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      How to get your questions answered. A few observations, and requests of all members. All folks who come here are volunteers who do this on their own time and their own dime.To avoid burning out our best contributors please follow these guidelinesf you are reading a post and it reminds you of a question you want to ask, start a new topic, if you place your question in someone thread it will be difficult to distinguish your question from the original poster, you will get better results posting a new topic with your question. 1. Before Posting please do a search and see if your question has already been answered. If you find the answer print it out and put it in a file to use as a reference file, I find this helpful myself. 2. If you can not find the answer and you do post a question, please print out those answers and refer to them to avoid duplicate questions. 3. Refer to the Frequently Asked Questions4. Duplicate questions will come up from time to time but the keeping them to the minimum will lighten the load on the regular volunteers.5. Respect folks privacy do not request their personal phone numbers for claims help, it is inappropriate and not why they are here.6. Keep the topics focused on veterans issues, in closing Search first Search ... Ask second.it may save a lot of time or at the very least enlighten you.
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    • A bit about Tbird and HadIt.com for those who've asked...

      The following is on my About page, but some have been asking how this all happened. So here is my little story. Tbird US Navy 1983 – 1990 E-6 HadIt.com the website domain registered Jan 20, 1997 the domain is registered and paid for through Jan 21, 2023 at which time I plan to register it for another 15 years Lord willing and the creek don't rise. I guess the best place to start is Jan 1991; I had gotten out of the navy Dec 1990. At my separation seminar, there was a DAV rep Jim Milton he told us to bring our medical records in and he would look through them for us and let us know if we should file a claim with the VA. Well, bless his heart, he opened my medical file, reads the first insert, looks me straight in the eye, and says you will be 50% for the rest of your life and he would file the claim for me. 50% was for surgery I had in the service. True to his word he met with me and talked with me for a long time filled out my paper work and urged me to file for PTSD. I would not file the PTSD claim, nor even discuss it. By Feb 1991 I had moved to the San Francisco bay area and was staying at a friends apartment and pretty much I was just a puddle. In desperation one night I called suicide hot line, I had no job, no idea about going to the VA. They talked with me for a long time and explained to me that I could go to the local VA hospital even if I did not have insurance. Now, I know what you are thinking if I was 50% why didn't I just go to the VA in the first place, two reasons 1, this was Feb 1991 and the 50% didn't come till May and 2, even if it had come through it is unlikely that I would have had the mental acuity at the time to put the two together. I relate this here because it is where so many of our brothers and sisters are coming from, perhaps where you started. Fuzzy and unsure, in pain and sometimes homeless they come to the VA hospital for help. And that is where I ended up. Up to the pysch ward I went, blah, blah, blah, a few days later I was released with a promise of a call from the out patient program, which I would soon be entering. Blah, blah, blah, after many missed communications, and no call backs I was at the Day Hospital everyday M-F. And this brothers and sisters is where I began to learn and formulate my plan for HadIt.com. Veterans, veterans everywhere…I spent a year in the day hospital and about another year at a sheltered workshop before I got back on my feet. So I just talked to veterans everyday waiting for appointments, waiting for prescriptions, waiting for a vet rep and I started to learn the system. While in the navy I was data analyst and had to learn a 5 volume manual and just about anything