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@  Asiadaug : (16 November 2014 - 02:07 AM) Thanks. I Have Seen The Fast Ltr 10-35 And Have Seen Cases Where The Va Has Apparently Agreed That Tinnitus Can Have Delayed Onset. I Did Not In Looking Over The Fast Ltr See Where They Had Ruled 10-028 Into That. And, I Am Not Sure In The Vas Issuance Of ‘policy’ Type Letters How They Might Roll In Previous Instructions Into Newer Ones. Maybe There Is Some Intranet Traceability Capability? I Was Just Curious As There ‘appeared’ To Be Conspicuous Absence Of That 10-028. I Am Assuming 10-028 Was Written In 2010. But It May Be I Should Not Assume Anything.
@  carlie : (15 November 2014 - 05:56 PM) Asiadaug - You Might Be Looking For Fast Letter 10-35, Http://www.hadit.com/forums/topic/40962-Va-Fl-10-35/ Also Check Out This Link To Links For Delayed Onset Tinnitus - They All Refer Back To Fast Letter 10-35, Https://www.google.com/webhp?sourceid=Chrome-Instant&ion=1&espv=2&ie=Utf-8#q=Tinnitus, Delayed Onset, Va Fast Letter
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Disability Benefits Questionnaires

DBQ Forms - Link

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#1 carlie

 
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Posted 20 March 2012 - 02:00 PM

http://benefits.va.g...DBQFormName.asp

#2 Tbird

 
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Posted 23 March 2012 - 04:51 AM

Disability Benefits Questionnaires - List By Form - VA Claims Transformation Plan http://ow.ly/9PI7E

#3 cooter

 
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Posted 23 March 2012 - 07:13 AM

I'm in the process of utilizing one of these DBQs with my Orthopedic surgeon for a IME, and the only crucial item that has us stumped, is how does this form work it's way in when writing out the IME. I understand the format of the letter is going to change somewhat, but exactly how?
In my case, we're using it to rebut some of the items/opinions my C&P examiner noted in his DBQ for a current claim being adjudicated. Does my Dr just argue the differences of opinions pointed out in their exams only? Or does it changed anything at all, and just use the DBQ as a supplement. I realize this is something just coming out, and I probably won't get a correct answer, but I'm open to anyone's opinions.


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#4 Veldrina

 
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Posted 02 April 2012 - 05:35 PM

Cooter, I'm not sure I understand your situation fully, but to answer re the letters: There are now DBQs for almost every condition, mental & physical. The new letter format is called SNL (simplified notification letter). Basically you will not be getting the huge ponderous ratings with all the explanations as to how we determined your claim. Instead, the ratings will be short & sweet, with only grants or confirm&continue ratings listed. The actual notification letter you get will explain the decisions, but not in depth like it used to be. (ie: if you claim hypertension & none was found in either your service or treatment records, the denial will simply read along the lines of "denied because there is no diagnosed condition."). The DBQ format of the exams allows the rater to more accurately input the evaluation, and lessens the chance that a doctor will miss discussing a key element (such as range of motion for a joint or if thee's arthritis) because they are all bulleted and must be answered in the same order by the doctor as we input them into our ratings.

#5 john999

 
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Posted 02 April 2012 - 07:34 PM

Back about 45 year ago it was the same way. You got two pages of reasons why you should be satisfied with 10% for being unable to work, and by the way don't bother us any more.

#6 cooter

 
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Posted 02 April 2012 - 09:26 PM

John>..The way I understand, these DBQs has already been utilized 6 other times during the past years. Maybe they used one of these DBQs with you..lol

Veldrina>..Thanks for explaining that part of it. I noticed after reading my copy of the C&P exam I had recently, the Questionnaire didn't have anything written about medications and their effects. Is this something they left out on purpose, cause I thought I was reading somewhere that it was suppose to be added to it.


Coot

Edited by cooter, 02 April 2012 - 09:37 PM.


#7 Veldrina

 
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Posted 06 April 2012 - 06:55 PM

each DBQ is different & closely follows the rating schedule. i think the most they touch upon re medication is of you are on continuous medication for control of a condition or not. For diabetes it's whether u are on oral hypoglycemics or insulin for control.

#8 cooter

 
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Posted 07 April 2012 - 01:42 AM

As I'm in total agreement with this, wouldn't VA think opiates be considered as continuous medication for a chronic pain condition as well? If it's not, then the only reason I can think of is, chronic pain is considered a temporary condition, but at the same time it could also last years and years. Some medications has side effects that's worse than the disability itself. I find it hard to think the VA would even consider pain medicine as not part of an exam where pain is involved.


Coot

#9 Veldrina

 
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Posted 09 April 2012 - 07:25 AM

If it's a condition whose evaluation is based on "continuous medication for control" then opiates could be considered such. Again each condition is different, and sometimes they concentrate more on physical manifestations for a higher evaluation rather than pain or pain control.

#10 cooter

 
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Posted 09 April 2012 - 10:22 PM

So it would make since for anyone in this situation where chronic pain is essential to be considered is to have a Dr state, his/her chronic opiates is needed for "continuous medication for control".


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#11 racemech

 
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Posted 10 April 2012 - 06:43 AM

Hopefully this does not sound off topic. I have four Rated Conditions and another ten that are secondary and or, residual that have not been rated. With the DBQ process, do I submit the other ten as soon as I get them completed all at once, or do I submit them gradually? My overall total physical and mental condition has deteriorated so rapidly in the past three years, I can barely keep up with it myself.

#12 cooter

 
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Posted 10 April 2012 - 10:40 PM

That's a very good question and no doubt will probably lure in a few different opinions here.
Just so you will get more eyes on your question, you'll need to start your own thread in the (Veterans claims Research) Forem. This thread has already started and probably been read by other members that won't come back. That's the reason I say you need to start your own. That's all you gotta do to get going on the right track.


