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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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    • This is the latest Compensation & Pension (C&P) Clinicians Guide dated 20180719. The only other one I've seen is dated 2002, including the one on this website and the VA website. I got this from my claims agent, who got it from the VA.

      VA Compensation & Pension (C&P) Clinicians Guide 2 Final Corrected 20180719.pdf
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      Last month June 2020, we over 50k visitors they viewed over 160k pages. Veterans and their advocates, spouses, children, and friends of veterans come looking for answers. Because we have posts dating back 15 years and articles on the home page, they usually can find an answer or at least get pointed in the right direction.

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    • VA has a special where we can ask questions TODAY, at 3:00 to "people that matter?"  Someone should ask why we can not ask them questions EVERY day, why today only? (This is a big problem with VA..the 800 number often does not give specific answers).  We should have people in VA who "solve Vets problems" like Allison Hickey did a few years ago. 
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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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LightningFan75

Need Help with an unfavorable C&P for PTSD Secondary to MST

Question

I need some unofficial guidance with my claim for PTSD.  I think I have two uphill battles ahead...I just had my C&P and have received the notes from the exam.  The doctor has completely discounted that the event happened, much less any secondary markers, attributing my trauma to a childhood incident.  His notes contradict themselves on multiple occasions.  He states that I denied any history of alcohol abuse, yet states later in the exam that I disclosed that I started abusing alcohol after the incident.  He also discounted and falsely reported several facts surrounding my time in the service.  He stated I was never in combat, never had foreign service or received any combat medals and to view my DD-214 for more information, yet my DD-214 shows multiple combat medals, foreign service and he his report lists my service dates where i received combat pay and hostile Fire/Imminent Danger pay.

His notes are mostly snippets copied and pasted from my past appointments that support his denial, but he leaves out all of the relevant parts of my session.

He never looked me in the eyes and stared at his clip board the entire time

He said I started therapy after I lost my job and that I lost my job in April, when in fact I was therapy months before I lost my job which was 7/16.  I told him all of this and he reported it wrong.

He also put down: 

On the SIMs, a measure of symptom validity, the score of 37 indicated significant symptom exaggeration/over reporting.

On a PTSD symptom validity screen, the score of 25 indicated significant symptom exaggeration/over reporting.

Basically he's calling into question my integrity and makes no reference to my MH sessions with my provider, who never once questions my honesty in our sessions.

My test scores from my MH sessions are:

PHQ-9 (Depression): 23

PHQ-9 was administered and score indicates severe depression.

(RANGES: 0-4 Minimal; 5-9 Mild; 10-14 Moderate; 15-19 Moderately severe;

20-27 Severe)

GAD-7 (Anxiety): 19

GAD-7 was administered and score indicates severe anxiety. (RANGES: 0-4 Minimal; 5-9 Mild; 10-14 Moderate; 15-21 Severe)

PCL-5 (Posttraumatic distress): 64 (very severe symptoms reported)

PCL-5 was administered and the score is > or equal to cutoff score of 33 and may be consistent with a diagnosis of PTSD..

 

That leads me to my next issue...my MH provider continually throws out the term PTSD in our sessions, has started me on a treatment plan that consists of BOTH MST and PTSD therapy and yet WILL NOT put PTSD as a diagnosis.  Instead I'm diagnosed with:

DIAGNOSES (per chart):

Major depressive disorder, single episode, moderate

Anxiety disorder, unspecified

 

On top of that my VA psychiatrist put contradicting statements in my last exam:

DIAGNOSIS:

Mental Health Diagnoses and Relevant Medical Conditions:

Unspecified Trauma-Stressor-related Disorder r/o PTSD

Significant Psychosocial and Contextual Factors: MST (Sexual assault)

CASE FORMULATION AND RESPONSE TO TREATMENT:

35 y/o female veteran with anxiety, depressive Sx's and significant

clinical

distress since index trauma, in 2011. High suspicion for PTSD. No prior MH treatment.

 

So he in essence ruled out PTSD and then stated he had a high suspicion for PTSD.

 

I apologize that these thoughts may seem all over the place, but my treatment notes are a mess and the C&P examiner added 112 pages to it with mostly copy and paste, so it's hard for me to make sense of and I'm very hesitant to upload personal information.  I just don't know what to do when MH provider says I have PTSD from MST, puts me in treatment but won't diagnose me, and then a C&P appointment with a doctor who acted like he had better things to do and went mostly off my test scores and didn't really listen to a word i said since his notes are riddled with inaccuracies.

