Anxiety - am I doing this right?

[USMCNASA]

Brand new here.  I'm posting because I'm so confused and unsure if I'm doing the right stuff, or if I should be doing it at all.

I'm hoping to find answers on how to file a claim for GAD/Major depression.  Here's my story.

1996-2000 high school captain of soccer and baseball teams.  Captain of Snare Drum line in marching band.

2000 - enlist in USMC, squad leader in boot camp, meritoriously promoted to PFC at graduation.

2001 - Class leader in A school

2002 - PCS to Japan (Iwakuni) volunteer for secondary school, awarded Microminiature soldering credentials.  Perform extra duties and awarded Meritorious Mast for going above and beyond.  Compete in meritorious board for Cpl, and win.

2002 cont. While celebrating the win (but not yet actually promoted) engage in arm wrestling match, and lose, terribly.  Suffer spiral fracture which requires evacuation to naval hospital for surgery - internal fixation (plate and 8 screws).  Require months of rehab, and continuous wear of mechanical brace and continued light duty for months.

Ok, this is where things get hairy.

2002 cont. PCS back stateside (NY) while still wearing mechanical brace and on light duty.  Within 1 week of reporting, promotion ceremony is held.  I had to be promoted while wearing a brace and a sling, no "pinning" of rank and no "earning" of blood stripe.  From this point on, I'm pretty much viewed as a punk, and a melingerer.  I stop volunteering for extra duties or assignments, motivation drops, etc.

2003 - Drink heavily.  Merry an awful woman who is into drugs.

2004 - pop on piss test.  Before NJP, I make Sergeant due to previous meritorious promotions and excellent pro/con, rifle, PFT scores.  This infuriates most Marines in my squadron, and further solidifies my reputation as a shitbird, because I am a piss-popped mellinger who made Sergeant before most people.

2004 cont. NJPed, busted down to Cpl. Result of NJP is that I will not be discharged, based on demonstration of excellent performance earlier in service, but will not be allowed to re-enlist.  During a PT session I fall and get a class III AC joint separation, which again requires light duty and use of a sling.  Anyone who didn't think I was a melingerer before, starts thinking/calling me one now.

2005 - EAS.

2005 - Civilian diagnosed with everything from ADHD, to GAD, to MDD, to bipolar.  Various medications do not improve mental performance or fatigue.  

2013 - buddy talks me in to visiting VA for disability due to arm.  Awarded 30%, feel like I don't deserve it because of NJP.

2019 - visit VA mental health clinic, diagnosed with GAD and MDD.  Therapist suggests sleep study.  Just got results.  I have mild sleep apnea.

 

I have decided to file a claim for GAD/MDD and sleep apnea.  I have buddy statements on the official VA forms from Marines who served with me from boot camp through Japan stating I was a stellar Marine.  I have statements from Marines who served with me in NY stating I was not at all stellar, and performed poorly.  I have statements from civilian coworkers stating I had performance issues, was fired from a job, and was on the chopping block at another.

I have medical records from Naval hospitals for all my injuries.

So, from other service members, does it sound like I have any chance at a case? How should I file? I have an appointment with my previous Psych. Nurse Practitioner in 2 months from now, to request a nexus letter.  I don't know if she will write one, but based on our prior treatment session discussions, I believe she agrees my GAD and MDD or related to my service.

Where do I go from here?  Should I even be filing a case at all?

[broncovet]

Welcome to hadit.  

   To be awarded benefits for service connection, you always need 3 things:  (IDK if you have them or not):

1.  Current diagnosis of a disability.  Did your doctors diagnose you with GAD/MDD?  

2.  Documentation of an in service event which caused your GAD/MDD.  

3.  A doctors opinion that your (current diagnosis) is "at least as likely as not" due to (a documented event in service).  This is known as a "nexus".  

     Of course, I dont know if you have documentation of this or not, I have not seen your records.  You can check your file to see if these 3 key Caluza elements are documented.  

