Letter From Md On Service Illness

[john6012]

A doctor I knew while in the military sent me a letter that states, "I had a degree of inappropriateness and lack of professional decorum, experiencing paranoid ideation and emotional upheavel ranging from joyfullness and elation to dispair accompanied by uncontrollable weeping at work and at home. It is my professional opinion that the individual has a long-standing history of somewhat debilitating clinical depression, manifested by a degree of paranoid ideation and bipolar features with significant mood fluctuations which interferred with his job performance. Unfortunately, due to the intense work atmosphere, the individual was neither identified as being impaired, nor was he properly treated for symptoms of his disorder. As a result, his judgement was degraded at times he was required to perform effectively in a highly important and taxing position. There is no doubt in my mind that the work environment contributed adversely to the individual's psychological condition.

In retrospect, I render the following minimal diagnosis: Clinical depression with paranoid and bipolar features.

I sent the letter to the regiuonal VA office with a short cover letter indicating I would like to reopen my rating file. My question is, is the letter adequate for them to take action and what would be the potential outcome? Do I need to take a letter to the C&P exam and hand it to the examiner? Thanks in advance, John

[john6012]

I have the letter from the MD who personally witnessed what occurred during my military service; however there is no letterhead on the comments--but his SSAN is there and he is a retired 0-6. I have his letter and am compiling letters from others. I drove to Little Rock AFB this past weekend to see an old friend who was also aware of what occurred and left the VA form (and suggested comments) with him to fill out. And, confiscated a Little Rock phone directory and found a slew of old military friends! I think when I finish I'll have letters from two MDs and probably 3-4 letters from senior NCO's. I don't care much for the VA form that I filled out "this is a true staqtement to the best of my knowlege and belief. I wrote in the comment that this is a true and factual statement and not a comment of my best knowledge and belief. I am proceeding to file the claim ebcause I know I'm right. It may be uphill but sooner or later I reach the top and coast down the other side. Also, I sought psychological help during a period of depression in 1994, nine years after my military separation - if that will be of any benefit.

I have the letter from the MD who personally witnessed what occurred during my military service; however there is no letterhead on the comments--but his SSAN is there and he is a retired 0-6. I have his letter and am compiling letters from others. I drove to Little Rock AFB this past weekend to see an old friend who was also aware of what occurred and left the VA form (and suggested comments) with him to fill out. And, confiscated a Little Rock phone directory and found a slew of old military friends! I think when I finish I'll have letters from two MDs and probably 3-4 letters from senior NCO's. I don't care much for the VA form that I filled out "this is a true staqtement to the best of my knowlege and belief. I wrote in the comment that this is a true and factual statement and not a comment of my best knowledge and belief. I am proceeding to file the claim ebcause I know I'm right. It may be uphill but sooner or later I reach the top and coast down the other side. Also, I sought psychological help during a period of depression in 1994, nine years after my military separation - if that will be of any benefit.

[tssnave]

Hang in there and good luck.

Because St Louis said they didn't have any med records on me before I sent in my oringial VA claim when I did send in my claim I also sent in a letter from the doc that treated me while I was on active duty umpteen years ago. My claim was denied because my National Guard records didn't have any note about my having treatment in he NG. The fact that I wasn't claiming to have been treated in the NG seemed to be lost on the VA. They denied, we appealed. Years went by while the VA tried to get my medical records to no avail. Then, rather than accept the letter from the active duty doc who treated me, they required that he send in his SSN as proof that he was who he said he was so they could check his duty station history! Give me a break - it's as if the VA thinks we're all liars and are guilty until proven innocent which just annoys me to no end. The doc was on active duty himself when he wrote the initial letter and by the time they required him to prove who he was he was a recently retired full bird. He was willing to send in an ORB (Officer Record Brief) that had his SSN and duty assignments which of course lined up with what he'd written in his support of my claim.

I could not get over that they would not take a medical statement from an active duty doc and made him prove who he was years later and that he had really been assigned at the same base I had been when I was first treated. There's no way a civilian doc would give his personal SSN to the VA. It was ridiculous.