you were suppose to do was in that manual. So I figured there must be a manual on how to do a VA claim or at the very least regulations. So I found out about the Code of Federal Regulations, United States Code, Veterans Affairs Manuals and so on and so forth. Of course this was 1991/1992 I was living in a tiny studio apartment in a particularly bad neighborhood, working in a sheltered workshop making a nickel per envelope I stuffed throw in PTSD and you will see that it was a difficult task for me to get somewhere where they had copies of these, let alone that they would let me look at. And there was so much knowledge around me, it was like the gold rush in those days, I could just sit on a bench a veteran would sit down next to me a little conversation later I had another nugget, I made copious notes. Phone numbers to call, ask for this guy or that guy he'll give you the straight scoop and they'd slip me a piece of paper with a number on it. You want to read this regulation or that one and another slip of paper into my hand. I spent a lot of time on those benches watching the squirrels they gathered their nuts and I gathered mine :) So I'm thinking I could put a little handbook together print it out and hand it out at the VA. Or perhaps fliers. Still formulating, time goes by, 1994/1995 I am being treated for PTSD regularly and doing and feeling much better and I go to work for a company as a marketing systems analyst and I discover the internet. Well let me tell you that was perhaps one of the most significant life changing events I have ever experienced. And I might add finally a positive one :) It seemed only natural to me that surely there must be a website that contained all the knowledge I wanted, well as it turned out not so much, lots of stuff but I wanted to get straight to the claims information and there was a lot of stuff to wade through to get to it. So taking my lesson from the squirrels earlier I started to gather, gather, gather…and learn HTML and work as a marketing systems analyst and work my claim. 1996/1997 major PTSD cork blows and unemployed. Working my claim, working the website. 20 Jan 1997 register HadIt.com domain name right after getting off the phone with the VA and saying I've had it with this. As fate would have it the old DAV board goes down just as mine opens up and folks start to wander in. So HadIt.com has two main components the website which supports the discussion board with links, articles, research resources etc. The website starts to grow, I can't tell you how many times I had to switch servers for space and features. I continue on a downward trend and in 1998 ended up back home in St Louis living in my sisters basement in therapy and working it, I swear I would have swung a dead chicken around my head at midnight naked if I thought it would have helped. The website continued to do great during this time, I just stayed in the basement bought new software, new books, and learned how to make things work and I continued to use this knowledge to make HadIt.com better. My 100% finally came through from the VA and I had a friend who is an advocate who helped me thru my SSDI claim, he was literally at my side thru the entire process and that came through for me. My therapist and sister continued to try and get me to leave the basement, but to no avail. At some point in 1998 or 1999 I put a counter on the website and was shocked to discover how many visitors we were getting. Time goes by my sister gets married and I move from the basement to the upstairs, there is much celebration that Aunt T is living in the light again. More time goes by and I settle into my life in St Louis and spend more time on the site trying new things, finding more information. 2003 I buy my own home VA loan. For years now I have just considered HadIt.com my job and I get up every morning go to the office and work for several hours, take an afternoon break and see where the rest of day takes me. I have a place in the office to use the computer and a comfortable to place to read journals and articles and take notes. Blah, blah, blah so that is my story and HadIt.com's intertwined.
    • HadIt.com Pass It On Cards

