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Michael Palmateer, Veterans Advocate

How VA Medical Centers Can Help You

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Helpful Things to Know About Your VA Medical Center

Today’s blog focuses on when you need Someone, Something, or Some Money to help you at home.

Although we share the experience of Serving Our Country, each of us Veterans has our own very unique and individual story. Today’s chapter in that story may, for many Veterans, include physical and/or mental health challenges that were never a struggle in the past; tasks that used to be accomplished with ease may be much harder or next-to-impossible to do today. For a lot of Veterans pushing through and making it happen anyway, all the while never asking for help, is a way of life.

You might say: “Who, me? Need help? No…not me. I got this.”

(And then, the reality check, behind the closed-door at home we really could use a helping hand).

VAMC help

It is important to know that your VA Medical Center does have options to help at home. 

  • “It takes me at least fifteen minutes to get out of bed; and I gotta hold onto everything around me.”
  • “Forget it…i just won’t wear socks today.”
  • “I don’t care I can’t remember the last time I showered. I’ll do it when I’m up to it.”

Michele L. Sullivan, one of the 50 most powerful women in philanthropy once said “Asking for help is a strength, not a weakness. We all need help throughout our lives.”

If your days are filled with physical and/or mental health struggles, please know that your VA Medical Center does have options to help at home. Options that many Veterans may not know are out there. This blog entry will hopefully provide some basic, general guidance.

Curious? Here’s How VA Medical Centers Differ

VAMC Help

Not all VA Medical Centers offer the same type of help. It’s important for you to contact your nearest one and ask!

First, it’s important to note that each VA Medical Center (VAMC) operates somewhat differently than another VA Medical Center. You might be wondering “Eh? But It’s just one VA though, right?“. The answer is, well, yes, but, consider this: like each school in one school district, each VAMC is guided by its own leader (Director). Each Medical Center Director has some autonomy about how the VAMC under their direction will carry-out its mission (within the regulations of the Veterans Administration, of course).

 

Also, each Medical Center has its own unique limitations. For example, some limitations may be based on what support services are available in the VAMC’s public community/region (like how many home health agencies exist in a specific area to be able to contract with that local VAMC for providing care for Veterans).

Even if we think that all of our VAMC’s should be the same and do everything the same way, the simple fact is, they aren’t and they don’t.

I say this to make the point that not every option for services is available at every VA Medical Center, and the options that ARE available may look different in one area than they do in another area. Don’t let that stop you, however, from seeking the help that you think may be the best for YOU.

What Options for Help At Home Does the VA Offer?

VAMC Help

If you need assistance with daily living such as getting dressed and mobility, you could apply for the Home Health Aide Program and potentially have a CNA come to your home.

Here is a list along with a brief description of some possible options that your VA Medical Center might be able to provide YOU in order to bring Someone, Something, or Some Money to help YOU at home!

Home Health Aide Program (and,  if eligible, possibly homemaker)

If you need assistance with some activities of daily living (ADLs), like bathing, getting dressed, toileting, eating, and mobility, you would apply with your Patient Aligned Care Team (PACT) social worker. If approved, you would have a CNA come to your home a specified number of hours each week to assist. Also, If approved and you live alone, you may be eligible for someone to assist with homemaking tasks (like light-housework, meal prep, etc.)

Veteran Directed Program

Again, the application would be with your PACT. If service-connected eligible, and approved for this program, you would be provided an allotted amount of money and linked to a coordinator, to plan, hire, and pay the support services that you may require in order to remain in your own residence safely and sustainably.

DME – Durable Medical Equipment

Your Primary Care Physician (PCP) and PACT may assist you in securing a range of devices that may assist with safety, mobility, and accessibility at home. For example, a lift chair or over-bed lift. You would want to identify your specific obstacle and ask for a device that would assist.

Prosthetics devices

Much like DME, and sometimes one-in-the-same, but these might include items like a cane, a walker, a manual wheelchair, a scooter, or an electric wheelchair. A shower chair or safety grab-bars to protect from falls.

HISA Grant

Home Improvement and Structural Alterations may be what is needed to keep a Veteran in their own

VAMC Help

Alterations can be made for veterans in their home such as handicap-accessible bathrooms

residence safely and sustainably. This may include widening doorways, adding ramps, making alterations to bathroom facilities, etc. A Veteran’s PCP would begin this HISA referral with their order, as needed. The maximum cost expenditure allotment available to a Veteran for alterations to their residence differs depending on if a Veteran’s disabilities are service-connected or not service-connected. If service-connected, could be eligible possibly for SHA or SAH: Special Housing Adaptation Grant or Specially Adapted Housing Grant

 

Caregiver Program

This option used to be available to only post-9/11 Veterans injured or ill due to their service. It is still an option for these Veterans, but recent legislation may be opening this program to all era Veterans as well. In this program, the VA acknowledges that many Veterans already have a caregiver.  An application which may be found online) would be required to be submitted. If approved, a Veteran’s Caregiver may be paid and provided support resources.