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#13 carlie

 
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Posted 10 April 2012 - 11:20 PM

As I'm in total agreement with this, wouldn't VA think opiates be considered as continuous medication for a chronic pain condition as well? If it's not, then the only reason I can think of is, chronic pain is considered a temporary condition, but at the same time it could also last years and years. Some medications has side effects that's worse than the disability itself. I find it hard to think the VA would even consider pain medicine as not part of an exam where pain is involved.

Coot


Coot,
If I am understanding your issue correctly, I'd like to add my thoughts by a
hypothetical example.

Vet is SC'd for condition X
Vet files claim for secondary disability of pain due to SC'd condition - gets 10 %
Vet files claim for secondary disability of hemorrhoids (as a residual side effect of constipation)
due to medications taken for pain to treat the primary SC'd disability.

Does this example work ?

#14 cooter

 
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Posted 10 April 2012 - 11:39 PM

Actually carlie what I was getting at is when I had my last C&P exam, the Dr stated I was only to do sedentary work. Ok, now the meds (opiates) I'm taking has me running ever which way but loose. ha..Since the side effects are really disabling, I was curious of the reason why it wasn't part of the DBQ questions. I also thought I read somewhere that it was suppose to be included in the exam. But nothing was mentioned about any meds the Vet is taking.


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#15 carlie

 
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Posted 11 April 2012 - 12:05 AM

Actually carlie what I was getting at is when I had my last C&P exam, the Dr stated I was only to do sedentary work. Ok, now the meds (opiates) I'm taking has me running ever which way but loose. ha..Since the side effects are really disabling, I was curious of the reason why it wasn't part of the DBQ questions. I also thought I read somewhere that it was suppose to be included in the exam. But nothing was mentioned about any meds the Vet is taking.
Coot


Coot,

Your SC'd for disability X.
You are RX's meds to treat disability X.
Your doctor writes an opinion that you now have a diagnosis of condition of Y
and this is a residual condition due to treatment of SC'd disability X.
You file a claim for disability Y and submit the doctors opinion.

Also,look over the criteria for DC's 7232,7233, 7234 and see if it applies.
JMHO

#16 cooter

 
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Posted 11 April 2012 - 12:23 AM

Now that one will work! I'll check out those codes too..xo


Coot

#17 Veldrina

 
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Posted 12 April 2012 - 09:10 PM

remember, "pain" is not a compensable disability under VA regulations. But yes Coot, it would help if doc said that.

Race, if u have 10 other issues, u could put them all in, but again i will stress that the more issues u bombard the V with, the less chance of getting it resolved quickly. Also, sometimes folks put in for things that are actually the same issue, such as insomnia, memory loss, depression, anxiety and PTSD. While it sounds like 5 issues, in reality all mental conditions are one, & all those conditions are symptoms of most mental conditions (ie anxiety can appear under both depression & PTSD, insomnia can occur under anxiety, depression or PTSD, etc.). By claiming it as "a mental (or psychiatric) condition to include: PTSD, depression, sleep problems, memory problems," etc, or something like that, you can condense the issues into one.

#18 carlie

 
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Posted 12 April 2012 - 09:59 PM

vel,
I'm referring to a MH condition due to the pain of the SC'd disability.

#19 manning01

 
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Posted 09 June 2012 - 07:58 AM

Cooter, I'm not sure I understand your situation fully, but to answer re the letters: There are now DBQs for almost every condition, mental & physical. The new letter format is called SNL (simplified notification letter). Basically you will not be getting the huge ponderous ratings with all the explanations as to how we determined your claim. Instead, the ratings will be short & sweet, with only grants or confirm&continue ratings listed. The actual notification letter you get will explain the decisions, but not in depth like it used to be. (ie: if you claim hypertension & none was found in either your service or treatment records, the denial will simply read along the lines of "denied because there is no diagnosed condition."). The DBQ format of the exams allows the rater to more accurately input the evaluation, and lessens the chance that a doctor will miss discussing a key element (such as range of motion for a joint or if thee's arthritis) because they are all bulleted and must be answered in the same order by the doctor as we input them into our ratings.


I just went to a C&P yesterday which was very good I do like these new forms they fill on the computer very detailed and it covered everything. So I guess a lot less of they forgot to put in a certain ROM etc and sending it back to the VAMC for more info or clarification. But my question I don't see anywhere for them to make the service connection statement like in the past i.e. most likely, least likely, is caused by military service etc. Unless they can put that in the remarks section XVII. Are they now leaving it up to the raters on review of all the evidence to make that determination?

#20 etihwr

 
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Posted 28 July 2012 - 09:44 AM

Actually Veldrina your wrong!

You stated "Also, sometimes folks put in for things that are actually the same issue, such as insomnia, memory loss, depression, anxiety and PTSD. While it sounds like 5 issues, in reality all mental conditions are one, & all those conditions are symptoms of most mental conditions (ie anxiety can appear under both depression & PTSD, insomnia can occur under anxiety, depression or PTSD, etc.). By claiming it as "a mental (or psychiatric) condition to include: PTSD, depression, sleep problems, memory problems," etc, or something like that, you can condense the issues into one."

You only have one brain so PTSD and Depression though rated as one can actually be helpful to each other. If you were to be 30% for PTSD and the rater feels worse than 30% for Depression you will be rated Depression w/PTSD at 50%. If they didn't do that, they are not doing their job. The benefit of the doubt rule should be applying. Also all the mental healh issues can come with sleep issues but they sleep issues can be rated seperately. People do get sleep studies and have been found to have restless leg syndrome and/or sleep apnea. Sleep Apnea can be linked to PTSD.

You can do a NEXUS letter to link Sleep Apnea to PTSD and Depression. Get your doctor or doctors to write the nexus letter (see attached) so you can get linked to your sleep issue. 50% for PTSD and 50% for Sleep Apnea is an 80% rating.



