Meandering Musings

Everything not fit to publish

My Friend Depression

| Comments

The title may seem bizarre or even downright crazy to you. I actually hope it does. Depression is not fun, it is extremely disturbing. Moreso when psychosis, paranoia, and anxiety is added to it. It is worse than that for someone not used it. What about us old farts that have been living with it for a very long time? I can’t speak for everyone but in my case, depression feels like a friend. Not a nice friend of course, but my only friend. Well, sometimes it is a nice friend. I would be empty a lot of the time without it which is why I am describing it as a friend. Another reason is that I don’t have a way with words.

My current shrink, who is getting fired very soon, wrote: “He endorses ongoing low mood, energy, motivation, anxiety, varying sleep, ongoing paranoia, and auditory hallucinations”. Why did she write that? Because I refuse to go back on meds (at least for now) because the side effects are worse than all of my symptoms and somehow she thinks that translates to an endorsement. It did get me thinking about how it would feel to not have depression, anxiety or psychosis. What I have realized is that MH issues have become a part of me. People tell me that I am not my depression but I really am. It drives everything, both negatively and positively, and has for over two decades.

What makes it hard is that it feels like a foreign entity has moved into my head and has some control of the wheel upstairs. It has become part of my personality. That is not fun but I don’t think I would handle it well if I were to wake up one day with depression, anxiety and psychosis gone. As twisted as it may sound, I feel warm and content when my depression is at its lowest. Which means my brain is spinning and there is just chaos upstairs, but in the middle of it, there is a sense of peace. Maybe it is some kind of weird addiction. I believe I would feel cold, empty and lonely if it suddenly vanished. It would be a lot like it was when depression first moved in and I did not handle it well for a few years.

It is not that good of a thing that I have become used to it, but it is infinitely better than the alternative. It is much better if it can be resolved but my depression has been labeled as ‘intractable’ by more than one shrink. So it seems like I am stuck with it. It may sound surprising but my days are pretty stable. It doesn’t matter if I am just a little down and anxious or everything is off the charts. Stable doesn’t necessarily mean good. Most days, leaving the house even to check the mail or go grocery shopping (whoever invented self-checkout is my hero) takes effort. It is even harder to leave if I know I have to interact with someone. The hallucinations are distracting; the anxiety makes it difficult to relax. It is not fun but I am accustomed to it to the point where my days are all the same. That doesn’t sound good either but with all of my MH and neuro issues that is a blessing. Doing poorly but being stable is much better than being all over the place. That is true even if the worst of my unstable periods are no worse than my times when I am stable.

The serious problems that people with MH issues sometimes have can be traced back to an inability to deal with it and allowing it to take total control. It is an easy thing to allow and I have allowed it a few times in my past leading to my getting bloody or ending up committed. I might be fooling myself thinking that I have gained enough control to never need to be committed again but I truly believe that I won’t and I am much worse than I was when I got thrown into the psych ward at the Phoenix VA. I was in the middle of the fall term at Arizona State when I was committed for 8 days and still finished the term with honors. How bad could I have been? I wish I knew, I have little memory of it. I do know because I have my medical records that the ward shrink said school is impossible in my condition. Yet another reason I distrust them.

As much as I would like to get a BS in Mathematics I seriously doubt I could deal with school today. My current downswing that lead to where I am today happened when I was working on my Masters thesis and project and I was very lucky to finish. A kind and understanding adviser helped to push me through it. I struggle to work on my programming projects and even my Rails project is challenging lately and I don’t know of an easier environment than Ruby on Rails. I don’t want to give the impression that things are easy to deal with. They are not but it has become the new normal. A sense of normalcy makes it easier to deal with and feels more natural but there is nothing natural about any of this.

I talk to a lot of people on various forums, usually fairly young, that struggle to get stable. They fail a lot and they end up hurting themselves over and over. It is sad and tragic. I think the answer is one that no one wants to hear: give it time. Problem is that many don’t have time. Meds aren’t working, therapy isn’t and they are in danger. Many have no support or anything at all to lean on. I was once like that but I was fortunate to have free care and most importantly children. They are why I am still here. Whether still being here is a good or bad thing varies through the day but my constant suicidal ideation never takes control. It is just background noise these days. I did have a date set once: Jan 1, 2000. Seemed like a nice date. I had everything set up and my kids were staying at a friend’s house for New Year’s and I went to say goodbye and once I saw them I knew I would not do it.

The point of this rambling is that it is possible to make peace with MH issues even if they never go away. I am not saying that being friends with depression is a good thing. It probably is the opposite but acceptance goes a long way. Acceptance doesn’t mean giving up. It is simply acknowledging it exists and trying to minimize it. Push it into the background and find something to do. I was and am fortunate to have children, going to school was simultaneously helpful and stressful but it gave me a solid base as a programmer and have multiple projects going albeit slowly. Read books and it really doesn’t matter what kind, it keeps your mind on something beyond your problems and keeps it active. If you let it, MH issues and meds can slow your mind. Go for a walk, run, bike or swim. Not only is it good for you physically, but it also produces hormones that help your MH problems. I recently took up guitar although it is coming along very slowly. I started fishing again and that is very peaceful. I am considering getting back into creating pewter items and learning candle making. As a hobby and perhaps make a little on the side. I burn a lot of candles that help my anxiety and it is quite expensive to buy good quality candles. So it is also an attempt to save money. There are lots of other hobbies a person can get into cheaply or even free.

