Focal Point #: Ptsd The C
If every Veteran with a PTSD claim picks up a copy of their C-File, and finds out which of the 4 Pillars of their VA claim was lacking 5-Star Evidence, they could drastically accelerate the time it takes to get to the VA PTSD rating phase of their claim.
The 2 most important stars? Competent Evidence and Credible Evidence. While important in EVERY claim, we need to approach competency and credibility of PTSD evidence a bit differently to have a better experience at the VA.
Knowing how much evidence the VA Claims Evidence Thermometer needs in a PTSD claim is also vital. Some elements of a claim only need enough evidence to get you to the at least as likely as not level. But other elements like insulating your claim from a VA rebuttal of a legal presumption will require more evidence.
Knowing the 4 Piillars of the PTSD claim, and how much evidence is needed to solidly build each of the 4 pillar is the number one thing that Veterans should know.
Dont Dress In Your Sunday Best
If you arent normally dressed up, showered, and shaved daily, then dont show up to your examination this way. Show up the way you look on any given day. An examiners impression of you can have an outcome on his report .
If you tell the VA doctor that you have trouble getting motivated to take a shower or shave, but you look like youre headed to a job interview, this may give the doctor the impression that you are exaggerating your symptoms. If you cannot work because of PTSD, do not make it look otherwise.
Why You Should Write Down Your Symptoms Before The C& p Exam
Veterans dont need to bring their complete medical records or itemized medical histories to the VA facility, but they should bring a written list of symptoms, even embarrassing symptoms, to refresh his memory. Remember, this exam is the chance to show how PTSD affects your life day-to-day. What veterans sometimes feel are unimportant details could be the key to the claim. The examiner needs to know all the details. If the veterans treating medical providers have provided a favorable opinion in the matter the veteran should bring that medical evidence too. This will further help the examiner see the totality of the veterans symptoms.
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Dont Exaggerate Your Symptoms
Weve seen several C& P exams where the examiner accuses the veteran of malingering, or exaggerating his or her symptoms. Often, this is NOT the case. However, if an examiner BELIEVES you are malingering, it may affect the entire report. Doctors use exams, such as the MMPI, on veterans who they think are malingering. This will obviously negatively affect your claim.
Tip #: Questions To Ask Yourself Before Your Compensationand Pension Exam For Ptsd
1. Do you have a medical diagnosis of PTSD from the military,a VA doctor, or a private doctor? If not, you need to get to the doctor andtell them everything going on with you! Without a diagnosis of PTSD, your VAclaim will get denied.
2. Can you prove the event or in-service stressors that causes or made your PTSD worse? You can do this by writing a Statement in Support of a Claim for PTSD on the VA Form 21-4138. Make sure to list the event or stressors and the approximate timeframe of when your PTSD began. I also recommend you get at least one Buddy Letter from a first-hand witness who can speak to how they know you, what they witnessed, and how your PTSD is limiting or affecting your life. This is very important when lay evidence is necessary because it helps explain to the RVSR your current level of occupational and social impairment for PTSD.
3. Have you been seeking treatment or therapy for PTSD? Why or why not? If so, when was the last time you saw a Psychologist or Psychiatrist? Do you take PTSD medications? Do they help, yes or no?
You might also like my post on How to Prove Your PTSD Non Combat Stressors.
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Bring Someone With You
* Ask your spouse or a friend or other family member who knows you well to go with you to the exam. I offer this recommendation for two reasons:
> For most veterans, a VA Compensation and pension examination for Posttraumatic Stress Disorder is a stressful experience. Bring someone who will support you.
~ If after the exam you feel overwhelmed, extremely anxious, very depressed, etc., consider calling the Veterans Crisis Line , or the War Veterans Call Center , which is run by the Vet Center Program specifically for combat veterans and MST survivors.
> Some examiners will interview your significant other as part of the exam. I personally believe that C& P psychologists and psychiatrists should always interview a veteran’s spouse or other family member if the veteran requests it.
> But some examiners are so pressed for time that they really can’t fit it in, while others won’t conduct family interviews because they do not believe it adds to the evaluation results. . It is up to the examiner to decide.
Dont Downplay Your Symptoms
Remember what youre there for! When someone asks you How are you today?, we often automatically respond good, and you? But youre not good. Youre suffering from a disability. This is a disability evaluation, so you want to answer honestly.
