WhyMista

I had an appointment with my longtime MH nurse and she read over my C&P and to her it looked favorable and she was the one who had told me about a year ago to consider filing for it. She also filled out more progress notes noting how its not possible for me to work so that should hopefully help. I appreciate people who take an interest in the mental health of veterans. Also as an aside what made you go the PsyD route? I am a psychology major and had looked into that route as well since I have about a year or so left and how its received in the workforce compared to Phd's or among colleagues?

Thank you, I will have to go and get my progress notes from the last year together and submit that paper. Also they recently increased my rating from 50%-70% last year because of some other medical evidence I submitted.

This is my most C&P. I am rated 90% 70%-PTSD 50%-Migraines 10%-TBI/w light sensitivity 10%-Tinnitus 10%-R Shoulder (forget the specifics) 0%-Mild R ankle laxity. Based on these results what do you think my chances are for IU. They are incorrect about the number or prorstratinng migraines a month its arounf 4-5 a month how could I get that fixed. Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review CONFIDENTIAL Page 9 of 20 --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS SECTION I: Diagnosis and medical history ---------------------------------------- 1. Diagnosis ------------ Does the Veteran now have or has he/she ever had a traumatic brain injury (TBI) or any residuals of a TBI? [X] Yes [ ] No [X] Traumatic brain injury (TBI) Date of diagnosis: 2005 2. Medical history ------------------ Describe the history (including onset and course) of the Veteran's TBI and residuals attributable to TBI (brief summary): The veteran is already SC for TBI. he states that he was exposed to a IED blast in Iraq in 2005, which rendered him unconscious for a brief moment. he says migraine headache started soon after the explosion. SECTION II: Assessment of facets of TBI-related cognitive impairment and subjective symptoms of TBI ----------------------------------------------------------------------------- 1. Memory, attention, concentration, executive functions -------------------------------------------------------- [X] No complaints of impairment of memory, attention, concentration, or executive functions 2. Judgment ----------- [X] Normal 3. Social interaction --------------------- [X] Social interaction is routinely appropriate 4. Orientation -------------- [X] Always oriented to person, time, place, and situation CONFIDENTIAL Page 10 of 20 5. Motor activity (with intact motor and sensory system) -------------------------------------------------------- [X] Motor activity normal 6. Visual spatial orientation ----------------------------- [X] Normal 7. Subjective symptoms ---------------------- [X] Three or more subjective symptoms that mildly interfere with work; instrumental activities of daily living; or work, family or other close relationships. Examples of findings that might be seen at this level of impairment are: intermittent dizziness, daily mild to moderate headaches, tinnitus, frequent insomnia, hypersensitivity to sound, hypersensitivity to light If the Veteran has subjective symptoms, describe (brief summary): Migraines, sensitivity to light, tinnitus (on right). 8. Neurobehavioral effects -------------------------- [X] No neurobehavioral effects 9. Communication ---------------- [X] Able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language. 10. Consciousness ----------------- [X] Normal SECTION III: Additional residuals, other findings, diagnostic testing, functional impact and remarks ----------------------------------------------------------------------------- 1. Residuals ------------ Does the Veteran have any subjective symptoms or any mental, physical or neurological conditions or residuals attributable to a TBI (such as migraine headaches or Meniere's disease)? [X] Yes [ ] No [X] Headaches, including Migraine headaches 2. Other pertinent physical findings, scars, complications, conditions, signs, symptoms and scars CONFIDENTIAL Page 11 of 20 ----------------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No c. Comments, if any: No response provided 3. Diagnostic testing --------------------- a. Has neuropsychological testing been performed? [ ] Yes [X] No b. Have diagnostic imaging studies or other diagnostic procedures been performed? [ ] Yes [X] No c. Has laboratory testing been performed? [ ] Yes [X] No d. Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No 4. Functional impact -------------------- Do any of the Veteran's residual conditions attributable to a traumatic brain injury impact his or her ability to work? [ ] Yes [X] No 5. Remarks, if any: ------------------- Migraine headache and sensitivity to light are the only residuasl from TBI in service at this juncture. **************************************************************************** Headaches (including Migraine Headaches) Disability Benefits Questionnaire Name of patient/Veteran: CONFIDENTIAL Page 12 of 20 Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a headache condition? [X] Yes [ ] No [X] Migraine including migraine variants Date of diagnosis: 2005 2. Medical History ------------------ a. Describe the history (including onset and course) of the Veteran's headache conditions (brief summary): The veteran reports onset of severe recurrent headache right after the IED explosion in 2005. b. Does the Veteran's treatment plan include taking medication for the diagnosed condition? [X] Yes [ ] No If yes, describe treatment (list only those medications used for the diagnosed condition): Topomax, Imitrex. 3. Symptoms ----------- a. Does the Veteran experience headache pain? [X] Yes [ ] No [X] Pulsating or throbbing head pain [X] Pain on both sides of the head CONFIDENTIAL Page 13 of 20 b. Does the Veteran experience non-headache symptoms associated with headaches? (including symptoms associated with an aura prior to headache pain) [X] Yes [ ] No [X] Nausea [X] Sensitivity to light [X] Sensitivity to sound c. Indicate duration of typical head pain [X] Less than 1 day d. Indicate location of typical head pain [X] Both sides of head 4. Prostrating attacks of headache pain --------------------------------------- a. Migraine / Non-Migraine- Does the Veteran have characteristic prostrating attacks of migraine / non-migraine headache pain? [X] Yes [ ] No If yes, indicate frequency, on average, of prostrating attacks over the last several months: [X] Once every month b. Does the Veteran have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability? [ ] Yes [X] No 5. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No c. Comments, if any: No response provided. 6. Diagnostic testing --------------------- Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No 7. Functional impact -------------------- Does the Veteran's headache condition impact his or her ability to work? CONFIDENTIAL Page 14 of 20 [X] Yes [ ] No If yes, describe the impact of the Veteran's headache condition, providing one or more examples: Difficulty with concentration. 8. Remarks, if any: ------------------- No remarks provided. /es/ Physician, Compensation & Pension (PM&R) Signed: 06/07/2016 09:19 Date/Time: 07 Jun 2016 @ 0730 Note Title: COMP & PEN MENTAL HEALTH/PSYCHOLOGY EXAM Location: Signed By: Co-signed By: I applied for IU and this is my C&P for my migraines and TBI which is correct save for them saying I only have prostrating migraines once a month its like 4 or 5 times a month. Is there a way to get that corrected or should I wait and see and how do you think that looks with regards to my chances with getting IU. Taking into account my C&P for PTSD done the same day 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes[ ] No 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD Comments, if any: The Veteran reported having the following PTSD CONFIDENTIAL Page 15 of 20 symptoms at this time: Irritabiity and anger outbursts; sleep disturbance, with nightmares and related fatigue; troubling recall of combat events; hypervigilant thoughts and behaviors; exaggerated startle response; marital and family distress and avoidance of stimuli associated with his combat epxeriences. Mental Disorder Diagnosis #2: Personality Disorder traits b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes[X] No c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [X] Yes[ ] No[ ] Not shown in records reviewed d. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [X] Yes[ ] No[ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis: The Veteran reported having the following PTSD symptoms at this time: Irritabiity and anger outbursts; sleep disturbance, with nightmares and related fatigue; troubling recall of combat events; hypervigilant thoughts and behaviors; exaggerated startle response; marital and family distress and avoidance of stimuli associated with his combat epxeriences. Please refer to TBI exam for TBI relatedsequela. 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with reduced reliability and productivity b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes[ ] No[X] No other mental disorder has been diagnosed CONFIDENTIAL Page 16 of 20 c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [X] Yes[ ] No[ ] No diagnosis of TBI If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: The Veteran reported having the following PTSD symptoms at this time: Irritabiity and anger outbursts; sleep disturbance, with nightmares and related fatigue; troubling recall of combat events; hypervigilant thoughts and behaviors; exaggerated startle response; marital and family distress and avoidance of stimuli associated with his combat epxeriences. Please refer to TBI exam for TBI relatedsequela. SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence review ------------------ In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: ------------------------- Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes[ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [ ] Yes[ ] No If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) CONFIDENTIAL Page 17 of 20 [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [ ] Yes[ ] No 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: Please refer to previous C&P PTSD exams dated 5/7/2012 & 3/23/2015 for additional background and history. Veteran married his current spouse in April 2016. Veteran has a 9 month old biological child and a 9 year old step child with current spouse. Veteran has a 6 year old daughter from first marriage and reported "very little" contact with this child. Veteran reported regular phone contact with his parents. Veteran denied any current hobby/interests other than "taking care of my son". b. Relevant Occupational and Educational history: Veteran reported he is a Junior in college but last attended the University of Texas in 2014. Veteran reported interest in resuming his college career in the future. Veteran denied any work history since previous C&P PTSD exam dated 3/23/2015. c. Relevant Mental Health history, to include prescribed medications and family mental health: Veteran's current psychotropic medication is lithium carbonate. d. Relevant Legal and Behavioral history: Veteran indicated he was arrested for DWI in 2007, and making a terroristic threat (non-felony) in 2011. e. Relevant Substance abuse history: Veteran acknowledged a history of excessive alcohol use in the past but denied any current difficulty related to alcohol use. f. Other, if any: No response provided. 3. PTSD Diagnostic Criteria CONFIDENTIAL Page 18 of 20 --------------------------- Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threateningsituat ions (non-combat related stressors.) Do NOT mark symptoms below that are clearly not attributable to the Criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic the of "I event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) the following: [X] Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined"). [X] Persistent negative emotional state (e.g., fear, horror, CONFIDENTIAL Page 19 of 20 of anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Exaggerated startle response. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Chronic sleep impairment [X] Flattened affect [X] Disturbances of motivation and mood 5. Behavioral Observations: --------------------------- The Veteran's thought process and communication skills appeared to be within normal limits. The Veteran denied having any symptoms of delusions or hallucinations and none were apparent. The Veteran was cooperative, maintained good eye contact, and exhibited no inappropriate behavior. CONFIDENTIAL Page 20 of 20 The Veteran denied having any current suicidal or homicidal ideation, plan, or intent. The Veteran appeared able to maintain personal hygiene and basic activities of daily living. The Veteran was well-oriented to all three spheres. The Veteran's short and long term memory appeared to be without gross deficits. 6. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes[X] No 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes[ ] No 8. Remarks, (including any testing results) if any:

Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review CONFIDENTIAL Page 9 of 20 --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS SECTION I: Diagnosis and medical history ---------------------------------------- 1. Diagnosis ------------ Does the Veteran now have or has he/she ever had a traumatic brain injury (TBI) or any residuals of a TBI? [X] Yes [ ] No [X] Traumatic brain injury (TBI) Date of diagnosis: 2005 2. Medical history ------------------ Describe the history (including onset and course) of the Veteran's TBI and residuals attributable to TBI (brief summary): The veteran is already SC for TBI. he states that he was exposed to a IED blast in Iraq in 2005, which rendered him unconscious for a brief moment. he says migraine headache started soon after the explosion. SECTION II: Assessment of facets of TBI-related cognitive impairment and subjective symptoms of TBI ----------------------------------------------------------------------------- 1. Memory, attention, concentration, executive functions -------------------------------------------------------- [X] No complaints of impairment of memory, attention, concentration, or executive functions 2. Judgment ----------- [X] Normal 3. Social interaction --------------------- [X] Social interaction is routinely appropriate 4. Orientation -------------- [X] Always oriented to person, time, place, and situation CONFIDENTIAL Page 10 of 20 5. Motor activity (with intact motor and sensory system) -------------------------------------------------------- [X] Motor activity normal 6. Visual spatial orientation ----------------------------- [X] Normal 7. Subjective symptoms ---------------------- [X] Three or more subjective symptoms that mildly interfere with work; instrumental activities of daily living; or work, family or other close relationships. Examples of findings that might be seen at this level of impairment are: intermittent dizziness, daily mild to moderate headaches, tinnitus, frequent insomnia, hypersensitivity to sound, hypersensitivity to light If the Veteran has subjective symptoms, describe (brief summary): Migraines, sensitivity to light, tinnitus (on right). 8. Neurobehavioral effects -------------------------- [X] No neurobehavioral effects 9. Communication ---------------- [X] Able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language. 10. Consciousness ----------------- [X] Normal SECTION III: Additional residuals, other findings, diagnostic testing, functional impact and remarks ----------------------------------------------------------------------------- 1. Residuals ------------ Does the Veteran have any subjective symptoms or any mental, physical or neurological conditions or residuals attributable to a TBI (such as migraine headaches or Meniere's disease)? [X] Yes [ ] No [X] Headaches, including Migraine headaches 2. Other pertinent physical findings, scars, complications, conditions, signs, symptoms and scars CONFIDENTIAL Page 11 of 20 ----------------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No c. Comments, if any: No response provided 3. Diagnostic testing --------------------- a. Has neuropsychological testing been performed? [ ] Yes [X] No b. Have diagnostic imaging studies or other diagnostic procedures been performed? [ ] Yes [X] No c. Has laboratory testing been performed? [ ] Yes [X] No d. Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No 4. Functional impact -------------------- Do any of the Veteran's residual conditions attributable to a traumatic brain injury impact his or her ability to work? [ ] Yes [X] No 5. Remarks, if any: ------------------- Migraine headache and sensitivity to light are the only residuasl from TBI in service at this juncture. **************************************************************************** Headaches (including Migraine Headaches) Disability Benefits Questionnaire Name of patient/Veteran: CONFIDENTIAL Page 12 of 20 Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a headache condition? [X] Yes [ ] No [X] Migraine including migraine variants Date of diagnosis: 2005 2. Medical History ------------------ a. Describe the history (including onset and course) of the Veteran's headache conditions (brief summary): The veteran reports onset of severe recurrent headache right after the IED explosion in 2005. b. Does the Veteran's treatment plan include taking medication for the diagnosed condition? [X] Yes [ ] No If yes, describe treatment (list only those medications used for the diagnosed condition): Topomax, Imitrex. 3. Symptoms ----------- a. Does the Veteran experience headache pain? [X] Yes [ ] No [X] Pulsating or throbbing head pain [X] Pain on both sides of the head CONFIDENTIAL Page 13 of 20 b. Does the Veteran experience non-headache symptoms associated with headaches? (including symptoms associated with an aura prior to headache pain) [X] Yes [ ] No [X] Nausea [X] Sensitivity to light [X] Sensitivity to sound c. Indicate duration of typical head pain [X] Less than 1 day d. Indicate location of typical head pain [X] Both sides of head 4. Prostrating attacks of headache pain --------------------------------------- a. Migraine / Non-Migraine- Does the Veteran have characteristic prostrating attacks of migraine / non-migraine headache pain? [X] Yes [ ] No If yes, indicate frequency, on average, of prostrating attacks over the last several months: [X] Once every month b. Does the Veteran have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability? [ ] Yes [X] No 5. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No c. Comments, if any: No response provided. 6. Diagnostic testing --------------------- Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No 7. Functional impact -------------------- Does the Veteran's headache condition impact his or her ability to work? CONFIDENTIAL Page 14 of 20 [X] Yes [ ] No If yes, describe the impact of the Veteran's headache condition, providing one or more examples: Difficulty with concentration. 