It is difficult to get the motivation to do this but it is worth it to push through and do it. It is very easy and destructive to wallow in the crap that is mental illness. Lying in bed all day is the easiest path, it is also the most unhelpful. Depression and other illnesses feed on you and quickly spiral out of control, sometimes even if you are fighting it but certainly if you allow it to roam freely inside you. After two decades of this, I believe that the best therapy is staying busy and active.

VA Disability Primer - Part Deux

| Comments

Steps in a claim

The first step in a claim is to talk to a VSO or VA accredited lawyer and get an evaluation to see where you stand. A VSO is always free. Links to the right for veteran organizations have VSO search tools. A lawyer cannot charge you until you file an appeal (Notice of Disagreement) so it is not typical to hire one unless you get to the point of appeal. Either one is up to you, but I would be suspicious of someone who has a monetary motivation for your initial claim to be denied or lowballed.

If you go through a lawyer or VSO you will sign a power of attorney so they can act on your behalf. This includes filling out the form and submitting it to the VA. You can do it by yourself by going to this site and downloading the application and mailing it in or use E-Benefits. E-Benefits also gives you access to your disability and payment information and to various documents including the VA home loan certificate and proof of ratings.

When applying there are two basic routes: standard and fully developed claim (FDQ). A fully developed claim should contain everything needed for the VA to rate you. If you have private medical records, submit those. If you are applying for employability, make sure you have the TDIU application (VA Form 21-8940) filled out and if possible the forms from your last five years of employment. Note that does not mean employment in the past five years. These are forms that your employer(s) have to fill out. For some reason, my VSO didn’t know that and I got kicked off the FDC process. If you are filing for unemployment without the separate required form, the VA will deny the claim on those grounds. If you can’t get the forms from your employer, it shouldn’t hurt your chances.

When you submit records don’t overwhelm the rater. Don’t submit 1000 pages without leaving breadcrumbs for them. They have a very limited time to review cases so do everything in your power to make their job as easy as possible. If pertinent information is buried, the odds of them missing it and causing a lengthy appeal increases. You are your best advocate. Building your case takes time and typically the effective date of any award is the application date. To get around this the VA has a program called Intent to File. You can file this on E-Benefits, by mail or phone and is good for up to a year so it can preserve your effective date which is important for various reasons including back pay.

You could also include disability benefits questionnaire’s (DBQ). These are forms that your doctor can fill out. The only exception I am aware of is that if this is a new claim for PTSD, the VA will not accept it. Note that VA doctors typically will not fill these out, these are the same forms evaluators use and the VA hires doctors to do nothing but disability compensation. If this is a new claim make sure you give your service medical records to them for review. They need to review your medical records for their opinion on service connection to hold weight. Getting these forms filled out might make your claim go faster.

Often, but not always you will be sent for one or more Compensation and Pension Exams(C&P). These are exams to help determine service connection and level of disability. Even if you fill out DBQ’s, you might get sent for more exams. These are either in the C&P department of your local VA hospital or through private companies that VA contracts with such as VES and QTC. These companies are often large military-industrial members such as Lockheed Martin (QTC). The doctors that do them for VA are hired to do only those exams. The ones from private companies are typically contractors. I have had them from both VA and QTC and they were equally good and useful to my claims.

The two most important things with C&P exams are to not miss it and be honest. Missing an exam can result in a denial. If you can’t make it, reschedule. Being honest is critical. If you exaggerate your symptoms it can result in criminal fraud charges. It happens more than you might think. If you under-report your symptoms it can result in a lower rating. If they are testing your range of motion, you don’t have to go past the point of where it hurts but don’t say it hurts if it does not. That should be obvious of course. In a psych exam, which is totally subjective it is tougher and can be a little nerve-wracking. Write notes to make sure you cover everything and give them a really good idea about your bad, good and average days and the frequency of them. The notes helped me immensely because my memory is bad. They typically last an hour but my last psych C&P lasted about 3 hours which was definitely to my advantage. She could observe how I devolved over three hours of trying to maintain focus.

Once all the forms are filled out and exams completed, all there is left to do is wait for your letter in the mail. Once you get your letter, it is official. If E-Benefits tells you your new rating and you haven’t gotten your letter don’t believe it. That site is often incorrect. Once that happens, any back pay will be deposited in your account (make sure the VA has your direct deposit information when you apply) and your new monthly payments will start the following month. Typically, back pay goes back to the date of application or intent to file. To be more specific, back pay goes from the first of the month following your effective date. If your effective date is January 15, 2017, the back pay starts February 1, 2017. The rule for your effective date is: The date of application or the date entitlement arose, whichever is later. That could mean that the effective date could be later than your application date (such as the date of the C&P exam) but that is rare from what I understand.