You would be surprised at how many C& P exams and medical records weve read where the veteran is asked about a disability, and he or she responds with Im fine, or Im ok. We know that when you were in the military, you were expected to suck it up and move on, and any complaints about pain or illness were met with ridicule. We get it, but youre not in the service anymore, and your life depends on you getting help with your medical condition.
So, speak up! This is another reason why we suggest bringing another or family member with you.
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Tips For Your C& p Appointment
During your C& P exam, you will likely meet with a medical or mental health professional to discuss your illness, injury, or psychological disorder. Its also likely that the doctor will perform a physical exam. Its important to know your objective when reporting for the examto communicate your situation as precisely and accurately as you can, being as complete as possible.
You probably wont have a great deal of time to explain your case, so its critical that you come prepared for this appointment. Its your opportunity to present your situation, in detail, and all that youve been experiencing. Remember that the person seeing you needs to understand how your injury or illness affects your daily life, your routines, your work, and your relationships.
Here are some tips to help your appointment go smoothly and promote a more favorable outcome for your claim:
At Cuddigan Law, we understand how critical it is for veterans to get disability benefits. Thats why we provide free information to help veterans with their claims. Download our free book, The Essential Guide to VA Disability Claims, or call us today at to ask us a question about your disability case.
Alcohol & Other Drug Use
* HadIt.com has an article on their website offering advice to veterans scheduled for a C& P PTSD exam. I recommend reading it as it contains some good advice.
I do not recommend following this piece of advice in the article.
“Do not talk about alcohol or drug related issues. You are not there to be assessed for those problems. You are there to be assessed for your psychiatric functioning as today relates to your service history. If the examiner asks about alcohol or drugs, politely remind them that you are not there for those issues, if youve ever had them, but for how impaired you are in your daily functioning. Its best to avoid even talking about them.”
> I think I understand where the author is coming from–some examiners, particularly in the past, would try to blame an alcohol or other drug problem for all of a veteran’s symptoms and difficulties. Such an inappropriate bias may still exist with some examiners. If so, write down what happened during the exam as I mentioned above.
> Otherwise answer questions about alcohol and other drug use honestly and completely. In my experience, most veterans suffering from substance abuse and PTSD developed the alcohol/drug problems after or along with PTSD. Consequently, if the examiner documents this relationship, then you may very well receive service connection for PTSD and the substance abuse condition, and the functional impairment you suffer from both PTSD and substance abuse will ‘count’ toward your disability rating.
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How Will Va Diagnose Me If I Have More Than One Psychiatric Condition
Psychiatric disorders can sometimes be difficult to tell apart as many disorders have overlapping symptoms. For instance, a veteran who suffers from PTSD will often suffer from symptoms of anxiety and depression. Sometimes a veteran, who VA treats for PTSD, may have a C& P examiner state he doesnt have PTSD. The examiner may, instead, say the veteran suffers from an anxiety disorder. However, mental disorders are evaluated under the same VA disability rating formula under 38 C.F.R. s. 4.130. So, in some practical ways, the actual diagnosis matters less than what VA assigns for a rating. But, understandably, many veterans who are suffering from PTSD want the VA to recognize that they have PTSD. They want them to see that they are suffering from that condition in particular, not generalized anxiety or another similar disorder. For more on PTSD and depression, click here.
Does Being Labeled A Malingerer Hurt My Ptsd Case
Unfortunately, bias against the malingering veteran still exists among VA examiners. This bias can hurt those whose PTSD has legitimately gotten worse. Therefore, it is just as important to use the tips in this section during any subsequent PTSD exams. You must be prepared to submit evidence that your PTSD has gotten worse to back up the increased rating claim.
NOTE: In the early 2000s, the VA published a Best Practice Manual for PTSD Compensation and Pension Examinations. This manual gives very technical, detailed instructions for clinicians administering C& P exams for PTSD, including the tests used for malingering, such as the MMPI-2. It is unclear how much weight VA C& P examiners give this manual since it has not been updated in over 10 years. Be that as it may, VA has not officially repealed it. Also note that because the manual pre-dates the publication of the DSM-V, its analysis revolves around the diagnostic criteria of the DSM-IV, including the Global Assessment of Functioning scale.
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Ptsd Exam For Civilians
More than 5 million people in the United States suffer from PTSD, including a large percentage of civilians. If you experience any of the symptoms of a mental health illness, your diagnosis can only be made after the following steps:
- A physical examination by a medical doctor or other licensed professional.
- A mental health evaluation performed by a psychiatrist, psychologist, or other licensed mental health professional.
Finally, your test results either by a medical doctor or mental health professional will be compared to criteria established by the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition .
Tips For Attending C& p Exams For Ptsd
First and foremost, veterans must attend the C& P exam for PTSD. Failure to do so without providing good cause can result in VA denying your claim without looking into further evidence. However, once you are at the C& P exam, there are several steps you can take to ensure VA is addressing your concerns fairly and appropriately. First, you should always be as honest as possible. Do not under- or over-report your symptomology. Instead, make sure to carefully explain to VA what you are experiencing on a daily basis and how it affects your functioning. Second, be aware that you can bring somebody with you to the exam if you feel as though they can offer additional information, or if you do not feel comfortable attending alone. Finally, remember that VA examiners are likely to observe you from the very beginning. This means that from the moment you walk into the waiting room, examiners may observe your interactions with other patients and the staff.
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Tip #: 8 Things For Your Va C And P Exam Forptsd
1. Know whats in your medical records! There is no substitutefor knowing whats in your service treatment records, VA medical records, orany private medical records.
3. Review the eCFR, Title 38, Part 4, Schedule for RatingDisabilities
4. Do NOT have your best day
5. Be UNFOMFORTABLY VULNERABLE
6. PTSD claims comes down to your current level of Occupationaland Social Impairment.
7. Know your true story coldand potential in-servicestressors that caused or made your PTSDVA worse.
8. You must be prepared to talk about your life in detail.Before joining the military. During the military. And after your active dutyservice.
What Do I Do At A Va Compensation And Pension Exam
It is always a good idea for the veteran to take a witness to the examination. This person can be a spouse, adult child, family member, or close friend. A witness is important for a couple of reasons. First, it is easy for a veteran to not fully understand how PTSD affects him. The witness will be able to discuss how the veteran interacts with others, which is a crucial part of PTSD. Second, veterans tend to forget important details about the exam. Third, this person can help the veteran deal with the stress veterans experience during VAs C& P exams.
If possible, the veteran should take the witness into the examination room with them. Unfortunately, the examiner frequently denies this request. Even if the witness cannot go with the veteran, it is important the veteran proceed with the exam. Failure to cooperate with a C& P examination can result in denial of the claim.
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Focal Point #: Proving The Ptsd Stressor Event
If I had a nickel for every-time a Veteran didnt know which TYPE of stressor event he/she was claiming, I could probably buy myself a seat in Congress. Seriously, not knowing what TYPE of stressor you are proving up is one of the biggest reasons for wrongful VA denials of PTSD, and one of the biggest causes of delay in a military PTSD claim.
If your stressor occurred during combat, do you know what evidence you need to prove that the stressor occurred?
What if the stressor occurred in a combat zone, but not during actual combat?
If your stressor event occurred during a friendly fire casualty situation, will the VA consider this combat?
How much 5-star evidence do you need for a non-combat stressor?
Summary Of The Focal Points In A Ptsd Claim
If you can nail these aspects of a PTSD claim, you will maximize your VA PTSD rating. Get out in front of your VA PTSD claim or appeal and dont wait for the VA to assist you in developing these elements:
2) Know how to prove up your UNIQUE type of Stressor Event.
3) Get a solid Diagnostic Exam.
4) Learn how to provide 5-Star Evidence to get you the Impairment Rating you deserve in a PTSD claim.
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What You Should Do
* If you take psychiatric medications, be sure to keep taking them as prescribed on the days leading up to the exam and on the day of the exam.
* If the examiner asks you to complete questionnaires, tests, inventories, etc., make sure you understand the instructions before you begin answering. Most such questionnaires are fairly easy to understand and complete, just don’t rush through them. At the same time, don’t agonize over each item. Usually “the first response that comes to your head” will be the best one.
> Neither minimize symptoms and problems nor over-report them. If you’re not sure if you have a particular symptom as described on a questionnaire or test, it’s probably better to not endorse it.
> If you are asked to complete tasks, such as remembering a group of words, drawing figures, or saying as many birds as you can think of in one minute, do your best. The psychologist will probably know if you pretend to have really bad memory or another cognitive problem.
What Is The Purpose Of A Va C& p Exam For Posttraumatic Stress Disorder
A C& P exam validates a disability claim. If a veteran has been receiving mental health treatment at a VA medical facility, the doctor conducting the exam will not be his treating doctor. So, it is not enough to see a VA doctor for many years and that doctor diagnoses the veteran with PTSD. The veteran still must report for a C& P exam with a different doctor, who may not reach the same conclusion.
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