C&P Exams: Mental Health and Anxiety Disorder

hi my name is Casey Walker I'm an attorney  and I'm the founder of VA disability Group   today we're going to be talking about generalized  anxiety disorder incidentally gives me a little   bit of anxiety to do this type of public speaking  so there you have it maybe I have a diagnosis but   let's let's dig into generalized anxiety disorder  the VA has a a diagnosis they will accept found in   the dsm5 which is the mental health manual that  practitioners must give diagnosis through that's   called generalized anxiety disorder and anxiety  itself can also be a symptom of other conditions   so let break those two out one a symptom you can  have anxiety and be diagnosed with PTSD because   anxiety can be a symptom of PTSD you can have  anxiety and be diagnosed with depression but   here we're talking about the actual diagnosis of  generalized anxiety disorder let's break that out   what does that mean well the VA relies on the DSM  5's requirements for how to diagnose generalizing   that anxiety disorder specifically I'm going  to go straight to the DSM and what's needed   for a diagnosis generalized anxiety disorder  is a distinct diagnosis found in the DSM with   the following requirements number one excessive  anxiety and worry occurring more days than not   for at least 6 months number two the person finds  it difficult to control the worry number three the   anxiety and worry are associated with three or  more of the following six symptoms and then they   break out these random six things restlessness or  feeling keyed up or on edge being easily fatigued   difficulty concentrating or mind going blank  irritability muscle tension and sleep disturbances   then after we move on from that element move on  to the next element which is the disturbance is   not better explained by another mental health  disorder and then next the anxiety worry or   physical symptoms cause clinically significant  distress or impairment in Social occupational   or other important areas of functioning and then  lastly the disturbance is not attributable to the   psychological effects of a substance or another  medical condition so are we abusing drugs alcohol   so those are the requirements so in order for  a practitioner to come to determination that   someone has generalized anxiety disorder those  are the elements you're going to walk through   it's required because they have to practice with  the DSM now I provided a link in the description   that breaks the nuances and differences between  the old DSM 4 which changed in 2013 to the DSM   5 and these are the practitioners requirements  in order to assess and determine whether someone   has generalized anxiety disorder you can take a  look for yourself there to see if you think you   still have generalized anxiety disorder if you  might have it today so why would a veteran want   to claim generalized anxiety disorder You' got so  many different types of mental health conditions   you got PTSD you got depression you got anxiety  you got phobias you got all kinds of conditions   well it's a generic one and you see it diagnosed  quite often but the most common mental health   condition that veterans tend to claim is PTSD but  here's the problem with PTSD not all veterans had   a stressor on active duty and in order to claim  PTSD post-traumatic stress disorder you need to   build a point to a stressor on active duty now if  that stressor wasn't from combat the evidentiary   burden becomes quite High you got to demonstrate  that it actually happened whereas combat by virtue   of the nature of combat itself it's con seeded  that there's a stressor so I bring this this a   long way long-winded way of saying that sometimes  you can't claim the easier PTSD with the less   evidentiary burden so something like a generalized  anxiety disorder might be the better approach for   you perhaps you have an underlying condition  that you're service-connected with maybe it's   back maybe it's migraines and sometimes those  conditions can cause secondary conditions and   maybe it causes anxiety maybe your headaches  or you're never sure if you're going to get   one of these extreme headaches or maybe have bad  vertigo maybe you start have anxiety going out in   public because you become incapacitated in public  and it's embarrassing so that would be another   way that generalize anxiety disorder might be a  superior claim to say a PTSD if you didn't have   a stressor so let's talk about how is generalized  anxiety to sort of evaluated by the VA before we   get into this remember that the first objective  is you have to get service connection so we're   about to discuss the evaluation or the symptoms  first things first you have to be diagnosed and   you have to be service connected we already walked  through the diagnosis criteria but you have to be   service connected once your service connected  then we move on to what's your evaluation show   me the money what's the percentage assigned so  let's talk about that we're going to look at   38 CFR 4130 this is commonly referred to as the  rating schedule and in the rating schedule they   break out the mental health symptoms and as you  can see there's a Litany of different symptoms   but the breakdown if you really summarize this is  occupational and social impairment occupational   and social impairment you'll notice they have  0 10 30 50 70 and 100% evaluations there is no   80 and there is no 90 so if you have a 70%  evaluation be careful because the next the   next evaluation could go up to 100 which might  be good but they might find you incompetent so   70% if you're sitting there don't try to get the  80 or 90 because it doesn't exist if you have the   50 don't go for the 60 because it doesn't exist  but what does social and occupational impairment   mean well when you're talking let's talk about  social impairment well maybe maybe you've gotten   three divorces in the last 10 years and you're  struggling to maintain a relationship with your   spouse maybe your kids have lost contact with  you and you have no desire to talk to them maybe   you're perpetually fighting with your neighbors  maybe your co-workers have kind of shunned you   because you're always aggressive or frustrated  maybe um you're going to church and you're having   Conflict at church or whatever religious facility  you might go to um maybe you're perpetually going   to counseling with your significant other or  people who are important to you in your