 Aid and Attendance

This is also known as “House-bound.” There is a VA application that You would need to have your treating Physician complete. If approved, this would provide compensation to a Veteran to help the Veteran pay for caregiving, including possibly a non-professional caregiver family, friend, etc.) The more need a Veteran has for assistance with daily living, the higher the probability of approval for this compensation. 

Home-Based Primary Care

There are times when (for various reasons) a Veteran’s health-care would be most beneficial to be provided to the Veteran in the Veteran’s own residence instead of at a VAMC, community-based outpatient clinic (CBOC), or other medical facilities.  If this applies, a Veteran may wish to talk to their PCP about the option of being transferred to a Home-Based Primary Care Team that will come and care for the Veteran at home.

The programs, items, and options listed above are not the only things available from your VAMC, but they are things included in the conversation about“Helping me at Home.”

It is generally health-care professionals’ goal to do what can be done to keep a Veteran in their own home environment, safely and sustainably but, if staying at home is not working, or not safe;If more assistance or supervision is needed than what can be offered at home; in the next blog entry for “Helpful Stuff to Know About Your VA Medical Center,” we’ll address ideas and options specific to Veterans if and when our Veterans may want or need to consider care outside of home.

Amanda Dejesus, Veterans' Advocate

How GAF Scores Affect Your VA Disability Claim

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What is a GAF Score?

VA GAF Scores

The Global Assessment of Function scale is a 100-point score that measures a veteran’s overall level of psychological, social and occupational functioning on a hypothetical continuum.

GAF stands for Global Assessment of Functioning Scale. A clinician can use this to measure a veteran’s overall level of functioning and their ability to carry out activities of daily living. For veterans who are claiming PTSD or any mental health condition, they should know that their GAF score can play an important role in how the VA decides their claim. Before proceeding, you should know that the VA has now been using the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V). The DSM-V no longer uses GAF scores, but instead now uses the assessment tool known as the WHODAS 2.0.

 

The Global Assessment of Function scale is a 100-point score that measures a veteran’s overall level of psychological, social and occupational functioning on a hypothetical continuum, with 100 measuring minimal limits of daily functioning and the measurement of 0 indicating that the veteran or individual is having severe difficulty with daily activities and functions.

Typical GAF Score Ranges In The Scale

  • 100-91: Superior functioning in a wide range of activities – no symptoms
  • 90-81: Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities. Socially effective and generally satisfied with life
  • 80-71: Transient symptoms and expectable reactions to psychosocial stressors; no more than slight impairment in social, occupational or school functioning
  • 70-61: Some mild symptoms or some difficulty in social, occupational, or school functioning, but generally functioning pretty well; has some meaningful interpersonal relationships
  • 60-51: Moderate symptoms or moderate difficulty in social, occupational, or school functioning (i.e., few friends, conflicts with peers or coworkers)
  • 50-41: Serious symptoms or serious impairment in social, occupational, or school functioning
  • 40-31: Some impairment in reality testing or communication or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood
  • 30-21: Behavior is considerably influenced by delusions or hallucinations or serious impairment in communication or judgment, or inability to function in almost all areas
  • 20-11: Some danger of hurting self or others or occasionally fails to maintain minimal personal hygiene; or gross impairment in communication
  • 10-1: Persistent danger of severely hurting self or others or persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death

How the VA Uses GAF Scores

The VA many times will evaluate for GAF scores for the purpose of a Compensation and Pension (C&P) examination. A C&P examiner

VA GAF Score

A C&P examiner will assess for GAF scores based on an interview with the veteran during the examination and review the veteran’s medical records.

will assess for GAF scores based on an interview with the veteran during the examination and review the veteran’s medical records. Then, the VA will use the results of the exam including the GAF score to assign the suitable rating for the veteran’s mental health condition.

Since GAF scores can fluctuate on a day to day basis due to a person’s personal level of functioning, solely relying on a GAF score for continued levels of impairment may not be the most reliable indicator for the veteran’s level of functioning.

For example, a veteran can be having a good day which results in GAF score of the 70-61 range and then dropping to the 41 to 50 range after having a bad day due to their mental health condition and the severity of their conditions. This can often time lead to the VA assigning a possible incorrect rating for a veteran’s mental health condition just based on a GAF score from a VA C&P examination.