Am J Geriatr Psychiatry. 2010 Jun 10. [Epub ahead of print]
Sleep-Disordered Breathing in Vietnam Veterans with Posttraumatic Stress Disorder.

Yesavage JA, Kinoshita LM, Kimball T, Zeitzer J, Friedman L, Noda A, David R, Hernandez B, Lee T, Cheng J, O'Hara R.
From the Department of Veterans Affairs Health Care System (JAY, LMK, TK, JZ, TL, JC, ROH), Palo Alto, CA; Department of Psychiatry and Behavioral Sciences (JAY, LMK, TK, JZ, LF, AN, BH, TL, JC, ROH), Stanford University School of Medicine, Palo Alto, CA; and Memory Center (RD), CMRR - CHU, University of Nice Sophia, Antipolis, France.
Abstract

OBJECTIVE: To study the prevalence of sleep-disordered breathing (SDB) in Vietnam-era veterans.
METHODS: This was an observational study of Vietnam-era veterans using unattended, overnight polysomnography, cognitive testing, and genetic measures.
RESULTS: A sample of 105 Vietnam-era veterans with posttraumatic stress disorder: 69% had an Apnea Hypopnea Index >10. Their mean body mass index was 31, "obese" by Centers for Disease Control and Prevention criteria, and body mass index was significantly associated with Apnea Hypopnea Index (Spearman r = 0.41, N = 97, p < 0.0001). No significant effects of sleep-disordered breathing or apolipoprotein status were found on an extensive battery of cognitive tests.
CONCLUSION: There is a relatively high prevalence of SDB in these patients which raises the question of to what degree excess cognitive loss in older PTSD patients may be due to a high prevalence of SDB.
PMID: 20808112 [PubMed - as supplied by publisher]


Prim Care Companion J Clin Psychiatry. 2010;12(2). pii: PCC.07m00563.
Correlates of daytime sleepiness in patients with posttraumatic stress disorder and sleep disturbance.

Westermeyer J, Khawaja I, Freerks M, Sutherland RJ, Engle K, Johnson D, Thuras P, Rossom R, Hurwitz T.
Mental Health Service, Minneapolis VA Medical Center, Minneapolis, Minnesota ; Department of Psychiatry, University of Minnesota, Minneapolis ; and Department of Psychology, University of Texas, Houston.
Abstract

OBJECTIVE: To assess the correlates of daytime sleepiness in patients with a lifetime diagnosis of posttraumatic stress disorder (PTSD) and ongoing sleep disturbance not due to sleep apnea or other diagnosed sleep disorders.
METHOD: The sample consisted of 26 veterans receiving mental health care at the Minneapolis VA Medical Center, Minneapolis, Minnesota. The Epworth Sleepiness Scale was the primary outcome measure. Other sleep-related instruments consisted of the Pittsburgh Sleep Quality Scale, a daily sleep log, and daily sleep actigraphy. In addition, data included 3 symptom ratings (Posttraumatic Stress Disorder Checklist, Clinician Administered PTSD Scale [CAPS], and Beck Depression Inventory). Data were collected from 2003 to 2005. Current and lifetime PTSD diagnoses were based on DSM-IV criteria and were obtained by experienced psychiatrists using the CAPS interview.
RESULTS: Univariate analyses showed that daytime sleepiness on the Epworth Sleepiness Scale was associated with daytime dysfunction on the Pittsburgh Sleep Quality Index (P < .001), less use of sleeping medication (P = .02), and more self-rated posttraumatic symptoms (P = .05). Within posttraumatic symptom categories, hypervigilance symptoms were more correlated with daytime sleepiness (P = .03) than were reexperiencing and avoidance symptoms (P = .09 for both).
CONCLUSION: In this selected sample, daytime sleepiness was most strongly and independently associated with daytime dysfunction.
PMID: 20694134 [PubMed]PMCID: PMC2910986Free PMC Article


Chest. 2009 May;135(5):1370-9.
Update on sleep and psychiatric disorders.

Sateia MJ.
Section of Sleep Medicine, Dartmouth Medical School, Section of Sleep Medicine, Lebanon, NH 03756, USA. msateia@dartmouth.edu
Abstract

Current data demonstrate a high rate of comorbidity between sleep disorders and various psychiatric illnesses, especially mood and anxiety disorders. The disturbance of sleep quality and continuity that is associated with many sleep disorders predisposes to the development or exacerbation of psychological distress and mental illness. Likewise, the presence of psychiatric illness may complicate the diagnosis and treatment of sleep disorders. This focused review examines the literature concerning the interaction between major International Classification of Sleep Disorders, 2nd edition, diagnoses and psychiatric conditions with respect to sleep findings in various psychiatric conditions, psychiatric comorbidity in sleep disorders, and reciprocal interactions, including treatment effects. The data not only underscore the high frequency of psychopathology and psychological distress in sleep disorders, and vice versa, but also suggest that combined treatment of both the mental disorder and the sleep disorder should become the standard for effective therapy for all patients.
PMID: 19420207 [PubMed - indexed for MEDLINE]Free Article


Sleep Med Rev. 2008 Jun;12(3):169-84.
Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature?

