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Psychiatric Qtc Examination


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14 replies to this topic

#1 cannoncocker

 
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Posted 17 July 2009 - 11:42 AM

This is a very specific question or can be answered in general either being of great help to me.

I am scheduled for a QTC SC Chronic Anxiety in Asheville, NC and I don't really know a more appropriate place to post this question.

As we all know everybody is biased on any given subject even before the facts are heard/sight unseen. So my question is if anyone of us has been to a psychiatric exam in Asheville with the QTC psychiatric examiner/contractor and if so are they fair arbiters for ptsd or any other SC psychological problems. I mean do they already have their minds made up? If that were the case is there anything I could do to counter that?

I know it's almost ridiculus to ask this without the examiners name but I wouldn't want somebody putting my ID Info out here on the internet so I would not do that to them. Although i presume they only have one for that area so you would know automatically who it was.

Thank you for any pointers and info

Too, any pointers on how to approach an exam like that would be really helpful since the VA psychologist is the only exam like that I have been to.

#2 LarryJ

 
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Posted 17 July 2009 - 11:56 AM

Advice?
Never been to Asheville.
Advice?
NEVER, EVER, when they walk in and ask you "how you doin?". NEVER, EVER sat "Oh, I'm just fine." NO, dumbell, you AIN'T "jist fine"! You ain't BEEN "jist fine" ever since you suffered whatever "stressor" you are suffering from!
You got that?
You tell them how you REALLY feel. The daily effects it has on you. The loss of pleasure, the anxiety, the loss of friends, the way the meds screw up what IS left of you.
BUT, YOU AIN'T DOIN' FINE! Not even on your BEST of DAYS are you ever doing fine!
If you are, then you are wasting everybody's time. Go home.

now where's that bottle of Welbutrin? And the codiene? Then I'll be as close as I'm ever going to get to being "jist fine"!

#3 cannoncocker

 
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Posted 17 July 2009 - 12:32 PM

LarryJ I think that's about the best breakdown for me I've had in awhile. Completely understandable and logical.

Don't give them all the pleasantries, tell them what the problem is. Gotcha.

My concern now is the bias factor, more like hoping out loud for a square deal, that's all.

Also Larry, I really had it in my mind that I was gonna walk right in there like I didn't have a problem in the world, you know same way you go to work and regardless of what's going on in your personal life you just play it off like all is right with the world.

I'll be using that advise. Focus on the problem not prove you are a good actor.

#4 LarryJ

 
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Posted 17 July 2009 - 12:53 PM

By the time I got thru with my C&P for my depression, I was, quite literally, in tears, and shaking. To the point that they had to call my wife, at her work, to come and get me. And, NO, it was not an ACT on my part.....the dude just opened up some stuff that I was not expecting to have to go through. Probably the best psych exam anyone has ever had. He spent over almost an hour and a half with me.

And, NO, I was not "Just Fine"! Come to find out, I hadn't been "just fine" since about 1964!

peace, bro

#5 12R3G

 
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Posted 17 July 2009 - 12:59 PM

Ditto...

I went to my VA mental health intake the other day...when the psych came for me she asked "how are you", to which I replied "fine."

I skipped a beat and then told her that "fine" is sorta the expected, automatic response. I was there so I wasn't really "fine". We had our intake inteview and I left after discussing treatment options, an appointment with a psychiatrist and a change in meds (depression). So much for being "fine"

My point is that if you were really fine, you wouldn't be there. If you automatically answer "fine" or even "okay"--and if you are like me, that is invariably what how I respond--follow up with a "so much for the automatic social response...now, let me tell you how I really am..."

but try not to say anything that indicates you are "fine"

Good luck

#6 Pete53

 
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Posted 17 July 2009 - 02:54 PM

For some reason QTC has a bad rep with Veterans. From watching Hadit it seems that for many they got a fair exam from them.

Like Larry has said you have to put on the hat you wear at home and explain how you feel every day, your loses and disappointment and even your distrust of VA and its motives. Every emotion is fair game.

In other words be prepared to spill your guts.

#7 Hoppy

 
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Posted 17 July 2009 - 08:35 PM

Cannoncocker,

I wanted to respond to your question about the anxiety C&P. However, having no idea as to the issues in your claim I went back and read as many of your old post I could find. The best way to deal with a bias is with better medical evidence.