Allison Reddick, Attorney

New VA Appeals Process: What to Expect in 2019

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RAMP program

The new appeals system is set to replace the current “legacy” system on February 19, 2019. Are you and your VA Claim ready?

As the number of appeals filed with the VA increases, the average wait time for veterans to receive decisions increases exponentially.  In order to try and rectify the clogged up system, President Trump signed into law the Veterans Appeals Improvement and Modernization Act of 2017 which introduced the RAMP program.  This Act revamps the entire VA disability benefits appeals process and will replace the current appeal system.  The new appeals system is set to replace the current “legacy” system on February 19, 2019.

Any claims filed on or after February 19, 2019, will be worked under the new appeals system.  If you currently have pending appeals in the legacy system and you did not opt your appeals into the RAMP program, they will continue to be worked under the legacy system.  The plan is for the VA to work all of the legacy appeals until all appeals are under the new system, though this process could take years to complete.  The VA will be conducting reviews of appeals in the legacy system and new system simultaneously.

Under the new system, once a veteran receives a decision, he or she still has one year from the date of the decision to appeal it.  If the veteran decides to appeal the decision, he or she must choose between three appeal avenues or lanes: Higher Level Review, Supplemental Claim, or file a Notice of Disagreement (NOD) directly to the Board of Veterans Appeals.

Higher Level Review

Currently, there are two Regional Offices conducting Higher Level Reviews: Seattle and St. Petersburg.  In the Higher Level Review lane, a more senior VA adjudicator (called Decision Review Officers in the Legacy system) will perform a de novo review of your file and make a decision based on the evidence already of record.  De novo means that they will review your appeal without regard to prior decisions and make a decision based on their view of all of the evidence.  In this lane, you are basically getting a different person to review the same evidence because you cannot submit new evidence in this lane.  There is no duty by the VA to assist in gathering additional evidence or records; the decision is made based on the evidence in the record. This lane in the RAMP program could potentially be utilized for extremely blatant and obvious errors that could be easily rectified without the need for additional evidence.

Supplemental Lane

RAMP Program

In the Supplemental Lane, new evidence is required to reopen a previously denied claim or file for an increased rating of a service-connected condition.

The Supplemental Lane will be conducted at various Regional Offices throughout the United States.  In this lane, new evidence is required to reopen a previously denied claim or file for an increased rating of a service-connected condition.  The evidence must be “new and relevant” to the claim; “new” meaning not previously submitted or received by the VA and “relevant” meaning significant and related evidence to the issue you are claiming.  For example, the new and relevant evidence could be evidence of symptoms warranting an increased rating or a nexus opinion for service connection. In the Supplemental Lane of the RAMP program, the VA has a duty to assist the veteran in developing or finding evidence for their claim.  For example, if you send correspondence stating that you have been receiving treatment at a specific facility and give details of the time period, providers, and other related issues, the VA has a duty to try and find these records for you.  The more specific you are, the easier it will be for the VA to find the records.  However, it may be better for you to get the records and send them to the VA as new and relevant evidence so that you know they will be added to your file.

NOD Direct to the Board

I find this to be the most interesting change in the new system.  In the legacy system, a veteran had to wait to get a rating decision and then appeal it with an NOD. Then the veteran had to wait to receive a Statement of the Case and then file a VA Form 9 to get in line for review at the Board.  This process could take an average of at least 3+ years.  The new RAMP program cuts out Statement of the Cases and VA Form 9s allowing veterans the ability to appeal directly to the Board after receiving a rating decision.  This could potentially save a lot of time for more complicated issues that would likely not get granted at the Regional Office, like non-presumptive Agent Orange conditions.

If a veteran chooses to file an NOD directly to the Board, there are three review options to choose from:

  • Direct Review: This lane will most likely be the fastest lane at the Board. It is a review by the Board based on the evidence of record at the time of the prior decision.  This means that additional evidence cannot be filed and there is no request for a hearing.  The Board makes a decision based solely on the evidence of record.
  • Evidence Submission: This lane allows for submission of additional evidence but within 90 days of filing the NOD. There is no request for hearing so the Board makes their decision based on the evidence of record and any additional evidence filed within the 90 day period.
  • Hearing: This lane will most likely be the slowest lane as additional evidence can be submitted and there is a request for hearing. This means that evidence can continue to be submitted until the Board schedules and conducts a hearing with the veteran.

There are many similarities but also differences between the legacy system and the RAMP program’s appeals system.  It is important to know your options moving forward with your current appeals and any future appeals.  These changes are expected to go into effect February 19, 2019, and we will continue to update on these changes as we enter this new chapter in VA appeals.