Spoormaker VI, Montgomery P.
Centre for Evidence-Based Intervention, University of Oxford, 32 Wellington Square, Oxford, OX1 2ER, United Kingdom. spoormaker@sleephealth.eu
Abstract

Sleep disturbances are often viewed as a secondary symptom of post-traumatic stress disorder (PTSD), thought to resolve once PTSD has been treated. Specific screening, diagnosis and treatment of sleep disturbances is therefore not commonly conducted in trauma centres. However, recent evidence shows that this view and consequent practices are as much unhelpful as incorrect. Several sleep disorders-nightmares, insomnia, sleep apnoea and periodic limb movements-are highly prevalent in PTSD, and several studies found disturbed sleep to be a risk factor for the subsequent development of PTSD. Moreover, sleep disturbances are a frequent residual complaint after successful PTSD treatment: a finding that applies both to psychological and pharmacological treatment. In contrast, treatment focusing on sleep does alleviate both sleep disturbances and PTSD symptom severity. A growing body of evidence shows that disturbed sleep is more than a secondary symptom of PTSD-it seems to be a core feature. Sleep-focused treatment can be incorporated into any standard PTSD treatment, and PTSD research needs to start including validated sleep measurements in longitudinal epidemiologic and treatment outcome studies. Further clinical and research implications are discussed, and possible mechanisms for the role of disturbed (REM) sleep in PTSD are described.


J Clin Psychiatry. 2007 Aug;68(8):1257-70.
Sleep disturbance in adults with posttraumatic stress disorder: a review.

Lamarche LJ, De Koninck J.
School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
Abstract

OBJECTIVE: To present a critical review of the literature and research on sleep difficulties in adults with posttraumatic stress disorder (PTSD), more specifically the existing treatment options, and to formulate recommendations regarding future treatment approaches and research related to sleep and PTSD.
DATA SOURCES: The following databases were consulted: PsycInfo (1872-2006) and MEDLINE (1966-2006). The search was conducted using the following key terms: PTSD and sleep, PTSD and nightmares, PTSD and dreams, PTSD and insomnia, PTSD and periodic limb movement disorder, and PTSD and sleep disordered breathing. Only studies examining sleep disturbance among adults with PTSD were included, and only articles written in English were consulted.
STUDY SELECTION: Studies and reviews related to the prevalence, causes, and treatments of sleep disturbance among adults with PTSD, as well as those examining the relationship between sleep and PTSD, were selected.
CONCLUSIONS: Promising treatment options are available for treating sleep difficulties among adults with PTSD. In particular, cognitive-behavioral therapy including a component for nightmares (imagery rehearsal therapy) and insomnia has been found to significantly improve sleep disturbance among these individuals. It is proposed that with the inclusion of other components, such as a screening for other sleep disorders, relaxation exercises, positive self-talk, imagery rehearsal related to recurring images before bed, and a daytime nap, sleep-related symptoms may improve to a greater degree, which may then lead to a significant decrease in other PTSD symptoms and overall PTSD severity. The inclusion of sleep medicine specialists should also be considered for sleep medicine treatment of individuals with PTSD. Collaboration between mental health professionals and sleep medicine specialists is therefore recommended for treatment of sleep-related difficulties among individuals with PTSD.
PMID: 17854251 [PubMed - indexed for MEDLINE]


Tijdschr Psychiatr. 2007;49(9):629-38.
[Sleep disturbances in post-traumatic stress disorder. An overview of the literature]

[Article in Dutch]
van Liempt S, Vermetten E, de Groen JH, Westenberg HG.
Onderzoekscentrum Militaire Geestelijke Gezondheidszorg Defensie, Centraal Miliair Hospitaal, Postbus 90.000, 3509 AA Utrecht, Netherlands. s.vanliempt@umcutrecht.nl
Abstract

BACKGROUND: Nightmares and insomnia are experienced by 70% of patients suffering from post-traumatic stress disorder (PTSD). These sleep problems are often resistant to treatment and exert a strong negative influence on the quality of life. In the last few decades several studies have reported on the characteristics of sleep disturbances in PTSD.
AIM: To provide an overview of objective features of sleep disturbances - as opposed to self-report methods - in patients with PTSD.
METHOD: Articles on this topic, published in peer-reviewed journals between 1980 and the present, were retrieved from Medline and Embase, using the search terms 'PTSD', 'sleep', 'nightmares', 'insomnia', 'polysomnography'.
RESULTS: Studies reported on changes in sleep efficiency, arousal regulation, motor activity during sleep, rem characteristics and delta sleep activity during sleep. Also, correlations were found between nightmares and sleep apnoea in ptsd. In some studies on sleep disturbance no objective sleep disturbances were found in PTSD patients. However, most studies on PTSD related sleep disturbances were conducted in small, heterogeneous groups, and results were therefore inconsistent. Even the results of larger and more homogeneous studies were sometimes contradictory.
CONCLUSION: There is a discrepancy between the clinical importance of sleep problems in PTSD and unambiguous objective sleep disorders. Future research should try to establish objective criteria for identifying the altered sleep patterns in PTSD. These criteria should help us to understand the neurobiological mechanisms of sleep disturbances in PTSD and develop new treatment strategies.
PMID: 17853372 [PubMed - indexed for MEDLINE]Free Article

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#21 yelloownumber5

 
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Posted 29 July 2012 - 02:46 PM

Vel,

How about this "Generaly, pain is not a diagnosis. However, ........................"

yep!


remember, "pain" is not a compensable disability under VA regulations. But yes Coot, it would help if doc said that.

Race, if u have 10 other issues, u could put them all in, but again i will stress that the more issues u bombard the V with, the less chance of getting it resolved quickly. Also, sometimes folks put in for things that are actually the same issue, such as insomnia, memory loss, depression, anxiety and PTSD. While it sounds like 5 issues, in reality all mental conditions are one, & all those conditions are symptoms of most mental conditions (ie anxiety can appear under both depression & PTSD, insomnia can occur under anxiety, depression or PTSD, etc.). By claiming it as "a mental (or psychiatric) condition to include: PTSD, depression, sleep problems, memory problems," etc, or something like that, you can condense the issues into one.


Edited by yelloownumber5, 29 July 2012 - 02:47 PM.