      Hi I've updated our HadIt.com Pass It On Cards. They are in a PDF format you can print them out cut them there are 12 to a page. If you have found HadIt.com helpful and would like to pass it on to other veterans this is an easy way to do it.I hope you find them helpful, feel free to leave a few anywhere veterans gather, veterans centers, veterans hospitals, public libraries, be creative. Please make sure though, that if you want to leave some at any business you ask permission first.Here you go http://www.hadit.com...it_on_cards.pdf
    • VA Training and Fast Letter Forum Index

      VA Training and Fast Letter Forum Index The following is the index with links to the various Training and Fast Letters plus a few miscellaneous. These letters are not necessarily in the original formatting. I have tried to present them in an easy-to-read form instead of some forms as originally presented. Some of the paragraphs were WAAAAYYY too long. lol - HadIt.com Member fanaticbooks Something to be aware.... Some of these letters may be rescinded, outdated, or otherwise no longer viable. I have still included them because sometimes they provide additional insight or just plain more information than the newest version. Use them wisely. The oldest letters will display at the bottom with the latest letters displayed at the top, all in sequential numbers. Coding of the letters... FL = Fast Letter TL = Training Letter First two numbers = last two digits of year of origin Training Letter http://www.hadit.com/forums/index.php?/topic/40694-va-tl-00-07/ http://www.hadit.com/forums/index.php?/topic/40693-va-tl-00-06/ Fast Letter Number Title http://www.hadit.com/forums/index.php?/topic/44262-va-fl-11-15/ http://www.hadit.com/forums/index.php?/topic/44260-va-fl-11-13/ http://www.hadit.com/forums/index.php?/topic/44261-va-fl-11-11/ http://www.hadit.com/forums/index.php?/topic/44310-va-fl-11-09/ http://www.hadit.com/forums/index.php?/topic/42151-va-fl-11-03/ http://www.hadit.com/forums/index.php?/topic/40957-va-fl-10-49/ http://www.hadit.com/forums/index.php?/topic/40958-va-fl-10-46/ http://www.hadit.com/forums/index.php?/topic/40959-va-fl-10-45/ http://www.hadit.com/forums/index.php?/topic/40960-va-fl-10-42/ http://www.hadit.com/forums/index.php?/topic/40961-va-fl-10-39/ http://www.hadit.com/forums/index.php?/topic/40962-va-fl-10-35/ http://www.hadit.com/forums/index.php?/topic/40963-va-fl-10-34/ http://www.hadit.com/forums/index.php?/topic/40964-va-fl-10-32/ http://www.hadit.com/forums/index.php?/topic/40966-va-fl-10-30/ http://www.hadit.com/forums/index.php?/topic/40967-va-fl-10-26/ http://www.hadit.com/forums/index.php?/topic/40968-va-fl-10-25/ http://www.hadit.com/forums/index.php?/topic/40819-va-fl-10-24e1/ http://www.hadit.com/forums/index.php?/topic/40818-va-fl-10-24/ http://www.hadit.com/forums/index.php?/topic/40817-va-fl-10-22/ http://www.hadit.com/forums/index.php?/topic/40814-va-fl-10-04/ http://www.hadit.com/forums/index.php?/topic/40969-va-fl-10-03/ http://www.hadit.com/forums/index.php?/topic/40812-va-fl-10-02/ http://www.hadit.com/forums/index.php?/topic/40808-va-fl-09-52/ http://www.hadit.com/forums/index.php?/topic/40806-va-fl-09-50/ http://www.hadit.com/forums/index.php?/topic/40970-va-fl-09-41/ http://www.hadit.com/forums/index.php?/topic/40971-va-fl-09-38/ 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Not Sure Where To Turn

32 posts in this topic

Posted · Report post

I have been on this site for a while but new to posting. I am 90% disabled for PTSD and Bipolar II Mixed and currently going through a hard time. In the past I was turned down for TDIU and SSD because nothing in my records stated I couldn't work just my condition is guarded. I have no place in the area to get an IMO since I live in the booneys. My VA treating doctor and social worker have recently wrote short letters that may or may not help my case. They were reluctant to do so. I just left my last job because stress and panic it caused me on the job due to my PTSD. I was wondering if I can (appropriate) to share my two letters and get oppinions on how it may help or not help my case? The letters are about a half a page put together. I've been able to get employment but not maintain it. Thanks.

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Posted · Report post

Appropriate? Sure. I don't see anything wrong with it and many here do so they can get an opinion just as you seek. Just redact what personal information you don't feel comfortable allowing other to know.

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Thanks for the quick response. I didn't know where else to go to get an opinion. Below are the two letters redacted.

Psychiatrist

___ is under my care over a year. He is treated for PTSD and bipolar disorder mixed type. He reports he is experiencing severe anxiety at work and difficulty concentrating at work. As a result his perormance at work has suffered. This is affecting his self esteem. Since his move to __________ he has alreay changed his job twice. Because of his emotional problems cause by his psychiatric issues he is unable to hold on to a job and perform satisfactory. Considering the chronicity of the conditon prognosis is guarded.

Social Worker

This letter is to inform you that I have been working with _____ in individual therpy for over a year. He is also participating with medication management with (above Dr). He has been diagnoses with chronic PTSD, as well as Bipolar Disoder mixed. At this writing, the veteran continues to struggle with moderate to severe symptoms, resulting in serious impariment in individual, social, and occupational functioning. Problems with excessive anxiety, panic attacks, mood liability, poor concentration, memory problems, social impariment, and irritability contribute to reduce reliability and productivity on the job. In addition, ____ has difficulty adapting to stressful situations, making it difficult to manage the day to day stressors of work. This has been reflected in his ongoing attempts to maintain employment, which has led to multiple changes in postions and job duties, in attempt to accommodate his ongoing problems. Also, the vulnerability for increased symptoms remains high, especially under times of increased stress. Even with treatment to date, symptoms have remained chronic and at least moderate to severe. Prognosis is guarded, due to the veteran's fragile functional status, as well as his progression of symptoms to date.

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Posted · Report post

You can go on line to VONAPP and fill out a request for increase

in your SC'd conditions, request IU on a 21-8940

and fax in copies of the statements.

Some people may make a choice to also follow up the above with a

hard copy in the mail - certified RRR, or if you were close to the RO

you could hand deliver this and get a date stamped copy.

