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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.
    • Listen Live Every Wed 5:30 PM CST to SVR Radio, Veterans Issues are discussed with various guests.

      Listen Live Every Wed 5:30 PM CST to SVR Radio, Veterans Issues are discussed with various guests. Please check the little home I am carving out for our SVR partners. http://www.hadit.com/svr.html
    • 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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Disability Benefits Questionnaires


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

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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.

Coot

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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.

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Posted · Report post

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.

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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

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Posted · Report post

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.

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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

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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.

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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".

Coot

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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.

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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.

Coot

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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 ?

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Posted · Report post

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

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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

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Posted · Report post

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

Coot

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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.

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vel,

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

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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?

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Posted · Report post

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

case report sleep apnea PTSD.pdf

Nexus Letter.doc

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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

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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
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Posted · Report post

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?

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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.

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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.

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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.

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