life   so those would be examples of social impairments  and now let's talk about occupational impairments   well maybe you are yet again you're you're  fighting with your co-workers that's an   occupational impairment because no employer wants  their employees fighting in the workplace maybe   you're perpetually being given remedial training  or additional training for the same thing over and   over and over again this is really demonstrating  that you're not uh sustainable employee perhaps   you're constantly calling and sick and missing  a lot of work because your anxiety is just so   bad or maybe you have an inability to focus  on the job and you find your you got to write   maybe you got to write a contract up and you  just find yourself staring at the computer for   multiple days so that would be examples of those  would be examples of Occupational impairment but   it's looking at the totality of both social and  occupational impairment it's not a just because   you find something in the 50% range doesn't mean  you're going to be stuck with a 50% evaluation   or just because you have something in the 70%  range there's a little bit of overlap in all   these degrees of impairment the adjudicator's job  was look at the totality of evidence and to try to   determine which evaluation best fits the Veteran's  case so let's segue from the symptoms found in the   rating schedule to the actual disability benefits  questionnaire commonly referred to as a DBQ this   is the actual report that examiners whether it be  a VA contracted examiner or if you bring the DBQ   which is a form that's public facing meaning  you can print it and bring it to an examiner   yourself they both are going to go through the  same criteria criteria so let's walk through   that criteria and look at the important aspects of  this form the DBQ we're looking at today is mental   disorders and notably it's other than PTSD and  eating disorders so this is just a generic all   their mental health conditions fall under this  DBQ PTSD has its own criteria Eating Disorders   have their own criteria we're not talking about  those we're talking about generalized anxiety   disorders and that condition would be found  in assess based on the mental disorders DBQ   so with that mind let's take a look first let's  look at the section one which is going to break   down the diagnosis when you're looking at the  diagnosis that diagnosis must come from the DSM   DSM 5 we have a separate video on that it's in  the description so take a look at that but the   diagnosis must come from the dsm5 it's incumbent  on the veteran to the extent possible to try to   get examiners to maintain the same diagnosis and  the reason for this is when you go to section   one number two it talks about differentiation  of symptoms and it expressly states does the   veteran have more than one mental health disorder  diagnosed why is this relevant well if you have   two or three mental health disorders that have  been diagnosed and you're only service connected   with one of them the VA could weaponize symptoms  attributable to these other diagnosis and say   those are only attributable to those conditions  for which you're not service-connected Therefore   your symptoms have actually aren't as severe as we  thought because they're attributable to conditions   that you're not service connected with so I hope  that makes sense but you you only want to pursue   things things your serve is connected for and so  if you only have one diagnosis and your serve is   connected with that you avoid all that type of  scrutiny now in most cases I would say about   75 to 80% of the time the examiner is going to  say that in number two be there is it possible   to differentiate what symptoms are attributable  to each diagnosis the overwhelming majority of   the time maybe even 95% of the time they check no  because there's so much overlap in mental health   symptoms so they check no and when they check no  that means you're not it's not going to be held   against you if you have more than one Mental  Health diagnosis moving from there let's take   a look at number three so we're in section one  number three occupational and social impairment   now you're going to find that this comes directly  from the rating schedule and the criteria that we   just looked at straight from uh 38 CFR part 4  which is the uh disability evaluations based   on social and occupational impairment guys this  is this is the Box this is the section that the   adjudicators run with if you could summarize this  whole form on one number it's number three and   it's what box check and each one of those boxes  corresponds 100 70 50 30 10 and 0% disability   evaluation so sometimes these adjudicators or  decision makers get a little lazy they don't look   at the totality evidence they go straight to this  box and they say what did the examiner check and   that's what they give you I would say that happens  about 80% of the time so this box if you're going   to bring a DBQ to your examiner and say hey would  you fill this out for me and just go straight to   that box make sure they check that box the the  one that you think you're eligible for because   if they check something less the adjudicator is  going to rely on something you have procured and   given to the VA against you so number three  is critical let's move on to section two one   specific spot on section two of this DBQ evidence  reviewed if the examiner checks no records were   reviewed most judges aren't going to lend any  probative value to this assessment similarly if   a VA compensation and pension examiner checks  no records were reviewed no probative value   should be assigned to this now what you have  happen is if you procure the examination from a   private practitioner the VA will weaponize that  against you but what you commonly see is if the   VA compensation and pension examiner checks no  records reviewed they don't even look at it and   that's a big problem now another consideration  there is if they check records reviewed they're   either lying or they reviewed the records and  one easy way is sometimes the examiner will   will write records not made available to me so  they'll check that they reviewed the records   but then they'll say records not made available  to me well we have a discrepancy here this is   a big issue and all credibility has been lost  so if it's an unfavorable report you call that   out if it's a favorable report you don't call it  out U moving on from