Jump to content










Photo
- - - - -

Smc Housebound For Ptsd Denied


This topic has been archived. This means that you cannot reply to this topic.
18 replies to this topic

#1 MikeS

 
MikeS

    E-5 Petty Officer 2nd Class

  • First Class Petty Officer
  • PipPipPipPipPip
  • 118 posts
 

Posted 07 April 2011 - 08:24 AM

Hi all:

Rating increased from 70% TDIU for PTSD to 100% scheduler for PTSD with Panic Disorder with Agoraphobia and Depressive Disorder.

Housebound denied.

Housebound was denied because I keep my VAOC appointments. I thought my VAOC appointments do not go against my claim for Housebound.

Housebound was denied because I try to go with my wife to a grocery store once a month. The C&P examiner wrote that I do go to the grocery store once a month but what I told him was that I "try" to go with my wife, "not alone".

Housebound was denied because a recent Progress Note from my VA PTSD Doc said that I go to a gym. What my PTSD VA Doc really wrote was that I tried to go to the gym but I could not stay because I paniced. My VA PTSD Doc failed to put in that note that that was 2 years ago.

You guys might want to know that my Housebound C&P was done by a CRNP. She told me that she had no idea how to explain that a vet with PTSD can be Housebound, so she told me that she just would "cut & paste" my VA PTSD Doc's Progress Notes because she said that he explained my situation better that she ever could. Still, she answered the question: "Can veteran travel beyond current domicile?" as YES.

I only have 60 days from March 27th to appeal the Housebound denial because I signed up for the ECA Initiative.

Any guidance would be appreciated.

P.S. Even though I applied "only" for Housebound, my entire file was reviewed including all Nexus information.

Thanks,

MikeS

#2 Berta

 
Berta

    HadIt.com Elder/SVR Radio Panelist

  • Podcast Crew
  • PipPipPipPipPipPipPipPipPipPip
  • 29192 posts
 

Posted 07 April 2011 - 09:33 AM

"She told me that she had no idea how to explain that a vet with PTSD can be Housebound, so she told me that she just would "cut & paste" my VA PTSD Doc's Progress Notes because she said that he explained my situation better that she ever could.


DUH and double duh- doesn't she know what agoraphobia is?

This is absurd.

I wonder if you can challenge this to get another C & P. If the CRNP has to "Copy and paste" and cannot write an opinion of her own-I think it can be challenged on that basis as she had to 'speculate' by using another medical statement instead of her own.( gee- if she just copies and pastes stuff she could become a de novo review DRO!)

Ridiculous.
Others will chime in.

Did you have any lay statements submitted with the HB claim?

Do your treatment records reveal any panic attacks attributable to the agoraphobia?

"recent Progress Note from my VA PTSD Doc said that I go to a gym" That has to be corrected by the doctor.

#3 Pete53

 
Pete53

    Moderator/HadIt.com Elder

  • Moderator
  • PipPipPipPipPipPipPipPipPipPip
  • 21904 posts
 

Posted 07 April 2011 - 09:38 AM

MikeS

Glad you got the 100% and the denial is completely bogus and I think that you know it. I am 100% with agoraphobia and SMC and I go to appointments, occasionally go to out which I have to have someone with me or my dog. Sometimes I don't leave the house for weeks. I also go out to lunch with a friend.

Actually all I think that you really need is a Doc to diagnose agoraphobia to win an appeal on this one.

Fight for it you earned it.

Good Luck

#4 john999

 
john999

    HadIt.com Elder

  • HadIt.com Elder
  • PipPipPipPipPipPipPipPipPipPip
  • 22380 posts
 

Posted 07 April 2011 - 10:05 AM

These awful C&P exams done by CRNP's are just a scandal. Like Pete says if you have agoraphobia by definition you are housebound. If the NP does not understand this she should be fired.

