Mental health CP exam

[wood78221]

Hello everyone,

So my story is that I filed for an increase, ended up getting reduced from 50 to 30. Overall rating wasn't effected. I filed a supplemental with a DBQ from my private doctor so now I have an upcoming CP exam with QTC. I have read that some people on the forums say " tell them about all your mental health issues (PTSD, anxiety, etc..). However, I am only S/C for depression secondary to tinnitus. So should I just only talk about depression? For my last exam in May I elaborated on all my mental health issues and it got me reduced. Thanks 

[Vync]

What was their justification for the reduction? As far as the reduction, they should have sent you a proposal to reduce letter saying you have about 60 days to provide evidence to justify a continued rating. If you don't reply or the evidence doesn't suffice, can can move forward with the reduction.

Requesting an increase can be tricky. In my opinion, the best approach is to always examine copies of your treatment records after they are made available. Compare them to the rating criteria. If you qualify for a higher rating, then file for the increase. In some cases you may win an increase based on the C&P exam findings, but it's easier to show you already qualified for the increase through the evidence of record.

I can personally agree that depression secondary to tinnitus is a real downer. They are supposed to rate you based on the MH diagnosis' social and occupational impact on you. If you have a PTSD or other diagnosis, there's still a chance it may be related, but even if you try to get SC for it, they will still give a single MH rating. If you served in combat, that should be relatively automatic with the VA needing confirmation of diagnosis and in-theater presence, otherwise a VA C&P examiner would need to make that determination.

 

 

[wood78221]

13 minutes ago, Vync said:

What was their justification for the reduction? As far as the reduction, they should have sent you a proposal to reduce letter saying you have about 60 days to provide evidence to justify a continued rating. If you don't reply or the evidence doesn't suffice, can can move forward with the reduction.

Requesting an increase can be tricky. In my opinion, the best approach is to always examine copies of your treatment records after they are made available. Compare them to the rating criteria. If you qualify for a higher rating, then file for the increase. In some cases you may win an increase based on the C&P exam findings, but it's easier to show you already qualified for the increase through the evidence of record.

I can personally agree that depression secondary to tinnitus is a real downer. They are supposed to rate you based on the MH diagnosis' social and occupational impact on you. If you have a PTSD or other diagnosis, there's still a chance it may be related, but even if you try to get SC for it, they will still give a single MH rating. If you served in combat, that should be relatively automatic with the VA needing confirmation of diagnosis and in-theater presence, otherwise a VA C&P examiner would need to make that determination.

 

If the reduction doesn't change the overall rating, you are not entitled to that 60 day period. In my case, it did not effect my payments. However,  I filed for PTSD originally and ended up with Depression 2nd to Tinnitus. 

I filed an increased and I really don't even think the examiner or maybe even the rater looked at my treatment records. So many things were left out that could of raised my rating. I keep hearing that medical records hold a lot of weight..however in my experience with the VBA, they don't mean much. That is my experience. CP exam is 99 percent. My VSO only said to hammer home depression and nothing else. 

Edited July 27, 2020 by wood78221 (see edit history)

[Vync]

Interesting, I didn't realize that, but you are definitely doing the right thing by contesting the decision.

I have found that if I go out of my way to specifically tell the VA which medical record findings were in my favor, they more often than not looked at them to verify. From what I have heard, they may search for specific words or diagnosed conditions, but generally do not read every word on every page of your records (although that violated 38 CFR 4.2 and 4.6 by overlooking potentially favorable evidence). That's why I tell people to spoon feed the VA exactly what they need. Don't rely on them to be thorough. Although it's required, it's not realistic.

That sounds like my situation. I filed for PTSD and they diagnosed me with depression, despite already having a PTSD diagnosis in my records. If your VSO said to focus on depression, then that sounds reasonable. I'd keep a log of social and occupational impact tinnitus has on your situations. For me, I have trouble hearing people at work, people over the phone, my wife, my kids, the TV, people at the store, anything when in a crowd, and worst of all, I can't get that buzzing to stop when I try to sleep. Ironically, they did a hearing test and only found minimal hearing loss. Lost sleep is the big one for me. The VA gave me a Marsona sound machine to help cover it up. It's helpful, but doesn't always work. Hope this helps you out.