 

 

 

 

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Remember, under VA Policy you are not locked in to PTSD.  You can receive the same ratings for Depression as you do for PTSD.

With MH issues it is the impact of the issue on your Life.  Not the "name" of the issue.  The VA should (yea I know...) automatically rate for any other MH issue that is diagnosed other than PTSD as part of the same claim.

So your current therapist records are viable no mater what the diagnosis is.  As long as the records document the impact on work and lifestyle you should be fine.

 

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Since my last post I think I've pretty much become persona non grata to the entire Orlando MH staff with the exception of my PTSD therapist who has been purposely remaining out of it in order to keep treating me with objectivity, which I can appreciate.  The chief of MH and the AO's no longer return my calls and the MST coordinator is vehemently sticking to the story of "the VA does NOT write nexus letters".  My primary provider went so far as to state that since I didn't report the incident that there is nothing in my record to prove that it happened so he can't give an opinion.  He stopped responding when I reminded him that his job was to help me and that the VA mandated that statements from someone you served with backing up the events and witnessing changes in behavior, etc. are as good as reporting and should be counted as such.  He stopped responding to my messages.  At this point I'm honestly ready to call the IG and let them explain why they're causing they're veterans anxiety and demeaning them when they ask for help.

 

The bright spot in this is that I started my prolonged exposure on Thursday and even though it was just informational to begin with, the notes were uploaded to MHV and it looks like my PTSD doc dropped the r\o and may have inadvertently given connection?  Below is the excerpt...can I upload this and use it as evidence of diagnosis and SC along with my buddy letter?

VA Notes
Source: VA
Last Updated: 04 Nov 2019 @ 0707

 

Sorted By: Date/Time (Descending)
 

VA Notes from January 1, 2013 forward are available 3 calendar days after they have been completed
and signed by all required members of your VA health care team. If you have any questions about your
information please visit the FAQs or contact your VA health care team.

 

Date/Time: 31 Oct 2019 @ 1425
 

Note Title: MH PSYCHOTHERAPY NOTE
Location: ORLANDO VAMC
Signed By:
Co-signed By:
Date/Time Signed: 31 Oct 2019 @ 1540

 

Note
LOCAL TITLE: MH PSYCHOTHERAPY NOTE
STANDARD TITLE: MENTAL HEALTH NOTE
DATE OF NOTE: OCT 31, 2019@14:25 ENTRY DATE: OCT 31, 2019@14:25:19
AUTHOR: 
EXP COSIGNER:
URGENCY:

STATUS: COMPLETED
 

PROLONGED EXPOSURE: INITIAL SESSION
Time in session (in minutes): 70
Session Number: 1
SESSION FORMAT
Face-to-face session

 

SESSION LOCATION
PTSD clinical team
DIAGNOSIS:
Primary (focus of treatment): Unspecified Trauma-Related Disorder

 

Assessment:
PCL-5
A PCL-5 was performed and was positive. The score was 64.
PHQ-9
A PHQ-9 screen was performed. The score was 18 which is suggestive of
moderately severe depression.

 

SESSION CONTENT

Veteran completed session 1 of Prolonged Exposure therapy for PTSD. The
following occurred during the session:
Facilitated a good therapeutic relationship.
Provided psychoeducation and introduced PE treatment for PTSD to
Veteran, including:
-Information about PE as a treatment option.
The following information was given:
-Readiness to engage in treatment.
-Addressing Veteran's questions or concerns about treatment.
Veteran expressed the following concerns: Veteran discussed fear associated
with imaginal exposures. Her fears were validated and discussed within the
context of the rationale for treatment.
Presented treatment rationale, focusing on describing factors that
maintain trauma-related fears and symptoms (i.e., avoidance and
unhelpful thoughts and beliefs). Also, described key therapeutic
elements of PE: imaginal and in-vivo exposure procedures. Veteran's
response to rationale involved: The Veteran was able to discuss
acknowledgement of the rationale for treatment.