Jessica Rodriguez, Veterans' Advocate

What You Need to Know: Schizoaffective Disorder

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Schizoaffective Disorder

Schizoaffective Disorder is a chronic mental health condition that is often misdiagnosed.  This mental illness causes both psychotic episodes as well as a mood disorder. This can lead to a partial diagnosis if all symptoms are not carefully considered.

There are two types of Schizoaffective Disorder; Bipolar Type and Depressive Type, which leads to a tricky diagnosis. This means that the psychotic episodes such as hallucinations and/or delusions are paired with a major mood disorder, being either bipolar or depression. The person can have episodes of depression or mania at the same time as symptoms of schizophrenia are present; which include the hallucinations and delusions. They must also have at least a two week period of delusions or hallucinations without any symptoms of a major mood episode, and also must meet criteria for a major mood disorder for the majority of the time.

How Schizoaffective Disorder Is Diagnosed

schizoaffective diagnosis

The causes of this mental illness can be related to stressful events in one’s life, drug use, genetics, and brain chemistry

To have an actual diagnosis of Schizoaffective Disorder a person must have the following symptoms; hallucinations and/or delusions, disorganized thinking, depressed mood or manic behavior. For the Schizoaffective depressive type, a person will show signs of depression like sadness, emptiness, and feelings of worthlessness. For the Schizoaffective bipolar type, a person will show manic behavior for example feelings of euphoria, increased risky behavior, and racing thoughts.

The causes of this mental illness can be related to stressful events in one’s life, drug use, genetics, and brain chemistry. Symptoms usually begin to manifest between the ages of 16 and 30, which happen to include the primary age group for military service. Treatment for Schizoaffective Disorder consists of medications like antidepressants, mood stabilizers, and antipsychotics combined with psychotherapy.

Service Connection with the VA

When trying to receive service connection for Schizoaffective Disorder, you must show evidence of the cause or exacerbation of Schizoaffective Disorder during active duty. It is important to understand that you did not have to have an episode while in service. There are multiple prodromal symptoms that may be present before a person actually exhibits an episode for the first time. These prodromal symptoms are a precursor to Schizoaffective Disorder, they are shown prior to the first episode and possibly before any diagnosis of mental illness has been established. These symptoms include depression, anxiety, social withdrawal, isolation, problems with memory, thinking, and attention; trouble functioning in school or at work, unusual thoughts and behaviors; low-stress tolerance, and loss of energy. These symptoms can be a huge help in proving your claim and winning service connection. You can read more about Schizoaffective disorder here.

Amanda Dejesus, Veterans' Advocate

Pyramiding: What Is It and How It Affects VA Claims

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Pyramiding Conditions for VA Disability

Pyramiding for VA disability compensation purposes means receiving separate ratings for the same disability or the same manifestation. Any veteran who is trying to claim multiple disabilities needs to know about the VA’s rule against pyramiding. A single symptom cannot be rated more than once, even if the cause comes from two different disabilities. When a veteran has two different conditions that cause the same symptom, the highest-rated condition will only be considered. This prevents a veteran from being overcompensated by the VA.

Applying for VA disability compensation can be very overwhelming and confusing. There are certain criteria that are required to be met to be eligible, evidence that needs to be submitted, and exams that need to be attended. This process can become even more confusing for veterans who are trying to get multiple disabilities service-connected and now have to worry about pyramiding.

How does the VA restrict Pyramiding?

VA Pyramiding

A single symptom cannot be rated more than once, even if the cause comes from two different disabilities.Only the highest rated condition will be considered

The difficult part about this is that a veteran will need to prove that they suffer from a multitude of symptoms without overlapping symptomology and diagnostic codes.

A good example to help explain this would be in the case of Esteban v. Brown when the court had to decide if the veteran suffered from only one disability which would give him a single rating, or multiple disabilities which would give him separate ratings for the separate disabilities. In this case, the veteran suffered from three conditions: disfiguring scars, painful scars, and facial and muscle damage. The court ultimately decided to not separate these conditions and rated them as one condition as a whole. Each of these conditions resulted from the same disability; however, the symptoms are completely different.

In order for pyramiding to apply, the veteran’s symptoms must be exactly the same. It can become complicated when there are many symptoms involved and when they are also shared between conditions. Since the same symptoms cannot be rated twice, the shared symptoms must be separated. If two different conditions share one specific symptom, only one of the conditions will be considered for rating purposes.

Pyramiding and Mental Health Claims

When it comes to mental health disorders, conditions like PTSD, depression, and anxiety will not be rated separately. The VA will instead consider all of these symptoms together and will issue one rating for your mental health condition.

The same rule applies to many other conditions. For example, if you are suffering from irritable bowel syndrome and GERD, these conditions will likely be combined to establish one rating for these conditions.