[wood78221]

1 hour ago, Vync said:

Interesting, I didn't realize that, but you are definitely doing the right thing by contesting the decision.

I have found that if I go out of my way to specifically tell the VA which medical record findings were in my favor, they more often than not looked at them to verify. From what I have heard, they may search for specific words or diagnosed conditions, but generally do not read every word on every page of your records (although that violated 38 CFR 4.2 and 4.6 by overlooking potentially favorable evidence). That's why I tell people to spoon feed the VA exactly what they need. Don't rely on them to be thorough. Although it's required, it's not realistic.

That sounds like my situation. I filed for PTSD and they diagnosed me with depression, despite already having a PTSD diagnosis in my records. If your VSO said to focus on depression, then that sounds reasonable. I'd keep a log of social and occupational impact tinnitus has on your situations. For me, I have trouble hearing people at work, people over the phone, my wife, my kids, the TV, people at the store, anything when in a crowd, and worst of all, I can't get that buzzing to stop when I try to sleep. Ironically, they did a hearing test and only found minimal hearing loss. Lost sleep is the big one for me. The VA gave me a Marsona sound machine to help cover it up. It's helpful, but doesn't always work. Hope this helps you out.

I had 2 PhD's saying I met DSM5 PTSD and they wouldn't give it to me for my initial claim (verified stressor also). Oh well. I'll respond in a few weeks and let you know how this supplemental goes. 

Edited July 27, 2020 by wood78221 (see edit history)

[Buck52]

I  personally think they need to diagnose you with both Depression and PTSD

Most veterans I know who had PTSD also has depression  they are suppose to go by the one most severe   usually that is PTSD.

I Was service connected for PTSD also had a Depression diagnose.  in my case they went with the PTSD  what I should have did was NOD the depression and be service connected for both,  but they only rate one of the two  which is usually the one with the most symptoms and the severity.

WE CAN'T HAVE TWO MENTAL DISORDERS AT THE SAME TIME  DEPRESSION IS CLASSED AS A MENTAL DISORDER 

with the exception of a TBI

Edited July 28, 2020 by Buck52 (see edit history)

[wood78221]

2 hours ago, Buck52 said:

I  personally think they need to diagnose you with both Depression and PTSD

Most veterans I know who had PTSD also has depression  they are suppose to go by the one most severe   usually that is PTSD.

I Was service connected for PTSD also had a Depression diagnose.  in my case they went with the PTSD  what I should have did was NOD the depression and be service connected for both,  but they only rate one of the two  which is usually the one with the most symptoms and the severity.

WE CAN'T HAVE TWO MENTAL DISORDERS AT THE SAME TIME  DEPRESSION IS CLASSED AS A MENTAL DISORDER 

with the exception of a TBI

The DBQ my doc filled out actually stated also that I meet DSM5 for PTSD. I am wondering would that actually award it from that? However, my original claim was over a year old for PTSD. I might not even be able to file for PTSD anymore. Thanks

[Buck52]

yes in my opinion you should be awarded PTSD or increase it  Depends on your symptoms as to how they rate it

DSM5 means you meet all the diagnostic scores for the diagnose of a mental disorder.   they have unspecific M.D.'s   (mental disorders)that depending on the symptoms of each disorder , they can and will break it up  but also they can give the PTSD Rating

here is the mental disorder criteria for PTSD & GENERAL RATING DISORDERS

General Rating Formula for Mental Disorders

   Rating

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 work like 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%

 

 

[wood78221]

1 hour ago, Buck52 said:

yes in my opinion you should be awarded PTSD or increase it  Depends on your symptoms as to how they rate it

DSM5 means you meet all the diagnostic scores for the diagnose of a mental disorder.   they have unspecific M.D.'s   (mental disorders)that depending on the symptoms of each disorder , they can and will break it up  but also they can give the PTSD Rating

here is the mental disorder criteria for PTSD & GENERAL RATING DISORDERS

General Rating Formula for Mental Disorders

   Rating

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 work like 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%

 

 

We will see what happens. Originally when I got denied the first time for PTSD they said I didn't meet DSM5. I filed new evidence from my doc saying I meet DSM5 and they gave me another exam, which led to me being SC for Depression 2nd to tinnitus (they went with VA CP medical opinion).