#22 MarkInTexas

 
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Posted 05 August 2012 - 10:04 AM

I find it kind of humorous that the VA would consider that a Veteran "bombards" them with multiple issues when they file a claim. Considering that many mlitary members separate, or at least used to, without any real counseling regarding existing conditions, and what options are avalable to them. And unless things have changed, there isn't any friendly separation briefing about filing claims within a certain amount of time, what benefits a Veteran is eligible for if they do file a claim prior to separation or immediately afterward. I know that it's been a long time since I separated back in 1994, and that the Internet has helped all of us tremendously. (I would not have had a clue about what benefits were out there if it weren't for the Internet to be honest.)

However, if an individual(s) is paid to do a job, and if they are taking tax payers money to do their job, for which they receive monetary compensation themselves, then they are public servants, and any attitude that a Veteran is a burden, or that their claim is a burden, simply because they filed a claim with multiple conditions is completely negligent.

What a lot of the civilians working in the VA, along with many others, fail to recognize is that our military is an all-volunteer force, and that all of these military members and veterans volunteered and gave years of their lives to serve their country to protect those same people that feel a little irritated and overwhelmed at having to review a multi-condition compensation claim. And as for the non-volunteer veterans that were drafted, I hope that these poor overworked, overburdened office workers sitting in their air conditioned offices, playing Angry Birds or checking their Facebbok status remember that the draftees were taken from their normal everyday lives, trained and sent off to war to protect them, their parents and their grandparents, and then returned later (if they were lucky enough to survive) back to their hometowns with illnesses, conditions and other conditions that would not manifest for years, even decades later.

And keep in mind that in those days, and to a lesser extent now, it was not considered popular to be disabled or to "ask" the government for assistance, even medical, for fear of the stigma of being labeled as getting government assistance. I know I personally was in turmoil over filing for quite some time before I actually sat down to start climbing the mountain of paperwork that the VA "bombards" uninformed Veterans with. (And before anybody takes it the wrong way, yes......the VA makes us "ask" them for assistance, and then prove exponentially why we need it. You can be healthy, never served a day of mlitary service in your life, and get tens of thousands of dollars of government assistance annually, including 100 percent medical/dental care, free tuition to higher education, and nobody bats an eye, and they call that an "entitlement".) We have to file for and justify ourselves each step of the way, and quite often multiple times for a single condition.

I know that just as far back as 1994, most men and women who were separating were afraid that the doctor would put something down on their exit examinations that might slight their chances at some civilian career. I know now that this was foolish youth, and that 90 percent of employers that I've encountered don't really even ask to see or request copies of military medical examinations. (Some will though.) Most veterans upon separation want to be identified as healthy and capable, and don't know about what options were/are available to them, until in many cases, it is too late.

I say this because conditions do affect us as we grow older, and what was small then, may be a major problem now. And the VA isn't exactly opening its doors to Veterans and providing counseling on how to file their claims properly, even though this would be the best and most proper way to allow a Veteran to enter the system, or better still hiring VA "counselors" who actually sit down and complete forms/applications with the Veterans. (The government provides information and counseling on just about any other program that is out there to assist claimants "before" they file a claim.) The VA is the only government entity I know of that tells you to file it, and gives a disclaimer that they'll do only what they have to do, and the rest is up to you.

If I'm wong on any of this, please somebody jump in and correct me.

I'm sorry I rambled so long. I hope that I didn't bombard you guys with too much. Have a great Sunday.

Mark

Edited by MarkInTexas, 05 August 2012 - 10:10 AM.

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#23 roses15534

 
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Posted 13 September 2012 - 04:01 PM

I just got my rating increased from 30% to 80% and on the decision letter it stated for my fibromyalgia condition went from 10% to 40% and it said note an examination will be scheduled at a future date to evaluate the severity of your service connected fibromyalgia. Now they just did a comp and pension on it why are we doing this again? when will this be? what is it for really?

#24 justrluk

 
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Posted 28 September 2012 - 08:14 AM

roses: it's a boiler-plate response for conditions the VA thinks could improve over time. I've had the same thing for Migraines.They stated in the award letter that an appointment would be made to follow up and act as the "future exam". That was due last November and I've not heard from them on this issue since.

#25 meghp0405

 
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Posted 24 December 2012 - 03:16 PM

roses: it's a boiler-plate response for conditions the VA thinks could improve over time. I've had the same thing for Migraines.They stated in the award letter that an appointment would be made to follow up and act as the "future exam". That was due last November and I've not heard from them on this issue since.


your follow up exam can be anywhere from 1-5 years. Continue to visit your doctor and more importantly, continue to address not only your SC conditions, but those symptoms you may be experiencing that could possibly be rated secondary to you current SC disabilities.

#26 justrluk

 
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Posted 26 December 2012 - 08:43 AM


your follow up exam can be anywhere from 1-5 years. Continue to visit your doctor and more importantly, continue to address not only your SC conditions, but those symptoms you may be experiencing that could possibly be rated secondary to you current SC disabilities.

Great idea - I also journal and take this with me to doctor appointments.



#27 Veldrina

 
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Posted 27 December 2012 - 03:34 PM

OK....but it's still only one mental condition, despite multiple diagnoses on Axis 1.  That's what I was referring to.  As for the Sleep apnea linked to PTSD, it's uncommon from what I've seen, but not impossible.  We raters have to go by what the doc says, so if the doctor gave a nexus with rationale as to how your apnea is related to your PTSD, we raters have to write it up in our decision as is.  ;)

Actually Veldrina your wrong!

You stated "Also, sometimes folks put in for things that are actually the same issue, such as insomnia, memory loss, depression, anxiety and PTSD. While it sounds like 5 issues, in reality all mental conditions are one, & all those conditions are symptoms of most mental conditions (ie anxiety can appear under both depression & PTSD, insomnia can occur under anxiety, depression or PTSD, etc.). By claiming it as "a mental (or psychiatric) condition to include: PTSD, depression, sleep problems, memory problems," etc, or something like that, you can condense the issues into one."

