Coach Edgar

good morning everyone, i just have a question on TDIU claim, I was awared TDIU as of yesterday 02-03-17.. i spoke to a va rep and asked her abput my retro pay, effective date for my TDIU is March 6 2016. how long would it be before i recive my retro pay, cause my DAV rep told me that it could take months cause something to do with ssi disability and aduit,

my claim was moved to gathering eveidence on the 25th of january, then on the 30th moved back to pre for decision, and this morning it is in pending approval. is that normal? the date changed as well it is say febuary 5th 2017 to Feburary 8th 2017... TODAY THIS MORNING I CHECKED AND IT WAS ALREADY PENDING NOTIFICATION, BUT MY A8 LETTERS STILL SAY THE SAME RATING I HAD BEFORE.. HOW WOULD I KNOW WHAT VA AWARDED ME WITH...

No The Enemy thank you for your response, my claim was filed for increase and also for TDIU on July 29, 2016... yes that was the word suspense that my VSO told me that they had in the system for DAV. do you work for the VA?

No The Enemy thank you for your response, my claim was filed for increase and also for TDIU on July 29, 2016... yes that was the word suspense that my VSO told me that they had in the system for DAV. do you work for the VA?

HELLO WANTED TO KNOW IF ANYONE HAS BEEN THROUGH MY SITUATION OF CLAIM GOING BACK AND FORTH TO GATHERING EVEIDENCE... MY CLAIM HAS BEEN SENT BACK 4 TIMES, IT WAS IN THE PREPARATION FOR DECESION THEN THIS EVENING IT WENT BACK TO GATHERING EVEIDENCE, WHEN THIS MORING I WAS TOLD IT WAS IN THE PREPRATION FOR DECISION. I SPOKE TO MY REPRESENTIAVE THE DAV ON MONDAY THEY TOLD ME THAT VA HAS A SUSPENED LETTER FOR MY CLAIM TO BE DONE BY FEBUAY 14TH 2017, CAN SOME ONE PLEASE LET ME KNO WHAT TO DO...