     If you have these 3, you are good to go for Service connection.  But you will need documentation of your symptoms.  

You are gonna need to demonstrate chronicity, that is, that you have an ongoing disability with symptoms.  If you dont have any symptoms, you will either be denied or rated at zero percent.  

     If you are missing one or more of the 3 Caluza elements, described above, then you will likely be denied.  If denied, you can still be service connected if you are able to obtain all 3.  Sometimes you need an IMO (Independent medical opinion) that your condition is related to service.  Or, you may need a doctor to diagnose you, if your medical records dont contain a diagnois.  

     But to get the in service event, you are gonna need documentation FROM military service.  I could already be in your records, or sometimes one or more of your buddies can write you a letter testifing, for example, they saw you taken to the hosptial with injuries from an in service arm wrestling contest, or the like.  Your buddy cant document your injuries by diagnosing or providing a nexus, but they can testify they saw you participate in an arm wrestling contest and observe you were hauled off in an ambulaance.  If you were treated for this in service and the doc documented the in service event, that may well suffice if you can obtain those medical records.  

Edited May 30, 2021 by broncovet (see edit history)

[USMCNASA]

Broncovet,

I was not diagnosed with GAD/MDD in service, but the VA has diagnosed me with GAD/MDD and prescribed meds.  

I've had ongoing symptoms, my wife of 8 years was more than willing to write a statement of all my symptoms, and I'm hoping the statements from coworkers that span the last 10 years will help show my symptoms have been ongoing.

I guess my concerns are that even though I know I was outgoing, assertive, and not depressed before breaking my arm and going to NY, I don't know how to best give the VA proof of that, or if statements are all I can give.

 

I haven't filed yet.  I want to wait to talk with the civilian psych. nurse practitioner I used to see, and get her opinion on service relation, and see if she will write a nexus letter.  If she agrees, I guess all I can do is submit, and see what VA says.  

Edited May 30, 2021 by USMCNASA (see edit history)

[broncovet]

You dont need a diagnosis "in service", you need a current diagnosis.  While there is nothing wrong with a doc diagnosis in service, its not necessary.  

As far as "proof" of your symptoms, mention those to your doctor.  Your doc can or should document your symptoms.  You certainly should be honest with your doctor and express to him your concerns...you can explain you were outgoing and assertive prior to your in service event in the military.  

Now, you likely had a pre service physical, as well as an exit from service physical.  

Yes, your wife can provide testimony, if she knew you before service, of these changes you described.  I never recommend lying to VA or trying to deceive them in any way to get benefits.  That is highly likely to backfire.  But, if your wife knew you before, you can have her write up a letter in her own words on how your personaility changed after your military service.  

With VA benefits, there is a "presumption of soundness".  Ok, you got a physical to get in.  The doctor is "presumed" to have done his job and noted any symptoms of depression, for example.  

So, unless noted on your physical entrance exam, you are presumed in good health physical and mental.  

When you exit from the service, the doc examines you again.  If he notes, for example, symptoms of depression, well this suggests you got that while in service.  

 

[Berta]

I dont think you need to be concerned about the NJP because the VA has service connected you already.

However, I think the GAD/MMD claims will need ,- an inservice nexus, - the cause and link to the GAD/MMD.

" guess my concerns are that even though I know I was outgoing, assertive, and not depressed before breaking my arm and going to NY, I don't know how to best give the VA proof of that, or if statements are all I can give."

What happened prior to breaking your arm and going to NY, that caused the GAD/MDD disorder?

Was it the incident (s) that caused the NJP?

It certainly sounds like others saw your change in behavior- and that is a good thing to have those buddy statements, but was there anything else that might have caused the MMD/GAD?

 

 

 

 

[Berta]

To add, I dont think the NPD will help with any claim such as PTSD /GAD /Depression etc, if you claim that as the inservice event that caused your MH issues.

Because the VA could state that the NPD was "willful misconduct" but others here might disagree with me.

