Good afternoon and welcome to Facebook live with Chisholm Chisholm and Kilpatrick
my name is Emma Peterson and I'm joined today by Courtney Ross and Michelle DeTore and
We're going to be talking with you a little bit about depression
service connection for depression symptoms of depression
and pretty much everything you need to know and sort of a basic understanding of how this disability works in the VA disability system as
Always if you have questions or comments
please feel free to leave them in the comment section and we will try to get them as best as possible a
Lot of the information we're talking about today is available on our website at cck-law.com in our blog section
So, please be sure to look on that section of the website if you've got further questions
All right
So with that we're just gonna dive right in. So Courtney, what are some common symptoms of depression?
Sure, so obviously the symptoms for each individual could vary but generally speaking some of the more common symptoms are
persistent feelings of sadness of worthlessness
Feelings of guilt a lack of motivation or interest in activities that you may have previously enjoyed
maybe difficulty sleeping or difficulty concentrating
a lack of appetite
Resulting in a change in a person's weight there can also be other physical manifestations
so for example digestive or stomach problems due the
Feeling depressed. So those are just
Examples of some of the common symptoms again, it will vary for each individual. So it's a broad range
It's the typical things you think of but maybe also some physical things too. Yeah. Pain
GI issues things like that exactly. Yeah
Alright, so Michelle, how do we show direct service connection for depression? Sure. So direct service- connection has three elements
So the first element is that you need to have a current disability. The second element is that there needs to have been a
In-service event or injury and the third element is that you need a medical Nexus
so basically a medical opinion linking your current diagnosis to the in
In-service event or injury. So what are some
In-service causes of depression. I know people might think of more like injuries causing
you know physical injury what what would cause depression? So it could be anything from
Your military service so there could have been an event in your military service, you know, such as you know
Things can happen while you're in service, but you could also have things that are not service related
So, you know, you could maybe have a death in the family
That was very traumatic and it happened while you were in service
And at that point in time you started experiencing depression there could be incidents
Like I said earlier or events in service that caused the depression, but I think that a lot of times people
Associate that fact that depression has to be directly related to your military service
But in reality it just had to occur-- begin during your military service. It doesn't have to be military related depression
It can be anything in your life. As long as you were on active duty at that time. Yep. Okay.
alright, and what about
Really covers sort of direct service connection: something happens, we have an nexus you have a diagnosis. What about secondary service connection Courtney?
Yeah
So secondary service connection is a different type of way to get
Service-connected. And the way it usually works is a veteran has a condition that has already been service-connected by VA
So they're already receiving benefits for it. And the depression has resulted from that already service-connected condition
So just to give you an example to provide a little bit of context one of the more common
secondary service connection is where a veteran might have an orthopedic condition maybe a back condition and it's really severe and it has
Impacted the veterans daily life and what they're able to do and the result is that it started to cause them to feel depressed
And develop that depression diagnosis. Okay now
There are other conditions that can result from depression, right?
so for example
a lot of the
Psychotropic medications might cause weight gain and lead to maybe orthopedic conditions or aggravate orthopedic conditions
So it really can work both ways in that
Something might happen to you in service to cause an injury and you become depressed
And then also the depression itself might lead to other conditions so it can go both ways. Exactly
Yeah, or the depression might develop from a condition that has already been established as service-connected. Okay, great
What if for veterans who suffer from depression prior to service?
Yeah, so you could still get service-connected for the depression
even if it existed prior to service if your military service
Aggravated that condition and you would need to establish that to VA that even though it existed prior to it your military experience
worsened into the condition.
Now we talked a little bit Michelle talked a little bit about needing a medical Nexus. So oftentimes VA will schedule you for a C&P
examination
So, how does that work for depression, Michelle?
Sure
So a lot of times in the processing of your va claims
VA will go out and schedule you for an examination
It could be, you know through our private facility or through a VA Medical Center
And what you'll do is you'll go to a VA examination and you'll talk to, typically a psychiatrist or a psychologist
And they'll go through the symptoms of your disability and you know, whether it's an increased rating examination or a service connection examination
They'll discuss why that condition is related to service or like Courtney said related to a service-connected disability or they'll go through
exactly, you know the
Severity of the condition and they do that for both types of examinations
And then at the end the examiner will compile their findings and submit that to the Department of Veterans Affairs
It is something that veterans are able to get a copy of one thing
I will say just to be mindful of is it does sometimes take a few weeks for the examiner to finish their findings and get
That submitted so sometimes it's not readily available. However other times it is pretty readily available
I would say within the week, but if you do have representatives that are working on your case
Whether it's a veteran's service organization or a private attorney or practitioner
Through access to VA's electronic systems specifically VBMS you're able to quickly get that
Examination and download it from there so that you can review it
Okay, so I think the takeaway there is that they're not going to give it to you at the end of the exam--
--a copy you're gonna have to request it if you want to see it
and it might take a little bit of time to get it and you should certainly reach out to a VSO like our colleagues at
DAV your accredited rep. or whoever you're working with on your claim or if you're working with your claim by yourself. That's absolutely fine
Go down to the RO ask them for a copy
Yeah, make someone help you get this because you absolutely have a right to see it
You can also go to the VA Medical Center and there's a release that you fill out
It's a 5345 and once you submit that to them they should be able to give it to you. Okay, that's great
And then get that form online, right? Yep. Okay, wonderful. So, it's VA from probably 21
It 21 - 5345 and you just go to VA.gov
the forms page
Great
Now what can a veteran do if they receive an unfavorable of the exam Courtney?