If your service medical records are silent for any anxiety or other psychological complaints and you were not treated until years after your discharge direct service connection for an anxiety disorder not including PTSD would be a miracle. From what I have read it appears that you have not been in treatment for a psych condition up to this point. One of your posts shows a diagnosis. However, it appeared that it was your guess as to what the diagnosis should be. If I am wrong on this let me know. If that diagnosis was made by a shrink it does not relate it to the hearing condition.

I found some statements that indicate that you are specifically advancing the claim for anxiety as secondary to the sc’d hearing problem. The sc’s hearing condition being rated at 0%. It would be a good idea to bring to the attention of the anxiety examiner the reasons the hearing problem specifically causes you anxiety. Make it very clear as to the difficulty you have at work and in your personal life. Give specific examples of events that have been problematic due to the hearing problems. As far as how you are doing I always tell them “things could be better, I dodge bullets every day”. Now the ball is in their court. They have to try and figure out why I said that. Then I go into specific details as to how I am confronted by simple everyday events that endanger me as a result of my physical limitations. I guess if you have a hearing problem you would be dodging the problems associated with mis understood conversations and an occasional automobile that crosses paths with you.

If you have not been in treatment and you are relying on this single C&P to diagnosis and relate your condition to the hearing problem I would not expect a high rating. High ratings are hard to get from the VA. If you need a high rating some ongoing psych treatment would be a good idea.

I have a brother with hearing loss. Sometimes it is like talking to a wall.

#8 Wings

 
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Posted 17 July 2009 - 09:53 PM

Cannoncocker,

I wanted to respond to your question about the anxiety C&P. However, having no idea as to the issues in your claim I went back and read as many of your old post I could find. The best way to deal with a bias is with better medical evidence.

If your service medical records are silent for any anxiety or other psychological complaints and you were not treated until years after your discharge direct service connection for an anxiety disorder not including PTSD would be a miracle. From what I have read it appears that you have not been in treatment for a psych condition up to this point. One of your posts shows a diagnosis. However, it appeared that it was your guess as to what the diagnosis should be. If I am wrong on this let me know. If that diagnosis was made by a shrink it does not relate it to the hearing condition.

I found some statements that indicate that you are specifically advancing the claim for anxiety as secondary to the sc’d hearing problem. The sc’s hearing condition being rated at 0%. It would be a good idea to bring to the attention of the anxiety examiner the reasons the hearing problem specifically causes you anxiety. Make it very clear as to the difficulty you have at work and in your personal life. Give specific examples of events that have been problematic due to the hearing problems. As far as how you are doing I always tell them “things could be better, I dodge bullets every day”. Now the ball is in their court. They have to try and figure out why I said that. Then I go into specific details as to how I am confronted by simple everyday events that endanger me as a result of my physical limitations. I guess if you have a hearing problem you would be dodging the problems associated with mis understood conversations and an occasional automobile that crosses paths with you.

If you have not been in treatment and you are relying on this single C&P to diagnosis and relate your condition to the hearing problem I would not expect a high rating. High ratings are hard to get from the VA. If you need a high rating some ongoing psych treatment would be a good idea.

I have a brother with hearing loss. Sometimes it is like talking to a wall.

x
x
x

Excellent post Hoppy!!!

#9 cannoncocker

 
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Posted 18 July 2009 - 08:27 AM

Yes sir, those are some issues you guys bring to my attention. I, probably like most of you and 99% of the world keep our emotional baggage in our back pocket and only bring it out rarely. That is to say it is not like having the flu, take some asprin, rest, get back to work.... There are so many responses that deserve a page each but since we can't do that I put as much as I can out there. First, I have a degree in psychology, which for those in the know, without a Masters Degree, that and 3 dollars will get you a cup of coffee, but it does give me the language, procedures, DSM info.....So I have that to help me contend on their field.

Most of this is going to be directed to Hoppy as his response was well beyond the norm! First I was in Field Artillery spending a large portion of my time in Special Weapons, which specifically was a section chief in tactical nuclear weapons which obviously required me to maintain a security clearance. So if you cared about keeping your position and staying in you basically kept any of your psychological problems to yourself. As a matter of fact regardless of your MOS or job I did not see lines in front of the psychiatrists office while I was in. As LarryJ pointed out you really push all the problems to the back until you find yourself in a position, like his and mine, because I got exactly that way when the VA psychologist got finished with me I was crying like a newborn. I had never been so embarrased in my life. I could hardly keep showing for appointments but I felt like if all that was inside I needed to give it a try to resolve it. I actually have been taking mood medications: steraline, diazepam, and paroxetine. Currently taking the paroxetine and had to stop taking diazepam because they made my body ache. Point is I started dealing with this in 2006. I don't drink/smoke/take drugs so I am not dealing with those issues.