You only have one brain so PTSD and Depression though rated as one can actually be helpful to each other. If you were to be 30% for PTSD and the rater feels worse than 30% for Depression you will be rated Depression w/PTSD at 50%. If they didn't do that, they are not doing their job. The benefit of the doubt rule should be applying. Also all the mental healh issues can come with sleep issues but they sleep issues can be rated seperately. People do get sleep studies and have been found to have restless leg syndrome and/or sleep apnea. Sleep Apnea can be linked to PTSD.

You can do a NEXUS letter to link Sleep Apnea to PTSD and Depression. Get your doctor or doctors to write the nexus letter (see attached) so you can get linked to your sleep issue. 50% for PTSD and 50% for Sleep Apnea is an 80% rating.

 


#28 Veldrina

 
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Posted 27 December 2012 - 03:54 PM

OK, I'll bite....

I find it kind of humorous that the VA would consider that a Veteran "bombards" them with multiple issues when they file a claim. Considering that many mlitary members separate, or at least used to, without any real counseling regarding existing conditions, and what options are avalable to them.

 

The VA does try to put itself out there on the web, & service orgs are always ready to help with filling out claims. 

 

And unless things have changed, there isn't any friendly separation briefing about filing claims within a certain amount of time, what benefits a Veteran is eligible for if they do file a claim prior to separation or immediately afterward. I know that it's been a long time since I separated back in 1994, and that the Internet has helped all of us tremendously. (I would not have had a clue about what benefits were out there if it weren't for the Internet to be honest.)     <-----and there ya go

However, if an individual(s) is paid to do a job, and if they are taking tax payers money to do their job, for which they receive monetary compensation themselves, then they are public servants, and any attitude that a Veteran is a burden, or that their claim is a burden, simply because they filed a claim with multiple conditions is completely negligent.

 

Given, and while I'm sure some grumble more than others, you also need to understand the overwhelming amount of claims we face here at the VA. We are pressured by congress, by service orgs, by vets, & by management to "get it done ASAP"...however, we face stumbling blocks such as incomplete exams, no medical opinions, incomplete forms, too little info, too much info, etc. and we are given a # of how many cases we are expected to produce daily.  The sad truth is, the more issues you claim, the longer your claim will take, and if you constantly send more info or more claims, it delays your claim further because it must now be reviewed, due process must be given, more exams may need to be ordered, etc.  No one is saying you can't file a 30 issue claim....but pls don't expect to have that claim done within the year. 

What a lot of the civilians working in the VA, along with many others, fail to recognize is that our military is an all-volunteer force, and that all of these military members and veterans volunteered and gave years of their lives to serve their country to protect those same people that feel a little irritated and overwhelmed at having to review a multi-condition compensation claim. And as for the non-volunteer veterans that were drafted, I hope that these poor overworked, overburdened office workers sitting in their air conditioned offices, playing Angry Birds or checking their Facebbok status remember that the draftees were taken from their normal everyday lives, trained and sent off to war to protect them, their parents and their grandparents, and then returned later (if they were lucky enough to survive) back to their hometowns with illnesses, conditions and other conditions that would not manifest for years, even decades later.

 

I disagree with your comment that we fail to understand....we understand very well.  In fact it is driven into our heads every single day...every poster, every meeting we have, every email...everything is about serving the vet & the sacrifices vets have made.  Also, my office is not air-conditioned, & we don't have access to Angry Birds, or Solitaire....  Frankly we have very little time to do much, let alone play games.  By law we are given two 15 min. breaks & a half hr lunch...and if u work in Manhattan, that's barely enough time to get out of the bldg to even acquire said lunch...forget about eating it, u must eat as u work.  many of us do.  Hell, many of us, including myself, forgo the breaks & sometimes lunch just to try to get things done.  And it's not so much irritation we feel as the overwhelmingness (if that's a word)...yes, we are very overwhelmed, completely in fact.  There is a backlog of cases from here til kingdom come, and everyone is breathing down our necks to get them done, however, as i said, we face obstacles. It's not an insult, it's a fact.  If you send every medical record ever from your pediatrician up to your present doc, it must be reviewed, and that will take us all day, during which we are panicking because there are now more cases piling on our desks with deadlines, however we don't want to miss any pertinent info in the 30 issue claim.  Just know your claim may have to be put on the backburner several times as we try to juggle everything else thrown at us (ie some cases like ALS will take priority over yours no matter how long you've been waiting). 

And keep in mind that in those days, and to a lesser extent now, it was not considered popular to be disabled or to "ask" the government for assistance, even medical, for fear of the stigma of being labeled as getting government assistance. I know I personally was in turmoil over filing for quite some time before I actually sat down to start climbing the mountain of paperwork that the VA "bombards" uninformed Veterans with. (And before anybody takes it the wrong way, yes......the VA makes us "ask" them for assistance, and then prove exponentially why we need it. You can be healthy, never served a day of mlitary service in your life, and get tens of thousands of dollars of government assistance annually, including 100 percent medical/dental care, free tuition to higher education, and nobody bats an eye, and they call that an "entitlement".) We have to file for and justify ourselves each step of the way, and quite often multiple times for a single condition.

 

Understood, which is why we have all been told to "grant if you can, deny if u must", meaning give every reasonable doubt affordable to the veteran. 

I know that just as far back as 1994, most men and women who were separating were afraid that the doctor would put something down on their exit examinations that might slight their chances at some civilian career. I know now that this was foolish youth, and that 90 percent of employers that I've encountered don't really even ask to see or request copies of military medical examinations. (Some will though.) Most veterans upon separation want to be identified as healthy and capable, and don't know about what options were/are available to them, until in many cases, it is too late.