 

INDEX TRAUMA to be addressed in PE is related to:
MST
Sexual assault while in the military

 

HOMEWORK
Veteran is to complete the following practice items between sessions:
Listen to audiotape of therapy session one time.
Read "Rationale for Treatment" handout and note questions.

 

PLAN
Next session planned for agreed upon date/time of: November 5, 2019
****************************************

 

PAIN SCREEN:
Veteran reports:
Significant pain or changes in pain.
Pain level reported = 5, on 0-10 scale with 0 indicating no pain
and 10 most pain imaginable.
Location(s): Back, wrist, shoulder.

 

Veteran receiving treatment for pain: Yes

 

 

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On 10/23/2019 at 10:54 AM, SameOldSong said:

I found a link to a snippet that might be of interest on the "r/o PTSD" commentary:

https://www.mentalhelp.net/ptsd/why-the-va-doesn-t-want-to-diagnose-iraq-war-veterans-ptsd/

It discusses the refusal to put PTSD on medical records in the Veterans Health system.

 

I think that's the email referenced in an IG report I read....where of course they found no evidence that the providers heeded the "suggestion".  However that article is my story almost verbatim...my MH primary even told my they didn't have time to diagnose PTSD. 

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On 10/23/2019 at 11:30 AM, Hyrb said:

Remember, under VA Policy you are not locked in to PTSD.  You can receive the same ratings for Depression as you do for PTSD.

With MH issues it is the impact of the issue on your Life.  Not the "name" of the issue.  The VA should (yea I know...) automatically rate for any other MH issue that is diagnosed other than PTSD as part of the same claim.

So your current therapist records are viable no mater what the diagnosis is.  As long as the records document the impact on work and lifestyle you should be fine.

 

While that's true, my C&P examiner was clever enough to tie EVERY....SINGLE...Mental diagnosis I have to childhood trauma, negating service connection for all of it.  So one doctor, who never served, who I had never met before and talked to for 90 minutes and never looked me in the eyes, falsifying ALL of what I said, took away all of my SC issues with one stroke of the keyboard.  While I did write a scathing letter of impeachment, I have yet to hear whether it was received or if the appointment is still being used in my claim.  My file is flagged for hardship but they're still dragging their feet.  I have a claim in for IU as well, but they sent a request back to my outside examiner for migraines for clarification on Oct 2nd and still haven't received a response.  He's 12 days past his deadline and they've put no pressure on him to close it out.  They just don't care...I feel like as long as you're not suicidal they get to check off a box and move on.  Yet they don't see that what they're doing is causing veterans to lose everything and BECOME suicidal.  It's all about reacting and putting out fires instead of preventing it from happening.  I'm just fortunate I have a husband who loves me and would do anything to make sure I'm ok...and 2 dumb dogs that are natural service dogs, who can sense my panic attacks well before they hit me.

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  • Our picks

    • This is the latest Compensation & Pension (C&P) Clinicians Guide dated 20180719. The only other one I've seen is dated 2002, including the one on this website and the VA website. I got this from my claims agent, who got it from the VA.

      VA Compensation & Pension (C&P) Clinicians Guide 2 Final Corrected 20180719.pdf
      • 5 replies
    • I don’t say thank you enough to all of you...
      You, yes you, are the reason HadIt.com has remained a resource-rich resource. Thousands come each month to read, ask questions, or to feel a sense of community.

      Last month June 2020, we over 50k visitors they viewed over 160k pages. Veterans and their advocates, spouses, children, and friends of veterans come looking for answers. Because we have posts dating back 15 years and articles on the home page, they usually can find an answer or at least get pointed in the right direction.

      You all made that possible. Thank you.
        • Like
      • 3 replies
    • Help HadIt.com stay online buy a subscription
      If you can afford it and want to help hadit.com consider buying a subscription this gives you as free viewing of the site and allows me to budget in subscription payments.
       

      You can try it for 1 month for $5 or get a monthly subscription or a yearly subscription.

      Subscribe here https://community.hadit.com/subscriptions/
      • 1 reply
    • VA has a special where we can ask questions TODAY, at 3:00 to "people that matter?"  Someone should ask why we can not ask them questions EVERY day, why today only? (This is a big problem with VA..the 800 number often does not give specific answers).  We should have people in VA who "solve Vets problems" like Allison Hickey did a few years ago. 
        • Like
      • 8 replies
    • 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)
        • Like
      • 9 replies
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