This initial diagnosis was after one or two sessions so it is not complete but plan on obtaining and submitting to the DAV and VARO after our next seesion
My diagnosis in DSM IV form:
AXIS1 300.1 Panic disorder/o Agoraphobia
311 Depressive Disorder NOD
300.02 Generalized Anxiety Disorder
Axis II 799.9 Deferred
Axis III Chronic pain, hypothyroidism, hyperlipidemia, hypertension
Axis IV limited social support
Axis V GAF:50

How the chronic anxiety was suppose to have been submitted as secondary to:
1.(primary) A situation that could have gotten my entire crew and anybody else within the kill zone of a 155mm artillery round. The situation was entirely my fault, event though I was not entirely trained for that job but nevertheless I took it and was responsible when I accepted that job.
2.(secondary) Chronic pain from pinched S1Nerve Root, protruding discs/extruding discs/segrgated disc material/old disc material leakage/current disc material leakage. This restricts my range of motion severely which is is entirely contrary to my nature. It is driving me crazy to not do the things I could do, not just economically, or the constant pain, but as the pain increased over the years it affected me psychologically.


I cannot give any further info than that in a public forum on number 1 but Many of you are so right that I/you had no idea how things like that will affect the decisions you make the rest of your life. I personally tend to be obsessive and that has prevented me from taking jobs, for instance I took a job as a County Safety and Health Manager which required me to make those same life and death decisions so I had to walk away from that job. I have only 1 clinical nursing and one micribiology to finish the requirements for an RN Nursing degree but I can't take those life and death decisions. I guess it comes down to the fact this created a lack of trust in myself which has pretty much wrecked my career choices and didn't even recognize why till I started therapy. Being on the obssive compulsive side this has amplified the affects on my economic life and personal life. Come to find out this has affected pretty much my entire life and I really hadn't connected the dots until the last few years. Now that I know the orgin it is hard to say if that is good or bad. That is a heavy burden that there is no logical physical reason we are not dead, my crew and anybody else in the area. That round with a time fuse and round with point detonating fuse should have detonating. Why it didn't kill us all, there is no reasonable explanation.

So that is pretty much me. Hearing is a whole separate issue and has nothing to do with my psychological state. QTC has has ordered the psychiatric exam and evidently need further information from the QTC Audiologist.

Should I submitt an ammended 4138 to the VARO explaining this and or explain this to the QTC examiner?

I do appreciate you guys taking the time to track my info down and give such excellent insights. Hopefully one day I can do the same but if I tried now I would only mess their claim up royally. Like they say, you need to know your limitations.

#10 cannoncocker

 
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Posted 18 July 2009 - 09:25 AM

I had neglected to mention the fact I attempted suicide right after this situation in the service but all that is left is a scar that is unfortunately obvious what it is. I just wrapped it up and let it heal on my own and since it was in the field during the winter it was easy to conceal, concealed for the reasons i mentioned above. To many it probably wouldn't mean much but I took my responsibility seriously especially nearly killing my friends and crew and knowing the ripple effect it would have had on the theirs famalies.

And my chain of command did not write this situation up since they were partially at fault for assigning me to a position that I was not accutomed to. We just punched the round out of the tube and continued on but I never felt the same about myself and while i was at that unit there was no trust left. That was about the worst part of that becauuse I had to live with that everyday I saw them. It just never seemed to end.

#11 john999

 
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Posted 18 July 2009 - 03:44 PM

I believe that many of these anixeity disorders are covered up or ignored by vets because the vet actually thinks he is losing his mind. I could not explain this to the army psychiatrist I saw. He just sort of looked at me.

#12 Hoppy

 
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Posted 18 July 2009 - 08:43 PM

Cannoncocker

This post starts off a little discouraging and gets better as it goes. I am still in a fog about the issues in your claim so this is the best way for me to explain what know about the VA. I also studied psychology and completed all the core classes for a BS at UCLA. I had some tutoring from a Service officer who had a masters degree in psychology, worked at a VA hospital for ten years, was a rating specialist for the VA for twenty years and switched over to a service organization and was a service officer for ten more years.

Have you been on VA boards or are you new to VA compensation? Are you familiar with the laws that apply to service connection of a disability? Have you read any BVA cases? I am still not seeing the types of statements that you need to win service connection. Are you seeking nexus statements? Does the psychologist specifically say your current condition is related to military service? He has to say this. You can write letters to the VA in support of your claim stating your logic. If you do not have a masters degree working under the direct supervision of a PHD the raters probably will not even read your arguments. Even if the psychologist states that your current condition is related to service the VA is not required in all cases to accept his opinion.