You may also get a note in your letter about future exams. The VA can reevaluate you at a later date and unless there is evidence it is not likely to improve, you will likely get scheduled for another C&P 2-5 years down the road. If you are not scheduled for future exams your disability is called static. After my first claim, I was scheduled for another review 2 years later and got that along with an increase in my rating. That was 1999. I was scheduled for another review in 2002 and that never happened until I explicitly put in a claim in 2015. So there is no telling what will happen. For this reason, it is critical that you put in a change of address with VBA (and annoyingly VHA separately) whenever you move. If you don’t do that and miss an appointment, you might lose your rating.

Appeals

If you disagree with the decision there is information in your letter and a form to appeal. It is called a Notice of Disagreement (NOD). The appeal process has several paths and using one does not take away the other paths in most cases. The rarest is the clear and unmistakable error (CUE). It is rarely used and only covers very obvious errors of fact or law. Differences of opinion (50% vs. 70% for example) are not a CUE. The second is the reconsideration. These happen when you have new and material evidence that was not previously considered. You can’t file for this on existing evidence. An important item to note is that you have one year to file your NOD. If you file for reconsideration, the clock does not stop and if you haven’t filed a NOD, you lose the right to appeal and lose your effective date. If you have a month or two left to appeal and your reconsideration isn’t done, file your NOD. If your reconsideration comes out well for you, you can always withdraw your appeal.

The NOD has two paths: DRO Review and Board of Veteran’s Appeals (BVA). The former is much faster and if you still disagree you can still go to BVA. A Decision Review Officer (DRO) can handle your appeal “De Novo”, which means they will look over your case as if it were a new case. You can also have a hearing officer look over your case but is not treated as a new case.

BVA is the much slower path and is in front of a judge. The VA’s duty to assist still applies here. It is not required to get a lawyer but it is the first time in the process where it makes sense. BVA can re-adjudicate your case and if needed remand back to the VA for rating. Typically, the last stop is the US Court of Appeals for Veterans Claims (CAVC). They will not re-adjudicate your case. They are there to ensure you received due process and all rules and regulations were followed. Sometimes, the rulings have huge effects for the veteran, such as the relatively recent ruling that allowed TDIU recipients to receive additional payments when otherwise qualifying for it. Usually, they only apply to the vet in the case unless it is heard in front of a panel of judges. CAVC definitely requires a lawyer, do not think you can go it alone here. Unlike BVA, the VA will send lawyers to CAVC to argue their case and the duty to assist does not apply here. This is a “normal” court with an adversarial system. Do not think you can win your case against a seasoned VA attorney by yourself.

There is so much more to appeals than I know about. I have been fortunate and have always gotten what I applied for (and sometimes more) so I don’t have any personal experience. Looking at my three claims, they all went well because I had lots of evidence in the form of medical records and in the case of my first two claims an excellent VSO. Not only is treatment important to help you with your disabilities, but it is also critical in making a solid case. 22 years of medical records says more than I could in 1000 C&P exams.

I have been to a lot of sites and the one with the most consistently useful information is Veterans Benefits Network. It is not perfect of course, but most misinformation is quickly corrected. Someone will be able to help, no matter where in the process you are at. The link is in the sidebar.

Effective date

I mentioned effective dates earlier in regard to back pay. It is also important in several other areas. If you were getting care at the VA for disabilities that are now service connected and had to pay for it you may be eligible for a refund of those costs.

Other important things to note about effective dates are the so-called 5, 10 and 20-year rules.

5-year rule - After holding a rating for 5 years the VA must show sustained improvement to lower a rating.

10-year rule - After holding a rating for 10 years they cannot remove the service connection designation. That means that it will always be rated, even if at 0%.

20-year rule - After holding a rating for 20 years it cannot be lowered.

These do not apply in cases where fraud was proven.

The 20-year rule can be a little tricky. Say you had a 50% rating for whatever on February 1, 1997. On September 1, 2010, it was raised to 90% but on June 1, 2015, it was lowered to 70%. February 1, 2017, the rating cannot be dropped below 50%. But since the 90% was reduced, that effective date no longer applies but the 70% is locked in June 1, 2035, assuming it is not further reduced.

Other benefits from your state, the VA and the federal government may also be important to your effective date.

Disability Benefits

An important benefit is that your compensation is tax-free.

There are many benefits, besides compensation, to having a disability rating. Some are from your state, such as free license plate and registration, reduced or no property taxes, fishing or hunting licenses, etc. Here is a link to each states benefits. There are also discounts at federal parks.