#5 MikeS

 
MikeS

    E-5 Petty Officer 2nd Class

  • First Class Petty Officer
  • PipPipPipPipPip
  • 118 posts
 

Posted 07 April 2011 - 11:13 AM

[quote name='Berta' timestamp='1302190428' post='241024']
"She told me that she had no idea how to explain that a vet with PTSD can be Housebound, so she told me that she just would "cut & paste" my VA PTSD Doc's Progress Notes because she said that he explained my situation better that she ever could.


DUH and double duh- doesn't she know what agoraphobia is?

This is absurd.

I wonder if you can challenge this to get another C & P. If the CRNP has to "Copy and paste" and cannot write an opinion of her own-I think it can be challenged on that basis as she had to 'speculate' by using another medical statement instead of her own.( gee- if she just copies and pastes stuff she could become a de novo review DRO!)

Ridiculous.
Others will chime in.

Did you have any lay statements submitted with the HB claim?

Do your treatment records reveal any panic attacks attributable to the agoraphobia?

"recent Progress Note from my VA PTSD Doc said that I go to a gym" That has to be corrected by the doctor.
[/quot

BERTA:

The nurse did answer the question: "Are there other body parts or system impairments that affect the ability of the veteran to protect self from the daily environment?" YES.

Description of impairment: PTSD, Panic Disorder with Agoraphobia. Right after that statement is when she "cut & pasted" my PTSD VA Doc's notes.

Also, that same DX is present in over 2 years of Progress Notes from my PTSD VA Doc and VA shrink.

#6 MikeS

 
MikeS

    E-5 Petty Officer 2nd Class

  • First Class Petty Officer
  • PipPipPipPipPip
  • 118 posts
 

Posted 07 April 2011 - 11:17 AM

MikeS

Glad you got the 100% and the denial is completely bogus and I think that you know it. I am 100% with agoraphobia and SMC and I go to appointments, occasionally go to out which I have to have someone with me or my dog. Sometimes I don't leave the house for weeks. I also go out to lunch with a friend.

Actually all I think that you really need is a Doc to diagnose agoraphobia to win an appeal on this one.

Fight for it you earned it.

Good Luck


Thanks for the input. I have been DX'd with Panic Disorder with Agoraphobia by the C&P examiner, my VA PTSD Doc, and my VA psychiatrist. No IMO.

#7 MikeS

 
MikeS

    E-5 Petty Officer 2nd Class

  • First Class Petty Officer
  • PipPipPipPipPip
  • 118 posts
 

Posted 07 April 2011 - 11:26 AM

One other thing:

The rating decision ignored a vital part of my Statement in Support of Claim.

I wrote that I had moved to within 1 mile of the VAOPC so that I could more easily make my appointments.

I wrote that I bought a small old house as close to the VAOPC as I could find.

I also wrote that the move put my wife and I into debt and added more monthly costs because we moved from an apartment where we paid no taxes, no water, no sewage, and we did not have to pay for anything that broke.

Frustrating!

Thanks.

Mike S.

#8 Pete53

 
Pete53

    Moderator/HadIt.com Elder

  • Moderator
  • PipPipPipPipPipPipPipPipPipPip
  • 21904 posts
 

Posted 07 April 2011 - 12:06 PM

Some other thoughts about agoraphobia is that not all agoraphobics have the same fears. What happens is that over time we try to avoid situations or places that cause panic attacks. I know some that can go shopping and are still agoraphobics cause they cannot go to a restaurant, or a movie or deal with standing in line or as the classic definition fear of open spaces.

Reading on the person who did your C&P is unqualified. Since you did get 100% at least you can decide the best way and if I was in your shoes I would ask for a Hearing with a DRO as soon as possible.

The VA should be ashamed for putting unqualified examiners in the first place. Cut and paste is not an opinion.

#9 MikeS

 
MikeS

    E-5 Petty Officer 2nd Class

  • First Class Petty Officer
  • PipPipPipPipPip
  • 118 posts
 

Posted 07 April 2011 - 02:21 PM

Some other thoughts about agoraphobia is that not all agoraphobics have the same fears. What happens is that over time we try to avoid situations or places that cause panic attacks. I know some that can go shopping and are still agoraphobics cause they cannot go to a restaurant, or a movie or deal with standing in line or as the classic definition fear of open spaces.