Yeah, so a veteran could submit evidence or argument to counter that unfavorable examination
so a few examples of specific things you could do is consider getting your own private medical opinion to assess your
Depression and see if that private doctor can provide a nexus to your time in service or again to a condition that's already service-connected
you could also submit lay testimony that outlines the onset of your
Psychiatric symptoms in service, or I mean how your symptoms have progressed since you left service.
And you could also consider submitting an argument in another lay statement if you don't feel like that exam
Accurately captures your experience with that examiner
So
If you think it's inadequate in terms of what you reported to the examiner is not being correctly documented on that examination
So it sounds like there's sort of three general types of evidence. You can submit: medical evidence about your depression
lay evidence about what you
Experienced and when you experienced it and then some lay argument or just argument against maybe some negative evidence in your case. Yeah
Now, how can a veteran submit evidence with an appeal under VA's new system, under the AMA? Yes
We have a lot of content about this. So, please please please go to our website and check it out
But how can veterans do that in this new system?
so it's very different under the new system in terms of the rules force when you can submit evidence and it all depends on which
Review option you select when you get a decision, so when a veteran gets an initial decision
They have three different options now to select they can choose a higher level review of the decision
They can choose to file a supplemental claim or they can choose to file an NOD
Directly to the board which gives them again three docket options. If you choose higher level review
You cannot submit any additional evidence
It's only argument if you choose to file a supplemental claim you can submit additional evidence
But it needs to be what's called new relevant evidence
And if you go to if you choose to file an NOD to the board again there are rules for if
You can submit evidence will depend on which docket you select for the board
So if you choose the direct docket, it's similar to higher-level review in that you can not so any additional evidence
It's only argument
If you choose the evidence docket, you will have 90 days from the date that you file the NOD to submit additional evidence
Or if you select the third docket, which is the hearing docket
You're allowed to submit evidence at the time of the hearing or within 90 days after the hearing
Okay, so if you caught all that, that's all great. But again, I really strongly encourage you
I think we all three would to go to our website check out
What we have on the AMA and the different lanes and dockets
You can pick yes talk with whoever you work on your case with about which lane or docket to select
Yeah
because
You want to be sure that you're picking a lane or docket that you can add evidence if that's something you need to do. Yes
And that also is important not only for service connection cases, but also increased rating cases
so what kinds of evidence do veterans need to show an increased rating for if they've already been service-connected for depression. Sure
Like the evidence we were just talking about you can use medical evidence lay evidence
basically, you need to show that your condition increased in severity or that the original rating was incorrect and you can do it by just
submitting medical evidence lay evidence or
Any type of argument may be against the evidence that is a record showing that that evidence
supported a higher rating than what you currently have. And VA has
diagnostic codes for every condition pretty much under the sun almost all of them not all of them, but almost
And there are a couple DC's or diagnostic codes that relate to depression
But I think the thing to know is that all the mental health conditions have the same criteria
So they've got you know a couple DC's
9433; 9434 and so on but the rating criteria is the same whether you have depression PTSD anxiety
It's the same type of factor, so how does VA rate depression
Sure, so generally speaking the rating criteria for mental disorders
Which as Emma just said said would be what depression what VA uses to rate depression.
it's looking at the occupational and social impairment that's caused by your depression and
the symptom your specific symptoms and how they they result in that occupational and social impairment and
For each criteria. So a veteran let me back up and say that a veteran can be rated at 0%
10% 30%
50 70 or 100
so that's the way the rating criteria is set up and for each one of those ratings there is a list of
Symptoms and impairments that VA will consider to decide which rating they think the veteran fits in
It's not an exhaustive list
So veterans might have symptoms that fit in with the 50% and others that seem to be more applicable to the 70%
Rating and they might have symptoms
Resulting from the depression that aren't listed at all in that rating criteria and VA still needs to be considering those other symptoms as well
in terms of how they affect the social and occupational
Occupational impairment. Do you need to hit every criteria?
Most the criteria to get the rating none of the criteria. How does that work?