The VA rating system is very technical. It is very different than other systems such as social security. If you go to a social security psychologist and he decides you have an anxiety disorder and even relates it to military service you can get compensation from the Social Security administration. That is of course you do not work and are unemployable. SSA only compensates total disability.

If you go to a psychologist and he says you have an anxiety disorder and he relates it to your military service and his opinion is based entirely on your subjective statements of historical events that occurred in the military and your SMR is silent for any complaints of psychology symptoms the VA generally is not allowed to give weight to the diagnosis if you were not to be determined to have been in combat. See BVA citation 9925065 below.

Do you know what the requirements for meeting the criteria for the VA to determine that you were in combat? Do you meet these requirements? Non combat veterans who file claims years after the military for injuries sustained and mental conditions whose military records are silent for the injuries and mental conditions generally cannot meet the requirements for service connection.

I have seen some exceptions that might work in your favor if you are a non combat veteran who worked at a dangerous job. I have seen panic disorders that were service connected after service based on specific jobs that were highly stressful. I will post them as I find them. I have seen panic disorders service connected almost the same way as PTSD. I will try and find these cases and post them. It is possible that BVA recognizes the types of long term stress situations that predate panic disorder. There is significant research that shows that individuals with long term stressors develop panic disorder at a rate four times higher than the general population. It would be a question if they feel your assignment or MOS in the military was capable of being a long term stressor. Definitely get the psychologist you are working with to work stress related to your MOS or assignment into the report. Find some research and get the psychologist to work it into the report. The trick is to get the RO to make the award. The RO may not be as thorough as the BVA.

A concern is that I could also find cases that were denied based on the lack of in-service symptoms.

Note that in both cases below the doctors specifically relate the current condition to stress in the military service.

BVA Citation Nr: 9925065
“A medical opinion which is based entirely upon a reported history from a veteran himself lacks a clinical foundation and accordingly lacks any significant probative value.”
----------------------------------------------------------------------------

Citation Nr: 0313005
Decision Date: 06/17/03 Archive Date: 06/24/03

DOCKET NO. 01-02 085 ) DATE
)
)

On appeal from the
Department of Veterans Affairs Regional Office in Boston,
Massachusetts


THE ISSUE

Entitlement to service connection for a generalized anxiety
disorder with agoraphobia.


REPRESENTATION

Appellant represented by: Vietnam Veterans of America


WITNESS AT HEARING ON APPEAL

Appellant


ATTORNEY FOR THE BOARD

Robert C. Scharnberger, Associate Counsel

INTRODUCTION

The veteran served on active duty from April 1951 to December
1953.

This case comes before the Board of Veterans' Appeals (the
Board) on appeal from an October 2000 rating decision of the
Boston, Massachusetts, Department of Veterans Affairs (VA)
Regional Office (RO).

The veteran testified at a personal hearing before the
undersigned Veterans Law Judge on February 15, 2002. A copy
of the transcript of that hearing has been associated with
the record on appeal.


FINDINGS OF FACT

1. All evidence necessary for an equitable adjudication of
the veteran's claim for service connection for a low
back disability has been obtained by the RO.

2. The veteran's generalized anxiety disorder with
agoraphobia is shown to be causally related to service.


CONCLUSION OF LAW

The veteran's generalized anxiety disorder with agoraphobia
was incurred in active service. 38 U.S.C.A. § 1110 (West
2002); 38 C.F.R. §§ 3.102, 3.303 (2002).


REASONS AND BASES FOR FINDINGS AND CONCLUSION

I. Background

As an initial matter, the Board notes that there has been a
significant change in the law during the pendency of this
appeal. On November 9, 2000, the President signed into law
the Veterans Claims Assistance Act of 2000 (VCAA),
38 U.S.C.A. § 5100 et seq. (West 2002); see 38 C.F.R.
§§ 3.102, 3.156(a), 3.159, 3.326(a) (2002). This law
eliminated the concept of a well-grounded claim, redefined
the obligations of VA with respect to the duty to assist, and
imposed on VA certain notification requirements.