The VA will more likely than not schedule you for a C&P exam to help

determine the current level of disability.

What ever is done will take plenty of time - most likely at least a year

or more before you get any answer.

Good luck.

JMHO

VONAPP : http://www.gibill.va.gov/apply-for-benefits/application/

21-8940: http://www.vba.va.gov/pubs/forms/VBA-21-8940-ARE.pdf

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Posted · Report post

I

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Carlie and wdroberson thanks for your replies. Charlie I have applied through my service officer as you directed already I appreciate this information. Wdroberson or anyone I feel the same way having the word guarded in the letter. But what about the doctor stateing that "I can't hold onto a job" (maintaining) this would mean even in a guarded state? This sounds definate to me and is exactly what TDIU is meant to address. What do you think any hope there how about for SSD purposes (I do have an attorney for the ssd).

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Posted · Report post

I am 90% disabled for PTSD and Bipolar II Mixed and currently going through a hard time.

Jay,

Please clarify you SC'd condition/s and update your profile at Hadit

with the correct percentage.

Mental Health disability's (not necessarily inclusive of eating disorders)

do not comp at the 80 OR 90 percent evaluation levels.

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Posted · Report post

I've always appreciated my Psychologist writeup for TDIU. The part about if placed in work situation this veteran would be a danger to himself & others. That's the part that they seemed to notice. I had TDIU in three weeks after I applied.

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iF YOU HAVE NOT WORKED IN A YEAR THAT PROVES YOUR POINT. i WOULD SEEK OUT A lAWYER FOR sOCIAL sECURITY AND TAKE cARLIES ADVICE FOR

sorry for caps

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Posted · Report post

Carlie. I am 70% for PTSD (Biploar merged with the PTSD). The other % percentages are for hypertension, Reynauds, which added together equals 90%. I couldn't find where to update my profile to reflect this.

I did get a lawyer for SSD.

The VA doctors at my VA are hesitant to write any letter for anyone. This is the best I was able to get out of them. Thus the reason for me asking how far a letter like this might get me. Thanks for all your comments.

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I couldn't find where to update my profile to reflect this.

Jay,

I updated your profile to show the current level of SC at 90 %.

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Jay,

Thank you for your service! :smile:

I'm sorry to hear of your ailments and difficulty with the VA.

At some point you have to bite the bullet and submit strong evidence.

It may be an IMO, or a letter from a Psych doc that you can't work for these reasons...

Be sure to make any C & P's and don't understate your problems (read up on preparing for C&P)

Good luck!

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Posted · Report post

Notorious Kelly your correct that stronger evidence is probably warranted but not being near any place to get an IMO and VA docs not being all that helpful I felt/feel stuck. I was hoping the line in the psychiatrist letter stating I am unable to hold on to a job and perform satisfactory might be just enough. I may have to rely on the C&P or SSD if I were to get it.

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Would a letter stating I am catastrophically disabled by the VA help for TDIU and SSD?

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I would definitely say so.

DEFINITION OF CATASTROPHICALLY DISABLED

1. Catastrophically disabled (CD) means to have a permanent severely disabling injury, disorder, or disease that compromises the ability to carry out the activities of daily living (ADL) to such a degree that the individual requires personal or mechanical assistance to leave home or bed or requires constant supervision to avoid physical harm to self or others.

2. A veteran may meet the initial CD requirement by a:

a. Clinical evaluation of the patient’s medical records that documents that the patient previously met the criteria set forth in following paragraph 3 and continues to meet such criteria (permanently), or would continue to meet such criteria (permanently) without the continuation of on-going treatment; or

b. Current medical examination that documents that the patient meets the criteria set forth in following paragraph 3 and will continue to meet them, or would continue to meet such criteria (permanently) without the continuation of on-going treatment.

3. This definition is met if an individual has been found, by the Chief of Staff (or equivalent clinical official) at the Department of Veterans Affairs (VA) facility where the individual was examined, to have a permanent condition specified in following subparagraphs 3a, 3b, or 3c:

a. One of the permanent diagnoses found on website: http://vaww.va.gov/v...01/report01.htm (see “View CD Diagnoses”).