So there is a definite misconception that you have to have all the symptoms listed in each rating criteria for each percentage
However, that's incorrect. You have to just show they're-- They're examples
So they're saying that you know
These are some examples of what would be a 70% or 50% and you don't need to have all of them
Ideally, you should be falling within some of them. But as long as you're showing that you know, the
Occupational and social impairment that you're experiencing falls under what they consider to be at that level
I think that that's usually enough to get you the increased ratings. And it's a little different than maybe like an
Orthopedic rating and which relies on you a very mechanical range of motion, hearing loss
It has set levels like Courtney said like Michelle said the the diagnostic criteria for mental health conditions are examples
So it really goes from you know, no social and occupational impairment up to total
Social occupational impairment because every person is unique in how their mental health condition manifests
So you certainly can get creative with your arguments and lay statements.
Now a lot of times people are diagnosed with more than one mental health condition at a time
So Michelle, are they gonna get two ratings for that? How is that gonna work?
So as we've discussed earlier, um, all mental health conditions are under the same criteria
So unfortunately, there's usually no way to parse out the symptoms
So they're almost always just rated and combined together
However, sometimes VA can parse out the symptoms
Maybe your anxiety is one thing but your PTSD is another thing and they can they can separate them and medical opinions are there
It's very uncommon that they're able to do it. But typically they'll take the two diagnostic codes. They'll give you one condition
They'll say you have PTSD with anxiety depression and it's rated at 70%
Because they can't separate the symptoms that you have from your PTSD your anxiety and your depression.
You're not gonna get a 30 for PTSD and a 30 for depression
You're just gonna get one rating of all those symptoms as if it was one condition? Yep.
But they'll list out the different
diagnoses that you might have
Yep. Okay, and I think that's important to note because sometimes we come across clients that want to file claims for you know
They have anxiety and they want to file for PTSD or vice versa
so certainly talk with your representative about whether or not that's a good idea if VA is under rating you because they're not
Considering some symptoms because they say it's due to a non service-connected
Psychiatric Disability it might be worth it. But if they're considering everything you have
It might not be worth it because you're not gonna get an additional reading by filing for service connection. And sometimes it does, you know
Sometimes they're not considering it because it's part of another condition
But sometimes you have the opposite effect where VA is considering it and saying that it's part of that condition
but if you go and file for PTSD when youre service connection for anxiety
They might say well now you're saying these symptoms are due to a non service-connected condition and we're gonna reduce or lower your rating
Yeah, so it's just something to be mindful of when you are filing for multiple diagnoses. Okay.
So what if a veteran is unfortunately hospitalized due to their depression. Do they get any special compensation for that?
Yeah
So if you if veterans hospitalized for 21 days or more they can get what's called a temporary total ratings or a temporary
100% rating for the time that they are hospitalized until the time that they are discharged. If you-- if a veteran's
Hospitalized and this is again assuming it's for the depression and then the service-connected condition
If they're hospitalized for the depression for at least six months
They'll get the temporary total rating for that six months of hospitalization. And then for the six months following discharge
Okay, and of course like any condition out there a veteran can get TDIU due to depression if it prevents you from working
Okay, so you can either end up with a temporary rating if you're hospitalized or if you can't work certainly consider looking into that tdiu
Rating.
Are there common mistakes that VA makes when adjudicating depression claims?
Yeah, I mean one of the things we were talking about previously was, you know, in-service incurrence of depression
So sometimes VA will make the mistake that saying that well know your depression is due to this other event that happened while in service
But it's not related to your military service and they're missing the fact that it still happened during military service
They'll also sometimes say that well you had depression in service but it resolved and now your depression is really due to your
post service life stressors
Without considering the fact that it was still you know going on maybe you just weren't treating for it. So those are very
common errors that we see and then they also try to parse out and say that oh, it's due to your
Personality disorder these symptoms. It's not due to this anxiety that's due to service
Okay, and anything veteran to remember Courtney when claiming depression?
Yeah, I think just kind of thinking back about the the things that we talked about in terms of establishing direct service connections
So keeping in mind that you need the diagnosis so you need the current disability
And you need to be able to point to something in service whether it is a military event or something that happened to you in
service
Outside of your military experience and then that medical Nexus is gonna be really important you need something tying together your current disability
To your time and service or again to a condition you may already be service-connected for that has resulted in your depression
Okay, Michelle anything that I think veterans need to be mindful of when claiming depression?
So just because you started up claiming depression and you later get a diagnosis of PTSD
Doesn't mean that you now are required to file a new claim VA is supposed to broadly construe your claim for depression to include all
Psychiatric conditions because you're not a medical doctor you don't necessarily know what your medical diagnosis is
But you are competent to talk about the symptoms you're experiencing and VA is supposed to be aware of that and treat cases as such
Okay, great. That's pretty much all we have hopefully short and sweet information on depression
Once again, Emma Peterson with Courtney Ross and Michelle Detore from Chisholm Chisholm and Kilpatrick and we'll see you next time