Without deciding whether the notice and development
requirements of VCAA have been satisfied in the present case
with respect to the issue of service connection for a
generalized anxiety disorder with agoraphobia, the Board
finds that no undue prejudice to the appellant is evident by
a disposition by the Board herein, as the grant of his claim
of service connection for a generalized anxiety disorder is a
complete grant of the benefits sought on appeal. Cf. Bernard
v. Brown, 4 Vet. App. 384 (1993); see also Grantham v. Brown,
114 F.3d 1156 (Fed. Cir. 1997); see also Barrera v. Gober,
122 F.3d 1030 (Fed. Cir. 1997) (where appealed claim for
service connection is granted, further appellate-level review
is terminated as the Board does not retain appellate
jurisdiction over additional elements of claim: original
disability rating and effective date).

II. Service connection for a generalized anxiety disorder
with agoraphobia

In general, service connection will be granted for disability
resulting from injury or disease incurred in or aggravated by
active military service. 38 U.S.C.A. § 1110 (West 2002); 38
C.F.R. § 3.303 (2002). If a condition noted during service
is not determined to be chronic, then generally a showing of
continuity of symptomatology after service is required for
service connection. 38 C.F.R. § 3.303(B) (2002). Service
connection may also be granted for any disease diagnosed
after discharge when all the evidence, including that
pertinent to service, establishes that the disease was
incurred in service. 38 C.F.R. § 3.303(d) (2002).

In order to grant service connection, it is required that the
evidence shows the existence of a current disability, an
inservice disease or injury, and a link between the
disability and the inservice disease or injury. Watson v.
Brown, 4 Vet. App. 309, 314 (1993). This principle has been
repeatedly reaffirmed by the United States Court of Appeals
for the Federal Circuit, which recently stated that "a
veteran seeking disability benefits must establish . . . the
existence of a disability [and] a connection between the
veteran's service and the disability". Boyer v. West, 210
F.3d 1351, 1353 (Fed.Cir. 2000).

The veteran's service medical records do not show any
treatment for or complaint regarding anxiety or any other
psychiatric disability. The veteran's separation examination
is negative for any psychiatric disability. An August 1954
physical examination done for reserve purposes revealed a
normal psychiatric system.

Private medical treatment records indicate that the veteran
has been treated for anxiety since 1965 and the first
indication that he began taking Valium was in April 1965. VA
outpatient treatment notes dated from July 1997 to April 2001
indicate that the veteran has been treated for depression and
for a panic disorder with agoraphobic features.

The veteran underwent a VA examination in April 2000. The
veteran told the examiner that his anxiety suddenly developed
while he was in service and that he had difficulty flying
home. The examiner noted that there was no record of
treatment in service, but from the veteran's description, it
was quite clear that the anxiety disorder began while in
service. The examiner noted a long history of anxiety that
interfered with employment. The examiner diagnosed
generalized anxiety disorder with agoraphobia. The diagnosis
was based on the veteran's restlessness, constant fatigue,
difficulty concentrating, anxiety, and sleep disturbance.
The examiner also indicated that the veteran suffered from
panic attacks.

The veteran testified at a personal hearing in February 2002.
He testified that he first experienced a panic attack while
flying home on leave while in the military in 1952. He
indicated he had additional panic attacks while aboard a ship
in the service but that he never sought treatment while in
service. The veteran testified that he began treatment in
about 1955, and that he has been taking Valium since about
1965. He indicated he has had anxiety and panic attacks
continuously since they first began in service.

The Board sought a VHA opinion. The opinion of Dr. Kaup,
dated in January 2003, was that it was at least as likely as
not that the veteran's anxiety/depression symptoms began
during his military service. Dr. Kaup stated that the
service medical records were negative for any mention of a
psychiatric disability, but that based on the veteran's
statements and his medical expertise, it was at least as
likely as not that the veteran's disability began in service.
Dr. Kaup reviewed the claims folder including the private
treatment notes and the April 2000 VA examination report.
Dr. Kaup indicated that the veteran most likely has an
anxiety disorder/

Based on the above, the Board finds that service connection
for generalized anxiety disorder with agoraphobia is
warranted. The veteran currently suffers from this
disability based on the medical records and the April 2000 VA
examination. While the service medical records are negative
for any mention of a psychiatric disability, the VA examiner
indicated that it was quite clear that an anxiety disorder
began in service. Dr. Kaup considered the clinical records,
the veteran's history and, based on his medical training,
assessed that it was as likely as not that the veteran's
current disability is related to service. There is no
competent opinion suggesting that current psychiatric
disability does not owe its etiology to service. Giving the
benefit of the doubt to the veteran in this case, the Board
finds that service connection is warranted for a generalized
anxiety disorder with agoraphobia. 38 U.S.C.A. §§ 1110,
5107(B) (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2002).




