mskallday

Hello all, just wanted to share my success story. I etsed from Active Duty in December 2015, and used the quick start program. I had a very pleasant experience with the Milwaukee VA. I received 80% combined disabilty with a few deferments. All but hearing loss was found service connected. I'm amazed at how fast the process was for me. Thank you all for the knowledge I have found on this site. Not sure if I should try to argue some of the 0% I got, but I'm thinking that I should just be greatful for what I got.

Thanks for the input Navy4life!

That is is crazy... So far I had an excellent experience with the Milwaukee VA, but I say that without my ratings haha. I guess I'll see, I did the quick start program on active duty, all my exams are done and moved into prep for decision phase week ago.

Thanks for the input Flores97!

Anyone else have any opinions on how these issues will get rated?

Iceturkee, the examiner agrees that it is service connected. Never had an MRI done on it. I'm very confused on how they rate back issues

Hello all, I recently got off active duty and had a CnP for my back. I was wondering what do you think the outcome of this exam will be? I have had back injuries all through my 6 years on active duty. A combined 11 months of No PT, no lifting profiles (dead mans profile). My range of motion is very poor in my back and continue to have issues with it. Every xray that I have gotten states disc narrowing suggesting DDD. I dont know why the examiner put it does not affect my ability to work, we discussed how it is an issue while in classes and in everyday functions. Thanks in advance everyone! 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a thoracolumbar spine (back) condition? [X] Yes [ ] No Thoracolumbar Common Diagnoses: No response provided. Diagnosis #1: lumbar strain ICD code: ?? Date of diagnosis: 2/27/2013 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's thoracolumbar spine (back) condition (brief summary): original clam veteran testifies to and has documentation of being seen for lumbago 2/27/2013, 3/15/2013 and 4/1/2013 after lifting 50# boxes. testfies to "got a shot in the back while I was in Germany because I couldn't walk, friends had to drive me to medical help. I've tried the RICE and Ibuprophen route, dosen't help. The Medic gave me stretching excercises --sometimes, makes it feel worse. I've even tried my Dad's TENS unit without relief. There has been no formal PT for back condition. b. Does the Veteran report flare-ups of the thoracolumbar spine (back)? [X] Yes [ ] No If yes, document the Veteran's description of the flare-ups in his or her own words: "it's there 24/7, stiff & tight" c. Does the Veteran report having any functional loss or functional impairment of the thoracolumbar spine (back) (regardless of repetitive use)? [ ] Yes [X] No 3. Range of motion (ROM) and functional limitation -------------------------------------------------- a. Initial range of motion [ ] All normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Forward Flexion (0 to 90): 0 to 60 degrees Extension (0 to 30): 0 to 10 degrees Right Lateral Flexion (0 to 30): 0 to 15 degrees Left Lateral Flexion (0 to 30): 0 to 15 degrees Right Lateral Rotation (0 to 30): 0 to 15 degrees Left Lateral Rotation (0 to 30): 0 to 15 degrees If abnormal, does the range of motion itself contribute to a functional loss? [ ] Yes (please explain) [X] No Description of pain (select best response): Pain noted on exam but does not result in/cause functional loss If noted on exam, which ROM exhibited pain (select all that apply)? Forward Flexion, Extension, Right Lateral Flexion, Left Lateral Flexion, Right Lateral Rotation, Left Lateral Rotation Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine (back)? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): mid thoracic to lumbar subjective tenderness b. Observed repetitive use Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional loss of function or range of motion after three repetitions? [ ] Yes [X] No c. Repeated use over time Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation d. Flare-ups Is the exam being conducted during a flare-up? [ ] Yes [X] No If the examination is not being conducted during a flare-up: [ ] The examination is medically consistent with the Veteran's statements describing functional loss during flare-ups. [ ] The examination is medically inconsistent with the Veteran's statements describing functional loss during flare-ups. Please explain. [X] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups. Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups? [ ] Yes [ ] No [X] Unable to say w/o mere speculation e. Guarding and muscle spasm Does the Veteran have guarding or muscle spasm of the thoracolumbar spine (back)? [X] Yes [ ] No Muscle spasm: [X] None [ ] Resulting in abnormal gait or abnormal spinal contour [ ] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: Localized tenderness: [ ] None [ ] Resulting in abnormal gait or abnormal spinal contour [X] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: Guarding: [X] None [ ] Resulting in abnormal gait or abnormal spinal contour [ ] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: f. Additional factors contributing to disability In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: None 4. Muscle strength testing -------------------------- a. Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Hip flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Knee extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle plantar flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle dorsiflexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Great toe extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 b. Does the Veteran have muscle atrophy? [ ] Yes [X] No 5. Reflex exam -------------- Rate deep tendon reflexes (DTRs) according to the following scale: 0 Absent 1+ Hypoactive 2+ Normal 3+ Hyperactive without clonus 4+ Hyperactive with clonus Knee: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Ankle: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam --------------- Provide results for sensation to light touch (dermatome) testing: Upper anterior thigh (L2): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Thigh/knee (L3/4): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Lower leg/ankle (L4/L5/S1): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Foot/toes (L5): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Other sensory findings, if any: full vibratory sensing 7. Straight leg raising test ---------------------------- Provide straight leg raising test results: Right: [X] Negative [ ] Positive [ ] Unable to perform Left: [X] Negative [ ] Positive [ ] Unable to perform 8. Radiculopathy ---------------- Does the Veteran have radicular pain or any other signs or symptoms due to radiculopathy? [ ] Yes [X] No 9. Ankylosis ------------ Is there ankylosis of the spine? [ ] Yes [X] No 10. Other neurologic abnormalities ---------------------------------- Does the Veteran have any other neurologic abnormalities or findings related to a thoracolumbar spine (back) condition (such as bowel or bladder problems/pathologic reflexes)? [ ] Yes [X] No 11. Intervertebral disc syndrome (IVDS) and episodes requiring bed rest ----------------------------------------------------------------------- a. Does the Veteran have IVDS of the thoracolumbar spine? [ ] Yes [X] No 12. Assistive devices --------------------- a. Does the Veteran use any assistive device(s) as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [ ] Yes [X] No 13. Remaining effective function of the extremities --------------------------------------------------- Due to a thoracolumbar spine (back) condition, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc.; functions of the lower extremity include balance and propulsion, etc.) [X] No 14. 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 15. Diagnostic testing ---------------------- a. Have imaging studies of the thoracolumbar spine been performed and are the results available? [ ] Yes [X] No b. Does the Veteran have a thoracic vertebral fracture with loss of 50 percent or more of height? [ ] Yes [X] No c. Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No 16. Functional impact --------------------- Does the Veteran's thoracolumbar spine (back) condition impact on his or her ability to work? [ ] Yes [X] No 17. Remarks, if any: -------------------- remains independent with ADLS, attends classes M-TH, drove self to exam in own Trans Am vehicle ------------- Dx: lumbar strain