The VA’s rule against pyramiding can be complicated to understand. Often times the VA gets the issue on pyramiding wrong due to their tendency to over apply this rule to prevent from overcompensating a veteran. The law states that a veteran is entitled to a separate disability evaluation when an injury manifests in two different disabilities. As long as the veteran’s symptoms do not overlap each other, the rule against pyramiding is not violated.

Anne Linscott, Attorney

WHODAS 2.0: What Does It Mean For Your VA Claim?

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What does the VA use to rate mental health conditions?

The VA uses The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) when evaluating mental health conditions. The most recent edition of the DSM resulted in a significant change in evaluating how a mental health condition affects someone’s ability to function. In previous editions of the DSM, the Global Assessment of Functioning (GAF) score was used to represent the level of impairment present due to a mental health condition. The 5th edition of the DSM no longer uses the GAF score as a means of representing the severity of a mental health condition. Instead, the DSM-5 has replaced the GAF score with an assessment tool called WHODAS 2.0 (World Health Organization Disability Assessment Schedule).

What is the WHODAS 2.0?

WHODAS 2.0 evaluates a person’s ability to perform activities in six areas of functioning over the prior 30 days.  These 6 areas include:

whodas 2.0

The VA uses the DSM-5 manual when evaluating mental health conditions. The DSM replaced the GAF score with a tool known as WHODAS 2.0

 

  • Cognition
  • Mobility
  • Self-Care
  • Getting along
  • Life activities
  • Participation

The WHODAS 2.0 uses a questionnaire to provide a score in each of the 6 areas of functioning and then uses these to come up with an overall global disability score. There are 2 versions of the WHODAS 2.0; a 36 question format and a 12 question format.  Both questionnaires can be completed by the patient, clinicians, friends, and/or relatives.  The 36 question format provides the most detail, and allows for the computation of the overall functioning score and also the scores for each of the 6 categories of functioning. The 12 question format is useful for providing brief assessments of overall functioning but does not provide separate scores for the specific areas of functioning.

Why the Switch?

A big reason for making the switch from GAF scores to the WHODAS 2.0 assessment was the criticism that using GAF to evaluate the severity of a mental health disability was too subjective. The American Psychiatric Association (APA) stated their concern with the use of GAF had to do with evidence that GAF requires specific training in order to properly use it, and the reliability of the GAF depended on this specific training. Then there was the criticism that the GAF focused too heavily on symptom severity rather than actual levels of impairment.  Another common reason for the switch was the GAF could be easily manipulated. For example, lower or higher scores could be assigned based on the rater’s ultimate goal rather than the true level of impairment.

How does this all affect your VA disability claim?

whodas 2.0

The GAF could be too easily manipulated for the rater’s ultimate goal rather than the true level of impairment.

As mentioned above, the VA uses the DSM-V to diagnose, evaluate, and rate veterans’ mental health disabilities. The VA will look at how a mental health condition affects a veteran’s ability to function socially and occupationally. For example, does the veteran have established relationships with friends and family? Is the veteran able to hold a steady job? Because the WHODAS 2.0 is the assessment tool the DSM-V now uses to assess someone’s ability to function, the impact of changing to the WHODAS 2.0 will mainly be felt by claims for an increased rating. With the elimination of the use of GAF scores, it is important to make sure your treating doctor accurately records the severity of any mental health symptoms along with the impact those symptoms have on your ability to function both socially and occupationally. The WHODAS 2.0 does not provide an assessment for whether or not a mental condition is related to military service, so it does not play a role in claims for service connection.

 

 

Shannon Brewer, Senior Attorney

Blue Water Veterans Now Get Agent Orange Rights

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Today, January 29, 2019, the Court of Appeals for the Federal Circuit released a decision which marks a seismic shift in the field of veteran’s law. A decade ago, the Haas case allowed the Department of Veterans Affairs to exclude Blue Water veterans from receiving the same benefits as other veterans who served in the Vietnam theater. Today, in Procopio v. Wilkie, the Federal Circuit undid the damage done by Haas and restored those benefits to the Blue Water veterans.

As a little bit of background, veterans who served “boots on the ground” in the Republic of Vietnam are entitled to a presumption that they were exposed to Agent Orange, a herbicide which is known to cause a host of health concerns such as cancers, diabetes mellitus, and ischemic heart disease. This presumption of exposure was extended to veterans who served on the rivers or “brown waters” in Vietnam. The VA determined that so-called Blue Water veterans, those who served aboard ships in the territorial seas of the Republic of Vietnam which did not enter the rivers, were not entitled to that presumption of exposure.