0%+ ratings qualify you for the VA home loan program with guarantee fee exemption. You may also qualify for vocational rehab; which is an exceptional program, and the 10-point federal civil service preference among others. Your state or local governments may also have a civil service veterans preference.

Once you have a 30% or higher combined rating, you get extra payments for dependents.

100% qualifies you for commissary, exchange and recreation benefits on military bases. 100% does not qualify for space-available flights, unfortunately.

If you are 100% or TDIU(See below) and have student loans you can get them forgiven.

Also at 100%, extra payment called Special Monthly Compensation (SMC) might come into play here. There are various levels of SMC and most require a single disability rated at 100%. The most common and lowest paying is SMC-S, which requires that the veteran is housebound or if any additional and unrelated to your 100% disabilities combine to 60%. It comes to an additional $350 or so. With the exception of SMC-K(loss of use of extremities, eyes, ears or muscle groups), you can only have one SMC payment as it includes the 100% rate but if you qualify for more than one, you get the highest payment.

The most important benefits are health benefits. All rated disabilities are treated for free and if you have a 50% or greater rating, you can get all care for free, except dental. VA health care is not insurance but having access to any non-dental care qualifies as meeting the minimum requirement in the ACA law. This benefit includes authorized care or emergency treatment outside the VA. At 100% you also qualify for dental care. Of course, if you have a dental rating, then you already qualify for dental.

There are also some benefits for survivors if a service-connected disability causes your death.

At 100% and your disabilities are considered static(called permanent(static) and total(100%) - P&T), your spouse and children under 26 qualify for educational assistance.

Here is a listing of benefits.

Unemployability

Sometimes a rating doesn’t adequately describe how it is affecting you, especially when it prevents your employment. If you are unable to follow substantially gainful employment and have a single rating of 60% or more(but less than 100%) or less two or more ratings that combine to 70% - 90% and one is at least 40%, you can apply for Individual Unemployability (TDIU).

Note that this does not mean you can’t hold any job. You could work 10 hours a week as a Wal-Mart greeter and that could be ruled to be marginal employment. The basic gist is that you can’t do anything more than marginal employment. If you are currently unemployed but could work when you get hired, you will not qualify for this program. Marginal employment is not strictly defined so caution and a discussion with a good VSO is in order.

Once you get approved for this, they have yearly income audits. When you feel you are ready to go back to work and find a job tell VA and you get a trial period of a year before you get your eligibility for TDIU reevaluated.

Your rating stays at where it is while on TDIU (unless there is evidence that an increase is warranted when you apply) but you get paid at the 100% rate which is substantially more than even the 90% rate. You may also qualify for SMC-S.

If you become employable, your rating returns to where it was before TDIU was granted.

Asking for an Increase

If you feel that your issues are worse than what you are rated for you can apply for an increase. The method is the same as a new claim except you don’t have to worry about service connection. You still need medical evidence and if you haven’t had continuous treatment, your claim will be harder to prove.

An important thing to keep in mind is when you have the VA reopen your file, everything can be reviewed. The rater is responsible for everything in your file so they will likely look at all ratings even if you only asked for an increase for one of them. The possible results of a claim for an increase are that it does get increased or it stays the same or it can be decreased. That is a risk you need to be aware of when you file.

Phew!

The last two entries were a very quick and dirty overview of the disability system. Hopefully, your head is not spinning. I will probably write more about these topics as there are a lot of details left to be covered.

Any incorrect or misleading information is unintentional. Please comment with corrections, any important omissions and good citation for it.

VA Disability Primer

| Comments

VA disability is one of the most well-known benefits but it is also one of the least understood due to its complexity and the subjectivity involved.

Contrary to popular belief the VA does have a duty to assist the veteran in his claim. This includes many things but it essentially requires the VA to help you obtain evidence to prove your claim including providing examinations at no charge. It does not include agreeing with your position or spending time or manpower on frivolous claims. This duty exists through all claims and appeals except in two conditions discussed later. Outside of those two cases, it is not an adversarial process although it can often feel like it. To get so far into the process where the duty to assist vanishes can take years, the best way to avoid a long claim process is to do your best to document everything from the beginning.

Your first step should be to see a Veteran’s Service Officer (VSO) to discuss concerns and go over your records. Your service and medical evidence and any relevant lay evidence are going to win or lose your case. The more relevant evidence that you submit from the beginning the higher your odds of getting a favorable decision and the lower your odds of having an extremely protracted fight at the various appeal levels. Spending a month or two getting your ducks in a row might just save you years of aggravation.

Disability Claims

There are basically two types of disability claims: a new claim and a claim for an increase in an existing disability. A new claim can be your first claim or if you feel you now qualify for disability benefits of a different issue. The steps involved are about the same except for a new claim the VA has to first determine if it is service connected or not.

Before we begin, it should be noted that a vet cannot have a dishonorable discharge, although a less than honorable discharge may be okay depending on the circumstances. Honorable discharges are good of course, unless said disability was caused by misconduct.