ORDER

Entitlement to service connection for a generalized anxiety
disorder with agoraphobia is granted.




____________________________________________
THOMAS J. DANNAHER
Veterans Law Judge, Board of Veterans' Appeals

IMPORTANT NOTICE: We have attached a VA Form 4597 that tells
you what steps you can take if you disagree with our
decision. We are in the process of updating the form to
reflect changes in the law effective on December 27, 2001.
See the Veterans Education and Benefits Expansion Act of
2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the
meanwhile, please note these important corrections to the
advice in the form:

? These changes apply to the section entitled "Appeal to
the United States Court of Appeals for Veterans
Claims." (1) A "Notice of Disagreement filed on or
after November 18, 1988" is no longer required to
appeal to the Court. (2) You are no longer required to
file a copy of your Notice of Appeal with VA's General
Counsel.
? In the section entitled "Representation before VA,"
filing a "Notice of Disagreement with respect to the
claim on or after November 18, 1988" is no longer a
condition for an attorney-at-law or a VA accredited
agent to charge you a fee for representing you.


Citation Nr: 0627773
Decision Date: 09/05/06 Archive Date: 09/12/06

DOCKET NO. 98-09 648 ) DATE
)
)

On appeal from the
Department of Veterans Affairs Regional Office in St.
Petersburg, Florida


THE ISSUE

Entitlement to service connection for an acquired psychiatric
condition, including a panic disorder.


REPRESENTATION

Appellant represented by: Disabled American Veterans


WITNESSES AT HEARING ON APPEAL

The veteran and his wife


ATTORNEY FOR THE BOARD

Linda E. Mosakowski, Associate Counsel
INTRODUCTION

The veteran served on active duty from October 1967 to
October 1969.

This matter comes to the Board of Veterans' Appeals (Board)
on appeal from a rating decision by the Department of
Veterans Affairs (VA) Regional Office (RO) in St. Petersburg,
Florida.

After the RO issued the February 2006 supplemental statement
of the case (SSOC), the veteran submitted additional evidence
with respect to his appeal. Generally, if, after
certification to the Board, pertinent evidence is submitted
without notice that the veteran has waived his procedural
right to have the agency of original jurisdiction consider
the evidence, the appeal is remanded to the RO for initial
consideration of the evidence and issuance of a supplemental
statement of the case. 38 C.F.R. § 20.1304©. That
regulation also provides, however, that the evidence need not
be referred to the RO if the Board determines that the
benefit to which the evidence relates may be fully allowed on
appeal without such referral. Id. Since the veteran's claim
for service connection is granted below, no referral to the
RO will be made.


FINDINGS OF FACT

1. The veteran currently has a diagnosis of a panic
disorder.

2. The veteran incurred an injury during service, described
variously as traumatic experiences and as duties that
required constant vigilance.

3. The veteran's current panic disorder is related to active
military service.




CONCLUSION OF LAW

The criteria for service connection for an acquired
psychiatric condition, including panic disorder, have been
met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R.
§§ 3.102, 3.303 (2005).


REASONS AND BASES FOR FINDINGS AND CONCLUSION

To establish service connection for a claimed disability, the
evidence must demonstrate that a disease or injury resulting
in a current disability was incurred during active service.
38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Generally, service
connection requires: (1) existence of a current disability;
(2) existence of a disease or injury during service; and (3)
a nexus between current disability and any injury or disease
incurred in service. See Watson v. Brown, 4 Vet. App. 309,
314 (1993)
(a determination of service connection requires a finding of
the existence of a current disability and a determination of
the relationship between that disability and an injury or
disease incurred in service).

Two doctors have diagnosed the veteran with a panic disorder.
The veteran has received treatment for a panic disorder for
several years. The record clearly establishes the first
requirement of service connection--that the veteran currently
has a panic disorder disability.

There is conflicting evidence about whether the veteran
incurred his panic disorder during active military service.
The veteran's service medical records contain no indication
that he had a psychiatric condition during service. His exit
examination also is silent as to any psychiatric conditions.
And while the veteran states that he received treatment
within two years of separation from service, neither the
veteran nor the RO could obtain the treatment records from
the veteran's physician.