Thanks for the input Dot09!

Thank you for the responses! Berta, I had all the MRIs done at army medical facilities including one at Walter reed. She told me to goto my primary care if I wanted a new one. As for the PTSD rating, I'm a little confused because I have symptoms and issues from the 50%,70% groups but I realize that the occupational block checked up top is the 30% one.

Hello all, I was Active duty in the Army for 6 years and have two deployments to Iraq. I have been lurking on this site for a while and have learned so much! I recently got out and had all of my exams completed, and my claim is currently in the preparation for determination phase. I was wondering if i could get some advice on two of my exams and see what everyone thought. 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a central nervous system (CNS) condition? [X] Yes [ ] No [X] Brain tumor Date of diagnosis: 04/2013 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's central nervous conditions (brief summary): veteran had a brain MRI due to c/o abnormal thyroid function. The MRI was done on 4/2/2013 and showed 14mm thin rim enhancing pineal gland lesion consistent with pineal cyst vs pineocytoma vs epidermoid. He subsequently had several more MRI's ( 5/13. 11/13, and 5/15) which were unchanged. It was felt that his symptoms were not related to the cyst. Veteran feels that his current symptoms which include vision changes, headaches, dizziness, nausea and memory problems are related to his benign cyst. He has been seem for memory loss and found to have no deficits. Seen by eye clinic diagnosed with benign retinal tuft and Myopic astigmatism. b. Does the Veteran's central nervous system condition require continuous medication for control? [ ] Yes [X] No c. Does the Veteran have an infectious condition? [ ] Yes [X] No If yes, is it active? [ ] Yes [ ] No d. Dominant hand [X] Right [ ] Left [ ] Ambidextrous 3. Conditions, signs and symptoms --------------------------------- a. Does the Veteran have any muscle weakness in the upper and/or lower extremities? [ ] Yes [X] No b. Does the Veteran have any pharynx and/or larynx and/or swallowing conditions? [ ] Yes [X] No c. Does the Veteran have any respiratory conditions (such as rigidity of the diaphragm, chest wall or laryngeal muscles)? [ ] Yes [X] No d. Does the Veteran have sleep disturbances? [ ] Yes [X] No e. Does the Veteran have any bowel functional impairment? [ ] Yes [X] No f. Does the Veteran have voiding dysfunction causing urine leakage? [ ] Yes [X] No g. Does the Veteran have voiding dysfunction causing signs and/or symptoms of urinary frequency? [ ] Yes [X] No h. Does the Veteran have voiding dysfunction causing findings, signs and/or symptoms of obstructed voiding? [ ] Yes [X] No i. Does the Veteran have voiding dysfunction requiring the use of an appliance? [ ] Yes [X] No j. Does the Veteran have a history of recurrent symptomatic urinary tract infections? [ ] Yes [X] No k. Does the Veteran (if male) have erectile dysfunction? [ ] Yes [X] No 4. Neurologic exam ------------------ a. Speech [X] Normal [ ] Abnormal b. Gait [X] Normal [ ] Abnormal, describe: c. Strength Rate strength according to the following scale: 0/5 No muscle movement 1/5 Visible muscle movement, but no joint movement 2/5 No movement against gravity 3/5 No movement against resistance 4/5 Less than normal strength 5/5 Normal strength Elbow flexion: Right:[X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Elbow extension: Right:[X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist flexion: Right:[X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist extension: Right:[X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Grip: Right:[X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Pinch (thumb to index finger): Right:[X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Knee extension: Right:[X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle plantar flexion: Right:[X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle dorsiflexion: Right:[X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 d. Deep tendon reflexes (DTRs) Rate reflexes according to the following scale: 0 Absent 1+ Decreased 2+ Normal 3+ Increased without clonus 4+ Increased with clonus Biceps: Right:[ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Triceps: Right:[ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Brachioradialis: Right:[ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Knee: Right:[ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Ankle: Right:[ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ e. Does the Veteran have muscle atrophy attributable to a CNS condition? [ ] Yes [X] No f. Summary of muscle weakness in the upper and/or lower extremities attributable to a CNS condition (check all that apply): Right upper extremity muscle weakness: [X] None Left upper extremity muscle weakness: [X] None Right lower extremity muscle weakness: [X] None Left lower extremity muscle weakness: [X] None 5. Tumors and neoplasms -------- --------------- a. Does the Veteran have a benign or malignant neoplasm or metastases related to any of the diagnoses in the Diagnosis section? [X] Yes [ ] No b. Is the neoplasm: [X] Benign [ ] Malignant c. Has the Veteran completed treatment or is the Veteran currently undergoing treatment for a benign or malignant neoplasm or metastases? [ ] Yes [X] No; watchful waiting d. Does the Veteran currently have any residual conditions or complications due to the neoplasm (including metastases) or its treatment, other than those already documented in the report above? [ ] Yes [X] No 6. 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 7. Mental health manifestations due to CNS condition or its treatment --------------------------------------------------------------------- a. Does the Veteran have depression, cognitive impairment or dementia, or any other mental health conditions attributable to a CNS disease and/or its treatment? [ ] Yes [X] No 8. Differentiation of Symptoms or Neurologic Effects ---------------------------------------------------- Are you able to differentiate what portion of the symptomatology or neurologic effects above are caused by each diagnosis? [ ] Yes [X] No 9. Assistive devices -------------------- a. Does the Veteran use any assistive device(s) as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [ ] Yes [X] No 10. Remaining effective function of the extremities --------------------------------------------------- Due to a CNS condition, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc., while functions for the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 11. Diagnostic testing ---------------------- a. Have imaging studies been performed? [X] Yes [ ] No If yes, provide most recent results, if available: Several brain MRI's since intial one in 4/2013 unchanged as described in medical history b. Have PFTs been performed? [ ] Yes [X] No c. If PFTs have been performed, is the flow-volume loop compatible with upper airway obstruction? [ ] Yes [ ] No d. Are there any other significant