Mental health claim denied via raters opinion. AMA attached

[FlyboyLeRoy]

Mental health claim denied even with a private dbq/nexus & c&p exam nexus/dbq that are both favorable and agreed upon diagnoses. Attached is my appeal for higher level review. How does it look to you?

[El Train]

I didn't have any luck with my HLR.  Doesn't mean you won't.  I too had overwhelming evidence and nexus from a forensic MD familiar with VA lingo.  Still denied.  I can easily win in an NOD.  But why should I have to go this route?  Because the rater wants me to go this route in hopes we give up.  Some of them are also lazy and rubber stamp it.  So be prepared for this.

I got approved the first time for PTSD because I had a VA Psyc diagnose me.  Also had some VA mental treatment history.  I had two stressors I told the VA C&P guy.  None backed up with buddy statements.  However I'm sure they were part of DOD records and corroborated with my service records. 

I applied for an increase with outside Dr's IME/DBQ.  The VA did not like this approach at all.  But in the end, I won on all mental and tbi conditions.  They don't make it easy.  I get it however.  There are a few bad apples out there trying to take advantage of benefits that ruin it for people that legitimately need it.  Keep up the fight and maybe go to VA mental health if you haven't.  They are pretty good actually.

[awgv001]

18 minutes ago, El Train said:

I got approved the first time for PTSD because I had a VA Psyc diagnose me.  Also had some VA mental treatment history.  I had two stressors I told the VA C&P guy.  None backed up with buddy statements.  However I'm sure they were part of DOD records and corroborated with my service records.

Just wanted to note that it is REQUIRED that you be Dx'd by a VA psych or other equivalent (LCSW for ex). They won't accept a diagnosis from private.

[FlyboyLeRoy]

1 hour ago, El Train said:

I didn't have any luck with my HLR.  Doesn't mean you won't.  I too had overwhelming evidence and nexus from a forensic MD familiar with VA lingo.  Still denied.  I can easily win in an NOD.  But why should I have to go this route?  Because the rater wants me to go this route in hopes we give up.  Some of them are also lazy and rubber stamp it.  So be prepared for this.

I got approved the first time for PTSD because I had a VA Psyc diagnose me.  Also had some VA mental treatment history.  I had two stressors I told the VA C&P guy.  None backed up with buddy statements.  However I'm sure they were part of DOD records and corroborated with my service records. 

I applied for an increase with outside Dr's IME/DBQ.  The VA did not like this approach at all.  But in the end, I won on all mental and tbi conditions.  They don't make it easy.  I get it however.  There are a few bad apples out there trying to take advantage of benefits that ruin it for people that legitimately need it.  Keep up the fight and maybe go to VA mental health if you haven't.  They are pretty good actually.

Good to know, thanks. I didn't have a VA diagnosis initially, but after my initial claim is when i had my VA exam which also agreed with the other two nexus/dbqs.

1 hour ago, awgv001 said:

Just wanted to note that it is REQUIRED that you be Dx'd by a VA psych or other equivalent (LCSW for ex). They won't accept a diagnosis from private.

Initially I did not have a VA pysch appointment: however, after this claim and before my appeal I did have a va pysch appointment which stated the same as my other 2 dbqs/nexuses. 

[broncovet]

Ok, I read as much of this as I could see.  My advice:

     1.  Appeal this denial to the BVA, (file a nod).  Yes, you have to have a diagnosis of PTSD BY A VA DOC, not a private physician, altho, that policy could be challenged in court if this gets to the CAVC.  Its my opinion that the requirement (which isnt in the regulations IM aware of) of a diagnosis "by a VA doc", is arbritrary and capricious.  VA docs are often trained in private practice, and private practice docs are often trained at VA.  So, it makes no sense at all, that they require a PTSD diagnosis be done BY A VA doc.  

     2.  You said something about buddy letters to veryify stressor.  Now that is a big deal.  Were those buddy letters "in evidence section" of the decision?  VA LOOOOVES to lose key critical evidence at every opportunity.  If they are not in the evidence section, then, your appeal should to the board should be "with new evidence" and submit those buddy letters confirming the stressor to the Board, with your appeal.  Dont count on the VA to forward those buddy letters.  That is the key for them to deny you.  

     3.  Combat.  If you were in a combat zone, then PTSD is pretty much presumed for combat Vets.  You almost had to be either a witness to horrific war events, or maybe lost a buddy.  You dont have to be with that buddy when he died for it to cause PTSD.  Its sort of like when if your parents or your spouse died, you would have to be WITH THEM when they died to grieve.   This isnt true.  Your grief may be worse if you werent with them when they died, becaue you feel guilty you were not there.    Since combat is often chaos, the standards for docuemtation of a stressor in combat are reduced.  Read this about VA's duties for combat vets and stressors:  https://www.bva.va.gov/docs/VLR_VOL1/vlr1finn.pdf

    

 

[Berta]

I am confused by this------you said you had no additional evidence, in the HLR statement,  but did they acknowledge the buddy statement , in the Evidence list, dated October 19th in the denial and then give a reason they rejected it?

Do you have proof of mailing the Buddy statement or putting it on ebenefits?

Broncovet is concerned as well on the buddy statement.

Buddy statements must include proof buddy served in your unit same time, same place and contain a detailed eye witness account of the stressor.

If the buddy gets SC comp for the same stressor they should tell VA that----a group of vets my daughter helped,were given copies of one vet's actual PTSD award based on the same stressor, in additional to this vets detailed buddy statement. ame unit, same time and place .

They all got proper ratings and also they all got more awards- one got the Distinguished Flying Cross.

I told that all before. My daughter, a vet, is fluent in Vietnamese.That fact was the key to their awards, from VA, and DOD,  as well as from the Vietnamese Government.

 

Did the Buddy give the VA their contact #? Did the VA call them to confirm what they wrote?

Did they sign an oath and get their signature notarized ?

If it was on a 21-4138 the oath is there no need for notarized signature- but I feel VA passes over 21-4138s as it is and might not have realized it was a buddy statement.

 

[FlyboyLeRoy]

1 hour ago, Berta said:

I am confused by this------you said you had no additional evidence, in the HLR statement,  but did they acknowledge the buddy statement , in the Evidence list, dated October 19th in the denial and then give a reason they rejected it?

Do you have proof of mailing the Buddy statement or putting it on ebenefits?

Broncovet is concerned as well on the buddy statement.

Buddy statements must include proof buddy served in your unit same time, same place and contain a detailed eye witness account of the stressor.

If the buddy gets SC comp for the same stressor they should tell VA that----a group of vets my daughter helped,were given copies of one vet's actual PTSD award based on the same stressor, in additional to this vets detailed buddy statement. ame unit, same time and place .

They all got proper ratings and also they all got more awards- one got the Distinguished Flying Cross.

I told that all before. My daughter, a vet, is fluent in Vietnamese.That fact was the key to their awards, from VA, and DOD,  as well as from the Vietnamese Government.

 

Did the Buddy give the VA their contact #? Did the VA call them to confirm what they wrote?

Did they sign an oath and get their signature notarized ?

If it was on a 21-4138 the oath is there no need for notarized signature- but I feel VA passes over 21-4138s as it is and might not have realized it was a buddy statement.

 

There was a buddy statement and it’s included in the evidence attached. With all contact info and a clear description of issues and all needed in service. However, this rater states a cp exam wasn’t warranted even with a credible letter, therefor my Claim is denied.  Makes no sense and goes against all of their laws.