Reading on the person who did your C&P is unqualified. Since you did get 100% at least you can decide the best way and if I was in your shoes I would ask for a Hearing with a DRO as soon as possible.

The VA should be ashamed for putting unqualified examiners in the first place. Cut and paste is not an opinion.


Pete:

I was thinking the same thing about a DRO.

It seems to me that the nurse was more qualified to perform an A&A for veterans with physical disabilities than with veterans with PTSD.

Which leads me to another problem that I have with a Housebound C&P. I came away from the C&P feeling guilty because I do not have physical disabilities and feeling badf for all the vets who are physically disabled.

I really do not know who should do a Housebound C&P for vets with severe PTSD.

Thanks,

MikeS

#10 john999

 
john999

    HadIt.com Elder

  • HadIt.com Elder
  • PipPipPipPipPipPipPipPipPipPip
  • 22380 posts
 

Posted 07 April 2011 - 02:28 PM

A psychiatrist! The VA used the NP because they are cheap.

#11 Pete53

 
Pete53

    Moderator/HadIt.com Elder

  • Moderator
  • PipPipPipPipPipPipPipPipPipPip
  • 21904 posts
 

Posted 07 April 2011 - 04:12 PM

Mike physical injuries are one thing but you have emotional scars and are as deserving as anyone else.

If there is one thing to remember all you can be responsible for is you and the VA is responsible for all of us

#12 stillhere

 
stillhere

    E-8 Senior Chief Petty Officer

  • Senior Chief Petty Officer
  • PipPipPipPipPipPipPipPip
  • 1367 posts
 

Posted 07 April 2011 - 04:44 PM

That is very true Pete! I was awarded SMC s because my heart was 100% and my PTSD and others added up to well way over what is required.

Mike is your only SC the PTSD? You obviously are having a very hard time dealing with this and the VA can be hard to deal with. I wonder if there is an exam sheet that she was supposed to follow during the C&P? Anyone know? I know for a fact there is a sheet for just about all of our illnesses but not sure if there is a specific one for Housebound?

#13 MikeS

 
MikeS

    E-5 Petty Officer 2nd Class

  • First Class Petty Officer
  • PipPipPipPipPip
  • 118 posts
 

Posted 08 April 2011 - 06:10 AM

That is very true Pete! I was awarded SMC s because my heart was 100% and my PTSD and others added up to well way over what is required.

Mike is your only SC the PTSD? You obviously are having a very hard time dealing with this and the VA can be hard to deal with. I wonder if there is an exam sheet that she was supposed to follow during the C&P? Anyone know? I know for a fact there is a sheet for just about all of our illnesses but not sure if there is a specific one for Housebound?


There is an exam sheet that she used but the problem is that it is primarily an Aid & Assistance worksheet. The only Housebound question is question #33 out of 34 questions on VA Form 21-2680. It states: "Describe how often per day or week and under what circumstance the claimant is able to leave the home or premises".

The nurse did explain that I have a real problem leaving my home but she did not commit to saying that I am Housebound. She did not say that I wasn't either.

#14 Berta

 
Berta

    HadIt.com Elder/SVR Radio Panelist

  • Podcast Crew
  • PipPipPipPipPipPipPipPipPipPip
  • 29192 posts
 

Posted 09 April 2011 - 07:36 AM

This 2010 BVA decision references Hartness-did they VA reference Hartness in the denial?