I tell you this so you won't be surprised if the VA makes all of your doctors and buddies prove that they were actually in the same unit as you were or in a unit in the same theater of operations to have witnessed whatever they are attesting to.

I try not to be paranoid but the whole process has really made me feel like the VA will simply deny, deny, deny based on the lamest, stupidiest reason they can reach for. I even asked my DAV rep if the VA knew the difference between the active Army and the National Guard. At the very least they should be able to read the dates on the records and line them up with my claim. He shocked me when he said that no, some of them didn't understand the difference. Don't know how they can help vets if they don't know the active from the reserve Army. ARRRGGGGG!

Anyway, after supplying his identifying info and going to the C&P exam where the doc wrote that she saw the nexus between where I had been treated on active duty and my current treatment (she didn't have any issue accepting the letter as fact without verifying info in my medical records) I was awarded 50% sc disability on the basis of the doc's letter for it first occuring during service, the C&P examiner's nexus verification, and current med records.

Hang in there and keep plugging away at it and don't be surprised if your buddy statements aren't accepted at first and you have to send in their identifying informaiton to prove to the VA that they are who they say they are and they served where they say they served. It's a crock but it's how the VA operates.

Good luck.

ts

[john6012]

I guess I should post this under a new topic but it is related to the original question.

How much should I expect to pay a psychiatrist for a letter that would indicate my present condition is directly related to my military service? I am in the midwest and I know the fees would be higher in say, California. I am expecting $125.00 for the 1st visit but is the psychiatrist going to have me return for followup visits? I'll bring the letters that I have from my MD but I sure don't want to have to retirn again and again and again....So, what should I expect?

[Cavman]

Yes, he will demand you make appointments for treatment if he thinks you have a problem and he feels he can help. If he feels you are there just for a letter he most likely will send you on your way. I`m sure he will work out some kind of payment plan with you. My doctor that I see waives the co pay for me for a long time now.

Cavman

[john6012]

Thanks Cavman. I think I'll go to my HMO MD and try to get a referral. The VA psy guy is treating me over the phone. If one capsule doesn't work, "take two". The medicine isn't working well at all. John

[tssnave]

Re: How much will the psych review cost and whether or not a shrink will do the letter for you and whether or not they will insist you get counseling from them if they do.

Here’s how this has played out for me here in the South: The first shrink I called said she only did marriage counseling and gave me referrals to 3 other shrinks. I went to one of their offices and talked with one of them but she was too busy to do an evaluation.

She told me that whoever did an evaluation, wrote up clinical notes, or prepared a letter in support of my claim would NOT treat me because it would be a conflict of interest. IOW, the shrink would have an incentive to write that you were really doing horribly to get your VA, Worker’s Comp, SS Disability, etc rated high enough to win your disability claim thereby making it so you could come to see them for treatment.

She said anyone who would work with me to write up the report would not be willing to treat me after the fact as a matter of ethics. I was glad she told me all of this because I liked her. She was a straight shooter and indicated that while she was currently swamped she might have time in the future if I wanted to seek treatment. I would definitely consider going to her.

So, since she was too busy to do a report right now, I took her referral and talked to another shrink who’s a guy. Can’t say I’m real keen on him but he is willing to let me come in and tell him everything I didn’t tell the C&P examiner and write up clinical notes about our visit. He was very adamant that he would not do anything more than write up the clinical notes (he wouldn’t make a disability determination).

It will cost me $125/hr and we’re figuring on 2 hours of face to fact talk time and another 2 hours for him to write up his report (he must be a slow typist) so I’m looking at $500 for clinical notes so I'll have something to send to the VA to offset the incomplete C&P exam notes. This is a one time cost and he won’t see me afterwards.

We’ll see if the VA will use these clinical notes when I put in for an increase in my disability from 50% to 70%.

So, before you have a shrink do a report for you for the VA, especially if you think you want to continue to see him/her for treatment afterwards, you may want to ask them if they are willing to treat you after they help you with the administrative part of your claim.

Note: all “shrinks” in this case are psychologists, not psychiatrists though I would assume the ethics are the same across the board for mental health care providers whether or not they have MD after their name.

Good luck, let us know how it plays out.

ts