SM = SERVICE MEMBER, MRS. BERTA this is my last C&P exam in november 2016: LOCAL TITLE: C&P EXAMINATION STANDARD TITLE: C & P EXAMINATION NOTE DATE OF NOTE: NOV 22, 2016 ENTRY DATE: NOV 23, 2016@12:21:58 AUTHOR: LOFLIN,PAUL M EXP COSIGNER: URGENCY: STATUS: COMPLETED Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [ ] Yes [X] No If no diagnosis of PTSD, check all that apply: [X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [X] Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire: 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: unspecified trauma-and stressor-related disorder ICD code: F43.9 Mental Disorder Diagnosis #2: persistent depressive disorder ICD code: F34.1 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): deferred to medical 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: symptom overlap c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 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 [X] No [ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: symptom overlap 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 ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): He was born in Weslaco, Texas and raised in Alamo by his biological parents. He has one brother. He stated that his father was an alcoholic and would "talk down at [him]." He was also physically abusive. He got along with peers and teachers and played sports in school. The veteran was living with his wife, daughter, age two and 8-year-old son, but they separated and he is now living with a friend. He visits with his children regularly. He stated that he was arguing and irritable with his spouse and that he was "swearing" in front of his children. "I was getting mad for no reason." His mother died in a nursing home with stroke (09/2016) and his father died of "alcoholism" (10/2016). He stated the symptoms of depression have increased since they died. "The whole world's on top of me." He continues to coach softball with teenage girls on the weekends. Relationships were good in the military. b. Relevant Occupational and Educational history (pre-military, military, and post-military): He graduated high school with average grades. There were no learning or attentional problems. He worked part-time at a department store during his teenage years. He was active duty Army (2002-2005) with highest rank SPC and rank at discharge of PFC due to disciplinary problem. Discharge was honorable. He received GWOT, NDSM, Global war on terrorism expeditionary medal. He was in Southwest Asia (2004). Post-military, he received a certificate for medical Assistant (2015). He has been unemployed since February 2015 after having productivity problems in a position as heavy equipment operator. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): He did not report pre-military mental health issues or family history of psychiatric problems, though his father drank heavily. Records indicate he was admitted to John Randolph Medical Center in January 2005 with "depression." Recent VA records show he has been receiving mental health treatment for trauma-related disorder and depression since January 2016. He has received both group and individual therapy. The veteran stated that symptoms of depression have been increased since his parents died 1-2 months ago. Currently, he reports symptoms of depression including feelings of guilt, decreased pleasure and interest in activities, decreased energy, irritability, tiredness, and problems sleeping. He stated that he feels guilty for not being with his parents anymore or with his family. He reports symptoms of trauma- and stressor- related disorder including occasional distressing dreams or intrusive memories, reactions to cues in the environment (seeing people with Middle Eastern clothing"), decreased interest in activities, irritability, hypervigilance, and problems sleeping. Medications: Buspirone, lisinopril. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): none e. Relevant Substance abuse history (pre-military, military, and post-military): 6-pack of beer per month. f. Other, if any: No response provided. 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: Feeling that his life was threatened during deployment with danger of being killed. 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: Seeing "dead bodies" when coming back from Iraq. 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: Hearing that one of his SM friends was killed. 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 Criterion 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 Criterion 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 violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. 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] 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: No response provided. 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] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. 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] 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] Chronic sleep impairment [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 -------------------------- MENTAL STATUS EXAMINATION Appearance: Casual, appropriate. Behavior: cooperative. Speech: WNL Mood/Affect: WNL, appropriate to content. Orientation: Oriented to all spheres. Cognitions: WNL, not formally tested. Safety: Danger to self/others? NO Safe to return home? YES Risk Factors assessment: [NO] Patient has current thoughts of hurting or killing themselves? [NO] Patient has current thoughts of hurting or killing someone else? [NO] Patient has is looking for a way to kill themselves or has a plan? [NO] Patient has taken actions to activate plan? [NO] Patient has history of compromised impulse control? Judgment: FAIR Insight: FAIR 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 -------------------------------------------------- Please comment on the effect of the Veteran's service connected disabilities on his or her ability to function in an occupational environment and describe any identified functional limitations. Please refrain from opining on if the veteran is unemployable or employable; instead focus and reflect on the functional impairments and how these impairments impact occupational and employment activities. Comment: The veteran is able to function independently and engage in activities of daily living. He is able to drive an automobile and research jobs or prepare for job interviews. However, symptoms of depression and trauma-and stressor-related disorder would negatively impact his motivation. Problems sleeping and tiredness may negatively impact performance and productivity. Irritability may cause interpersonal problems on the job. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. **************************************************************************** Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: 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 MEDICAL OPINION SUMMARY ----------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: Does the Veteran have a diagnosis of (a) unspecified trauma and stressor related disorder with major depressive disorder that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) friend killed in action during service? b. Indicate type of exam for which opinion has been requested: DBQ PSYCH PTSD INITIAL TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. c. Rationale: STRs show treatment for depression during service (2005). He served in Southwest Asia, feared for his life and found out that a SM friend of his was killed in service. He currently reports symptoms of depression and trauma-and stressor-related disorder, such as irritability, low energy, problems sleeping, intrusive memories, distressing dreams, reactions to cues in the environment. *************************************************************************