“With regard to housebound status, the threshold statutory
requirement is that the Veteran must have a single permanent
disability rated at 100 percent. In this regard, the Veteran
currently meets this requirement by way of his service-connected
schizophrenia. Still, he does not have additional service-
connected disability or disabilities independently ratable at 60
percent or more. 38 U.S.C.A. § 1114(s); 38 C.F.R. § 3.350(i).
However, with regard to being "permanently housebound," it is
also clear from the record that the Veteran has been unemployed
for many years due to his service-connected disabilities, and is
"substantially confined" to his home in terms of not being able
to leave for the purpose of earning a living, thus meeting the
standard under Hartness, 20 Vet. App. at 222. In this respect,
the Veteran has not worked due to his service-connected
schizophrenia since 1965. While no examination has indicated
that the Veteran is bedridden or confined to his house it is
apparent that his ability to leave the house to earn income is
precluded by his service-connected disabilities. After
considering the Veteran's age, disabilities and ability to leave
his house, the Board finds that entitlement to housebound
benefits by reason of his service-connected disabilities would
normally be warranted in the present case. 38 U.S.C.A. §
1114(s); 38 C.F.R. § 3.350(i).

Notwithstanding the above, in view of the Board's grant of
special monthly compensation based on the need for regular aid
and attendance herein, the issue of entitlement to special
monthly compensation on account of being housebound is moot. In
this regard, a Veteran may either receive special monthly
compensation based on the need for regular aid and attendance or
by reason of being housebound, but may not receive both
simultaneously. That is, regular aid and attendance is the
greater monetary award. Compare 38 U.S.C.A. § 1114(l) with 38
U.S.C.A. §1114(s). Therefore, the question concerning whether
the Veteran is housebound for special monthly compensation
purposes is a moot point.”


ORDER

Special monthly compensation by reason of being in need of aid
and attendance of another person is granted, subject to the laws
and regulations governing the award of monetary benefits.

http://www.va.gov/ve...es4/1032308.txt

(the claim is on remand due a FTCA settlement and Sec 1151 ending)

The BVA in their narrative however reiterates the Hartness decision adding this point.

(substantially confined means the inability
to leave the house except in instances of seeking medical
treatment)."

I feel this evidence can combat that :

"The rating decision ignored a vital part of my Statement in Support of Claim.

I wrote that I had moved to within 1 mile of the VAOPC so that I could more easily make my appointments.

I wrote that I bought a small old house as close to the VAOPC as I could find.

I also wrote that the move put my wife and I into debt and added more monthly costs because we moved from an apartment where we paid no taxes, no water, no sewage, and we did not have to pay for anything that broke."


You are right -this is a vital part of your claim and this is why they ignored it.This should definitely be pointed out in any response or rebuttal you make to the SOC.

I have friend with agoraphobia who cannot even drive anymore due to it.If this is a factor for you too make sure the VA knows it.

#15 MikeS

 
MikeS

    E-5 Petty Officer 2nd Class

  • First Class Petty Officer
  • PipPipPipPipPip
  • 118 posts
 

Posted 09 April 2011 - 02:54 PM

This 2010 BVA decision references Hartness-did they VA reference Hartness in the denial?

“With regard to housebound status, the threshold statutory
requirement is that the Veteran must have a single permanent
disability rated at 100 percent. In this regard, the Veteran
currently meets this requirement by way of his service-connected
schizophrenia. Still, he does not have additional service-
connected disability or disabilities independently ratable at 60
percent or more. 38 U.S.C.A. § 1114(s); 38 C.F.R. § 3.350(i).
However, with regard to being "permanently housebound," it is
also clear from the record that the Veteran has been unemployed
for many years due to his service-connected disabilities, and is
"substantially confined" to his home in terms of not being able
to leave for the purpose of earning a living, thus meeting the
standard under Hartness, 20 Vet. App. at 222. In this respect,
the Veteran has not worked due to his service-connected
schizophrenia since 1965. While no examination has indicated
that the Veteran is bedridden or confined to his house it is
apparent that his ability to leave the house to earn income is
precluded by his service-connected disabilities. After
considering the Veteran's age, disabilities and ability to leave
his house, the Board finds that entitlement to housebound
benefits by reason of his service-connected disabilities would
normally be warranted in the present case. 38 U.S.C.A. §
1114(s); 38 C.F.R. § 3.350(i).