“Blue Water and Brown Water” Distinctions

Blue water veterans

Blue Water veterans were exposed to Agent Orange, and they were plagued by the same diseases and disabilities as the veterans who served on the ground and in brown water

The Haas Court found that the VA was allowed to draw a line determining where brown water becomes blue water, to clarify the intent of Congress, and that the Court had to give deference to that line. The line was supposed to be based on the likelihood of exposure. However, as the Blue Water veterans are painfully aware, the dividing line was an arbitrary line, excluding veterans whose ships anchored in harbors into which those rivers flowed and excluding veterans whose ships came so close to the shore that they described bouncing off of the sand. As Blue Water veterans are also aware, the drinking water on those “blue water” ships and the very air drifting from the shore was likely contaminated with Agent Orange as well.

The Blue Water veterans were exposed to Agent Orange, and they were plagued by the same diseases and disabilities as the veteran who served on the ground and in the brown water, but they were not allowed the presumption of exposure which would allow them to receive benefits for their disabilities. Today, the Procopio case attempts to right the wrong done to the Blue Water sailors.

Blue Water Sailors Today

The Procopio Court looked back to the plain language of the 1991 Agent Orange Act and determined that the legislation which provides a presumption of exposure to veterans who served in the Republic of Vietnam unambiguously includes those veterans who served in the territorial seas of Vietnam. Any ambiguity in that language was inserted by the VA itself. Where the language Congress included in the Agent Orange Act was clear, the Procopio Court held that the VA’s interpretation was not needed and, thus, owed no deference by the Court.

The Federal Circuit decision speaks directly to the point, “Congress has spoken directly to the question of whether those who served in the 12 nautical mile territorial sea of the ‘Republic of Vietnam” are entitled to [the] presumption . . . . They are. Because ‘the intent of Congress is clear, that is the end of the matter.” The fight for Blue Water veterans to get their benefits has been long and hard, but they are now finally legally entitled to the presumption of exposure to Agent Orange…as they should have been all along.

If you would like to discuss your case further, please complete our Case Evaluation.

Cassandra Crosby, Claims Advocate

Class Action Mental Health Lawsuits and the VA

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Class Action Mental Health Lawsuits and the VA

mental health class action

“You may be eligible for VA benefits related to residual health effects of the medication as well as be eligible for
additional funds from class action lawsuits. “

Veterans and their family members who were treated by the military or the VA HealthCare system for mental health conditions need to be aware of several class action lawsuits currently active against several psychotropic medications. The medications include Abilify, Depakote (during pregnancy), Lamictal, Lexapro (during pregnancy), Paxil, Prozac, Risperdal, Seroquel, and Zyprexa.

While these drugs work wonders for most people, for some they have caused complications that can be debilitating, disabling, and even life-threatening. If you were prescribed one of these medications by the military or the VA and any of the following symptoms manifested after starting the medication, you may be eligible for VA benefits related to residual health effects of the medication as well as be eligible for additional funds from class action lawsuits.