there let's take a look at   section three and here we have the symptoms now  what you're going to see if you go back to the   rating schedule that we previously looked at found  in the in the regulation at 4130 38 CFR 4130 these   symptoms are verbatim they're coming directly from  the regulation and so these aren't just flippant   r symptoms that a bunch of practitioners said  let's throw let's throw anxiety on there maybe   suspiciousness that's a common one these are  straight from the regulation that's why they're   here now if an examiner checks that you have total  occupational and social impairment putting you in   100% realm and they only check anxiety they only  check one of these things that doesn't add up and   if an adjudicator is doing their job properly  they're going to say well it's great that they   they checked the 100% box but the symptoms aren't  there because these boxes weren't checked it's a   box checking game you got to check the box so if  you if you have severe symptoms make sure that   boxes are checked if you have suicidal ideation  at times if you have if you want to hurt someone   at times those boxes should be checked um if  you have difficulty with memory check that box   but the important aspect here though is that you  don't leave these boxes unchecked something has   to be checked so let's move on to section six  now I'm trying to hit the high points of this   DBQ we're still talking about generalized anxiety  disorder when you go down to section six every a   mental health exam an examiner must determine  whether the veteran is competent so sometimes   you have people who have dementia and dementia is  a mental health condition found in the DSM it's   not uncommon that someone with severe dementia  is incompetent and when you have that competency   determination and the examiner says no that you  are not competent and capable of managing your   financial affairs the VA is going to propose to  find you incompetent and that's powerful you don't   want that you don't want that every time there's  100% determination extra scrutiny is given to to   a veteran to determine whether they're competent  so this box six if they check no meaning you're   not competent to handle you financial affairs you  might lose the ability to handle your financial   assets you'll have a fiduciary pointed over you  and they'll essentially babysit your finances uh   you lose a little bit of Freedom you lose a lot of  freedom so just be careful if you're pursuing that   100% that's something that could be looked at a  little bit more with a little bit more scrutiny   so that's the DBQ I hope you found this helpful  walking through the specific pages and sections   of the DBQ let's talk about unique considerations  of generalized anxiety disorder when you file a   mental health claim file it broadly don't put  yourself in a box don't just put generalized   anxiety disorder don't diagnose yourself and  don't don't put yourself in a box with one   diagnosis instead when you make the initial claim  call it mental health with anxiety depression and   PTSD or anxiety depression and what other other  symptom you want to add there but you're given a   broad scope mental health so you're claiming all  mental health conditions every once in a while   the VA say well you claim PTSD and you have  generalized anxiety disorder so you don't get   that effed date of the PTSD or you didn't claim  generalized anxiety disorder so we're not even   going to consider it that would be an injustice  and that would be uh a poor decision but it still   happens so claim mental health broadly um number  two for Unique considerations is don't embellish   if you go into a mental health exam and let's  say you're a nuclear engineer or you have a   really good job or or you have a job just in  general don't go in there saying that you can't   remember who the current president is don't go  in there saying that you don't know how to count   from 10 to zero backwards or don't don't embellish  because you're going to lose all credibility and   the examiner will note it and then the adjudicator  will not want to give you a single thing not just   on your mental health claim but on all claims but  also don't be a tough guy so just be a straight   shooter make sure you're telling them about  the severe symptoms you have throughout the   month and maybe if you're even having a good day  don't don't be a tough guy let them know about   the bad days too another one is don't offer too  much information on traumatic events before the   military or after the military it's not uncommon  people talk about severe severely traumatic things   or disturbing things that happened to them before  they went on active duty well what the examiner or   mental health practitioner is often going to do is  they're going to ascribe any current diagnosis to   those former events that predate your active duty  that's a bad that's a bad thing because your your   goal is to convince the examiner that you have a  condition attributable to active duty so I'm not   saying a lie but you also don't want to lend too  much information that could be weaponized against   you especially if you know it's not attributable  that your current mental health symptoms AR   attributable to maybe a dog dying before you went  on active duty or your sister dying or maybe your   father got cancer and was really traumatic don't  offer it if they ask you did your father get   cancer before you went on active duty well the  answer would be yes but just don't lift it up   the goal is to minimize things before active duty  and then if some traumatic things happen to after   active duty maybe try to minimize those as well  and focus on things on active duty or condition   that your service connected with that might cause  a mental health condition lastly be likable don't   be a Chach just be likable it's it's a golden  rule if you're nice to someone they're going to   want to be nice back these these examiners know  that they hold the key to your examination report   into your evaluation just be nice be likable and  you're more likely to get a favorable report it's   just basic common sense so that's all I have for  you today I hope you found this helpful if you   like this video like And subscribe to the channel  thank you for watching comment below have a good day

Channel: VA Disability Group PLLC

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Length: 17min 9sec (1029 seconds)

Published: Mon Apr 22 2024