It has taken me a few days to come to grips enough to write this up as a diary as some have suggested. I apologize upfront if my rage comes through in any way whether it is whining or hyperbole as that is not my intent and I will do my best to objectively relate the narrative of events and opinion.
First of all, let me explain how the VA determines PTSD claims:
The formula for a successful PTSD claim is simple. You need three things:
- Evidence of an in-service stressor (the Combat Infantryman's Badge, combat Military Occupational Specialty, Combat awards and medals, etc. , for example, is presumptive of that)
- A DIAGNOSIS of PTSD (a VA directed Compensation & Pension exam is where that will come from, based upon the records and the exam)
- A "nexus" tying 1 and 2 together, for example orders placing one in combat operations and documented problems resulting from that experience
Ok, quick relevant military bio. I joined the Army in 1984 and became an Airborne Infantryman, a Paratrooper in the 82nd Airborne Division. Although I had fantasies of film school in Paris or becoming a diplomat, after I attended SERE school I reenlisted to attend the Special Forces Qualification Course at Ft. Bragg. I successfully completed the course but not without gut-wrenching hardship and sheer iron will power. I am small in stature and only 5'6, but my heart and desire were much bigger at that time. I became a weapons and tactics specialist and Special Forces soldier, commonly known as a Green Beret. I was assigned to 7th Special Forces Group (Airborne) immediately after an intensive Spanish course and assigned to an ODA, which is commonly known as an "A-Team". Irrelevant to this case, I also served in the Navy after my education at University of Michigan in Russian and Eastern European Studies as a Naval Intelligence Officer, but that is another can of worms.
Now, I am not going to go into personal stressors and events here, but my little conflict was the Invasion of Panama in 1989-1990. That conflict affected me in ways I had no idea of then. They really came to full force, drastically surfacing, when the Iraq war began. Not that they were there all along, there were things I should have taken notice of. But like a good soldier, I sucked it up and suppressed it. I self-medicated with alcohol for strange feelings that I later learned were panic attacks until I became a full fledged alcoholic. At first, the VA was denying my initial claim because they said that I didn't have the stressor event, however:
what the VA does in fact have, in addition to statements, is my DD214 with MOS: 18B Special Forces Weapons Sergeant, and my CIB/SSI and Expeditionary medal awarded through 7th Special Forces Group (Airborne) for combat operations in Panama.
and that is a presumptive stressor, so they back-off on that. Yet I had to appeal and file a Notice of Disagreement that I filed in 2005. I had not heard back from the VA until December of 2006, when they finally asked for, and sent me the paperwork for, a VA C&P exam.
Now I had already been hospitalized three times at this point. The first time was the morning that I woke up on my balcony from being passed out, surrounded by beer bottles, and a noose around my neck tied to the railing. I thought, "Jeff Dem, maybe you need some help, hmmm?" I was a kossack also at this point.
The last time I was hospitalized was a stress event I do not remember clearly, but I woke up in lock-up, restrained, after the German Polizei brought me to the hospital and I had to talk to a judge there who assigned me to stay. I guess in other terms, you could call that "committed". I spent three months in a PTSD specific ward.
So that December of 2006, the VA said that they had "reopened" my case due to new evidence I submitted from the hospital and wanted a confirmation exam (and said nothing of medical records). I found this odd, since I supposedly had an appeal in progress but thought, hell, just get it service connected and appeal the dates later.
Last May, my file was on the raters desk about to be finally adjudicated. In June I received a letter from the VA that said "we have received your notice of disagreement from July 2005" and subsequently yanked my "reopened" claim off the raters desk and put it back into the appeals section. It went to the Division Review Officer (DRO) who supposedly meticulously reviewed the entire file.
It was Monday that I finally received my decision, and I was denied. The Reasons and Basis portion states the following:
"A submitted statement from Dr. H******l noted complaints of dreams anxiety, panic, depression and nervousness and the doctor indicated officially the claimant had been diagnosed with PTSD. No treatment reports were included, there was no evidence that Dr. H*******l had reviewed any of the veteran's prior medical reports and the diagnosis appeared to be based solely on the claimant's personal history which he provided the examiner. The denial of service connection for PTSD was confirmed and continued.
Subsequent to the above decision a report from the Hans-Prinzhorn-Clinic indicated that the claimant had been treated from 01.06 through March of that year for a post-traumatic stress disturbance, recurring depressive symptoms and alcohol dependency. A VA examination conducted at the same facility reported that the clamant had been hospitalized at the facility on three occasions in the past. The clamant related a history of the first symptoms of depressive disorder in the winter of 1990 with an attempted suicide attempt. In 1991 he stated that he developed symptoms of PTSD. While working for a pharmaceutical company in 1998 he realized that he was suffering from a depressive disorder. He stated that he went to psychotherapy for the first time in 2002 after his second marriage ended in divorce [note, that is false, the marriage ended in 2004]. The doctor stated that the claimant was first hospitalized in 2005 for two months for depression and abnormal psychic reaction at the time of his divorce.