I am assuming this was only one NPD. At the BVA site I found many NPD cases, and most were far more serious than just one NPD and the VARO had made a "character of Discharge" determination that was a bar to VA benefits, that the BVA could not overturn.

Is there anything you have not told us about, that happened after you returned stateside, while in the military,that could have caused the MH issues?

 

"2002 cont. While celebrating the win (but not yet actually promoted) engage in arm wrestling match, and lose, terribly.  Suffer spiral fracture which requires evacuation to naval hospital for surgery - internal fixation (plate and 8 screws).  Require months of rehab, and continuous wear of mechanical brace and continued light duty for months."

Do you have residuals of that injury now?

The sleep apnea, you might need buddy statements on that unlesss it was diagnosed in the Military.

 

 

 

Edited May 30, 2021 by Berta
added more. (see edit history)

[USMCNASA]

Berta,

All of my reading has been online, and I haven't discussed any of this process with other vets who have gone through this process.  I thought I read that PTSD needs an in service "event or injury" but other mental issues don't need that.  Is that true, or will the VA still want me to pinpoint a specific "thing" that caused it.  

I don't think I could pin point a single thing.  I think breaking my arm the way I did, PCSing to a new station, and feeling like I was "less than" or like I didn't deserve to be promoted since I couldn't do the same stuff as well as I used to be able to, all created a storm in my head that just kept getting worse.  I know I started acting out, and making shit choices I never would have made before, but I don't know if I could specifically say a single event did that. 

[broncovet]

USMCNSA

    All SC needs the Caluza elements, which includes in service event.  With PTSD, its called a "stessor".  

The trauma  of getting a borken arm " could serve" as an in service event, but a decision maker at VA will ultimately decide that, not me.  

      Have you been diagnosed with PTSD by the VA?  

Edited May 31, 2021 by broncovet (see edit history)

[USMCNASA]

Broncovet,

No, I went in to see the VA after finding out I could recieve healthcare based on my 30% from arm.  I went for a corneal scratch, and then learned about the mental health clinic.  I started seeing VA mental health since it is free (no more copays with insurance) and my diagnosis with them is GAD and MDD.  They haven't ruled out ADHD, but wanted me to do the sleep study first to see if I have sleep apnea (I do and I never knew I had it) and then see if treatment helps with brain fog, forgetfulness etc.  

[Buck52]

I think he is asking about  filing for Depression (MDD)and (GAD)  I see no reason why not? And possible Sleep Apnea Claim secondary to his Depression/GAD It depends on his VA MH Clinic Doc's  and L.C.S.W.  they all can help with claims if the choose to, most of my  VA MH Clinic Docs helped me   they are the ones who set up my sleep study and was diagnose with mild /moderate sleep apnea...  So I could File a Claim secondary to my PTSD...BUT I HAVE NOT FILED A CLAIM FOR SLEEP APNEA. My reason not to is I am already over 100%  with 2 SMC's  so no more $$$ in the pot for me.

Now If he is filing for PTSD he will need to be Diagnose from the VA MH Clinic ONLY... and then have an in-service stressor.

The Caluza Elements that broncovet mention  are

To obtain service connection, a veteran must satisfy three basic criteria. The first is medical evidence of a current disability. The second requires medical evidence, or in some cases, lay evidence of a disease or injury. And the third is the nexus between the in-service injury or disease and the present disability.

Edited May 31, 2021 by Buck52 (see edit history)

[Buck52]

USMCNASA

If you have a diagnosis for MDD /GAD

FILE THE 21-526EZ FORM AND ALSO INCLUDE GAD .

ATTACH YOUR EVIDENCE AND SERVICE RECORDS AS EVIDENCE FAVORABLE TO YOUR CLAIM.

YOU CAN FILE THE 21-4138 Statement in support of claim  and Buddy letters are highly recommended.

