Flight,

New PTSD rules. As nearly everyone knows, there are new rules which will alter somewhat the way in which claims for compensation for PTSD are adjudicated. The good news is that with service in a “combat zone” where exposure to traumatic events may be expected there is no further need to “prove” the stressor. The bad news is that only a diagnosis from either a VA employed or contracted health care provider will trigger the presumption. With diagnoses submitted by private psychiatrists and/or psychologists, the old rule applies and the stressor must be proved. There is also no indication at present what effect if any this has on pending claims.

My suggestion, until sanity prevails on this issue, is to use private psychologists or psychiatrists as before to either initiate a claim or to ask for increased rating. Be sure to take the “doc” a copy of your c-file, duly tabbed at the appropriate entries of service records of assignments, awards, etc. plus any medical records during and after service that are pertinent. Write out in detail the account of the stressful incident or incidents. I see nothing wrong with recounting average number of missions/day or week, types of cargo (including people), conditions of delivery into a hot LZ, etc. Current case law requires acceptance of your lay statements absent a finding of lack of credibility. To find your statements lacking in credibility they must so state and justify it. Also remember to ensure that your psychologist or psychiatrist provides a full “axial diagnosis” complete with a GAF score. The doc needs to recite that the C-file has been “reviewed” in preparation of the nexus opinion. Remember that the minimum standard is that “it is more likely than not” that the condition is related to the term in service. (This standard applies to any injury, disease or disorder for which you are seeking compensation.)

Guardianships and fiduciary responsibilities are topics that are not pleasant, but if not addressed early on can result in some real nightmares. A spouse or parent who receives VA funds as pension or compensation may become incompetent and unable to handle their own affairs. When that happens it is critical to be prepared. Each state is different as to the requirements and conditions of guardianship. It is best to include in a living will, which everyone should have, an expression of preference of guardianship – spouse, child, sibling, etc.(consider the likelihood of loss of competence in that person as well and consider secondary designations.)

If the next of kin is already appointed guardian, VA must come up with a good reason not to appoint that person as fiduciary. Too many individuals seem to make a living as professional fiduciaries, charging fees from the veterans’ funds to administer their funds. They have nearly total discretion on how much they pay out for living expenses, etc. I strongly believe that this responsibility should remain in the family as much as possible. Some attorneys who practice Elder Law are beginning to understand the inter-relationship with VA law and educate themselves in it. If you seek legal assistance in this regard be sure that the attorney understands the complications.

Ischemic Heart Disease. As nearly everyone knows, ischemic heart disease is now on the presumptive list. However, Sen. Webb is now protecting the public purse. He wants a full VA scientific study of the veracity of the work done by National Academy of Sciences in determining that there is sufficient evidence of a relationship between AO and ischemia in the heart muscle. No never mind that the District Court in California in its infinite wisdom deemed VA less competent than NAS and required that NAS do the studies pursuant to the settlement in Nehmer. This is another area in which one must wait for sanity to strike.

In the meantime, if you have a heart condition and you have diabetes or PTSD rated at 70% or higher, it may be possible for you to service connect the ischemia (of which there are numerous diagnostic variations) with one or the other or both. Especially if you have had an MI, there are a considerable number of studies by VA of the relationship between heart conditions and PTSD (stress). Diabetes also carries a secondary issue with the heart. Consult a private practitioner on these issues. If your sole health care provider is VA and your spouse has a family physician, that is a good place to start and ask for a referral.