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Question Regarding Claim(S)


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#1 apachegirl

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Posted 16 May 2013 - 07:53 AM

Hello there  :)

 

I have a question regarding some claims I am putting together.   I have one currently that is still "gathering evidence" with my C&P exam completed on 4/29/13.  I believe I have done all I could for this claim and SHOULD (but we all know the stars must perfectly align) come out favorably with a min of 60%  - if they actually go by all my records.   This is for hypothyroidism.

 

Now my question is regarding claims following this.  Hypothyroidism causes depression (is a symptom) and I have been diagnosed by VA with Major Depressive Disorder (back in 2006).  This is before I really became aware of the hypothyroidism problems and service connection to it.  On active duty, I was given Paxil (in my medications list in records); however, I can not find the "sick call" slip for that date/time nor can I locate any dr's notes regarding that prescription.  From my research, this drug is really only used for psychiatric disorders so it is odd that I can not find any doctor notes or anything relating to it. 

 

Anyway, after I was seen in 2006 and diagnosed with the depressive disorder (I lost my job after this episode) I was given Prozac.  I haven't been to the VA in a very long time - I believe 2006-2007 was the last time.   I thought I would just manage on my own (yup that worked out beautifully).   My family care doctor (civilian) now treats me for the thyroid (unsuccessfully) but doesn't pay attention to my symptoms.

 

I decided it was enough (I have been cycling the depressive episodes now for 4 years) and registered with my VAMC here where I currently live and requested a PCP.  That appointment isn't until July (gotta love it) and then I know they have to refer me etc...   so it will take a bit.   This current episode has been the longest which is going on about 15 months now.   Luckily, I have kept my job but have missed quite a few days because of it (I am in the hole PTO wise). 

 

My question relates to filing a claim for the depressive disorder which I would guess should be secondary to the hypothyroidism?  I am pretty sure the tie can be made to that but just wanted to be sure I was heading in the right direction.   Do I wait and file the depression AFTER the thyroid comes back or do I attack it now (I can - I am in no rush and got nothing but time)?  If I wait, would it be recommended to see the therapist at VA for a while before filing?

 

Thanks - appreciate any help.

 

 



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#2 meghp0405

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Posted 16 May 2013 - 10:20 AM

I would definitely wait until you receive your rating decision for Hypothyroidism. Then you will have a SC disability. Then submit a claim for depression, secondary to Hypothyroidism. It would assist greatly if you had a nexus from your doc stating that your depression is a result from your Hypothyroidism condition. Don't ever take anything for granted from the VA!

 

 Then submit a claim for depression. Obtain copies of all your medical documentation to support your new claim and submit with a VA FM 21-526ez. This is a fully developed claim, which are being adjudicated a lot quicker than other claims.

IF you receive 60%, you can also file for TDIU using VA FM 21-8940. Submit this with the depression claim.


Edited by meghp0405, 16 May 2013 - 10:23 AM.


#3 stillhere

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Posted 16 May 2013 - 10:22 AM

Hmm if you have been DX'ed by the VA then they surely will see it and go from there in a perfect world. Have you looked at the ratings for your hypro does it state anything if depression is one of the ratings factors? The reason I ask in having my heart SC there are a number of different levels.

 

I don't have the time right now but I might take a look later.

 

Good Luck Stillhere 



#4 apachegirl

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Posted 16 May 2013 - 10:38 AM

7903  Hypothyroidism

 

Cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness 100

 

Muscular weakness, mental disturbance, and weight gain 60

 

Fatigability, constipation, and mental sluggishness 30

 

Fatigability, or; continuous medication required for control 10

 

 

The only thing I am missing from the 100% is bradycardia...    I get the opposite where my resting heartbeat is over 100bpm and if I try to do any cardio by rate will exceed 190bpm..  so not a good feeling.   

 

Hope I answered your question ..


Edited by apachegirl, 16 May 2013 - 10:38 AM.


#5 apachegirl

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Posted 16 May 2013 - 10:40 AM

I would definitely wait until you receive your rating decision for Hypothyroidism. Then you will have a SC disability. Then submit a claim for depression, secondary to Hypothyroidism. It would assist greatly if you had a nexus from your doc stating that your depression is a result from your Hypothyroidism condition. Don't ever take anything for granted from the VA!