<H1 style="MARGIN: 0in 0in 0pt">OR </H1>b. A condition resulting from two of the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) procedure codes, or associated V codes when available, or Current Procedural Terminology (CPT) codes provided the two amputation procedures were not on the same limb. These codes can be found at the following website: http://vaww.va.gov/v...01/report01.htm (see “View CD Diagnoses”).

<H1 style="MARGIN: 0in 0in 0pt">OR </H1>c. One of the following permanent conditions:

(1) Dependent in three or more ADLs; i.e., eating, dressing, bathing, toileting, transferring, incontinence of bowel and/or bladder, with at least three of the dependencies being permanent with a score of 1, using the Katz scale. NOTE: The Katz Index of ADL assigns a maximum of 18 points across all six ADLs. The most dependent rating on each ADL is a 1, and an intermediate functional limitation is a rating of 2, with independence rated as 3. To be catastrophically disabled, the veteran must have a rating of 1 on a minimum of three permanent ADLs. For example, a veteran dependent in all ADLs would have a total Katz score of 6. VHA DIRECTIVE 2004-067 CORRCETED COPY November 22, 2004 A-2

Similarly, a veteran dependent in three ADLs and needing less assistance in three other ADLs would score 9.

(2) A score of 10 or lower using the Folstein Mini-Mental State Examination (MMSE). NOTE: The MMSE has a maximum assignment of 30 points across eleven measures. A score of less than 10 is consistent with severe cognitive impairment. To qualify for CD status, there must be documentation in addition to the MMSE score of 10 or lower, showing that the patient has a permanent cognitive impairment. To show that the impairment is permanent, the reversible causes of cognitive impairment need to be ruled out. A common example is a delirious patient who may score very badly on the MMSE, but improve once the source of delirium is treated. It is also important for evaluators to remember that a low MMSE score by itself is not diagnostic (i.e., it is not specifically diagnostic of dementia), but it is an indication of cognitive impairment that warrants further evaluation.

(3) A score of 2 or lower on at least four of the thirteen motor items using the Functional Independence Measure (FIM). NOTE: The FIM contains eighteen measures in six domains. The thirteen motor items are in four domains: self-care; sphincter control; transfers; and locomotion. The scores across all these domains range from needing a helper because of complete dependence (score of 1 for total assistance and a score of 2 for maximal assistance), with intermediate scores 3 through 5 for modified independence, to scores 6 or 7 when no helper is needed. To be CD, the veteran must have a score of 2 or lower on at least four permanent conditions of the thirteen motor items using the FIM.

(4) A score of 30 or lower using the Global Assessment of Functioning (GAF). NOTE: The GAF is taken directly from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), p. 32, except that VHA only includes scores from 1 to 100, excluding 0 (insufficient information).

(a) GAF is a 100-point scale divided into ten defined levels, with higher scores indicating a higher overall level of functioning. For example, the Description of the GAF level 21 to 30 is as follows: “Behavior is considerably influenced by delusions or hallucination or serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) or inability to function in almost all areas (e.g., stays in bed all day, no job, no home or no friends).”

(b) GAF is to be used only to reflect psychological, social, and occupational functioning. Impairment in functioning due to physical illness or environmental limitations are not to be taken into consideration in using this scale. The scale rates both functioning and, particularly in the higher ratings, the severity of symptoms due to a mental disorder. Using GAF for documenting the CD may be only done in the context of a mental disorder considered to be of a permanent nature. For example, a patient with a serious suicidal attempt might well rate a score under 30, but generally within a few days or weeks will return to a much higher level both symptomatically and functionally. CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 A-3

4. References

a. Katz S, Downs TD, Cash HR, et al. “Progress in the Development of the Index of ADL,” The Gerontologist. Part I:20;1970.

b. Juva K., Sulkava R., Erkinjuntti T., et al. “Staging the Severity of Dementia: Comparison of Clinical (CDR, DSM III-R), Functional (ADL, IADL) and Cognitive (MMSE) Scales,” Acta Neurologica Scandinavica. 90:293;1994.

c. Folstein MF, Folstein S, McHugh PR. “Mini-mental State: A Practical Method for Grading the Cognitive State of Patients for the Clinician,” Journal of Psychiatric Research. 12:189; 1975. CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 B-1

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Thanks cooter for your reply. I will submitted the catastraphoic letter. I also received a letter today stating I am not feasable for employment from Voc Rehab. Can I use this for TDIU and SSD. It mentions after speaking with me the following issues were noted

inability to deal with authority figures which casuses you high anxiety

Difficulties dealing with and managing stressful situations on the job

Concentration issues affecting your job performance and completeing your educational training

PTSD and Bipolar causing you to struggle with social and occupational settings

Uncessful maintaining employment for any period in time and in any setting because of PTSD and Bipolar symptoms; you have not been

able to perform job duties and you continually are assigned different job assignments, have conflicts with coworkers and supervisors etc..

