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Adjustment Disorder news
- Thread starter PEBLO11
- Start date
I'm wondering if someone can help me figure out how this new Adjustment Disorder news applies to me. I'm currently in a Secretary of the Air Force appeal of the IDES.
Back in Nov 2012, my VA examiner diagnosed me with combat-related PTSD, and adjustment disorder for an unrelated issue. (my primary neuromuscular disease) Both of these were also exactly diagnosed by a VA clinic doc downtown. In Jan 2013, my base MEB had me go to Mental Health, to get a NARSUM addendum, which said that my PTSD is not unfitting. There was no mention of the adjustment disorder. The main NARSUM also makes no mention, or any other document. However, on my AF Form 356, the VA lumped my adjustment disorder together with the PTSD (they are two separate things) and gave me 30% for both.
Now, that diagnosis was 9 months ago, existed even before that time, and is still going strong today, so this is no "temporary" thing like the DSM IV said it was supposed to be. Not to mention based on my neuromuscular disease being progressive and degenerative, it never stops getting worse, and doesn't ever give me a chance to stop and "adjust to a new normal". I'm going to be "adjusting" for the rest of my life, until this disease kills me. I couldn't appeal this to the FPEB, though, because they don't consider conditions that are not being moved from Category I to II or vice versa.
I don't think it's unfitting, but I don't want to find myself like other people in this thread and be on terminal leave with a new house and job, only to have everything put on hold because the system needs to change my ratings up.
Help?
Back in Nov 2012, my VA examiner diagnosed me with combat-related PTSD, and adjustment disorder for an unrelated issue. (my primary neuromuscular disease) Both of these were also exactly diagnosed by a VA clinic doc downtown. In Jan 2013, my base MEB had me go to Mental Health, to get a NARSUM addendum, which said that my PTSD is not unfitting. There was no mention of the adjustment disorder. The main NARSUM also makes no mention, or any other document. However, on my AF Form 356, the VA lumped my adjustment disorder together with the PTSD (they are two separate things) and gave me 30% for both.
Now, that diagnosis was 9 months ago, existed even before that time, and is still going strong today, so this is no "temporary" thing like the DSM IV said it was supposed to be. Not to mention based on my neuromuscular disease being progressive and degenerative, it never stops getting worse, and doesn't ever give me a chance to stop and "adjust to a new normal". I'm going to be "adjusting" for the rest of my life, until this disease kills me. I couldn't appeal this to the FPEB, though, because they don't consider conditions that are not being moved from Category I to II or vice versa.
I don't think it's unfitting, but I don't want to find myself like other people in this thread and be on terminal leave with a new house and job, only to have everything put on hold because the system needs to change my ratings up.
Help?
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Well this might be an interesting wrinkle. I talked to our base temp PEBLO today, and got a copy of the Air Force memo on this issue. Comparing this to the Army memo, it looks like the two services are taking two different approaches. Whereas it seems the Army paused the IDES process for everybody that had adjustment disorder, to get them reviewed and evaluated specifically whether the AD is chronic and/or unfitting, what I'm getting from the Air Force is only a policy that chronic AD is not a basis for admin discharge, and if you have AD, you can request a "Review In Lieu Of" for consideration of an MEB.
Air Force memo is attached here. Looks like it just got released on 6 Aug.
So if I understand right, the answer to my own question is that nothing happens to me in my position with the AD, and any correction I would like to make to my rating will have to be after discharge, since it is listed in my Category II conditions.
Air Force memo is attached here. Looks like it just got released on 6 Aug.
So if I understand right, the answer to my own question is that nothing happens to me in my position with the AD, and any correction I would like to make to my rating will have to be after discharge, since it is listed in my Category II conditions.
I will try and explain this as a simple pie, even though pie can be complicated...
Adjustment Disorder and PTSD are not necessarily seperate things, they are somewhat co-dependant on each other. Being they are similar issues and rated the same, they can not legally rate them as two seperate things. This would be double-dipping.
They will rate both seperately, then combine both, then give you the higher rating for the condition that affects you the most.
My case was this:
The VA rated my PTSD and Anxiety disorders seperately.
PTSD GAF 50 (low score)
Anxiety GAF 65 (fairly low score)
The VA combined them as PTSD /w Anxiety Disorder with a GAF of 50.
The VA rated my original claims as PTSD /w Anxiety Disorder at the 50% rating.
I hope this helps you understand what they did and why!
I will try and explain this as a simple pie, even though pie can be complicated...
Adjustment Disorder and PTSD are not necessarily seperate things, they are somewhat co-dependant on each other. Being they are similar issues and rated the same, they can not legally rate them as two seperate things. This would be double-dipping.