 

 Then submit a claim for depression. Obtain copies of all your medical documentation to support your new claim and submit with a VA FM 21-526ez. This is a fully developed claim, which are being adjudicated a lot quicker than other claims.

IF you receive 60%, you can also file for TDIU using VA FM 21-8940. Submit this with the depression claim.

 

Thanks Meg...   I would appear then I am on the right track.  I have all my medical records since I was doing the thyroid so I will just sit back and wait.  I will be seeing the PCP in July and will ask for a referral to mental health again then.  I will see if they can make the tie or if the PCP can.   If I get impatient (which happens frequently) then I will just use my EAP (employee assistance) and go to a civilian mental health.

 

I am tired ..  literally and it is becoming too much.



#6 stillhere

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Posted 16 May 2013 - 10:42 AM

Here is an appeal from the BVA that puts it all in:

 

A rating of 60 percent may be assigned for muscular weakness,
mental disturbance, and weight gain.

A rating of 100 percent may be assigned for cold intolerance,
muscular weakness, cardiovascular involvement, mental
disturbance, brachycardia (less than 60 beats per minute),
and sleepiness.

The Board found, in its September 2005 decision, that the
veteran's hypothyroidism was manifested by muscle weakness
and mental disturbance. The Board remanded the case for VA
medical examination to determine whether the other criteria
for a 100 percent rating (cold intolerance, sleepiness,
cardiovascular involvement, and brachycardia) were shown.

The veteran had a VA medical examination in April 2006 during
which the examiner noted the veteran as having complicating
factors including sleepiness and cold intolerance. However,
the examiner noted the veteran's pulse as 77, and made no
notation of any cardiovascular disorder.

Thus, the veteran is shown to have four of the six symptoms
that the rating schedule associates with the higher (100
percent) rating. He is not shown to have brachycardia or a
cardiovascular disorder associated with hypothyroidism.

The Board notes that in view of the number of atypical
situations it is not expected, especially with the more fully
developed grades of disabilities, that all cases will show
all the findings specified; however, findings sufficiently
characterized to identify the disease and the resulting
disability, and above all coordination of rating with
impairment of function, are expected in all instances.
38 C.F.R. § 4.21.

Further, symptoms listed in the rating criteria are simply
examples of the type and degree of the symptoms, or their
effects, that would justify a particular rating; analysis
should not be limited solely to whether the claimant
exhibited the symptoms listed in the rating scheme. Mauerhan
v. Principi, 16 Vet. App. 436, 442 (2002).

The Board finds in this situation that the veteran's symptoms
more closely approximate the criteria for the higher (100
percent) rating. The Board notes that the VA examiner stated
that the veteran had ceased working in July 2005 because of
fatigue associated with thyroid disease; the fatigue was such
that the veteran was unable to drive for fear of falling
asleep behind the wheel.

The Board accordingly finds that the criteria for the higher
(100 percent) rating for hypothyroidism are met.



ORDER

An increased rating of 100 percent for the service-connected
hypothyroidism is granted, subject to the law and regulations
governing the payment of monetary benefits.



#7 apachegirl

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Posted 16 May 2013 - 10:58 AM

thanks for that info...   I really figure they will do the 60%.   For me, the cold intelorance is the most unbearable.  I have pictures of my body temperature dropping down to 96 degrees and falling.  Once I get to that point, I can't get warm and every joint, surface, and spot on my body starts to ache.  My hands turn purple when I am outside in below 70 degree weather.   The depression.. well that just manifests and cycles.  

 

Right now  - it is bad.  I never want to leave my house, force myself to get up for work.  I am a girl and just don't care to wear make up, dress or fix my hair (I just wake up and pull it up into a bun daily).  I swear I am in pajamas more than I am in regular clothes..  it sucks.  

 

I went for more bloodwork today so will get those results next week.  I am already Vitamin D deficient as well (by a lot) so start that replacement therapy next week as well. 

 

--again  thank you for all the info!



#8 Hoppy

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Posted 19 May 2013 - 02:15 PM

Considering that depression is a symptom noted in the rating schedule for the thyroid condition, a fully developed claim assuming the veteran is applying for a maximum benefit under the law would require in my book that they address any notation of depression in the medical records as it relates to the thyroid condition.  In essence a claim for a thyroid condition would be inclusive of depression. Unfortunately, the raters do not always fully develop claims.  It were me I would have filed the original claim as “thyroid condition with depression”.  This would make it more likely that they would fully develop the claim.