You have had two jobs since moving to _____ and were uncessful retaining them do to your service connected disabilities.

Based on this information, we are unable to find feasible for employment under guideline of Vocational Rehabiltating

Independent living services not needed at this time.

.

Thanks for everyones replies. Not having the complete support of my doctors with regards to writing lengthy supporting letters and no IMO anywhere near I am trying to gather what I do have to make a strong case. So any comments are welcomed and appreciated on how strong a case I may or may not have at this time using the 2 doctor letters, Catastrophic Disabled letter, and now the Voc Rehab lettter.

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YES, by all means submit the Voc Rehab letter. Their statement "Based on this information, we are unable to find feasible for employment " is strong evidence you can not work.

Submit this with the other docs to SSA and your claim for TDIU.

I can't remember if you mentioned earlier if you already have a claim in for TDIU or not. If you already did file, make sure the Voc Rehab letter gets in your c:file so it would be considered evidence in the claim.

Coot

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Ok so I turned in the two Dr. Letters below, Voc Rehab not feasible employment letter, and the Catastrophically disabled letter since 2009 into the Regional office via my Service Officer all this month. Today I received a chapter 35 DEA dependents pamphlet with a letter about my son and/or daughter may be eligible for these benefits. Does this mean I got the TDIU P&T I requested. I haven't had a C&P but I did have one two years ago that gave me the PTSD at 70%. This seems very fast to get one of these pamphlets already. Comments?

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For the moment, all I can say is, it's not a bad sign!

I sure nobody can give you a positive answer if it was granted or not. To early.

Coot

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I bet you get a rating letter pretty soon that says you are entitled to Chapter 35. That means P&T.

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Although I can say this Jay, just keep a look out on your bank account.

Coot

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cooter,

When you have something with this much info please post a link.

What is the link for this information ?

Thanks

I would definitely say so.

DEFINITION OF CATASTROPHICALLY DISABLED

1. Catastrophically disabled (CD) means to have a permanent severely disabling injury, disorder, or disease that compromises the ability to carry out the activities of daily living (ADL) to such a degree that the individual requires personal or mechanical assistance to leave home or bed or requires constant supervision to avoid physical harm to self or others.

2. A veteran may meet the initial CD requirement by a:

a. Clinical evaluation of the patient's medical records that documents that the patient previously met the criteria set forth in following paragraph 3 and continues to meet such criteria (permanently), or would continue to meet such criteria (permanently) without the continuation of on-going treatment; or

b. Current medical examination that documents that the patient meets the criteria set forth in following paragraph 3 and will continue to meet them, or would continue to meet such criteria (permanently) without the continuation of on-going treatment.

3. This definition is met if an individual has been found, by the Chief of Staff (or equivalent clinical official) at the Department of Veterans Affairs (VA) facility where the individual was examined, to have a permanent condition specified in following subparagraphs 3a, 3b, or 3c:

a. One of the permanent diagnoses found on website: http://vaww.va.gov/v...01/report01.htm (see "View CD Diagnoses").

<H1 style="MARGIN: 0in 0in 0pt">OR </H1>b. A condition resulting from two of the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) procedure codes, or associated V codes when available, or Current Procedural Terminology (CPT) codes provided the two amputation procedures were not on the same limb. These codes can be found at the following website: http://vaww.va.gov/v...01/report01.htm (see "View CD Diagnoses").