On the other hand, two doctors have specifically stated that
the veteran's current panic disorder is related to his active
military service. Service connection may be granted for any
disease diagnosed after separation when all the evidence
establishes that the disease was incurred in service.
38 C.F.R. § 3.303(d). If evidence sufficiently demonstrates
a medical relationship between the veteran's in-service
experiences and his current disability, it follows that the
veteran incurred an injury in service. See Godfrey v.
Derwinski, 2 Vet. App. 352, 356 (1992). From their
discussions with the veteran about his experiences during
service, both doctors determined that his current disability
stemmed from his active military service.

Dr. Suarez expressed the opinion that the veteran's panic
attacks with agoraphobia were related to "his duties in the
Army from 1967 to 1969 which required a constant vigilance."
The VA examiner in January 2006 related the veteran's panic
disorder to his "traumatic experiences in the military."
It, therefore, follows that the veteran incurred an injury in
service. See Godfrey, supra.

Other evidence in the record supports the doctor's opinions.
The veteran himself testified that, immediately following
service, he was subject to panic attacks that became so
severe he sought medical treatment. His wife testified that
right after the veteran's active service, he had trouble
breathing, one of the symptoms of his panic disorder. He was
also very nervous after his service. She testified that
before he went in the Army, he did not manifest those
symptoms. Thus, the second requirement for service
connection is met on this record.

Finally, at the veteran's January 2006 VA examination, the
examiner explicitly stated that it is more likely than not
that the veteran's current panic disorder is related to his
military experience. Since the record demonstrates all three
requirements for service connection, the veteran's claim will
be granted. Accordingly, there is no need to address whether
VA met its duty to notify and to assist the veteran in
obtaining evidence sufficient to substantiate his claim.


(CONTINUED ON NEXT PAGE)




ORDER

Service connection for an acquired psychiatric condition,
including a panic disorder, is granted.




____________________________________________
MARY GALLAGHER
Veterans Law Judge, Board of Veterans' Appeals

Edited by Hoppy, 18 July 2009 - 08:54 PM.


#13 Hoppy

 
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Posted 19 July 2009 - 01:04 PM

cannoncocker

This is the second long post in a row. I hope this works in your favor.

As you have figured out by now I do try to dig around and find out exactly how the claim is being advanced. The VA has little technicalities that can cause a valid claim to get denied without proper development. I posted some research that relates to you situation at the bottom.

It sounds like you are just beginning the diagnostic process. I say process because I have seen situations similar to yours wind up with five different diagnoses prior to getting rated. It is good that you are dealing with a VA shrink. Relying on a single C&P does not always work. If you get a poor workup by the C&P examiner then the claim will be denied. My recommendation is that you focus on linking any depression directly to the military as secondary to panic disorder and the back pain. You need to get the clinicians to back you up with their reports.

A problem may occur with VA treating physicians. Everything goes fine, they make diagnoses then when you tell them you want to get an opinion relating the current condition to military you hit a brick wall. As of yet you have not discussed this VA treating clinicians attitude about making a determination that your current condition is related to service. It is good that they have scheduled the C&P. The C&P examiner should address the relationship between the current condition and the military. There are numerous veterans on this board who have had to override C&P examiners reports with IMO's. You never know what you will get from a C&P. This is especially true when you consider the problem you brought up about biases. This is why I try to get a VA clinician to write a report prior to the C&P. When finances are available I even get an IMO prior to the C&P. If you can get a favorable opinion from the VA treating physician that the current condition is related to the military then the C&P examiner is put in a position of rebutting the treating clinicians statement. I am going to explain what I have ran into with a veteran who I am assisting at this time for panic disorder. I hope this will prepare you in the event you start running into difficulty with the VA examiner.

The veteran I am assisting was diagnosed by VA clinicians on multiple reports since 2006 with panic disorder and MDD. The VA required new and material evidence to re-open the claim. The RO stated they would not schedule a C&P until new medical evidence was submitted that addressed the issue that the current condition was related to the military. We have since dealt with five different VA clinicians.

We first went to the VA clinician who was running a panic attack group meeting that he was attending. We asked the clinician to read the SMR and make a statement addressing the relationship between the current condition and t5he military. The veteran had been to sick bay and psychiatrists while in the military with complaints that meet the DSM IV requirement for panic attacks and panic disorder. The veteran was seen over a sixteen month period in the military and was discharged for a personality disorder. This was at a time the DSM II was in effect. Panic disorder was not in the DSM II. Getting these old DSM II diagnoses changed to ratable conditions is not that difficult. I have assisted on at least 5 claims where this was done. The VA clinician (PHD) refused to read the SMR. After a visit to the customer care representative the clinician was advised by a psychiatrist that she had to read the SMR . The clinician read the SMR and wrote a report that did not address any relationship between the current condition and the SMR. The clinician cited VHA directive 2007-24. The clinician stated that they were an acute care facility and was not required to make the requested assessment. I have run into this problem before and it did not surprise me.

