Jim,

I'm a VFW service officer, Still following you on Vawatchdog, and I have question. A vet I am helping had a C&P done a few years back for an increase in his PTSD rating related to increase in symptoms, job difficulties, increased outbursts, the gambit of things increasing...So of coarse it was denied, he appealed, and has been waiting...in the meantime he was fired from his job and denied unemployment (worked 52 years/never filed before)...put in for TDIU...Checking his C&P exam and the examiner noted Chronic symptoms;suicidal thoughts;strained relationship;domestic violence;aggression;sleep impairment;severe nightmares;distressing recollections of killing in Vietnam;outbursts of anger;...)

...Description of Primary Stressors related to PTSD:

Vietnam veteran served in the military in 1968 and states he shot and killed VC while in Vietnam. Full exploration and explanation of PTSD stressor is beyond the scope of current evaluation. (If the examiner would have checked this out on his records he would have read veteran awarded Bronze Star with Valor, as sabottage team sent to his aide found enemy pinned down unable to advance, and he killed at least7) ...insult to injury under Axis V: GLOBAL ASSESSMENT OF FUNCTIONING is what he typed in there No number just that typed in there!! That group of words.All caps.

Lastly the examiner did the C&P exam, it does not indicated his title/degree/nothing, but it has he initiated it...Typed is THIS DOCUMENT WAS ORIGINALLY INITIATED BY XXXXXXX,XXXX X. Front page lists a Author: lastname, firstname,initial.....But we know this guy is a Psychologist!

Done on mar 22, 2010, Entry date is Mar 30, 2010. HE NEVER SAW THE PSYCH DR EVER STILL HAS NOT! They denied, he appealed asked for DRO Denovo and still waiting.... Do we challenge no GAF score? Examiner wrote the report, not a psych Dr. scope of examiner as addressed above...

 Thanks Jim and keep up the good work.

Reply:

This is the most challenging and heartbreaking sort of claim to try to help with. There aren't any easy ways to resolve it. The wait time will be beyond ridiculous. The veteran will suffer the consequences.

Mental health issues are notoriously difficult to quantify. A broken bone is pretty simple. It can be seen on x-ray, measured accurately and the science of broken bones can accurately tell us how long it takes to heal and what we may expect from the healing process. A problem with the psyche is elusive. We can't make an image of it and on any given day it may be better or worse.

A **LOT** of Vietnam veterans are coming to terms with their lives these days as they are getting older. Aging often isolates us whether or not we're veterans and as we hit 60 and beyond we see the end approaching. The future isn't full of hope and things to look forward to, in many minds it appears bleak and full of health crises and the finality of death. If PTSD was buried in the back of a mind for decades while work, family and life prevailed, suddenly those things aren't there to repress PTSD symptoms and the vet can deteriorate pretty quickly.

Your vet has been subjected to an inadequate C & P exam. Inadequate exams are nothing unusual. The communication between the VA Regional Office where the C & P order originates and the examine is usually too brief, consisting of an order that has very little background about what is really needed. This is what happens when the workload is crushing the workers and the bureaucracy of rules, policies, procedures, requirements and the need to process it all quickly with little oversight for quality becomes the normal way to do business.

The examiner can hardly be faulted in many instances. You mention a lack of review of service records. Unless the VARO ordered the examiner to review those records and then provided them, the examiner isn't allowed to have that choice. Orders are specific about what the examiner should do. If the RVSR ordering the exam tells the examiner to evaluate the right wrist, the examiner is not allowed to make note of a broken right leg. The C & P exam orders tend to be very narrow and specific.

What to do? If you're in the middle of a DRO appeal, I suggest that you do nothing. As a general rule I don't like to interrupt the flow of the process if I discover an inadequate exam. It's premature to object to the exam. To object before you know of the impact it will have will certainly add time to the adjudication of the claim. In this case, if the vet has an active application for TDIU and if he's eligible for that, the inadequate exam may not have much weight. Other factors can take priority in the mind of the adjudicator and he/she will see the inadequacy of the exam and make the award based on those other factors.

Then, if denied again and you're required to head to BVA, you have a great reason to do just that...the inadequate exam is all you need.

There aren't any positive answers to give you here. The only action to take is no action at all. Be very patient and hope for the best. Sticking to the process and not stepping outside the bounds of how the process works is pretty important. Once you try to make adjustments, things usually get off track and when that happens, you have real troubles.

Good luck.

Jim