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Mental Health Diagnosis changed at C&P exam

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jm0365

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Back story: Filed a claim for PTSD in 2016. The claim was denied, BUT the stressor was conceded. The C&P doctor stated that the symptoms weren't prevalent enough and I was already diagnosed with Bipolar disorder that wasn't service connected at the time. In 2018 I received a 50% rating for Bipolar and 30% for migraines. In 2022 Bipolar rating was increased to 70%.

I recently filed a TDIU claim for Bipolar and Migraines, and submitted letters in support from psychiatric doctor, primary care doctor and therapist.

At my Mental Health C&P the VA contract doctor updated my diagnosis to PTSD and Bipolar, with overlapping symptoms. She marked "Total Social and Occupational Impairment" and checked most symptoms. She also stated that the PTSD started upon return from combat deployment in 2008, and that it was misdiagnosed earlier.

I think that seems like a good exam in support of my claim, but my concern is that the addition of a new diagnosis that I didn't file for, in the middle of my claim, will somehow mess things up.

Is this something that I should be worrying about? Also, if I do get a rating for PTSD is there the potential for back pay since it was previously denied, or has that ship sailed?

Thanks in advance for any insights.

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You can only have one mental health claim. Doesn't matter if it's bi-polar, depression, ptsd, schizophrenia, etc.  If she wrote total occupational & social impairment, I would think that would put you at 100% mental health conditions.  

People get caught up in what they want their rating to say.  Example, my ptsd is combat related.  My awards letter say ptsd due to non combat.  Had me a little peeved at first, but then someone on the forum asked if it changes anything?  No.  It's not like I'm going to have a shirt made that say's '100% ptsd, non-combat related', and go to the local VFW hall, or vice versa.

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2 hours ago, El Train said:

You can only have one mental health claim. Doesn't matter if it's bi-polar, depression, ptsd, schizophrenia, etc.  If she wrote total occupational & social impairment, I would think that would put you at 100% mental health conditions.  

People get caught up in what they want their rating to say.  Example, my ptsd is combat related.  My awards letter say ptsd due to non combat.  Had me a little peeved at first, but then someone on the forum asked if it changes anything?  No.  It's not like I'm going to have a shirt made that say's '100% ptsd, non-combat related', and go to the local VFW hall, or vice versa.

Thanks for the response. I get that it doesn't matter for rating purposes.  My real concern is that somehow this is going to open up a new claim since I didn't file anything with PTSD. Are you saying that it'll still be processed as a the same mental health claim and not a new one for PTSD?

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My real concern is that somehow this is going to open up a new claim since I didn't file anything with PTSD. Are you saying that it'll still be processed as a the same mental health claim and not a new one for PTSD?

No, you dont have anything to worry about.  Your condition does not appear to have improved, unless there is evidence to the contrary you did not mention.  Dont worry about "opening up a new claim"..you have already done so, as tdiu is a "claim for increase".  I think you are concerned because you fear a reduction.  It sounds like you are already over 5 years, or nearly so, so that offers protections.  Its actually difficult for VA to reduce you.  

If it were me, I would go ahead and re apply for PTSD, submitting this exam as new evidence.  Your doctor apparently said you "had total occupational and social impairment"...that is word for word the 100 percent criteria.  

Also, "total occupational Impairment" precludes working.  In other words if you are, or can work, you dont have total occupational impairment.  

Its good to stay on top of your claim but dont get caught up in so many details, you cant see the big picture.  A rating specialist should decide if you are 100 percent PTSD, 100 percent Bipolar/depression, and/or tdiu.  

Based on what you posted you should get 100 percent, at least one of these 3 (PTSD, DEPRESSION, or tdiu).  You are not all that far from SMC S, which is another $420 per month or so, also.  

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6 minutes ago, broncovet said:

No, you dont have anything to worry about.  Your condition does not appear to have improved, unless there is evidence to the contrary you did not mention.  Dont worry about "opening up a new claim"..you have already done so, as tdiu is a "claim for increase".  I think you are concerned because you fear a reduction.  It sounds like you are already over 5 years, or nearly so, so that offers protections.  Its actually difficult for VA to reduce you.  

If it were me, I would go ahead and re apply for PTSD, submitting this exam as new evidence.  Your doctor apparently said you "had total occupational and social impairment"...that is word for word the 100 percent criteria.  

Also, "total occupational Impairment" precludes working.  In other words if you are, or can work, you dont have total occupational impairment.  

Its good to stay on top of your claim but dont get caught up in so many details, you cant see the big picture.  A rating specialist should decide if you are 100 percent PTSD, 100 percent Bipolar/depression, and/or tdiu.  

Based on what you posted you should get 100 percent, at least one of these 3 (PTSD, DEPRESSION, or tdiu).  You are not all that far from SMC S, which is another $420 per month or so, also.  

Thanks for the clarification and advice.  

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Over the last 50 years my mental health DX has been changed at least 5 times.  About 20 years ago I got a DX of bipolar II and I got 70% TDIU.  The VA is a little bit weird about PTSD DX'es, but I have that DX as well as schizophrenia and a few others.  These DX'es are arbitrary IMO.  I would not worry about since if your C&P exam says you are total then you should get 100%. I got SMC "S" a few years ago and you are close IMO.  VA is weird about PTSD because they saw a tidal wave of PTSD  claims coming at them and have tried to dodge them.

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6 hours ago, john999 said:

Over the last 50 years my mental health DX has been changed at least 5 times.  About 20 years ago I got a DX of bipolar II and I got 70% TDIU.  The VA is a little bit weird about PTSD DX'es, but I have that DX as well as schizophrenia and a few others.  These DX'es are arbitrary IMO.  I would not worry about since if your C&P exam says you are total then you should get 100%. I got SMC "S" a few years ago and you are close IMO.  VA is weird about PTSD because they saw a tidal wave of PTSD  claims coming at them and have tried to dodge them.

Thanks. That helps put me at ease a bit.

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