They will rate both seperately, then combine both, then give you the higher rating for the condition that affects you the most.
Hmm.... I could understand that, if they were for the same issue. For example, if someone got blown up with an IED in Iraq, and had PTSD and Adjustment Disorder from that event, then rating them separately could be double dipping. However, as I said in my case, the VA examiner himself acknowledged they were two different causes and issues--PTSD from combat, and AD about a life-changing (and ending) disease. Rating them together seems the OPPOSITE of double dipping, where the VA would be making some sort of argument along the line of "they are both mental conditions, therefore we're going to lump them together so we DON'T have to address each condition as being valid".
Using similar logic, the VA could lump together ANY combination of conditions, regardless of how unrelated they are in cause and type, and come up with some way they're similar.
Are you saying that PTSD and AD will ALWAYS be rated together, regardless of the situation of each of these conditions in any given patient?
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With that, the particulars changed the dynamics of your situation. In your case I wouldn't be able to advise on that, being that statement was said that the VA doc believes they are two very seperate issues.
In my case, I know that my Anxiety Disorder is seperate from the PTSD, but being the PTSD made it worse... I see no issue combining them. To me, logically it makes sense.
You may be having a battle with the VA if they do decide to lump them together, the DoD side I would say they definitely will combine them if they find you unfit for that, just due to the fact they suck about MH issues.
In some general cases like having multiple back issues they do combine them too, you'll see it quiet a bit on this site.
Here another point-of-view on the subject as stated by Attorney Leslie Gaines on December 9, 2011 in her "VA Ratings for Mental Disabilities" article.
"...We receive many calls from veterans who have multiple mental health conditions, and they are unhappy because they feel the VA has not taken all of their conditions into account when assigning a disability rating. For example, a veteran may suffer from PTSD and depression based on the DSM IV criteria; however, the VA has only assigned a total rating of 30% for both conditions.
Although assigning only one rating may seem odd because the veteran is suffering from two distinctly separate conditions, the VA regulations pertaining to mental health generally mandate that the veteran be assigned only one disability rating for all mental conditions, even if there is more than one. So in the above example, even though the veteran has PTSD and depression, only one rating will be assigned. Of course, it may logically follow that a veteran with more conditions may be more seriously impaired than a veteran with only one condition; however, that is not necessarily always the case.
The VA uses the General Rating Formula for Mental Disorders to rate mental disabilities. This is found in 38 C.F.R. § 4.130. The Rating Formula assigns ratings ranging from 0% all the way to 100%. A 0% rating means that “a mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.” A 100% rating is warranted when there is “total occupational and social impairment” due to certain symptoms. Most veterans fall somewhere in the middle. Their mental conditions warrant more than a 0% rating; however, they are not ratable at the 100% level.
The real issue when rating claims involving mental disabilities is determining the appropriate rating to be assigned, which really has nothing to do with the total number of conditions because the VA is using only one rating scale. When determining the appropriate rating, the VA considers the effect of the mental conditions on occupational and social impairment. Symptoms that are considered include but are not limited to: impairment in thought processes or communication; grossly inappropriate behavior; persistent danger of hurting self or others; suicidal ideation; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); memory loss; panic or depression affecting the ability to function; impaired impulse control; chronic sleep impairment; and decreased work efficiency.
Since the VA is rating these claims based on subjective symptoms there is often room for error in the ratings. Oftentimes, veterans will attend compensation and pension examinations at the VA, and the result is a rating decision that underrates the severity of the mental condition(s). This happens despite the VA regulations which state that the VA is to assign a rating based on all evidence of record, and not just “solely on the examiner’s assessment of the level of disability at the moment of the examination.” 38 C.F.R. § 4.126(a)..."
Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."
Best Wishes!
Ah, so what I'm getting out of that, there, is that YES, patients will "always" have all of their "mental" conditions lumped into one condition to be rated, regardless of source, timing, or severity.
Seems kind of silly, doesn't it? That someone may have chronic schizophrenia, severe PTSD from a traumatic event in 1990, adjustment disorder from a major event that happened two months ago, but it all gets lumped together in one condition to be rated?
Seems kind of silly, doesn't it? That someone may have chronic schizophrenia, severe PTSD from a traumatic event in 1990, adjustment disorder from a major event that happened two months ago, but it all gets lumped together in one condition to be rated?
It does seem off to lump them together like that, but at the same time, I could see it getting out of control if they didn't.
I've also read that the rater can in some cases where more than one distinctly different condition falls under the same category. They can bump the higher if the ratings to the next higher rating. If that makes sense. I don't know if this applies to behavioral health conditions, but I know I've seen it somewhere in the CFR.