8. Remarks, if any: ------------------- No remarks provided. /es/ Physician, Compensation & Pension (PM&R) Signed: 06/07/2016 09:19 Date/Time: 07 Jun 2016 @ 0730 Note Title: COMP & PEN MENTAL HEALTH/PSYCHOLOGY EXAM Location: Signed By: Co-signed By: I applied for IU and this is my C&P for my migraines and TBI which is correct save for them saying I only have prostrating migraines once a month its like 4 or 5 times a month. Is there a way to get that corrected or should I wait and see and how do you think that looks with regards to my chances with getting IU. Taking into account my C&P for PTSD done the same day 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes[ ] No 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD Comments, if any: The Veteran reported having the following PTSD CONFIDENTIAL Page 15 of 20 symptoms at this time: Irritabiity and anger outbursts; sleep disturbance, with nightmares and related fatigue; troubling recall of combat events; hypervigilant thoughts and behaviors; exaggerated startle response; marital and family distress and avoidance of stimuli associated with his combat epxeriences. Mental Disorder Diagnosis #2: Personality Disorder traits b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes[X] No c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [X] Yes[ ] No[ ] Not shown in records reviewed d. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [X] Yes[ ] No[ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis: The Veteran reported having the following PTSD symptoms at this time: Irritabiity and anger outbursts; sleep disturbance, with nightmares and related fatigue; troubling recall of combat events; hypervigilant thoughts and behaviors; exaggerated startle response; marital and family distress and avoidance of stimuli associated with his combat epxeriences. Please refer to TBI exam for TBI relatedsequela. 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with reduced reliability and productivity b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes[ ] No[X] No other mental disorder has been diagnosed CONFIDENTIAL Page 16 of 20 c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [X] Yes[ ] No[ ] No diagnosis of TBI If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: The Veteran reported having the following PTSD symptoms at this time: Irritabiity and anger outbursts; sleep disturbance, with nightmares and related fatigue; troubling recall of combat events; hypervigilant thoughts and behaviors; exaggerated startle response; marital and family distress and avoidance of stimuli associated with his combat epxeriences. Please refer to TBI exam for TBI relatedsequela. SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence review ------------------ In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: ------------------------- Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes[ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [ ] Yes[ ] No If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) CONFIDENTIAL Page 17 of 20 [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [ ] Yes[ ] No 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: Please refer to previous C&P PTSD exams dated 5/7/2012 & 3/23/2015 for additional background and history. Veteran married his current spouse in April 2016. Veteran has a 9 month old biological child and a 9 year old step child with current spouse. Veteran has a 6 year old daughter from first marriage and reported "very little" contact with this child. Veteran reported regular phone contact with his parents. Veteran denied any current hobby/interests other than "taking care of my son". b. Relevant Occupational and Educational history: Veteran reported he is a Junior in college but last attended the University of Texas in 2014. Veteran reported interest in resuming his college career in the future. Veteran denied any work history since previous C&P PTSD exam dated 3/23/2015. c. Relevant Mental Health history, to include prescribed medications and family mental health: Veteran's current psychotropic medication is lithium carbonate. d. Relevant Legal and Behavioral history: Veteran indicated he was arrested for DWI in 2007, and making a terroristic threat (non-felony) in 2011. e. Relevant Substance abuse history: Veteran acknowledged a history of excessive alcohol use in the past but denied any current difficulty related to alcohol use. f. Other, if any: No response provided. 3. PTSD Diagnostic Criteria CONFIDENTIAL Page 18 of 20 --------------------------- Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threateningsituat ions (non-combat related stressors.) Do NOT mark symptoms below that are clearly not attributable to the Criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic the of "I event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) the following: [X] Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined"). [X] Persistent negative emotional state (e.g., fear, horror, CONFIDENTIAL Page 19 of 20 of anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Exaggerated startle response. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Chronic sleep impairment [X] Flattened affect [X] Disturbances of motivation and mood 5. Behavioral Observations: --------------------------- The Veteran's thought process and communication skills appeared to be within normal limits. The Veteran denied having any symptoms of delusions or hallucinations and none were apparent. The Veteran was cooperative, maintained good eye contact, and exhibited no inappropriate behavior. CONFIDENTIAL Page 20 of 20 The Veteran denied having any current suicidal or homicidal ideation, plan, or intent. The Veteran appeared able to maintain personal hygiene and basic activities of daily living. The Veteran was well-oriented to all three spheres. The Veteran's short and long term memory appeared to be without gross deficits. 6. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes[X] No 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes[ ] No 8. Remarks, (including any testing results) if any: ---------------------------------------------------

