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Mental Illness Claims

dysthymic disorder

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#1 Mil T

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Posted 29 July 2012 - 05:53 PM

Hello All.
I am working with a young man that was discharged from Air Force in 2006 after 3+ years of service. His records show that he was diagnosed with Dysthymic Disorder and that he was discharged for Personality Disorder. Dr. report claims the Dysthymic Disorder was pre-existing. I reviewed his entry physicals and there is nothing there for mental illness so that is bogus.
He has since been diagnosed Paranoid Schitzophrinic for which we filed VA claim for.
I've read his files and it shows an above average to exemplory performance up until 2005 when it all went backwards. He has been seen in our town by mental health facility and documentation has been forwarded to VA as evidence.
My question is wether or not we should submit an addendum to include Dysthymic Disorder along with the Para Schitz. or should the Para Schitz be secondary to the Dysthymic Disorder? I have found document study's that mention that DD is connected to and is a pre-cursor to Schitz.
We have all the evidence to show this started in the service so I'm confident he will be SC. My goal is to achieve 100% for him since he has been deemed incompetent by the Social Security Admin already.

Ironically his mother 54 was also diagnosed while she served back in 1978. She was also discharged. She was also Sexually Assaulted. I talked her into filing as well. She had been told back then by family that she should keep her mouth shut and move on. I am treading new waters her but evidence is overwelming that I cannot see how the VA can deny a claim. I've put her in for the Schitz and PTSD.

Thanks
Mil T

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#2 john999

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Posted 29 July 2012 - 07:14 PM

I was discharged for a PD by the Army after 28 months and then SC'ed for schizophrenia within one year of discharge by the VA. The Army rode me out of town on a rail called a personality disorder. It took them 28 months and a tour in Vietnam to discover the PD. Years later they changed the DX to bipolar disorder and PTSD.

#3 Hoppy

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Posted 29 July 2012 - 08:18 PM

The fact that the veteran has a current diagnosis of schizophrenia will be the dominating issue in the claim. They can make a diagnosis of personality disorder based on the subjective history and veterans actions observed by the doctors while he was in the military. Like other mental conditions, symptoms of personality Disorder may not first occur until the early 20’s. The reason they can say it predated service is that Personality Disorders have been determined to developmental and there is long standing regs stating that personality disorders cannot be service connected. The Dysthymic disorder is a different story. They would need evidence collected in a clinical environment to establish that the Dysthymic disorder pre dated service.

If you get a qualified clinician to review the entire medical file including the SMR and back up the contention that early symptoms of the schizophrenia better explains the diagnostic picture and the veterans symptoms of schizophrenia first occurred proximate to military service, such a statement would be about the strongest evidence you can get.

The VA should schedule a C&P examination to reconcile the diagnostic picture. However, and this is a big “However”, John’s getting service connected as fast as he did is the exception. I have dealt with many Personality Disorder claims in the last 14 years. Many were successfully re-diagnosed and service connected. It was a battle. The first decision in most cases is a flat denial without even scheduling a C&P exam. You might need to get an IMO. If you get denied send me a personal message and we will hash out what to do on the hadit board. It has been several years since I have seen this type of claim on the board and the subject matter could benefit from being refreshed.

About two years ago a veteran I assisted filed a claim for “anxiety disorder”. The RO denied the claim saying that he did not have a current diagnosis of “anxiety disorder”. The current VAMC records in possession of the RO showed that he had a diagnosis of “Panic Disorder” made by five different clinicians over the five year period prior to the denial. Panic Disorder is an anxiety disorder. We amended the claim to include “Panic Disorder”. I attached some literature showing that “Panic Disorder” was an “Anxiety disorder” which resulted in an immediate 930 review. Point being, that there might be a benefit to amending the claim. However, they still denied the claim. It took an IMO to win what eventually was a slam dunk claim.


#4 john999

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Posted 29 July 2012 - 08:46 PM

Hoppy

If you consider that I spent two months in a military hospital for depression, anxiety and drug abuse after Vietnam it makes me wonder why it was so easy for the army to discharge me as a PD. I was taking stelazine right up to the time I was discharged. The army shrink who said I was a PD never even spoke to me. They wanted me out and the only issue was unsuitable or unfit. I then spent 2 weeks in a VA hospital a few months after I got discharged. The VA DX'ed me with schizophrenia and after I filed a claim I got 10% for schizophrenia, but the PD was still hung around my neck. Getting a PD dx removed from your profile is a difficult job. The VA even tried years later to sever SC due to the PD dx, but I had been SC'ed for over ten years. They tried to deny my CUE pretty recently harkening back to the PD dx some other VA doctor cooked up about 25 years ago when I asked for an increase.
The PD motivated discharge routine is a scandal.