The first step is to determine that a disability exists. It has to be chronic and disabling and on the list of recognized disabilities. If it isn’t explicitly listed you still could get it rated if it is closely related to a recognized disability. It also has to be connected to your service. This is by far the most difficult part of the claims process and the most critical. No service connection, no benefits for it.

There are three methods of connecting a disability to your service. The first is the primary connection and is fairly straightforward. It is an injury or illness that occurred during service and is an ongoing disability. Probably the best way to establish this is through a medical review board that leads to medical retirement or discharge but that is not required. Military treatment records work also. With an exception in the paragraph below, no treatment records mean that your odds are long but not necessarily impossible. You will also need what is called a nexus, that is a link to an in-service event to your current issues. A doctor will need to be able to say that it is at least likely as not (50% or greater probability) that said disability is related to your service. The very best nexus is continuing treatment records from military doctors to civilian (VA or private). The next method is the secondary connection. That is a separate issue caused by a service connected disability or its treatment.

The other method of connection is what is called presumptive disabilities (38 CFR 3.307 – 3.309). These cover several things and may have time limits. The first is a list of disabilities that if they manifest within one year of separation from active duty are presumed to be service connected. There are others like Agent Orange exposure or if you were at Camp Lejeune at one time or another over a period of several decades and have an illness that has been recognized as likely caused by whatever you were exposed to. You need proof that you were in the affected area during the timeframe authorized and that you have one of the disabilities listed. With a presumptive claim, you do not need to establish that your conditions are at least 50% or greater likelihood that your service caused or aggravated your issues. If you have a disability not listed and you were there, you will have to find another route to service connection.

National Guard and Reserve service do not confer 24/7 on duty presumption so only disabling issues incurred while on drill or deployed will likely count for VA purposes.

Disability Ratings

Once service-connected, the method used to connect is irrelevant to the rating. It will be rated by the schedule of ratings in the regulations. The schedule of ratings also lists which disabilities are ratable. If you don’t fit perfectly in a rating code the VA can choose what most closely resembles your disability. The bad part is that the ratings are often subjective. One rater might rate you 50% for a single disability and another rater could say 70% and it is possible that neither gets dinged for being wrong because both could be valid depending on how the evidence is interpreted. This is important to understand when it comes time to appeal. The rater is graded on how many claims are worked and completed and its accuracy and can lose their job with low production points and quality ratings.

Ratings are generally between 0% and 100% with 10% increases but most specific ratings will have different gradients and many have a maximum rating at less than 100%. Migraine headaches have a max rating of 50% despite the fact that they can often be 100% disabling. Ratings are often grouped together and treated as a single disability. The most obvious one is mental health disorders. Whether you have generalized anxiety disorder or PTSD the rating is all about symptoms and how it affects your daily life. You can also only be rated with a single mental health diagnosis but symptoms of all can be rolled into the rating. Typically issues that a person are considered to be born with (such as personality disorders) are not ratable. Below is the schedule of ratings for mental health, as an example.

General Rating Formula for Mental Disorders:

  100% - Total occupational and social impairment, due to such symptoms as:
        gross impairment in thought processes or communication;
        persistent delusions or hallucinations; grossly inappropriate
        behavior; persistent danger of hurting self or others; intermittent
        inability to perform activities of daily living (including maintenance
        of minimal personal hygiene); disorientation to time or place; memory
        loss for names of close relatives, own occupation, or own name

 70% -  Occupational and social impairment, with deficiencies in most areas,
        such as work, school, family relations, judgment, thinking, or mood,
        due to such symptoms as: suicidal ideation; obsessional rituals
        which interfere with routine activities; speech intermittently illogical,
        obscure, or irrelevant; near-continuous panic or depression affecting
        the ability to function independently, appropriately and effectively;
        impaired impulse control (such as unprovoked irritability with periods
        of violence); spatial disorientation; neglect of personal appearance and
        hygiene; difficulty in adapting to stressful circumstances (including
        work or a worklike setting); inability to establish and maintain
        effective relationships

 50% -    Occupational and social impairment with reduced reliability and
        productivity due to such symptoms as: flattened affect; circumstantial,
        circumlocutory, or stereotyped speech; panic attacks more than once
        a week; difficulty in understanding complex commands; impairment
        of short- and long-term memory (e.g., retention of only highly learned
        material, forgetting to complete tasks); impaired judgment; impaired
        abstract thinking; disturbances of motivation and mood; difficulty in
        establishing and maintaining effective work and social relationships

 30% -    Occupational and social impairment with occasional decrease in work
        efficiency and intermittent periods of inability to perform occupational
        tasks (although generally functioning satisfactorily, with routine
        behavior, self-care, and conversation normal), due to such symptoms
        as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or
        less often), chronic sleep impairment, mild memory loss (such as
        forgetting names, directions, recent events)

 10% -    Occupational and social impairment due to mild or transient symptoms
        which decrease work efficiency and ability to perform occupational
        tasks only during periods of significant stress, or; symptoms controlled
        by continuous medication

 0% -    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

You might be thinking that a person could fit multiple ratings and you would be right. This is where the subjectivity is involved. I have a 100% mental health rating and have 3 100% items, 3 70%, 3 50% and 2 30% listed in my award letter. I am not completely sure but I think what put me at 100% was that I applied for the unemployability rating (discussed later) and mental health is the only other rating where the ability to work comes into play. My examiner opined that I have reduced occupational and social impairment which is the 50% criteria. It is much easier to give someone a 100% rating than unemployment because they have to monitor the latter. I would love to find out the actual reason for my 100% MH rating but that could open me up to review and my curiosity isn’t worth the risk of getting a reduction.