Same with PTSD ONLY YOU NEED A VA DIAGNOSE FROM THE VA...THE PTSD CLAIM # IS   21-0781

Again buddy letters are recommended.and no matter what you file, I would note this to them '' PLEASE RATE MY CLAIMS TO TO HIGHEST DEGREE ALLOWED BY LAW''...IT MAY OR MAY NOT HELP  BUT IT LETS THEM KNOW YOU WANT A FAIR RATING.

PTSD AND MAJOR DEPRESSION DISORDERS ARE  CLOSE AS THEY HAVE A L0T OF THE SAME SYMPTOMS  BUT YOU MORE THAN LIKELY BE SENT TO A COMP & PEN EXAM and this examiner will read your records and evidence  and ask you some questions  and he will fill out the DBQ and provide the VA your Symptoms...ect,,ect,,  then a vVA Rater will make the decision and they rate you according to your Symptoms.

What this C&P Examiner puts X  in each box according to your symptoms  is very very Important

btw  Welcome to Hadit   glad to have you.

[Buck52]

Also as for as the VA MH Clinic docs helping, your therapist can   just be honest and ask them to give there medical opinion  is least likely as not  ect,,,ect,,, also you may want to check your VA Notes in Myhealthvet for favorable findings the Dr's have mention about your Depression and make copies  any favorable to what your claiming   you can use those copies as part of your evidence to help substantiate  your claim

[USMCNASA]

Buck52,

I had Marines and coworkers and family complete statements on VBA-21-4138-ARE.  Is the 21-526EZ the same as the online stuff at VA.gov or is it an actual paper form I need to fill out?

[Berta]

You said:

"All of my reading has been online, and I haven't discussed any of this process with other vets who have gone through this process.  I thought I read that PTSD needs an in service "event or injury" but other mental issues don't need that.  Is that true, or will the VA still want me to pinpoint a specific "thing" that caused it. "

They will definitely want a specific event in service, that is the link to the depression, or anxiety, etc, or any other MH issue that you claim.

Maybe these cases below will help you understand how important an established link is:

Since 1992 there have been 134,881 decisions at the BVA due to being denied at the RO level ,for claims that included anxiety and depression, and other MH issues such as PTSD.

Many have been denied.
Here is one of them from 2021:

"Based upon a longitudinal review of the evidence of record, the Board concludes that the Veteran’s current acquired psychiatric disorder, alternatively diagnosed as unspecified depressive disorder with anxious distress, unspecified anxiety disorder, and adjustment disorder with anxiety, did not begin during his military service and  is not otherwise related to any specific in-service event, injury or disease."

https://www.va.gov/vetapp21/files3/21015738.txt

This recent case also was denied :

 Entitlement to service connection for an acquired psychiatric disorder, to include depressive disorder, is denied. 

"Service connection is not warranted for this claim because while there is a current disability of a depressive disorder, it has not been linked to active duty or to a service connected disability.  The mental disorder has been linked to the non-service connected problems with the Veteran's knees and feet."
https://www.va.gov/vetapp21/files3/a21006382.txt
   

You mentioned you are seeing a Therapist-perhaps you revealed a possible nexus or  link in those therapy records. For the Nurse Practitioner to make a nexus statement, they will need a nexus of some sort and that will have to be proven.

Perhaps the loss of rank  and status with your fellow Marines could certainly cause depression ,-but I am not a doctor and I have no idea. And I have no idea if the VA would even accept that as a servie connectable claim.

We are not saying dont file the MH claim, but I know it will be denied without a solid proven nexus, as to an inservice cause.

 

 

[Buck52]

6 hours ago, USMCNASA said:

Buck52,

I had Marines and coworkers and family complete statements on VBA-21-4138-ARE.  Is the 21-526EZ the same as the online stuff at VA.gov or is it an actual paper form I need to fill out?