this is my last C&P exam in november 2016: LOCAL TITLE: C&P EXAMINATION STANDARD TITLE: C & P EXAMINATION NOTE DATE OF NOTE: NOV 22, 2016 ENTRY DATE: NOV 23, 2016@12:21:58 AUTHOR: LOFLIN,PAUL M EXP COSIGNER: URGENCY: STATUS: COMPLETED Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [ ] Yes [X] No If no diagnosis of PTSD, check all that apply: [X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [X] Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire: 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: unspecified trauma-and stressor-related disorder ICD code: F43.9 Mental Disorder Diagnosis #2: persistent depressive disorder ICD code: F34.1 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): deferred to medical 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: symptom overlap c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 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 [X] No [ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: symptom overlap 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 ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): He was born in Weslaco, Texas and raised in Alamo by his biological parents. He has one brother. He stated that his father was an alcoholic and would "talk down at [him]." He was also physically abusive. He got along with peers and teachers and played sports in school. The veteran was living with his wife, daughter, age two and 8-year-old son, but they separated and he is now living with a friend. He visits with his children regularly. He stated that he was arguing and irritable with his spouse and that he was "swearing" in front of his children. "I was getting mad for no reason." His mother died in a nursing home with stroke (09/2016) and his father died of "alcoholism" (10/2016). He stated the symptoms of depression have increased since they died. "The whole world's on top of me." He continues to coach softball with teenage girls on the weekends. Relationships were good in the military. b. Relevant Occupational and Educational history (pre-military, military, and post-military): He graduated high school with average grades. There were no learning or attentional problems. He worked part-time at a department store during his teenage years. He was active duty Army (2002-2005) with highest rank SPC and rank at discharge of PFC due to disciplinary problem. Discharge was honorable. He received GWOT, NDSM, Global war on terrorism expeditionary medal. He was in Southwest Asia (2004). Post-military, he received a certificate for medical Assistant (2015). He has been unemployed since February 2015 after having productivity problems in a position as heavy equipment operator. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): He did not report pre-military mental health issues or family history of psychiatric problems, though his father drank heavily. Records indicate he was admitted to John Randolph Medical Center in January 2005 with "depression." Recent VA records show he has been receiving mental health treatment for trauma-related disorder and depression since January 2016. He has received both group and individual therapy. The veteran stated that symptoms of depression have been increased since his parents died 1-2 months ago. Currently, he reports symptoms of depression including feelings of guilt, decreased pleasure and interest in activities, decreased energy, irritability, tiredness, and problems sleeping. He stated that he feels guilty for not being with his parents anymore or with his family. He reports symptoms of trauma- and stressor- related disorder including occasional distressing dreams or intrusive memories, reactions to cues in the environment (seeing people with Middle Eastern clothing"), decreased interest in activities, irritability, hypervigilance, and problems sleeping. Medications: Buspirone, lisinopril. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): none e. Relevant Substance abuse history (pre-military, military, and post-military): 6-pack of beer per month. f. Other, if any: No response provided. 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: Feeling that his life was threatened during deployment with danger of being killed. 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: Seeing "dead bodies" when coming back from Iraq. 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: Hearing that one of his SM friends was killed. 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 Criterion 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 Criterion 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 violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. 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] 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: No response provided. 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] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. 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] 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] Chronic sleep impairment [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 -------------------------- MENTAL STATUS EXAMINATION Appearance: Casual, appropriate. Behavior: cooperative. Speech: WNL Mood/Affect: WNL, appropriate to content. Orientation: Oriented to all spheres. Cognitions: WNL, not formally tested. Safety: Danger to self/others? NO Safe to return home? YES Risk Factors assessment: [NO] Patient has current thoughts of hurting or killing themselves? [NO] Patient has current thoughts of hurting or killing someone else? [NO] Patient has is looking for a way to kill themselves or has a plan? [NO] Patient has taken actions to activate plan? [NO] Patient has history of compromised impulse control? Judgment: FAIR Insight: FAIR 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 -------------------------------------------------- Please comment on the effect of the Veteran's service connected disabilities on his or her ability to function in an occupational environment and describe any identified functional limitations. Please refrain from opining on if the veteran is unemployable or employable; instead focus and reflect on the functional impairments and how these impairments impact occupational and employment activities. Comment: The veteran is able to function independently and engage in activities of daily living. He is able to drive an automobile and research jobs or prepare for job interviews. However, symptoms of depression and trauma-and stressor-related disorder would negatively impact his motivation. Problems sleeping and tiredness may negatively impact performance and productivity. Irritability may cause interpersonal problems on the job. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. **************************************************************************** Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: 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 MEDICAL OPINION SUMMARY ----------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: Does the Veteran have a diagnosis of (a) unspecified trauma and stressor related disorder with major depressive disorder that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) friend killed in action during service? b. Indicate type of exam for which opinion has been requested: DBQ PSYCH PTSD INITIAL TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. c. Rationale: STRs show treatment for depression during service (2005). He served in Southwest Asia, feared for his life and found out that a SM friend of his was killed in service. He currently reports symptoms of depression and trauma-and stressor-related disorder, such as irritability, low energy, problems sleeping, intrusive memories, distressing dreams, reactions to cues in the environment. *************************************************************************

Thank you Berta and Buck 52 for your response, VA is aware that i get SSDI for my SC disabilites.

Gastone i didnt list my friends name nor date of death, unspecified trauma and stressor related disorder with major depressive disorder (previously addressed as major depression) 50% Service Connected 03/01/2016

updatd ptsd notes.docx

whats eed Berta? Is the 50% above in a recent award? it was awared in march 1st 2016

yes Berta they diagnosed me with Unspcified trauma and stressor in Febuary of this year, when i went to my C&P exam in September the psychiatrist he diagnosed me with PTSD, and for me to follow up with the VA.. so in november i went to my second C&P exam and that is when the VA Psychiatrist di my exam and also wrote notes on my evaluation.

i cant seem to be able to find my 2007 VA decision.

hey Gastone my claim for IU is a fully develpoed claim.