Mental Health Medications

  1. Abilify: (generic Aripiprazole) Abilify was approved to treat certain mood disorders, specifically bipolar, schizophrenia, Tourette’s disorder, and irritability associated with autistic disorder. Pharmaceutical companies encouraged prescribers to use Abilify for off label disorders such as anxiety disorders, dementia, insomnia, PTSD, and obsessive/compulsive disorders. In some people, Abilify has been linked to causing obsessive/compulsive behaviors such as gambling and drug addiction. Otsuka America Pharmaceutical and Bristol-Myers Squibb failed to inform doctors and patients of the links between Abilify and compulsive behaviors, they hid evidence from the FDA and convinced doctors to prescribe Abilify off label (for conditions not approved by the FDA).
  2. Depakote and Lexapro: (generic divalproex sodium and escitalopram) Both drugs have been linked to birth defects when taken by pregnant women and to increased suicidal behaviors. Users of Depakote had a 12-fold increased chance of having a child with spina-bifida and there are also links to lower cognitive function. Lexapro (an SSRI) is linked to the birth defects omphalocele, craniosynostosis, and anencephaly.
  3. Lamictal: (generic Lamotrigine) Approved to treat epilepsy and bipolar disorder, Lamictal has been linked to aseptic meningitis, suicidal thoughts, birth defects, Stevens-Johnson syndrome, and Toxic Epidermal Necrolysis (also known as Lamictal rash). Glaxo-SmithKline failed to warn of the rare side effects and utilized a very aggressive marketing campaign to increase sales of its drug. The resulting settlement of $3 billion was one of the largest in history.
  4. Paxil: (generic Paroxetine) An SSRI also distributed by Glaxo-SmithKline, Paxil was promoted as non-habit forming when the company knew of severe withdrawal symptoms including anxiety, insomnia, irritability, nausea, and fatigue. Paxil is also linked to birth defects (especially heart defects when taken in the first trimester) and suicidal thoughts, with a specifically increased risk among 18-24 year-olds.
  5. Prozac: (generic Fluoxetine) Another SSRI, distributed by Eli Lilly, Prozac is linked to birth defects and suicidal thoughts, especially among younger patients. Eli Lilly failed to report potential side effects for almost a decade. While studies have linked birth defects to Prozac, the FDA has specifically connected persistent pulmonary hypertension of newborns to Prozac taken during pregnancy.VA class action medications
  6. Risperdal: (generic Risperidone) An antipsychotic approved for the treatment of schizophrenia, it has been linked to the abnormal growth of breast tissue in young men. Johnson & Johnson was aware of the risks and failed to increase warning labels despite requests by prescribers and was also accused of manipulating dated and withholding key data from the FDA to gain approval of the widely used drug for use with adolescents. Makers Johnson & Johnson were also cited for failing to explore and explain what appeared to be an excessive number of deaths among elderly patients. Risperdal is limited to use for schizophrenia, bipolar disorder, and irritability associated with autistic disorder.
  7. Seroquel: (generic Quetiapine Fumarate) This medication was approved by the FDA for use in the treatment of schizophrenia in adults and adolescents 13 years old and up and bipolar disorder in adults and adolescents 10 years old and up but AstraZeneca marketed for the treatment of dementia. The FDA has determined that Seroquel has increased the risk of death among dementia patients due to various side effects, mainly due to cardiovascular or infectious disease issues. Seroquel is also related to Tardive Dyskinesia (TDK), which is an irreversible condition characterized by involuntary facial movements and Neuroleptic Malignant Syndrome (NMS) which is a potentially fatal disorder that causes hyperpyrexia, muscle rigidity, altered mental status, and irregular heartbeat or blood pressure.
  8. Zyprexa: (generic Olanzapine) Eli Lilly was approved to market Zyprexa to sufferers of schizophrenia and bipolar disorder, but was marketed as effective for people with other mental conditions including Alzheimer’s dementia. Zyprexa has been linked to diabetes, excessive weight gain, pancreatitis, TDK, and NMS.

Are You Using These Medications?

If you have been safely using any of the above medications and are not experiencing any of the symptoms listed, please review any concerns with your treating providers but do not discontinue your medications without speaking to your provider.

If you have any of the conditions mentioned above and have taken the medication associated with it, please stay tuned to our page for future updates.

Cassandra Crosby, Claims Advocate

#MeToo: Reality of Sexual Assault in the US Military

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The Reality of Sexual Assault in the US Military

Sexual Assault victims, 2017

On April 27, 2018, the Department of Defense released its 2017 Fiscal Year Annual Report on Sexual Assault in the Military. Let me preface with a startling statistic….being someone who formally worked in the sexual assault prevention field; the cost of the DoD 2017 report was $3,345,000…..just for the report.  RAINN, one of the foremost national non-profit organizations working in sexual assault prevention and response has a total fiscal budget in 2015 of $6.6 million dollars.  Half of their entire annual budget was the equivalent of the DoD report.

The DoD reports that in FY 2017, sexual assault reporting increased by nearly 10%. A fact the DoD is so proud of they highlight it on the cover letter to the Chairman of the Armed Services Committee, Honorable William Thornberry. The DoD implies that the increase in reporting does not correlate with an increase in assault, but rather an increase in the confidence levels of those seeking services after an assault. They do not, however, discuss how they verify this fact.   And, there is a conspicuously and complete absence of the number of estimated actual sexual assaults in FY 2017.

Active duty service members make up 87% of the victims in the DoD report, the remanding victims are civilians/foreign nationals or unknown. It is significant to note that this report does not include statistics for those reporting the number of perpetrators being active duty military members, of which many active duty victims are prey. However, the data is lacking in its storytelling abilities across the board.

Where the numbers do not add up

The DoD report states that 6,797 active duty reported being a victim of sexual assault during the past fiscal year. The DoD report from 2014 showed 10,017 victims in 2017. This represents a Sexual Assault reportsdrop in sexual assault from 2014 by over 4,000, 49% in a two-year time span. However, national statistics by the Department of Justice show that sexual assault is only down by 0.98% from 2014 to 2015, and reports no significant changes for 2016. The Department of Justice’s numbers include military sexual assault.

What do the numbers really mean?

Higher percentages of sexual assault victims in the military are reporting sexual assaults than in any other demographic groups. When we gather numbers of sexual assault and the actual percentage reporting from the National Sexual Violence Resource Center and the Department of Justice’s National Crime Statistics Reports, the numbers really do not support the DoD’s report. The reporting rates for military men and women concerning sexual assault are still less than half of what they are for college students and the general population.