The second clinician was a VA psychiatrist who was prescribing him medication for his mental conditions. Initially the psychiatrist was interested in helping and read the SMR and wrote a report that the symptoms in the military were panic attacks. However, he said that there was no evidence of panic disorder. There was clear evidence of panic disorder in the military. I though the psychiatrist missed something, I went back to the psychiatrist and asked him to sign an addendum that he was aware of the notes in the SMR that specifically related to panic disorder and was still of the opinion that the requirement of panic disorder were not met. The problem was that if he signed the addendum it would show his incompetence. He was trying to sweep the panic disorder diagnosis under the carpet. Had he made the diagnosis of panic disorder it made the veterans claim for service connection very strong. An argument ensued during which the psychiatrist said he would no longer get involved because the veterans panic disorder was not related to the military because he had a predisposition for the condition when he entered the military. This psychiatrist was way off track. Predispositions are an entirely different issue that has been resolved by the VA’s General Council as being irrelevant. Additionally, the cause of panic disorder and the time frame that it can onset does not limit events to those that would predate service. There was no factual basis to his predisposition theory. Rather than argue with this guy it became time to get another clinician to address the veteran’s claim.

We did get his new primary doctor to read the SMR and write a nexus statement that should be sufficient to re-open the claim and get a C&P exam. In other claims I have had three primary doctors refuse to get involved for every one that will get involved. We got lucky with his new primary doctor.
Since then the VA has sent him to a new clinician who is of the opinion that panic disorder is curable with medication and therapy. This does not surprise me. The internet is loaded with clinicians who view panic disorder as curable. In expectation of an opinion that the panic disorder is not disabling I have sought reports linking the MDD as secondary to the long term untreated panic disorder. This veteran’s main problem is depression. 50% of all individual with panic disorder develop Major Depressive Disorder (MDD). He had symptoms of panic attacks in the military and was not treated. He was discharged with an opinion from a military psychiatrist that treatment would not be beneficial. The condition went untreated for 25 years. Now they are trying to say they can cure the panic disorder. They need to try and cure a long term untreated MDD. Lot’s of luck to the VA on this.

Below is the research that I feel would best link your symptoms to the military. The VA shrinks try and push everything back onto childhood experiences.

Recent life events

A number of authors claim that a major stressful event can be traced in the recent history of most PD patients (Barlow, 1988; Margraf et al., 1986), even though Shulman et al. (1994) reported that a precipitating factor could be identified in only 40% of PD patients in their sample. Several studies have shown that, indeed, panic patients experience more significant life events in the year preceding the onset of PD, especially those involving perception of lack of control, and that they see the impact if life events as more negative than controls (Faravelli, 1985; Faravelli & Pallanti, 1989; Rapee et al., 1990).

Edited by Hoppy, 19 July 2009 - 01:11 PM.


#14 john999

 
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Posted 19 July 2009 - 01:18 PM

Cannon Cocker

Hoppy is putting on a clinic for you with his answers. He sounds like a lawyer/doctor. You are getting your money's worth. If your records are silent on treatment or diagnosis for a mental disorder there are only two I know of that can be SC'ed years late. That would be depression secondary to a SC physical medical condition, or PTSD with verified stressor. Panic disorder was and is probably one of the most misdiagnosed disorders. I think it is closely related to PTSD, but there may not be just one stressor. It may be a life time of stressors that break under the last straw like the camel's back. If the last straw is some event in the military then they get to pay. The military is a great place to produce an acute phase of panic since they force you into situations the panic disorder person would avoid at all costs otherwise.

#15 broncovet

 
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Posted 19 July 2009 - 01:55 PM

Most of us have "good days" and bad days. When they ask how you are..dont lie..just tell them about Thursday..
"Thursday, I was about to go off the deep end...it did not go well at all...I was very angry about...."
In other words never lie to them..just simply tell them about your worst day, not your best day..today may be your best day, so tell them about the bad one.
JMHO...It is ok to have planned out in your head which day you are going to talk to your C and P examiner about..again, dont make stuff up..just tell them about the bad days. Its kind of like the news..it isnt newsworthy for them to talk about nothing happening today..but it is newsworthy about the car accident you were in where you wrecked your car and almost died last week.