I say this because conditions do affect us as we grow older, and what was small then, may be a major problem now. And the VA isn't exactly opening its doors to Veterans and providing counseling on how to file their claims properly, even though this would be the best and most proper way to allow a Veteran to enter the system, or better still hiring VA "counselors" who actually sit down and complete forms/applications with the Veterans. (The government provides information and counseling on just about any other program that is out there to assist claimants "before" they file a claim.) The VA is the only government entity I know of that tells you to file it, and gives a disclaimer that they'll do only what they have to do, and the rest is up to you.   <-----again, many service orgs do provide this service of helping u file a claim, and you can always ask questions at the regional offices...at least in mine we have a museum/intake center where we will get you a counselor if you request one.

If I'm wong on any of this, please somebody jump in and correct me.

I'm sorry I rambled so long. I hope that I didn't bombard you guys with too much. Have a great Sunday.

Mark


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#29 dsgsr

 
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Posted 27 December 2012 - 04:36 PM

Thank you Veldrina. I hope the majority of Rating Officers share you attitude.

 

 

David


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#30 dsgsr

 
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Posted 27 December 2012 - 04:40 PM

Thank you, Veldrina. I hope the majority of Rating Officers share your attitude.

 

 

David

 

 

Sorry for the double post.


Edited by dsgsr, 27 December 2012 - 04:42 PM.


#31 carlie

 
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Posted 27 December 2012 - 04:46 PM

Vel,
Thanks for all you do.

#32 MarkInTexas

 
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Posted 27 December 2012 - 05:50 PM

OK, I'll bite....

 

Vel,

 

I probably shouldn't copy/quote your response with my copy/quote because it would take 10 minutes to scroll down to read.  However, thanks for your response.  I had forgotten about this one because I typed it waaaaayyy back around August, and since that time I have been rated 200%.  (Just kidding. I'm still in Gathering Evidence stage.)

 

First, I should apologize for the Angry Birds and Facebook comments, and really am astonished at the work conditions you are undergoing with the limited lunch/break times.  I don't think I've ever seen a Federal office building without air conditioning, and that just basically makes me more aggravated at the VA for not providing an adequate work environment and resources for employees to perform their duties.

 

I believe we all are aware that the VA is way understaffed, and that it should really take a serious look at increasing personnel in key areas to truthfully push down the backlog.  Sometimes, I just feel that the VA is taking it's time with this just in hopes that veterans/family members will either give up or just go ahead and die.  When I say the VA, I'm not meaning you, nor your peers, but executive officials that are responsible for budgeting and personnel.  I also am disappionted in Congress for not truly addressing the personnel and backlog issue.  Although standing at a podium and bashing the VA for an embarrassing backlog makes for great political stump speeches at American Legion, VFW or other veterans organization rallies, or makes for good soundbites on television, it means nothing unless actual bills are passed funding more personnel and imposing true mandates upon the VA to dimiinsh the backlog.

 

I am saddened at the frustrations that you face in trying to perform to standards that the VA has established under the conditions that they provide.  I have heard time and time again that raters will tackle smaller claims in order to make a daily quota, and have always hoped that it wasn't true.  However, from what you say, it would make sense for a rater who is already under the gun to produce at a certain rate, to go to the easy catches first, and save the bigger stacks or files for later.

 

Although I don't particularly like this way of doing things, I can understand where a person wishing to draw a paycheck would do what it takes.  Once again, it comes down to an adequate number of personnel to perform the desired function.

 

A lot of frustration that Veterans, including myself, feel is that we are lost in the shuffle.  No word from the VA unless you finally reach the end, or file a Congressional inquiry (and yes, I've learned my lesson on that too...it only delays matters more.)  If the VA could open its channels more, including making eBenefits and VONAPP easier to use, with realtime updates on data and the location of a C-File, then perhaps the anxiety might diminish during the wait time, regardless if it involves one claim or thirty.

 

I recently did a refinance on my home to get a lower interest rate.  The company pretty much handled everything online, and I was able to upload files that were 10MB or more into their system.  Status updates were frequent, and almost everything was handled digitally.  The company even has an iPhone app to check status and upload documents/photos/information.  Now if a private lending company can do that, certainly the Federal government, and more especially the VA, can create an up to date system that allow for documents to flow easily into a database, and for a Veteran to be able to review up to the minute status, along with realtime required documentation.

 

I know you are not part of this process, but I figure while I'm on my soapbox, I'd address eBenefits a bit.

 

I do want to thank you for your interest in Veterans, and for your participation on this website.  And again, I apologize for the Angry Birds comment, but the remainder of it simply, and truthfully, echoes the frustrations of veterans awaiting a final disposition of their cases, whether they're sitting in a waiting line at a VARO, on the street, at a local VSO office or on here.  (I may just ramble more than they do.)

 

I also want to admit that I am one of the Veterans that filed multiple claims, and unfortuntately also filed additional information during the waiting process.  Some of it was due to my own ignorance of the system.  (As I mentioned, we didn't have the Internet back in 1994, and I doubt I even got a pamphlet from the VA).  I also dont have a local VSO capable of assisting.  (The poor guy is elderly and seriously ill.)  I trekked out on this one on my own, and have scraped along for over two and a half years, submitting some things as requested, submitting others when I found something in the attic that looked like it needed to be sent in to the VA.  (I did that the other day actually.)

 

I think of a lot of the rationale behind sending in the whole truckload of information is the fear of being denied and having to go through the appeal process, which tacks on several more years to a claim.  I know in my own case, I wanted to give everything I had to the VA up front in hope for an affirmative rating based on all of the information available rather than a NOD and the waiting game all over again with information that I had in hand.  (I don't know.  Maybe my logic was/is flawed.  We'll see, I reckon.)

 

OK, I've rambled enough.  Thanks again for taking part in this website, and for caring about the VA system and Veterans.  I wish there was something that we as Veterans could/can do to assist.  If there is, please let me know, and I'll be glad to write or call whoever you reccomend to address the personnel and work environment issues.

