get you increased.  Lay evidence is good to document an "in service event", but not to document symptoms, unless of course, say your wife goes with you to the doc and tells the doc of your symptoms.  This only makes sense if you had witheld information from your doctor.  

To get an increase, you have to show your symptoms got worse, since your C and P exam which awarded 70 percent.  

100 percent ratings for mental health disorders should document you have "total social and occupational impairment".  

This means you are probably unable to work due to SC conditions, and, probably have social issues as well.  You can compare YOUR symptoms to those in the criteria.  In no circumstances would you ever want to exaggerate symptoms, but instead report them honestly.  Va has a way of finding out if/when you are "malingering" (exaggerating your symptoms to get benefits.)   VA can/does make reductions, if your doctor reports your conditions have had "actual improvement" under ordinary conditions of life.  Now, if you have a temporary rating, or under 5 years, the critieria for reductions is not as strict for VA:

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

 

Here is the criteria:

38 CFR 4.130:

Edited May 26, 2019 by broncovet

[GeekySquid]

On 5/26/2019 at 1:08 PM, ndy856 said:

Are there any lay statement samples out there for a co-worker and spouse to follow?

 

I wanted to chime in here because Broncovet's statement is not completely correct concerning lay evidence or at least evidence not in the custody of the VA.

For example if you have been reprimanded at work for behavior related to  your PTSD, showing that to the doc is lay evidence. IF there have been police calls to your home, that is lay evidence. Statements from your spouse, relative, roommate that your night terrors are getting more frequent is lay evidence.

All of them are supporting information that you would submit if you ASKED for an increase, so giving them to the C&P doctor is okay to do. How they affect what the Dr writes is a different conversation.

On 5/26/2019 at 1:08 PM, ndy856 said:

and will another C&P be ordered when the previous one for 70% was only 14 months ago?

If you feel your condition has deteriorated in that time and provide supporting evidence, those lay statements or police reports, the VA will determine if an exam is needed. That said, there is a specific PTSD Review Exam DBQ. Its on line with the rest of them

Buddy statements do have a specific form they want. It is online

They have to be HONEST!!! getting friends to exaggerate what they see is not going to help you and can get you in trouble. you don't seem to have a protected rating so it is much easier for the VA to change its mind.

They need to be written like person writes, not like a fill in the blank template.

they have to be first person, "I saw him do whatever".

They have to be kind of detailed. Saying " I saw bob and he was anxious" won't cut it. "It took me 3 hours to calm bob down and make him realize there were no incoming mortar rounds" is more to the point.  "joe gets angry at work", not much value there. "joe shouts, screams and throws office furniture when a customer pisses him off" is much stronger.

Broncovet is correct that you have to tell the doctor the truthful answers and tell them what is going on, but yes you can upload buddy statements since you requested the increase and yes you can hand them to the Dr when you get there. But you do need to upload them to get them associated to your claims file to make sure the rater sees them. The Dr. might not upload them with their report.

 

 

[broncovet]

Your symptoms need to be documented by a doctor.  Diagnosis and treatment need to be done by a doctor.  

There are many cases regarding "lay evidence".  Veterans get denied when they expect "lay evidence" to over rule that made by a doctor.  

Lay evidence (such as buddy letters) work great to document things like an in service event.  But laypersons are not competent to diagnose, treat, or document your symptoms.  For example, laypersons can not document your sympots are PTSD, depression, or if you are just having a bad day.  Counting on "buddy letters" to document symptoms or to diagnose will almost always lead to frustration.  You could hand those buddy letters to a doctor and he may decide to include information in buddy letters to document your conditions and the doctors statements can make buddy letters probative.  

We have had many Veterans exclaim, "That doc exam was wrong."  

An expectation this veterans statement (lay evidence) will overrule a defective exam wont suffice.  

You need to get medical evidence to refute medical evidence.  

[ndy856]

5 minutes ago, broncovet said:

@broncovet  Hi, so because i'm already at 70%, the service connection will no longer be needed but the claim now have to prove on the worsen of the  symptoms. Is this correct? and the only person who can judge my symptoms are doctors?

 

Edited June 10, 2019 by ndy856
tag in Bron

[broncovet]

So, in your example, if Joe writes a letter that "Adam got mad at work started throwing things and the police were called", that letter may be cited by the doctor as "anger outbursts due to PTSD".  

But, it does not document symptoms of PTSD until/unless your doctor documents it.  

Your buddies are not competent to opine your temper tantrum at work was a symptom of SC PTSD.  

It could also mean other things..you were intoxicated, you were high, or you just had anger issues.  

But, if the doc says your behavior at work was a symptom of your PTSD, that would be probative.  

Laypersons are not competent to document symptoms or to diagnose a disease.  

[broncovet]

Ndy856

   Once service connected, you remain SC until such time that VA sends you a decision letter that you are no longer sc.  

   If you are applying for an increase in SC (that your symptoms got worse), then no, you need not "redocument" your caluza elements.  You need only show your symptoms worsened by a doctors statement that your conditions got worse. 

   The Veterans lay evidence that his symptoms of ptsd got worse are insufficient evidence; a doctor again has to determine if the symptoms you report are related to PTSd or something else, and document them as PTSD symptom increase.