I've also read that the rater can in some cases where more than one distinctly different condition falls under the same category. They can bump the higher if the ratings to the next higher rating. If that makes sense. I don't know if this applies to behavioral health conditions, but I know I've seen it somewhere in the CFR.
That is true, in my case I'd get over 75% mental health. So yes, things would go rampant, though it seems really frustrating right now, you have to thing of the backlash of people being able to double-dip and how long people have not been able to. People would be receiving thousands, if in hundreds of thousands in back pay of benefits. Our government would go severly bankrupt in less than 24 hours... I for one completely agree that going with the one worse condition and one rating together is common sense!!!
Indeed; but unfortunately, it's exactly as regulated in the e-CFR, Title 38!
Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."
Best Wishes!
PEBLO11,
Something strange happened now while I am waiting for my separation message. I got the LEAD PEBLO involved to check the status on my case an he received status saying " Waiting for the NEW DA 199 to get typed up".
What I dont understand is I already concured with my old DA 199 and also have a memo for AD saying " medically NOT unfitting". I dont know why I would need a new DA 199.
Another thing is, How would they rate met to give me a percentage on my DA 199 for AD, if I was never seen my a VA Doctor for it (AD got added to my 3947 after the VA C&P.
Can they leave the percentage part blank? and let the VA rate me later?
Thanks a lott. You have been of great help.
The HQPDA either found something that needed to be added as unfit or they think the DoD did a rating wrong. The only thing I would worry about is if they find an unfit condition and found it to be fitting for some reason. They also may have found whoever dictated the 199 typed things up wrong i.e. not connecting to combat related, wrong name spelling, wrong SSN, many different variables can be looked at right at this moment. Really the only thing I can say is wait to see the new 199 and compare it to the one you signed already and go from there.
The DoVA rating for AD may come directly off of the evaluation (C&P) or if there is not enough information, they may decide to send you our for further evaluation.
Get a copy of your C&P and read the BH notes, typically they are written in a manner that pairs up with the rating informatiion in the VASRD.
You are rated on the symptoms for BH, not the name of the condition.
As grizz13 pointed out, it may simply be a case of fixing a clerical error. On the other hand, they will, at some point, amend the DA199 to include the AD as meeting retention standards. This has to be on the DA199. That being said, the ones I got from JBLM were done as is, and then the soldier was allowed to finish out the process. The amended DA199 with the AD addressed was sent to us to give the soldier. No new signature was needed.
GSFOWLER,
Thats the thing... It was never part of my C&P... It got added on my 3947 after the C&P (when the Soldier's Counsel tried to find my BH issue as unfitting). So I was wondering if they can give me a rating for something not addressed during C&P.
Thanks
THANKS a lott for the info and input...
Now I am really worried about changing my unfitting to fitting. Am at 40% from DoD (20 for legs, 20 for back). The VA Reconsideration to take it to 40% for my back got rejected and said 20% is confirmed.... Now I hope they dont change that to fitting....All this before this AD shit kicked in.... Is it common to change Unfitting to Fitting?
I already singed my DA 199 before this AD shit came into picture. Also, my AD meets retention standards as per the memorandum. I dont know if the PEB will still change it to UNFITTING.
So regardless of Fitting or Unfitting, I will have a new DA 199...which dont have to be signed by me....Right?
That is great information. I did not know we get a new DA 199 regardless. I really hope that is the case with me....
When they said "NEW DA 199 getting typed", I dont want them to change my condition to FITTING and take away my retirement....after waiting to get out for so long....
PEBLO11...Thanks a lott !!!
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You WILL not matter what get to review the new DA 199 before it is sent back up to HQPDA again. Failure to do so can result in a VERY large lawsuit.
1. For not informing the SM what type of separation from the military, if there was a change.
2. Changing results of an official document that was already reviewed and signed, and not notifying SM of changes.
3. Not allowing due process for the SM to appeal if they decide to or not, or to seek legal counsel.
You will have a HUGE backing behind you here on this site, as for the moment take this as a grain of salt. You just might gain another 1-2.5 days of leave also, yes it might be a minor thing, but I know people that need that extra time.
For your question on post #557, can it happen YES, it is pretty rare if they do so. I have seen it once since posting on this site.
Continue to keep posting your frustrations, we will be here to help you along with this.
Hey all,
Just realized my IDES case is part of this clusterfuck. Is there any light at the end of the tunnel? I've been waiting for my proposed ratings since 12 Dec 2012 and now this bullshit happened. Is there anyway I can request to take the proposed ratings that are complete and leave the Army?
Just realized my IDES case is part of this clusterfuck. Is there any light at the end of the tunnel? I've been waiting for my proposed ratings since 12 Dec 2012 and now this bullshit happened. Is there anyway I can request to take the proposed ratings that are complete and leave the Army?