There was no mention of the second hospitalization. When hospitalized for the third time for three months in 2006 he was treated in a specific ward for PTSD. Diagnosis at the time were PTSD, severe depressive disorder and anxiety disorder. The doctor opined that the depression and anxiety were secondary to PTSD. The actual records of these hospitalizations were not provided. A review of the claimant's service records failed to confirm the events indicated above as to in-service depression and/or PTSD.
Although a current diagnosis of PTSD is of record a complete review of all the evidence of record does not provide a confirm diagnosis. In coming to this conclusion more weight has been given to past actual treatment reports and records which show a post-service depressive disorder as the correct diagnosis. Therefore, the prior denial of service connection for PTSD is confirmed and continued."
So now, my appeal is no longer denied on the basis of the stressor event or the nexis between the event and diagnosis, but on the diagnosis itself. This is a good place to state that I did go to a University shrink, a PhD psychologist, while in grad school in the States. This was when events that I now regret, were leading up to my divorce and this is what we mainly spoke about. I did not feel comfortable at the time going deeper nor did I feel comfortable with this therapist for some unknown reason to me to do that. So the therapy was pretty shallow. Nevertheless, he diagnosed me with Major Depressive Disorder.
This is now being used as the reason to deny PTSD, as the VA letter states above. What the DRO is ignoring at this time, are two diagnosis from two entirely different MDs. The VA states above that PTSD is not confirmed in diagnosis, but here are excerpts of the (translated into English) text of my VA C&P exam:
Mr. [Jeff Dem] has been three time a patient of our hospital. He is now a participant of our ambulant psychiatric care system. Because we received a request for physical examination there has been diagnosed a posttraumatic disorder in the past. At least more likely as not the severe depressive disorder and anxiety disorder has been caused by and is secondary to the diagnosis of PTSD, which is more likely as not the result of Mr. [Jeff Dem]'s experience in Panama. Because he was recently hospitalized in Germany in our hospital and he has been treated here we were asked for our diagnosis and our treatment. In the following statement we are giving an overview on the biography of the patient. It is important for the medical history. We explain the psychiatric and psychosomatic symptoms and coming to a diagnosis of posttraumatic stress disorder and major depressive disorder
[...] he was treated in a diagnosis specific ward for post traumatic stress disorders. Our diagnosis were posttraumatic stress disorder, severe depressive disorder and anxiety disorder. We treated Mr. [Jeff Dem] in a complex multimodal psychiatric and psychotherapeutic way with dialectical behavioural therapy, with cognitive therapy, with traumaspecific psychic treatment, with antidepressive and anxielytic pharmaceutical drugs such as Mirtazapine and Escitalopram. Due to psychiatric treatment inside our hospital we could stabilize Mr. [Jeff Dem] for a while [...]"
Prof. Dr. med. U. T******n
Medical Director
Hans-Prinzhorn-Hospital, Hemer
General Psychiatric Hospital
Now, I am not a medical professional, nor a trained VA rater, but to me this is a pretty clear and detailed diagnosis. Furthermore, the examiner is not merely a PhD Psychologist who deals mainly with student issues, but the General Director of a Psychiatric Hospital, my lead doctor in the PTSD ward, and a teaching professor at a medical school.
Add to that a second diagnosis from a neuro-psychiatrist, although admittedly weak as it was based on personal history and current conditions and I had not the chance to conduct therapy with him.
I am at a loss at this point with what I need to do to confirm diagnosis. Medical records would be good but are more complicated to get by German law. I asked for photocopies way back and only received, by law, summaries. However, the consulate in Frankfurt is getting those records somehow for my Social Security claim. Something I will be working on in the near future. But it is important to note, at no time did the VA try to get those records or inform me that more information was needed, they only requested an exam.
Well, thank goodness for Kossacks. Our very own Testvet came to the rescue this week. He put me in touch with an attorney (which I may only now at this point have since an appeal is going to the Board of Veterans Affairs in D.C.). She took me on pro bono, so I would think that she believes I have a case here. She wrote to me:
Yep, Bill [my VVA VSO] is right. It will take anywhere from 1 to 2 years to get a hearing with and decision from the Board. In the meantime, we will have work to do. I have some ideas as to why the VA most likely and wrongly denied you SC for PTSD.
This is encouraging. I am not yet giving up. However, the VA Foreign Medical Program will only pay for service connected conditions while back in the US as a 60% rated disabled veteran, I am entitled to full coverage. That means another one to two years of no therapy or medication. One to two years before they even look at a case, that seems to be so obviously wrong, that it would only take ten minutes to overturn, IMO.
Let have a last word about our current candidates. Both of our candidates has pretty decent track records in the Senate on veterans affairs, that is a fact of record. Although I did not vote for Senator Clinton, there is no denying she has been lot better than her colleagues in voting for veterans issues. And so has Senator Obama.
At this point, for me personally, since Monday when I received this letter, I really do not care who is elected President, as long as we finally get a human being in the oval office. And that is all I have to say about that.