Once rated, you are given a combined rating. This determines your disability compensation, medical and many other benefits. If you only have 1 disability rated it is very simple, you are rated what that disability is rated at. If you have one or more 100% ratings, you have a combined 100%. If you have two or more and no 100% it gets a little more complicated. It is often called ‘VA Math’ but it is a system used around the world. It is really called the ‘whole man system’. It starts out saying you are 100% abled and combine ratings from there. I will use my old ratings as an example. I had 50% mental health, 50% migraines and 20% seizure disorder and a few 0% ratings which aren’t a factor here. Take the highest first and work down. I am now considered 50% abled and 50% disabled after the first 50%. Every rating after this takes a proportional piece of the abled pie. The next 50% is taken out of the 50% abled for a value of 25%. This leaves me 75% disabled. If that were all my ratings, it would be rounded to the nearest 10th value, which would be 80%. I still have 20% left, so 20% of 25% is 5% which brings me to 80%.

In my case, the 20% was worthless for compensation which is the bad part of the whole man system. Each subsequent disability is worth less even if it is significantly impacting you. If you were at 85% you would need a single additional disability at 70%(or multiple disabilities that combine to near 70%) or higher to get to 100%. If you had a 90%, you need another 50% so you can qualify for the far more beneficial 100%. Four 50% ratings will get you to 94% rounded down to 90%, but an additional 10% rating will get you to 95%. The easiest way to figure this out is to use the VA’s table.

To further complicate matters there are bilateral factors. These are disabilities on paired limbs or muscles. This adds another 10%. The bilateral disabilities are combined first from highest to lowest, then 10% is combined and then the rest of your disabilities are combined as described.

A 0% rating may be disheartening since there is no compensation attached to a single 0% rating but there are lots of benefits, including free care for those ratings and a 10 point hiring preference for most federal jobs. The biggest is that it means your disability was service connected which is the most difficult part of the disability claim. You can appeal the 0% or later on put in for an increase if your condition worsens and you don’t have the service connection hurdle in your way. If you have two or more 0% ratings and no other compensable ratings, and those ratings affect your ability to work you can get a 10% combined rating.

Any incorrect or misleading information is unintentional. Please comment with corrections, any important omissions and good citation for it.

The VA System

| Comments

The U.S. Department of Veteran Affairs (VA) is a much maligned (both fairly and unfairly) but critical organization. It is the second largest federal agency. The Department of Defense is the largest, so this shouldn’t be a surprise. It employs a little under 350,000 people to serve 5,124,168 enrolled veterans as of 2014.

There are essentially three parts of VA and they have very little interaction: VHA(health services), VBA(benefits) and National Cemetery Administration. To get benefits you need to contact one or more of them depending on what you are trying to get. Signing up with one agency will not get you signed up with the others. Annoyingly, you need to contact both VHA and VBA if you move so you don’t miss important correspondence. All benefits and eligibility for them are authorized by various laws and VA is bound to them. All eligibility decisions can be formally appealed. Everything is based on what can be proven through military records along with civilian medical records if they exist. It is a maze of bureaucracy. The very best way to deal with it is to start with a Veteran Service Officer (VSO).

A VSO is a person hired by veteran’s organizations such as VFW. You do not need to be a member of the organization nor do they ever charge for their services. There are links to several organizations that provide VSO’s on the right side of the page, but it is not a complete list. Shop around and find one that seems to really understand the system. What you need to get started is your DD-214 (only if you are already separated, they can help start the process while still on active duty) and if applicable giving the VSO access to your medical records so they can decide how to proceed on any disability claims. Whether or not you can qualify for disability, which opens eligibility to a lot of services that the VA can provide, as well as financial compensation, depends solely on what is in your records and medical evidence as to your current condition and how it affects your life. To get the most help you will need to sign a limited power of attorney so they can work on your behalf on issues related to the VA. Otherwise, you will be left to fill out forms and submit them on your own; you will also not be able to get information as quickly as a VSO can.

When I was moving through my medical retirement proceedings, I was sent to a VFW VSO and he let me know everything I would likely qualify for and got the ball rolling before my retirement was completed. He got my application for disability put in as well as enrolling me in the nearest VA hospital in the area I was moving to. He also started me in the vocational rehab program which is a phenomenal program, especially stacked up against the GI Bill as it existed in 1996. It also covers things that the GI Bill does not such as vocational evaluations.