I just rececently had C&Ps for both PTSD and TBI/Migraines. Both were done at the VA after I repopened my claim for IU. Since it was done in house should it not show up in myhealthevet? I went back on ebenefits and it went from being estimated from 09/30/2016-02/01/2017 to being done sometime around august this year now that I just had my C&Ps on 20160607. I'm assuming it changed because they received the needed documents but why can't I see them so I can try and assess my chances. When I was speaking to both of them the last who was doing my tbi/migraines stated that he agreed my migraines are poorly controled and they should be trying more to reduce them from 4 a week and asked how I did in school and work when I was not suffering from them which I did excellent when I wasn't suffering from them. I'm hoping it comes back favorable

Yea I don't care what branch someone joins I just hate when people say they could have been a Marine but....they didn't want to wait, they were too smart or whatever. Have pride in whichever branch you served in. My dad is career AF so I actually joined because I grew up military. But its annoying when people give you the woulda, shoulda, coulda thing

I agree. Its so obvious. What I'll never get is I frankly don't begin to care what someone did or did not do until they start to try and convince me that they were in the shit as a super secret recon marsoc seal who was fast roping into bagdhad etc. You could have been a supply clerk for all I care just be who you are, nothing more nothing less. I too know guys who have more severe and less severe PTSD that were in the same things I was it depends on the person. Why people try to impress you with stories I'll never understand, its almost as incredibly stupid as the people who tell you either they almost joined the Marines or they could have made it but chose to serve in another. As if I really care either way...