<H1 style="MARGIN: 0in 0in 0pt">OR </H1>c. One of the following permanent conditions:

(1) Dependent in three or more ADLs; i.e., eating, dressing, bathing, toileting, transferring, incontinence of bowel and/or bladder, with at least three of the dependencies being permanent with a score of 1, using the Katz scale. NOTE: The Katz Index of ADL assigns a maximum of 18 points across all six ADLs. The most dependent rating on each ADL is a 1, and an intermediate functional limitation is a rating of 2, with independence rated as 3. To be catastrophically disabled, the veteran must have a rating of 1 on a minimum of three permanent ADLs. For example, a veteran dependent in all ADLs would have a total Katz score of 6. VHA DIRECTIVE 2004-067 CORRCETED COPY November 22, 2004 A-2

Similarly, a veteran dependent in three ADLs and needing less assistance in three other ADLs would score 9.

(2) A score of 10 or lower using the Folstein Mini-Mental State Examination (MMSE). NOTE: The MMSE has a maximum assignment of 30 points across eleven measures. A score of less than 10 is consistent with severe cognitive impairment. To qualify for CD status, there must be documentation in addition to the MMSE score of 10 or lower, showing that the patient has a permanent cognitive impairment. To show that the impairment is permanent, the reversible causes of cognitive impairment need to be ruled out. A common example is a delirious patient who may score very badly on the MMSE, but improve once the source of delirium is treated. It is also important for evaluators to remember that a low MMSE score by itself is not diagnostic (i.e., it is not specifically diagnostic of dementia), but it is an indication of cognitive impairment that warrants further evaluation.

(3) A score of 2 or lower on at least four of the thirteen motor items using the Functional Independence Measure (FIM). NOTE: The FIM contains eighteen measures in six domains. The thirteen motor items are in four domains: self-care; sphincter control; transfers; and locomotion. The scores across all these domains range from needing a helper because of complete dependence (score of 1 for total assistance and a score of 2 for maximal assistance), with intermediate scores 3 through 5 for modified independence, to scores 6 or 7 when no helper is needed. To be CD, the veteran must have a score of 2 or lower on at least four permanent conditions of the thirteen motor items using the FIM.

(4) A score of 30 or lower using the Global Assessment of Functioning (GAF). NOTE: The GAF is taken directly from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), p. 32, except that VHA only includes scores from 1 to 100, excluding 0 (insufficient information).

(a) GAF is a 100-point scale divided into ten defined levels, with higher scores indicating a higher overall level of functioning. For example, the Description of the GAF level 21 to 30 is as follows: "Behavior is considerably influenced by delusions or hallucination or serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) or inability to function in almost all areas (e.g., stays in bed all day, no job, no home or no friends)."

(b) GAF is to be used only to reflect psychological, social, and occupational functioning. Impairment in functioning due to physical illness or environmental limitations are not to be taken into consideration in using this scale. The scale rates both functioning and, particularly in the higher ratings, the severity of symptoms due to a mental disorder. Using GAF for documenting the CD may be only done in the context of a mental disorder considered to be of a permanent nature. For example, a patient with a serious suicidal attempt might well rate a score under 30, but generally within a few days or weeks will return to a much higher level both symptomatically and functionally. CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 A-3

4. References

a. Katz S, Downs TD, Cash HR, et al. "Progress in the Development of the Index of ADL," The Gerontologist. Part I:20;1970.

b. Juva K., Sulkava R., Erkinjuntti T., et al. "Staging the Severity of Dementia: Comparison of Clinical (CDR, DSM III-R), Functional (ADL, IADL) and Cognitive (MMSE) Scales," Acta Neurologica Scandinavica. 90:293;1994.

c. Folstein MF, Folstein S, McHugh PR. "Mini-mental State: A Practical Method for Grading the Cognitive State of Patients for the Clinician," Journal of Psychiatric Research. 12:189; 1975. CORRECTED COPY VHA DIRECTIVE 2004-067 November 22, 2004 B-1

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cooter,

When you have something with this much info please post a link.

What is the link for this information ?

Thanks

I usually do posts the links, but on this particular one if I remember right, I copied and pasted it from another web site forem that didn't provide the link. But I'm not 100% positive, so I'll do some searching just in case I'm wrong.

Coot

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Carlie, I found the page I copied it from. I was thinking I found it on another site but in fact it was here on a previous post.

Heres the link I copied it from. It starts about half way down the page.

Coot

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Carlie, I found the page I copied it from. I was thinking I found it on another site but in fact it was here on a previous post.

Heres the link I copied it from. It starts about half way down the page.

Coot

cooter,

Thanks for posting the link :-)

Good job !

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