Notwithstanding the above, in view of the Board's grant of
special monthly compensation based on the need for regular aid
and attendance herein, the issue of entitlement to special
monthly compensation on account of being housebound is moot. In
this regard, a Veteran may either receive special monthly
compensation based on the need for regular aid and attendance or
by reason of being housebound, but may not receive both
simultaneously. That is, regular aid and attendance is the
greater monetary award. Compare 38 U.S.C.A. § 1114(l) with 38
U.S.C.A. §1114(s). Therefore, the question concerning whether
the Veteran is housebound for special monthly compensation
purposes is a moot point.”


ORDER

Special monthly compensation by reason of being in need of aid
and attendance of another person is granted, subject to the laws
and regulations governing the award of monetary benefits.

http://www.va.gov/ve...es4/1032308.txt

(the claim is on remand due a FTCA settlement and Sec 1151 ending)

The BVA in their narrative however reiterates the Hartness decision adding this point.

(substantially confined means the inability
to leave the house except in instances of seeking medical
treatment)."

I feel this evidence can combat that :

"The rating decision ignored a vital part of my Statement in Support of Claim.

I wrote that I had moved to within 1 mile of the VAOPC so that I could more easily make my appointments.

I wrote that I bought a small old house as close to the VAOPC as I could find.

I also wrote that the move put my wife and I into debt and added more monthly costs because we moved from an apartment where we paid no taxes, no water, no sewage, and we did not have to pay for anything that broke."


You are right -this is a vital part of your claim and this is why they ignored it.This should definitely be pointed out in any response or rebuttal you make to the SOC.

I have friend with agoraphobia who cannot even drive anymore due to it.If this is a factor for you too make sure the VA knows it.



Berta:

No cases were referenced in their denial of Housebound.

Thanks,

Mike S.

#16 MikeS

 
MikeS

    E-5 Petty Officer 2nd Class

  • First Class Petty Officer
  • PipPipPipPipPip
  • 118 posts
 

Posted 11 April 2011 - 04:48 PM

Berta:

The rules for Housebound as they would apply to PTSD are very vague to me.

Is it unusual for a veteran with PTSD to apply for SMC Housebound?

Besides "Hartness", are there any other cases that I could use in my NOD?

Thanks,

Mike S.

#17 john999

 
john999

    HadIt.com Elder

  • HadIt.com Elder
  • PipPipPipPipPipPipPipPipPipPip
  • 22380 posts
 

Posted 11 April 2011 - 06:53 PM

If social phobia or agoraphobia is part of your PTSD then that should help you get HB. I think many PTSD vets are housebound to a great extent. I don't think it is unusual at all. If you have severe PTSD you may be afraid of many things outside your safe zone.

#18 MikeS

 
MikeS

    E-5 Petty Officer 2nd Class

  • First Class Petty Officer
  • PipPipPipPipPip
  • 118 posts
 

Posted 12 April 2011 - 08:21 AM

If social phobia or agoraphobia is part of your PTSD then that should help you get HB. I think many PTSD vets are housebound to a great extent. I don't think it is unusual at all. If you have severe PTSD you may be afraid of many things outside your safe zone.


It looks like there are as many "interpretations" of Housebound as there are ROs!

My God! Just think about the veterans (probably tens of thousands) who are not able to (try) to work their way through the VBA to get what is rightfully theirs like we all can (try)!

Thanks,

Mike S.

#19 Pete53

 
Pete53

    Moderator/HadIt.com Elder

  • Moderator
  • PipPipPipPipPipPipPipPipPipPip
  • 21904 posts
 

Posted 12 April 2011 - 01:27 PM

Mike:

Look we have discussed a lot of stuff but it appears that the person who did your C&P was unqualified and unable to apply VA regulations and rules. Focus on getting her C&P dismissed is my advice. Best way is for a Doctor to take it apart.

Good Luck