You know what you did and how it affected you. Its only when people start embellishing things or trying to garner attention which distracts from those who should rate it that it becomes an issue with myself.

Yep we had some of those types. When my vic was hit we had a guy who from that point on never left the wire again which in a line co is impossible unless you bitch out. Mind you myself, my gunner and a-driver(who took shrapnel in the face) all went back out within a week after a few days vomiting and shit. But he is the type of guy who goes home telling war stories. I knew a guy who claims all this ptsd stuff yet we were on the same deployment and he was never once close to an IED or a firefight and spent most of his time on a fob processing intel reports. The majority of my boys and myself have always been pretty low key, many women and people I've had classes with never knew I was in the Corps let alone in Iraq. Even my fiancee doesn't know very much. Now if I am talking to one of my boys or a few other friends I have that were in the Army of course we shoot the shit about all the bs and shit that went on or if I run into someone at the VA I'll do the same. It isn't the fact that someone is shaken up about shit that happened or that someone didn't do exactly what I did that bothers me its what you said the guys with all the cool stories who in reality shit themselves when things actually happened and are out trying to get people to "thank them for their service" when I've yet to meet anyone who actually went through much who enjoys that nor gives a shit what others who were not there think of their time deployed.

Yea I don't want it to come off as if I am disparaging people who had different experiences but from my experience many times the ones who speak the loudest about their time in did the least. Bragadocio is what I can't stand. The men I served with have no desire to talk about all the things they did etc.

Updated

When you filed did you do it via paper or online? If you did it online did you file PTSD with the addition that its combat related. All of my contentions gave me the option to add combat related when I filed for an increase in PTSD in february. It won't affect your compensation but as others have said you should get it fixed as it may come into play if/when you apply for an increase and also helps with you not having to prove the majority of contentions you make regarding your ptsd or other related disabilities.

So my claim finished yesterday. I was rated at 50% for migraines with light sensitivity and 10% for TBI for a 90% overall rating. So my new breakdown is as follows: 70%-PTSD 50%-Migraines with light sensitivity 10%-Tinnitus 10%-Left Shoulder dislocation with mild impingement 0%-Chronic right ankle sprain with laxity. However I do not see IU listed as denied or deferred. Other contentions I had which were denied like vertigo show "not service connected" and prior to my claim closing the last listed contention was IU. I checked my AB8 letter so I know that I am rated at 90% and also being paid at the 90% rate meaning IU was not granted. Obviously I'll need to wait for the BWI( I've never gotten a brown one from them) but I was wondering why it doesn't even show it being denied or deferred etc. I will be going up to see my MH provider so that she can write a detailed statement about how my PTSD has over the past three or so years has impacted my work and academic life as she is the sole person I have seen for MH since somewhere in 2011.

I will say this as well. It makes me rather indifferent to others. I have a severe lack of empathy for virtually everyone. Even among veterans I am very harsh and critical with regards to who I actually believe truly warrant any empathy from me. The ones deployed who claim they have severe PTSD when the worst they experienced was a stray mortar round landing within a few 100m of them or the well I always lived in fear of blah blah types. I also have and still do have a complete lack of emotion. Even anger rarely bothers me. The prevailing thing most people notice about me is my flat affect. Whether talking about the death of one of my Marines or whether to get white or wheat bread I have no inflection or expression in my voice or on my face and lastly I have yet to feel any sort of attachment to anyone my own child and soon to be second or my fiancee either. Now that is probably the one aspect I generally do not mention at the VA because in the end I'm utterly indifferent to that fact as well. I know that it SHOULD probably bother me but it doesn't and hasn't. Thankfully I am very adept at emulating emotions so no one not even my MH providers are aware of that fact.

I have seen that happen with my own claim that is an FDC. They seem to give you very broad dates and the worst case scenario if they end up needing more evidence or there is a backwards change in status and then as soon as that is straightened out it goes right back to the original timeline. I had the same thing occur with me.