#5 Hoppy

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Posted 29 July 2012 - 09:31 PM

John,

I did not hear about them re-evaluating you ten years later. They are ruthless. The disgnosis of PD can wind up in the trash. The problem is that there are adversarial clinicians within the system who do not have a clue as to how to make a differential diagnosis and they shoot from the hips with their BS reports.

#6 Mil T

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Posted 30 July 2012 - 04:24 PM

The fact that the veteran has a current diagnosis of schizophrenia will be the dominating issue in the claim. They can make a diagnosis of personality disorder based on the subjective history and veterans actions observed by the doctors while he was in the military. Like other mental conditions, symptoms of personality Disorder may not first occur until the early 20’s. The reason they can say it predated service is that Personality Disorders have been determined to developmental and there is long standing regs stating that personality disorders cannot be service connected. The Dysthymic disorder is a different story. They would need evidence collected in a clinical environment to establish that the Dysthymic disorder pre dated service.

If you get a qualified clinician to review the entire medical file including the SMR and back up the contention that early symptoms of the schizophrenia better explains the diagnostic picture and the veterans symptoms of schizophrenia first occurred proximate to military service, such a statement would be about the strongest evidence you can get.

The VA should schedule a C&P examination to reconcile the diagnostic picture. However, and this is a big “However”, John’s getting service connected as fast as he did is the exception. I have dealt with many Personality Disorder claims in the last 14 years. Many were successfully re-diagnosed and service connected. It was a battle. The first decision in most cases is a flat denial without even scheduling a C&P exam. You might need to get an IMO. If you get denied send me a personal message and we will hash out what to do on the hadit board. It has been several years since I have seen this type of claim on the board and the subject matter could benefit from being refreshed.

About two years ago a veteran I assisted filed a claim for “anxiety disorder”. The RO denied the claim saying that he did not have a current diagnosis of “anxiety disorder”. The current VAMC records in possession of the RO showed that he had a diagnosis of “Panic Disorder” made by five different clinicians over the five year period prior to the denial. Panic Disorder is an anxiety disorder. We amended the claim to include “Panic Disorder”. I attached some literature showing that “Panic Disorder” was an “Anxiety disorder” which resulted in an immediate 930 review. Point being, that there might be a benefit to amending the claim. However, they still denied the claim. It took an IMO to win what eventually was a slam dunk claim.


Hoppy. Thanks for the offer of assistance. I will take you up on that as I will be trying to do the right steps to try and stop the VA from sending it off to never never land. I have a lot of back up in the vets files with diagnosis etc. from the Air Force shrink so that may help. The vet also started seeing mental health specialists here in our small town not long after he was discharged. I will get those records and see what they say. I'm still wondering though if I should have all my bases covered with amending the claim to add the Dysthemic Disorder since that is what the Air Force actually diagnosed. This might be the perverbial monkey wrench that could sidetrack the claim if I dont' put it on there.
Mil T

#7 broncovet

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Posted 31 July 2012 - 07:19 AM

I agree with Hoppy. There is case law that suggests that Veterans have continuity of SYMPTOMS, not continuity of treatment. The docs can, and do sometimes change diagnosis and treatment. New pills, new research. This is why mental illnesses are all rated the same. There isnt separate ones for PTSD, another for MDD another for Schizo, etc. You are rated on symptoms, not which of these maladies mental disorders you have.

Further, since Veterans are rarely competent medical authorities, they can neither diagnose, nor treat their own illnesses. The VA wont award me benefits based on the fact that I think I am depressed.

However, the VA courts have repeatedly ruled the Veteran is competent (unless shown otherwise) to report his symptoms. A Veteran is not qualified to say "I have Obstructive Sleep Apnea", but he is competent to say..."I snore real loud" or "I fall asleep at inappropriate times during the day".

These are symptoms of Sleep Apnea. The Doc normally does a sleep study to confirm a diagnosis of OSA. Not only did my doc do a sleep study, since it was obvious to the sleep technician that I had apnea events, the also tried a CPAP mask, and observed how much air pressure required to releive me of apnea events.

In a similar way, the doc has tests available for mental illness. He can choose to order these tests, or not, and make his diagnosis based on his observations. But you have to have a docs diagnosis to get SC.

I think Vets make a mistake trying to diagnose their own maladies. If they make a mistake, or if Doc A differs from Doc B's diagnosis, then the Vet will have trouble making his application for Doc A's diagnosis stick. This is why I think its better to apply more generally for mental health disorders, than to limit your benefits to MDD, PTSD, etc. You may think you have MDD but your doc may diagnose you as Schizo. The VA likes to deny these, and make you start over. I dont want to start over.




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