diagnostic test findings and/or results? [ ] Yes [ ] No 12. Functional impact --------------------- Do the Veteran's central nervous system disorders impact his or her ability to work? [ ] Yes [X] No 13. Remarks, if any: -------------------- No remarks provided. I have some issues for this because I Have documented insomnia issues since 2011 and the exam states no sleep disturbances, also the examiner say no to ED, which i was diagnosed in service with and was also in my DBQ for it. The examiner was aware that i have not had an MRI in a year and did not think it mattered, also the examiner only spend a total of 5 minutes with me total. PTSD CnP 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [X] Yes [ ] No 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): hypothyroid, migraine headaches, low back pain 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)? [ ] Yes [X] No [ ] Not shown in records reviewed Comments, if any: the veteran described no clear incident of TBI 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 occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation 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 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? [ ] Yes [ ] No [X] No diagnosis of TBI 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 [X] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: 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 [X] 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) [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [ ] Yes [X] No 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): The veteran said that his life at home when he was growing up was good, no history of abuse. His father is a Catholic Deacon so family worked with the church. He was pretty well behaved in high school. Bought a house with his brother prior to joining the Army. That brother's son also lives with them now. The veteran stated that he "hates" the current arrangement. His nephew is very active and "drives me nuts." The veteran said that he feels like he has no time to relax. Never married and no children. The veteran reported that he served in the Army from 2009-2016. His job was in satellite communications. He deployed to Iraq in 2011 and 2014. His 2011 deployment was during the drawdown so not lot of security available. He experienced a lot of indirect fire. Rockets came in by his housing area during 1 incident, landing and exploding about 15 meters away. Alarms went off, one round came in, then another, third was very close. He jumped to the ground and slammed his head on a wall locker. No LOC. He described having a "near death" expereince from an IED. He was traveling to a green zone and the vehicle hit an IED. He said there were no injuries but "that scared the shit out of me." Lot of experience with indirect fire, he felt under constant threat. He started having bad sleep issues during his first deployment. He said that he did not want to go to sleep because all fire came in at night. During his 2014 deployment he was in an apache attack helicopter batallian. He said that he had very little security at that time, were under constant threat, and had a very heavy workload, averaging 16 hour days. He ran all the apache feeds, drone feeds, worked in strike cell, saw over 100 strikes through video feeds on Isis where people were injured or killed. Thinks about deployments daily, including "how shitty it was there." He said those thoughts put him into a bad mood. He said that he thinks about many near death experiences, and being desensitized to violence. He said that he has violent dreams about weekly. Avoids crowds, traffic jams, and fireworks. He said the driving gives him panic. Nothing that is particularly hard to talk about from his experiences. No real guilt. Can't connect with others like he used to. Can only get along with a few people that he knew from the Army. Since he got out he hasn't talked to anyone other than who he has to. Feels detached from others. Lost interest in many things. Used to like sports, exercise, and video games but he doesn't do those things anymore. Goes to school, comes home, and then "I just sit there." No positive feelings. He frequently feels paranoid about people, such as strangers who are walking around. Paranoid about vehicles that look run down or like something is heavy in the car. Concentration not good. Stays up for a day or two then crashes, and will sleep 4-5 hours before waking again. He said that his mind races during times when he stays up, but not making bad decisions during those times. Not happier than usual during those times. He said that a pineal gland tumor was discovered in 2012. His thyroid lab values were off, did brain scan to look at pituitary. Tumor on or near the pineal gland. Told that he would likely either have more physical or mental symptoms. No treatment for that tumor. Plan was to monitor it. Memory issues have gotten worse over last 1.5 years. Mid sentence he forgets things. Needs notes to remember. Will drive and realize he doesn't remember the route, like zoning out "but at the extreme." Conversations depend on how important the topic was. Memory gaps in his life, like his family's birthdays. Has blurred memory for some events from Iraq, things that he feels that he should remember but can't. b. Relevant Occupational and Educational history (pre-military, military, and post-military): The veteran said that he did poorly in school. He said "everything was hard, even gym." He said that he learned to read without difficulty and never repeated a grade. He recalled being placed in a special study group with a teachers aid. Graduated from high school in 2008. Now going to MATC for criminial justice. Not enjoying it, grades are middle of the road. Doesn't like being there, including getting irritated with "kids that are self-entitled." They are rude and he gets upset because they didnt have to serve in the Army to be able to go to school. Used profanity once to tell a student to stop talking and was reprimanded by the teacher. The veteran said that he has not worked since being discharged from the Army. Wants to work in law enforcement eventually. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): When asked about his current mood the veteran said "I'm in a miserable state all the time." He said that he is felt like that for over a year. Same issues when he was in active duty. He said that he began treatment through mental health in the military in 2012. Knew he was having issues after his first deployment. His brother encouraged him to seek help. He said that he had a few sessions with a psychologist but indicated that he doesn't like to talk so did not continue that treatment. Saw a psychiatrist monthly. No meds were really helpful, only adderall, which he has been on for year. Sleep meds don't work. He said that he has taken many SSRIs but they dont help and he said that he doesn't feel depressed anyway. Taken anxiety medication but that didn't help either. No mental health treatment since he was discharged from the military. Mood most days is irritable, like an emotional roller coaster. The constant in his life is being annoyed. Doesn't have good days, just worse days. Worries about himself or other people getting injured. If he is in a scenario he pictures people getting injured in various ways, he said "I make things up in my mind." He said that he isn't accident prone so he doesn't know why he is thinking about such catastrophes. Took adderall in middle school into high school, stopped becasue he thought he couldn't take that medication in the Army. He started that treatment again in the Army. Hearing has gotten worse since his last deployment when he was on an airfield. Hears things that aren't there such as talking and noises. Inaudible talking. Not threatening. No one giving him prescription for Adderall presently. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): denied. e. Relevant Substance abuse history (pre-military, military, and post-military): No alcohol now for one year. Was drinking heavily in 2012, not daily, but he binged on the weekends. No recreational drugs. Started drinking heavily in the Army. f. Other, if any: Before he leaves the house he checks every faucet multiple times, goes out door, goes back in, to make sure that no water is running. He said that he has a fear of flooding the house. Makes sure he locks the door four times before he leaves. Likes to have everything a certain way, and he doesn't deviate from that way. "Freaks out" if things are messed up. Gets sweaty with racing heart and feeling flushed during panic times. He said that his mind races at times, which happens frequently when he is driving. Sometimes he can talk himself down, sometimes not. Tries to get himself out of situations that make him panic. Doesn't do anything in his free time. Gets panicked on Sunday nights about homework and does it at the last minute. Hates himself for procrastinating because he will need to stay up all night doing work. He said that he was assaulted in 2012. He said that he was in a bar and his buddy was saying derogatory things that got a group of people upset. Vet tried to stop them going after his buddy. He tried shielding him, but took a few hits to the head. Not really unconscious but felt like "the lights were on and off." Confused after that incident and had a headache and his jaw hurt. Didn't report it because he was underage. Happened when he was in the Army. 3. Stressors ------------ Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: being close to a rocket attack Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No b. Stressor #2: his vehicle was hit by an IED Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No c. Stressor #3: witnessing enemy deaths via drone feeds Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. 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 #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criteria A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). 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) [X] Witnessing, in person, the traumatic event(s) as they occurred to others 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). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic 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 external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the 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) of the following: [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. [X] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) 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) of 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] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes 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. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 [X] Stressor #2 [X] Stressor #3 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks that occur weekly or less often [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting 6. Behavioral Observations -------------------------- The veteran arrived on time for the evaluation. He ambulated independently and was casually dressed. Speech and comprehension were within normal limits. His affect was mildly restricted and his mood appeared depressed. There was no obvious evidence for psychosis. His thought process was grossly logical and linear. Insight into his condition was intact. His cognitive functioning appeared within normal limits. 7. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 8. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any -------------------------------------------------- The veteran scored in the low average range on a test of his intellectual functioning. Verbal comprehension was average, perceptual reasoning was borderline, working memory was average, and processing speed was low average. He demonstrated low average ability to learn a story over trials and average ability to recall the material after a delay. His recognition memory for that information was average. He showed average ability to learn a list of words over trials and his recall of the material after a delay was mildly impaired. His recognition memory for that information was mildly impaired. He showed moderately impaired ability to copy a complex figure and borderline ability to recall the material immediately and after a delay. His recognition memory for that information was average. Word reading was average range. He scored in the low average range on a test of attention and visual scanning and in the average range on a related measure of mental flexibility. His performance on a test of conceptualization was borderline and he had tendency to lose his train of thought on that measure. He had difficulty on a measure of sustained attention. The veteran endorsed symptoms of severe level depression and significant symptoms of PTSD. He reported significant inattention both as an adult and a child. He performed poorly on a test of effort. On a measure of personality functioning he showed evidence of magnifying the severity of his psychiatric difficulties. He also reported preoccupation with his physical functioning, anxiety, depression, suspicion of other people, isolation, and an aggressive attitude. His overall profile was most suggestive of PTSD. In summary, this was an abnormal neuropsychological profile. The veteran performed poorly on a test of effort and had difficulty on measures of his visual-perceptual skills, thought processing speed, memory, conceptualization, sustained attention, and planning. His poor effort likely accounts for those findings. It is more likely than not that the veteran has PTSD that is due to hostile military or terrorist activity. Based on his report and review of records, the veteran had no incident of head injury with clear loss of consciousness; therefore, is less likely than not that he has any residual difficulties due to head injury. It is less likely than not that his reported pineal gland tumor or cyst has any impact on his current cognitive or psychiatric functioning. His claimed memory difficulty is likely a symptom of PTSD.