At this point if the C&P exam was not inclusive of a psych exam I would file a statement in support of the claim requesting a psych C&P and note that the rating schedule for the thyroid condition is inclusive of mental symptoms and depression.

I have been involved in numerous psych claims where the VA contracts with psychiatrists who invent false diagnoses to deny the veterans claims.  These diagnoses include personality disorders and substance abuse disorders. Basically they say things like “veteran does have minor symptoms of depression.  However, the diagnostic picture is dominated by symptoms of a borderline personality disorder”. Unfortunately raters give weight to these bogus diagnoses and deny claims. These false diagnoses can be rebutted and there are many veterans here on hadit who got these bogus diagnoses thrown out and later prevailed with their claim.  It is best to get a copy of the C&P before the claim is adjudicated and rebut false diagnoses as early in the process as possible. Let’s hope this does not happen in your claim.  If it does let hadit know.

 

 

 



#9 apachegirl

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Posted 09 September 2013 - 06:17 AM

Just wanted to take a few minutes and update this topic (will kind of be my journey log through the process).  

 

My appointment with my new PCP at VA kept getting pushed back and I finally got to see her 9/3/13.   She was an excellent doctor and of course is leaving the VA in November *sigh*.   She ordered a whole slew of bloodwork (10 vials when I went in) and made notes on everything (they are in my file).   I forgot to even ask about the mental health depression issue but she picked up on it and made the referral herself.  She noted everything including how easily I bruise now down to calluses on my feet  lol    She has ordered an ultrasound of my thyroid which I will have in October.  FINALLY someone listened.  I am keeping a log for her daily of how I feel and what symptoms I have because I tend to forget.  Hopefully I will get to see her one more time before she leaves.

 

As far as the claim goes, it is over a year old now and still processing.  I have more documents to send them this week.  I don't care how long it takes at this point just as long as they pay attention.  I am waiting on my new lab results before I send in the paperwork.  Once this one is done and hopefully service connected, I will send in another one for depression.  I wanted to ensure that I got to see the mental health at the VA before tying those two up.   I believe in her items and notes she notated the depression link to the thyroid. 

 

I still read here to prepare myself for worst and how to battle it.  I have spoken to Ask NOD through email and he helped me with the path on my paperwork.  I feel like I am doing the right thing so far.  I am more relieved someone paid attention and maybe at some point I can just feel better!

 

ETA:   My C&P exam was actually good and that doctor (civilian) contacted me after (on the sly) to let me know that my thyroid test results were abnormal and to go back to my doctor for meds and recheck.  She had also told me not to worry as she stated it was connected to service since they left me untreated since 2001.  


Edited by apachegirl, 09 September 2013 - 06:19 AM.


#10 carlie

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Posted 09 September 2013 - 07:56 AM

I agree with Hoppy and would make the claim issue for thyroid with depression.

Perhaps VBA will go ahead and do this on their own when evaluating the thyroid condition,

if found to be SC'd.

JMHO



#11 apachegirl

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Posted 09 September 2013 - 08:04 AM

I think I am just unclear on how to update the claim itself to include.  Right now, the only info I have tying the depression I have to it is my recent medical visit and the DBQ information my civilian doctor completed (he is not mental health in any way).   My VA doctor was talking to me about the fatigue and depression.  She wasn't sure if it would be all rated together or if I should just but out a long list of effects...  

 

Thyroid issues are so confusing  :blink:   I at least wanted to see mental health doctor here first before sliding into that base - at least they can see I have been making an effort to be seen since April of this year.  I can send that information tho..   After reviewing my VA file and the diagnosis for the depression disorder (back in 2006 and earlier), they never related it back to thyroid and I was oblivious back then about my disorder.   They figured it was due to money, family etc...  which it isn't.   Hard to explain I suppose  ...   I figured I couldn't set that record straight until I met with someone now  :(



#12 meghp0405

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Posted 09 September 2013 - 06:43 PM

a lot of suggestions here, but I would wait until you receive your rating decision before submitting an additional claim for depression. I believe that your C/P examiner may have done it for you. the more documentation that you keep sending and sending will only prolong your claim.

 

Wait for your current claim to be adjudicated and when you receive your rating decision, that will explain what the VA did or didn't do. Submit a claim for depression secondary to the thyroid and request  your effective date to be the date of the rating decision you received for your thyroid. 






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