The reality is that sexual assault and harassment are still alive and well in the world, including the military. And as much as the military would like to profess that their programs are working, there are still reports of victims on active duty that are afraid for their careers, reprisals, and their personal well being if they report harassment or sexual assault.

Maybe the DoD’s money would be better spent on hiring an experienced, non-profit to run their sexual assault reporting programs? The Department of Defense needs to pass the baton of sexual assault prevention to an unbiased agency with the experience and knowledge to manage the program properly, where rank, status, and gender no longer play a role in whose report is believed, where confidentiality is actually observed, and where no one’s careers are in jeopardy for reporting.

Why Tell Now?

For those who have experienced sexual trauma, there are long-lasting effects that can change the course of one’s life.  These effects can include PTSD symptoms such as flashbacks and depression; suicidal thoughts and attempts; substance abuse; eating disorders; sleep disorders; and self-harm issues. There can also be medical issues that arise from sexual assault either from the assault itself or from the secondary conditions, for example, PTSD can lead to peripheral neuropathy.

For veteran’s who did not report sexual harassment or assault while still active duty, there is hope. While you cannot file a claim for the assault or harassment itself, you can file a claim for any conditions, mental or physical, you experience as a result of that trauma, up to and including unemployability. The VA has different rules of evidence to support claims of personal assault so even if it was never reported, there are ways to support the claim.  Getting ready to file a claim is also important, as veterans will have to go through some re-traumatization when having to retell their story. But there are ways to get help in dealing with this issue and getting through the claims process to try to ensure veteran’s who have been victims can get the medical and financial help they need to compensate for the damage that has been done.

If you are one of the members of this elite class of people who gave their all to defend our country and ended up having to defend themselves against unwanted advances, assault, harassment, or rape; please utilize the tools available to begin to protect yourself from the long term residuals that affect so many who do not get the emotional, medical, and financial assistance they need to become survivors.

Amanda Dejesus, Veterans' Advocate

Medical Records and Your VA Disability Claim

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Medical Records and Your VA Disability Claim

In any claim for VA disability benefits, evidence is needed to help prove the claim. Medical evidence can be one of the most important pieces to the puzzle. It is important to know how you can obtain your own medical records, whether it is through a private doctor or medical facility and through a VA Medical Center and/or facility.

The VA has a “duty to assist” veterans or, in other words, help them obtain their medical records to support their VA disability claim. Even though the VA has a duty to assist, it is the veteran’s responsibility to provide any and all evidence that they wish to submit to the VA to help support their claim.

VA Medical Records

VA Medical Records

Medical Records can be vital to your VA Disability Claim.

If you have been treated at a VA Medical Center, the medical records can be requested directly from the VA Medical Center by using VA Form 10-5345a release or by visiting your local VA Medical Center. When using this VA Form 10-5345a, it is important that you are using the most updated form available. You do not want to be using an out of date form to help keep the VA from denying your request for your records.

Another way to access your VA medical records is through an online portal called My HealtheVet. This website allows veterans to create an online account where they can access their VA medical records. With this online account, there are three kinds of accounts available: a basic account which provides limited access to features available that is usually self-entered, an advanced account, and a premium account which gives the highest level of access to all of the sites’ features. First-time users should visit https://www.myhealth.va.gov/mhv-portal-web/home or contact their local VA Medical Center for assistance.

Private Medical Records

You can obtain records from private doctors or hospitals by simply contacting them and asking for your records. Some private facilities may request that you fill out a release form for them to release your records to you or they may have their own online portal that is similar to My HealtheVet, where you can access your private medical records.

You may also request that the VA obtain these records for you by signing a release form.

National Personnel Records Center

VA Medical Records

Many records kept in the NPRC are stored in paper format.

The National Personnel Records Center (NPRC) is a part of the National Archives and Records Administration. The NPRC stores records for veterans who have been discharged or have retired from the military. Most of these records are not stored electronically so it may take some time for the records that are being requested to be found. Most of these records are paper records that have been stored in boxes.

You can request personnel and service treatment records from the NPRC as well as a copy of your DD214 should you need a copy. You can request NPRC records online or by using a Standard Form 180. Any specific information like the name of the hospital where you were admitted for treatment during service or where you served in combat may be beneficial to include in your request.

Why Are Your Medical Records Important?

Medical records that are relevant to your claim can help paint a picture of the symptoms and the severity of your claimed condition. It is important that you always report worsening symptoms to your doctors so that your doctor can notate your worsening symptoms. This is always helpful in cases for an increased rating. Medical records establish the types of disabilities you have been diagnosed with and provide clinical findings, lab results, and important medical opinions from your medical providers who are most familiar with your condition.