You can file 2 ways  file the 21-526 ez paper form  and mail it to the VA Claims Intake Center Janesville Wi, make copies of your buddy letter attach them in with your evidence or as your evidence  ect,,,ect,,,

or use VA.gov   and file your claim electronically, upload your evidence and send that in at the time you send in your claim

Attach buddy letters 21-4138 to your paper claim or upload and send it with your electronic claim  the electronic claim is much faster   just pay sharp attention when you file electronically at VA.gov

Remember you don't need to be a combat Veteran to file a claim for PTSD  OR MDD. BUT YOU DO NEED A STRESSOR AND PROOF OF IT   THE STRESSOR CAN BE ANYTHING  THAT TRAUMATIZE YOU  ...YOU SEEN SOMEONE GET KILLED (CAR ACCIDENT)  (SOMEONE YOU KNEW DROWN) A FIRE THAT KILLED PEOPLE )  you witness a Murder)ecdt,,ect,, YOU SEEN SOMETHING THAT WAS TRAUMATIZING TO YOU THAT  YOU CAN USE AS EVIDENCE AS A STRESSOR ,  YOU JUST NEED TO PROVE THE TRUMA HAPPEN AND DATE AND LOCATION  AND ANYONE THAT WITNESS THE EVENT WITH YOU THAT CAUSED YOU TO BE TRAUMATIZED.

They (VA) will check out your story and if they find it to be of merit  then they should go on and maybe send you to a C&P Exam.

to check your symptoms of your Depression or they may convert it over to PTSD ?

sometimes the MH Doc make mistakes on diagnosing and the C&P Examiner may diagnose you with PTSD and not MDD?

They will need to differentiate the two

[USMCNASA]

I just had an appointment with my VA therapist.  She confirmed again that her and the VA Psych N.P I see both don't get involved in nexus letters at all, which is fine since I plan on seeing the civilian N.P. I used to see.  Here is my question:

I read online that nexus letters should come from experts in their field.  The non VA civilian N.P. I saw is a Family Nurse Practitioner who does mental health.  I never asked the question when I saw her previously.  I was her patient for about a year and a half, and she was good, she provided therapy and also prescribed medications.  If she writes a nexus letter, will it matter to the VA that she is not specifically a Psychiatric N.P.?

I did also see a clinical psychologist several years ago, who administered some testing, but he was in a different practice from the most recent Family N.P. I plan on asking for the letter.  I planned on asking the Family N.P. because I have seen her more recently.  I am so confused with all of this.  I would like to do it myself, and not pay $$$$ to have a firm do it all, but I'm wondering if that is a better route to go?  I'm afraid of going that route, because I don't know which firms are legit and which ones are just out for Vets' money.  Some sites look OK, but others look like they could just as easily be snake oil sales sites.

[GBArmy]

USMCNASA We need a little more info on your situation. Do you currently have any VA disabilities?  Are any of them for MH, like depression, anxiety or PTSD? I am assuming that you don't currently have any MH disabilities as service-connected and you are going for a new rating. If that is the case, it doesn't sound like your NP is certified for MH, but is knowledgeable in the MH field. The VA is going to do the eval on you using their own MH professionals. Your NP can provide a "buddy letter"  form 21-10210, but IMHO it won't provide much support. Your other doc info is more probative. You may want to see if he could provide support for your symptems. If on the other hand, this is for an increase, then your NP would provide acceptable evidence. If you don't have strong evidence going in for a diagnosis, your claim is difficult unless the VA docs have it in your file. 

[USMCNASA]

GBArmy,

Correct, I am going for a new MH rating; I have never had a mental health rating.  I have a 30% combined rating for my arm.  It seems really fristrating to me that the VA clinic MH providers won't provide nexus letters.  

My health report from myhealthEvet (I think it the blue ribbon report?) has my diagnosis as GAD and MDD, but they are not currently service connected.  I have 2 buddy statements from Marines who knew me in high school, and who also served with me prior to symptoms (to provide evidence that I haven't always been this way), 1 of them is from boot camp and the other is from Japan prior to my arm being broken, as well as both also playing high school sports with me.  I also have 2 buddy statements from Marines I served with back stateside after symptoms started (to provide evidence of in-service symptoms).  I also have 1 statement from a Marine I didn't serve with, but who tried to get me to go back to the gym after I got out of the service, and his statement talks about how I wouldn't do certain exercises or on certain things I would only do low weight because I was afraid of hurting my arm again, and eventually I stopped going to the gym with him because I was worried about my arm.  I have statements from 2 prior coworkers from different jobs (to provide evidence of ongoing symptoms and severity, aggression, forgetfulness, sporadic poor performance), and I have statements from family (to provide evidence of all the nitty gritty that only family knows).

