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Post Traumatic Stress Disorder Practical Applications in the the Administrative Law Process

Post Traumatic Stress Disorder Practical Applications in the the Administrative Law Process. Greensburg  Pittsburgh  Latrobe  Altoona. Michael V. Quatrini, Esq. Workers’ Compensation VA Disability Compensation Social Security Disability

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Post Traumatic Stress Disorder Practical Applications in the the Administrative Law Process

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  1. Post Traumatic Stress Disorder Practical Applications in the the Administrative Law Process Greensburg  Pittsburgh  Latrobe  Altoona

  2. Michael V. Quatrini, Esq. • Workers’ Compensation • VA Disability Compensation • Social Security Disability • Faculty and presenter for “Social Security: The Basics”and “Social Security Disability: Advanced Issues”for Pennsylvania Bar Institute and the National Organization of Social Security Representatives (NOSSCR). mvq@qrlegal.com www.qrlegal.com Quatrini Rafferty

  3. PTSD: Tools • PTSD is diagnosed by a variety of experts: • Psychiatrist • Psychologist • Neuropsychologist • Neurologist • Primary Care Physician • Licensed Clinical Social Worker / Physician Assistant • Guy down at the VFW

  4. PTSD: Tools Why do we focus on psychiatrists and psychologists? • Trained to identify, diagnose, and treat PTSD. • Will be recognized as “expert” for the purposes of testimony.

  5. PTSD: Challenges to Winning • Absence of Objective Findings? • Shaky testimony from the Client?

  6. PTSD: Tools How do we quantify disability / limitations? • Subjective: Symptomology • Criterion B / Criterion C / Criterion D / Criterion E • Attachment “A”

  7. PTSD: Tools • Objective-ish: • Neuropsychological testing (4-5 hours); • Subjective Reporting; • Behavioral Observations; • Testing: Mini-Mental Status Exam; Wechsler Test of Adult Reading; Wechsler Adult Intelligence Scale; Beck Depression Inventory; Boston Naming Test; Rey Complex Figure Test; Verbal Fluency and Color Word Interference Subtesting, etc.

  8. PTSD: Tools THEN vs. NOW • Testimony from… • Family; • Friends; • Co-Workers; • Another Veteran; • Pictures / Video

  9. Veterans Disability: Burden of Proof • Have to prove: the condition is “at least as likely as not” caused by/related to military service • Ex: IED explodes, launching veteran 20 feet and breaking a leg.

  10. Current Flow of a VA Claim • Application to Regional Office (6 mths to 1 year wait time…or more) • Ratings Decision (1 year to file Notice of Disagreement) • Decision Review Officer conference? • Statement of Case (60 days to file VA Form 9) • Board of Veterans Appeals (120 days to file appeal to CAVC) • Court of Appeals at Veterans Claims

  11. Veterans Disability: Case Study • Ex-Medic during Vietnam; • Denied on initial application: “no claimed markers consistent with claimed stressor” • Letter from service-member who served with Veteran; • Updated examination that reviewed all records and rendered full diagnosis.

  12. Social Security Disability: Burden of Proof • Have to prove: the condition prevents an individual from performing the exertional (lift/walk/stand, etc) and/or non-exertional (concentrate, maintain pace, etc) of full-time work. • Ex: Client undergoes two surgeries on low back, preventing return to the heavy lifting and long hours on feet required as construction worker.

  13. Social Security Disability: Case Study • Federal worker; • PTSD diagnosis due to MST; • VA Treating Doctor willing to complete directed questionnaire.

  14. Workers’ Compensation: Burden of Proof • Have to prove: the “injury” occurred in the course and scope of employment relationship. • Ex: Client sustains fracture of neck vertebrae while delivering packages as UPS driver.

  15. WC: There’s a Catch… • Physical – Physical Injury: Car wreck = fractured vertebrae • Physical – Mental Injury: Car Wreck = Anxiety Fall from roof = PTSD • Mental – Mental Injury: “Abnormal Working condition”

  16. Mental – Mental Injury Injured worker my demonstrate he/she were “exposed to abnormal working conditions and that his psychological problems are not a subjective reaction to normal working conditions.” Babich v. WCAB (CPA Dept of Corrections), 922 A.2d 57 (Pa. Cmwlth. 2007) Working conditions are abnormal, they must be considered in the context of their specific employment.

  17. Workers’ Compensation: Case Study: We lose. • Prison Nurse; • Administered medications to inmates in solitary confinement; • Psychological breakdown • No dispute over his condition or limitations; • Did it arise from an “abnormal working condition”?

  18. Mental-Mental: Who’s at Risk? • Police Officers? • Firefighters? • Corrections Officers? • Bank Tellers?

  19. Workers’ Compensation: Case Study: We win. • Construction Worker; • Putting ditch box into hole; backhoe drops it on him and he is pinned for two hours. Severe leg injury. Rehabs back to baseline physically. • Starts new job. Working new job…side of road caves in. Sustains head injury plus injury to same past leg. • Severe PTSD: cannot be in closed spaces, cannot work underneath construction machinery, etc.

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