 

Thanks again, and I will take your advice and not send in my pediatrician records from when I was two.  (I'm just kidding.  I couldn't resist.)  Have a safe and happy New Year.

 

Mark


Edited by MarkInTexas, 27 December 2012 - 05:55 PM.


#33 donh777

 
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Posted 27 December 2012 - 08:42 PM

I was discharged in 1964.  Had surgery on my wrist 2 weeks before discharge.  Had to go to local small town doctor for follow up as it gapped wide open one week  after the stitches removed.  In 2000 I filed for arthritis of the wrist.  VA doctor c & p exam asked me why I was fooling with a 0% or max 10% rating when your med records show a higher possibility of higher rating.  Susprised I asked him what he meant as I had a auto accident while on leave in 1963 with over 4 weeks in hospital at Tulsa, Okla and transferred to Tinker Air Base in Okla city before being discharged and then later a week at Brook medical center in San Antino for neurological tests.  At the time I thought it had to be an accident while on duty. DUMB Axx me.  And then it took me until 2005 to file on the back as I had got 0% for the wrist and my opinion was it wasn't worth the effort to file.  Got 10% on back and filed Nod and went to 40%.. Thanks to this site I have filed other claims and got increase in % for connected issues.  POINT is   I was in such a hurry to get out that I had no idea of benefits allowed.   I am now 70 but I haven't given up and still fighting and waiting......



#34 meghp0405

 
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Posted 27 December 2012 - 10:49 PM

I was discharged in 1964.  Had surgery on my wrist 2 weeks before discharge.  Had to go to local small town doctor for follow up as it gapped wide open one week  after the stitches removed.  In 2000 I filed for arthritis of the wrist.  VA doctor c & p exam asked me why I was fooling with a 0% or max 10% rating when your med records show a higher possibility of higher rating.  Susprised I asked him what he meant as I had a auto accident while on leave in 1963 with over 4 weeks in hospital at Tulsa, Okla and transferred to Tinker Air Base in Okla city before being discharged and then later a week at Brook medical center in San Antino for neurological tests.  At the time I thought it had to be an accident while on duty. DUMB Axx me.  And then it took me until 2005 to file on the back as I had got 0% for the wrist and my opinion was it wasn't worth the effort to file.  Got 10% on back and filed Nod and went to 40%.. Thanks to this site I have filed other claims and got increase in % for connected issues.  POINT is   I was in such a hurry to get out that I had no idea of benefits allowed.   I am now 70 but I haven't given up and still fighting and waiting......

it is not the doctors business on why you filed a claim. It's the docs responsibility, to determine what the diagnosis is and the nexus of the claim and the severity of the disability.


Edited by meghp0405, 27 December 2012 - 11:05 PM.


#35 meghp0405

 
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Posted 27 December 2012 - 11:02 PM

I'm in the process of utilizing one of these DBQs with my Orthopedic surgeon for a IME, and the only crucial item that has us stumped, is how does this form work it's way in when writing out the IME. I understand the format of the letter is going to change somewhat, but exactly how?
In my case, we're using it to rebut some of the items/opinions my C&P examiner noted in his DBQ for a current claim being adjudicated. Does my Dr just argue the differences of opinions pointed out in their exams only? Or does it changed anything at all, and just use the DBQ as a supplement. I realize this is something just coming out, and I probably won't get a correct answer, but I'm open to anyone's opinions.


Cooter,  It would be in your best interest to have your Doctor complete the DBQ in its entirity or at least what he can complete. Submit it with a VA FM 21-4138. State on the 4138 that this is a notice of disagreement (NOD) and  that you are requesting a decision review officer (DRO) to review your claim. The DBQ you are talking about is the longest DBQ on record as of now. He also needs to explain why he disagree's with the decision of the VA C/P examiner. However, when any Doc does this, they also have to provide information on how they came to the conclusion that they did. These forms are the best thing VA has come up with in assisting the veteran with their claim. I have submitted just over 400 of these with NOD claims. Each claim that was brought back to me was overturned in the veterans favor. Good luck!!

Edited by meghp0405, 27 December 2012 - 11:05 PM.


#36 Veldrina

 
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Posted 28 December 2012 - 03:44 PM

Thank you Veldrina. I hope the majority of Rating Officers share you attitude.

 

 

David

Honestly, we do.  :)



#37 SolInvictus

 
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Posted 28 December 2012 - 05:09 PM

MarkInTexas, thanks for articulating in a very potent way the frustration of our vet community. Nothing against Vel as a person but her professional brethren and their overlords in the government have done the loyal guardians of our nation a great disservice, and it's a shame all we can do within the confines of our laws is to impotently rant at their powerless employees.

#38 donh777

 
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Posted 28 December 2012 - 06:44 PM

it is not the doctors business on why you filed a claim. It's the docs responsibility, to determine what the diagnosis is and the nexus of the claim and the severity of the disability.

Maybe not but I am glad he did.   The gist of my remarks were to never give up on your claim.  jmo



#39 Captdc

 
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Posted 21 August 2013 - 03:16 PM

I am looking for the DBQ thatcovers TBI, any help would be appreciated.I have looked at the DBQs on the va web site but none has TBI listed?



#40 Berta

 
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Posted 23 August 2013 - 07:57 AM

I replied to you somewhere else and cant find my post.....

 

There is no TBI DBQ, the VA rates on residuals that could include many separate types of C & P exams or DBQs.

 

We have a wealth of info in our TBI forum here that includes the most recent proposed regulations on TBI.

 

Many of not most TBis ( such as from IED,MVA) could also be stressors for a PTSD claim. The VA must rate the PTSD as separate from the TBI if PTSD is claimed as the TBI stressor.


Edited by Berta, 23 August 2013 - 07:59 AM.





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