I had always assumed that a service member would need a medical discharge or retirement to qualify for these benefits. That is not true! You also do not need to be a boots-on-the-ground combat vet injured in the line of duty to qualify for benefits. If you are active duty, you are considered to be on duty 24/7. If you are on active duty and develop epilepsy, as in my case, and is a chronic disability you can get rated for it. Even if the condition existed before enlistment and you still passed the initial medical exam (assuming you disclosed it - never lie about medical issues to the military or VA, it can bite you hard) and it got worse you can get compensation for what got worse. In my case, my service did not cause it, at least as far as I can tell, but it happened on active duty so it is service connected. You could be walking off base and get run over by a drunk driver and if there are any disabling conditions it could be considered as service connected. As long as your disability wasn’t caused by misconduct you can likely get it service connected. If your disabilities happened while driving drunk, for example, it will not likely lead to a service-connected disability. It does have to be chronic and disabling. An acute incident that caused no problems once addressed will not qualify. Reservists and National Guard members do not have the 24/7 on duty presumption since they typically spend so little time each month drilling.

Disabilities are rated from 0%-100%, some are capped lower than that, and are combined (not added together) using what is called the “whole-man system”. It is a system that is used around the world in both private and public disability insurance systems. The max combined disability is 100%. I will write more specifically about the system, obtaining disability benefits and pitfalls to avoid in another post.

Other than a dishonorable discharge, less than honorable discharges might qualify you for some services and benefits. A VSO can help here.

VHA has rules mandated to them for health care that can be a little tricky. It is not as simple as “I served one enlistment give me free health care for life”. Again, a VSO can help you know what sorts of services you qualify for. The simplest is if you have any service-connected disability you can always get seen for that and any treatment your VA doctor thinks is appropriate for free. Your dependents(unless your spouse or child is a veteran or otherwise qualifies) do not get medical care from VA but there are some cases where they do qualify for CHAMPVA which is free insurance they can use in the private sector. Retirees and their families qualify for medical care through the DoD but that is outside the scope and control of VA.

There are 8 categories of vets that qualify for VA care called priority groups. Priority groups have nothing to do with scheduling, everyone is scheduled the same from my experience. If you fit into multiple priority groups, which many do, you will be placed in the highest group you are eligible for. Some vets will have co-pays but they are very low and only apply to some eligible vets and are means tested. If you have co-pays and private insurance you can use that to pay for it. I have read reports from vets on VBN that their private insurance assumes that you paid your deductible to the VA. It is a cheap way to meet your deductible.

This was a quick and dirty introduction to the VA system, I will write more in other articles as there is much more to add. The most important thing here is if you are a vet, take your DD214 and see a VSO and see what you might be eligible for.

Getting Off Meds

| Comments

Side effects of psych meds can be bad, withdrawal effects are often worse. Psychiatrists often ignore this fact when prescribing. They often dismiss withdrawal concerns because they have no personal experience with it.

Withdrawal effects happen because of dependence. In typical fashion, the drug companies use euphemisms like ‘discontinuation syndrome’ to hide the fact that they can be highly addictive. They change your brain systems and it gets used to it so when the effects of the drug go away, your brain reacts to less serotonin or dopamine or whatever neurotransmitters are being affected by the drug. In most cases, this dependence doesn’t cause craving, unlike other drugs. Once you taper off Prozac, for example, you aren’t likely to relapse. Benzodiazepines are an exception to this rule. They also have some of the worst and longest lasting withdrawal effects, especially benzos. Withdrawal effects can last years.

Like starting meds, your best defense for minimizing the pain is education. Do a search on personal experiences and research on your specific med. There are lots of sites that offer advice, although it is typically general. Like side effects, withdrawal effects and its duration depend on the person, specific drug, dosage and the length of time the med has been taken.

I am currently not on any psych meds, with a small exception, and have been off for almost two months. I still get withdrawal effects like insomnia, ‘fuzzy’ brain, ‘the shakes’ and rebound depression, anxiety, and psychosis. I feel like I am dying most days. For me, the trade-off is worth it. I have been living with depression for so long it doesn’t bother me that much, newer things like psychosis and anxiety are a little harder to deal with but is okay for now. Paranoia is the worst but manageable. Paranoia is the one thing that gives me pause about staying off.

Three months after initially starting the antipsychotic ziprasidone, I felt weak and really tired. I also noticed the loss of muscle mass. My doctor ordered a testosterone test, an irrelevant one that my primary doc had to school him on. It was also the first time ever, after 20 years of shrinks, a shrink tried to find an underlying cause, which puts a fine point on psychiatry being a pseudo-science. After getting the right tests showing extremely low testosterone, he wanted to put me on replacement therapy which has its own risks and severe ones that I would like to avoid. Luckily, despite my shrink being an MD, he isn’t capable of prescribing hormone replacement therapy, so it got kicked over to my primary doc who is thorough and very competent. As an aside, this is one great thing about the VA system; it is easy to coordinate care between your primary doctor and any doctor from any specialty clinic.