It's clear to me and family that my anxiety and depression are related to my time in the Marines, and I get why it is a difficult process to get things service connected after leaving the service, I just don't understand why the VA provides a mental health service to vets but won't give a statement on their opinion of service connection - they are the ones who would know best.  

I *think* I have the 2 of the three requirements covered pretty well, but would appreciate any suggestions on if I need to do more.

1.  Current diagnosis - I have this, from the VA clinic I regularly visit

2. In service event - I have this from buddy statements

3. Medical nexus - This one I need to get, and really wish I could get it from the VA.  I don't know how to approach the clinical psychologist I saw 5 years ago about a nexus letter.  I didn't have a therapy relationship with him, he only did testing for ADHD and depression.

 

I really appreciate all the comments and help with this.  I wish the process was easier.

Edited June 3, 2021 by USMCNASA (see edit history)

[GBArmy]

USMCNASA Your buddy letters are good; shows before and after. You have continuity. Diagnostic codes for MH are all lumped together. If you are granted s-c, then it is 0, 10, 30, 50, 70, and 100%. If you get 0 or 10% you are getting low balled and it may be fairly easy to appeal with your evidence and get at least 30% (or higher.) So it is a decent add to your already 30%, so a combined might get to 50% or better. But you're right; you need a pro to opine that it is from service. I would look at it as an investment. A few grand from a psych for an IMO and dbq would pay for itself in a couple of months. If you need to go thru a lawyer, there are several good ones, such as CC&K, Woods & Woods, Hill & Ponton, etc.  But understand, it is a lot easier to go for an increase on an existing s-c disability than to get an approval on a previously denied disability IMHO. I would make the investment myself.

[USMCNASA]

GBArmy,

My VA therapist suggested I go for a sleep study, and got my VA doc to put in a consult for a study using Care in the Community.  Her thinking is that my ADHD symptoms aren't actually ADHD (because I didn't exhibit them in childhood or in school, and they didn't improve when I was on medication for ADHD) and instead are a result of sleep apnea and exacerbated by anxiety.  She really has been the best therapist I've ever seen - I'm happy the VA provides mental health services, I just wish they would get involved in ratings.  I've done the first study, and the follow up CPAP test study, and I do have sleep apnea.  I have a third visit next month to go back to the sleep clinic to go over using a CPAP and get my prescription.  

I 100% know my life has been more difficult in many ways because of the MH issues I have.  I can't go back and change things, but I'm hoping a CPAP will help me sleep better and improve my functioning.

I guess my first step is to s-c my MH and then see about a secondary for sleep apnea.  Honestly though, if I get a CPAP through the VA out of this and it helps me, that alone would be worth all of my effort.  Thanks for the opinion on getting outside help.  I'll try to get together what I can myself, and maybe give one of those services you mentioned a call to see what they have to say about all of it.

Edited June 3, 2021 by USMCNASA (see edit history)

[USMCNASA]

I called a few of those firms, and they all let me know they handle appeals, but not initial claims.  It seems like I am at a block in the road.  

I found a site online where a psychologist reviews records and if a nexus is found, writes a nexus letter.  I'm not sure if posting links to service sites is allowed, so I won't post the one I found.  

 

I also did a google search for forensic psychologists near me, and the closest one is 3 hours away.

On one hand, I feel like a nexus letter from a site and a psychologist who specializes in them would be the best option, but on the other hand I'm worried the VA might look at a letter from a psychologist who writes nexus letters all the time as less credible.

 

Any thoughts?