I read where you stated my case should not
have been remanded.
I have known several people with MD. I have seen some of the behavior on manic, but to me the worse was the depression.
Until you have walked in someone's shoes, you shouldn't discount what they go through.
I don't post about everything I deal with, and according to the VA psychiatrists - my medications aren't working the way they're supposed to. As each individual is different, so are those with Bipolar Disorder. What works for one, doesn't necessarily work for another.
I have had enough CBT (ABC model) to last a lifetime. In a full-blown manic episode, where I was awake and aware in a locked ward for 12 days, they tried numerous medications, to include Thorazine and Haliperidol to try and slow me down. They told me I should have been a zombie, but I was unaffected. I was reading books, playing games, watching TV, and talking to other patients - all at the same time.
I am hyper/hyper-manic, and I live on the high end of the Bipolar scale. I have been informed that my down days are higher than most people with Bipolar Disorder good days. My psychiatrist says she thinks it is because of my outlook on life. Even when I was a homeless veteran, I kept telling people that it would pass and get better. It took the VA, IHS, and private psychiatrists over three years to diagnose my condition - due to the lack of depressive symptoms. I was finally diagnosed Bipolar Type 1 NOS in 1997. I went through medication management for awhile, until they found that Valproic Acid worked well - I actually felt normal again. I went off the medication, as my dose had become so low, it was no longer necessary a couple of years later. I was warned that my condition might flare up again.
At the end of 2004, it came back with a vengeance. Valproic Acid did not work this time, and they tried a numerous other medications to no avail. I was told to check myself into the hospital if I had not slept for three days. I did that, but I soon changed it to five, as I was in the hospital too much. By 1997, my psychiatrist informed me that he was debating on having me committed until they could control my condition. So I resigned my job and moved. I had been informed by people that my work was attempting to terminate me, due to hardship caused by my frequent hospitalizations. The only thing that had saved me so far, was I was very, very good at what I did.
I love working, am proud of what I was capable of doing, and kept working long after both the VA and my work said I should quit and file for Social Security Disability. I was already 50% service-connected disabled by the VA. I did not know then that the VA already had decided to award me 100% service-connected disability. I started treatment in the new VA area I moved to, and they immediately put me in for medication management, once again. This time, I responded to Depakote ER a little better (which is just extended release Valproic Acid) and they tried mood stabilizers with it. I currently take Abilify with it, but these medications are only partially effective. I have to keep a log of my sleep, and the VA monitors my CPAP usage for statistics on how many times I stop breathing, when I am able to sleep.
Due to what I did in the Army, I was an Interrogator & Psychological Operations Specialist, I have a healthy case of 'justifiable Paranoia' (their words) and PTSD. I have lived with it for almost 30 years now, and won't take up treatment space that could be better used for the young guys getting back from overseas. They give me Prazocin, Phenegran, and Ambien to help me sleep - see above paragraph, they don't always work.
I was Airborne in the Army, and have damage in my right foot, and knee. My PCP says I am developing arthritis in both knees and lower back. I also have Severe Obstructive Sleep Apnea, and use a CPAP - even when I just lay there to let my body rest. Like many American Indians, I have developed DM Type II, but it is controlled (HgbA1C 6.8 ), as is HTN.
I state the additional conditions only because they exist, I do not consider them disabling. I have volunteered for everything they thought might help to control my Bipolar Disorder. I have had to readjust my entire life, to reduce stress in attempts to prevent the manic phases that I go through a lot. I am also diagnosed Ultra-Radian, meaning I cycle very frequently, and at the highest risk for suicide. Due to PTSD and paranoia, I lock myself in my room at times. Not because I am afraid of what someone might do to me, but what I might do to someone. Being manic in a confined space is just no fun at all. I have to have a separate bedroom and bathroom, because my hours were driving my wife crazy. I spend a lot of time in my room, bouncing off the walls. My only communication with the outside World is through my computer - it is safe and I can always switch off the power button.
Even you have stated that my case should NOT have been remanded, the Social Security Appeals Council found seven issues to remand on:
1.) Taking the Social Security's examiner's comments out of context, and ignoring the examiner's conclusion that even if I was able to find employment, I would not be able to sustain it.
2.) Giving zero weight to an RFC performed by an outside psychiatrist, stating that it was a paid opinion, even though it was supported by longitudinal evidence.
3.) Completely ignoring a Medical Source Statement from a treating psychiatrist that was in the exhibit file.
4.) Stating I was not credible, when my statements were backed up by longitudinal evidence.
5.) Only counting one hospitalization, when there were four hospitalizations for the time period pertaining to his decision.
6.) Gave very little weight to the VA 100% disability determination, and ignored SSR 06-03p.
7.) Considered only HTN and Affective Disorder, and did not ask about other conditions in the Medical Record, such as Severe Obstructive Sleep Apnea.
It is one thing to read in DSM IV or V that this is the way to treat someone with Bipolar Disorder. To have that actually work in practical application may be another story entirely. I have been Mensa eligible since 2nd grade, so I am not a complete idiot. Although I did many stupid things, prior to being diagnosed and learning that I have to seclude myself from the World at times.
Clinically: A person in a manic state will eventually hit a burn out point, where they are doing too many things at once and getting nothing done, or engage in riskier and riskier behavior. Then something happens and they crash into a deep depression.
Personally: My Bipolar Disorder developed later than normal, and my training saved me from doing many things I would regret. However, the biggest regret I have, is that I can not trust myself. I can not tell you what condition I will be in next week or even tomorrow. I have my days where I am functioning very highly, and don't feel disabled at all. Then again, there are days I am off-track, haven't slept for days, and not good for much of anything. I never know how I am going to be - such is living life on the Roller Coaster called Bipolar Disorder.
The reason I have typed such a long response is that you are new to the board, and we (the members) refrain from judging others. Many of our members discount what they actually go through, because they are afraid others may not believe them, or some things are just too private to share.
You write like you worked at ODAR. You must have really done some research. Unfortunately, the remand that you described is typical, but most peple are not as astute as you and do not appeal. I would have loved to appeal this for you!