My testosterone levels were extremely low but she wasn’t sure replacement therapy was the thing to do. She wanted a series of tests done over time. I read up on natural ways to increase it and came up with a couple of supplements1 to take at night since testosterone is mostly created during sleep. It seemed to help; my second test was twice as high but still very low. My doctor was skeptical that my attempts to increase it was valid but said to keep doing it and we will check in a few months. The third test came back as bad as the first. She said she now feels comfortable with hormone replacement but I still was not. I was having severe health paranoia over this and imaginary issues and demanded to find the cause of it. She said it was likely the ziprasidone (which it was) but ordered a bunch of tests. All the thyroid tests came back good but the pituitary tests did not. My levels of prolactin were three times as high as they should be, which suppresses testosterone. This might be the reason the supplements didn’t help, I am not sure. So I started tapering off the antipsychotic.

Now, I had been discussing getting off all psych meds with my shrink for a few months because I felt like I didn’t need it and I had a feeling that one or more of them was causing my tiredness. This just clinched it, it set off my health paranoia. My psychiatric symptoms are worse but my ability to deal with them is currently pretty good. I know I will crash again sooner or later, but being out from the side effects even if only for a year is worth the trade-off of future suckage.

I started with ziprasidone, which I did way too fast and it hurt but I had a lab scheduled in 45 days and wanted to be clear of it for as much of that time as possible. The labs showed my testosterone was back to normal, which I didn’t need a test to tell me. I felt more energetic and stronger. The prolactin level was still just a bit high. My primary doc said that it will continue to decrease and no more labs are necessary. Antipsychotics are dangerous, to say the least, and there are scarier side effects that are much more common than the ones I experienced. The really scary part is that I never approached what is considered a therapeutic dosage but it still caused all these issues.

I waited a few weeks to make sure all the withdrawal effects were gone before tapering down mirtazapine. This one wasn’t as bad as some other antidepressants. I stepped down from 45mg in 7.5mg steps, which was about the smallest I could do easily. The lowest dose pills are 15mg, cutting them twice is problematic. The worst was the first step down, it was so painful I stayed there for 2 weeks. After that, it was pain-free and stepped down one week at a time.

The worst withdrawal caused by it is insomnia. I have had insomnia since I was 18, it started in the Army. The only positive effect from mirtazapine was that it kept insomnia away. A bad effect was I slept 12 hours. I used to be able to take melatonin and valerian root which worked well, but it didn’t work at all at after stopping mirtazapine. I tried doxylamine which didn’t either. Lately, they work a little better. I guess it is because my brain had changed and is slowly going back to normal. The good thing is that I no longer sleep 12 hours and still feel exhausted. I sleep 4-8 hours and rarely feel tired. The return of psychiatric symptoms minimize any gains by being very distracting and slowing my thought processes. Pick your poison.

The last thing was clonazepam, a benzodiazepine. I was only taking 1mg a day, and not always every day. Despite the reputation of being hard to get off, I tapered off pretty quickly. In about two weeks. That might have been too fast. I still have withdrawal effects, so I am not completely off it. I take 1-2mg a week, when the withdrawals get too bad and if I get a strong seizure aura.

The hardest part is the pushback from my psychiatrist. The psychiatrist I saw when I started was completely against it. I am a stubborn old cuss, so he gave in but he called it a ‘drug holiday’. My old shrink moved to inpatient and my new one thinks that the fact that I really don’t want to go back on meds means I don’t want to improve and I “endorse low mood and hallucinations”. I don’t even want to see her again because it will be a fight every appointment. Seeing a shrink is stressful enough and is a depressing experience, this just adds to it. Yeah, psychiatry sucks.

Do not ever forget to take your psych meds and when stopping one go very slowly. How slowly is a debate that never seems to get solved. My advice is to go as slow as you feel comfortable. There is no such thing as tapering too slowly unless the drug is causing a life-threatening condition. As an example: Venlafaxine. I tapered off in three weeks from 150mg. I took 37.5mg steps, which was way too large. My mind was cloudy and numb; I was dizzy and got what is commonly described as brain shocks which are painful. I was the walking dead for over a month.

Also, do not go cold turkey, ever. If you are not going off meds, make sure you never run out. The consequences can be painful or worse. Do not ever taper off without your doctor knowing. I can’t stress that enough. You will need them to write prescriptions in a way to make it easy to taper down slowly and to help if really bad things happen. Don’t let them dictate the schedule. If you are simply switching to a new med, the good news is that withdrawal effects are often minimized.


  1. Stress B Complex, Fish Oil(later on Hemp Oil), Vitamin D, Magnesium and Fenugreek. I still take all of those for other reasons other than Fenugreek.