VA NOTS FROM DOCTORS.txt

i first submitted my calim for PTSD in 07

May 2016 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: [X] Military service treatment records [ ] Military service personnel records [X] Military enlistment examination [ ] Military separation examination [X] Military post-deployment questionnaire [X] Department of Defense Form 214 Separation Documents [X] Veterans Health Administration medical records (VA treatment records) [X] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [X] Other: VHA medical record (CPRS) and VA e-folder (VBMS records) were reviewed. There was no physical C-File available as all documents were available in e-folder per C&P exam instructions. 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): Pre-military: Veteran was born in Weslaco, Texas and raised in Alamo, Texas. He was raised by both parents and grew up with a brother. Veteran described his childhood as "okay, my mom was a stay at home mother, my dad worked, and was also an alcoholic, always talking down to me and hitting my older brother when he was drunk." Veteran reported that he got along with other children and teachers while growing up. He participated in baseball and football while in school. Military: Veteran reported that he got along "pretty good" with other soldiers. Post-military: Veteran lives with his spouse and two children, seven year-old son and one year-old daughter. Veteran and his wife have been married since 2005. He described his relationship with his wife as "married, have our ups and downs." Veteran described his relationship with his children as "nice." He spends most of his time with his daughter. His hobby is to "coach a travel selected team for softball." He stated he spends time with friends "on the weekends" barbecuing. b. Relevant Occupational and Educational history (pre-military, military, and post-military): Pre-military: Veteran obtained a high school degree from Pharr-San Juan-Alamo High School. He reported that his grades were average and denied having any learning or attention problems. Military: Veteran served active duty in the Army from April 17, 2002 to April 16, 2005. MOS: 92F, Petroleum Supply Specialist. Rank at Discharge: E-3. Discharge: Honorable. Veteran was awarded the Army Lapel Button, National Defense Service Medal, Global War on Terrorism Expeditionary Medal, Global War on Terrorism Service Medal, Army Service Ribbon. Veteran served in Southwest Asia from February 7, 2004 to August 24, 2004. Post-military: Veteran completed a certificate for medical assistant in 2015 from Southern Careers Institute. Veteran is current unemployed; he was last employed February 2015. Veteran stated he was a heavy equipment operator for the city of Donna from December 2014 to February 2015. He stated he was fired because his "director told [him] [his] position was no longer needed." He denied having disciplinary problems at this job. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Pre-military: Veteran denied mental health history including hospitalizations for mental health problems. Veteran reported that his father was "always drinking alcohol." Military: Veteran stated that he was diagnosed with depression "January 2004." He reported that he was hospitalized for two weeks at John Randolph hospital in Virginia. Veteran reported, "When I came back from my tour in 2004, I woke up one morning and decided to cut my wrist with my Gerber knife. Then I realized what the hell I was doing, I drove myself to the local hospital in Virginia." Veteran denied seeing anyone wounded, killed or dead during deployment when he completed September 2, 2003 Post-Deployment Health Assessment. He did endorse feeling like he was in great danger of being killed. Veteran denied having little interest in doing things, feeling depressed, nightmares, avoidance behavior, hypervigilance, and feeling detached from others. He reported that his health in general was "very good." According to Report of Consultation from John Randolph Medical Center dated January 19, 2005, Veteran was "admitted to psychiatric services with depression." According to the Behavioral Health Initial Assessment from John Randolph Medical Center dated January 15, 2005, "He is in the process of getting divorced from his wife who lives in Texas. He said that he has been feeling stressed since this past weekend and yesterday he held a knife in his hand and wanted to hurt himself. He reported feeling depressed, having decreased energy, decreased appetite, decreased sleep. He has been having some flashbacks and nightmares about the war in Iraq." Post-military: Veteran is prescribed Buspirone and Fluoxetine; he stated he is compliant with psychotropic medication. Veteran attended primary care mental health integration initial appointment on January 19, 2016. He then attended mental health initial evaluation on February 10, 2016. Veteran attended VPTT Consult on February 23, 2016. He was no-show to follow-up appointment for VPTT on May 2, 2016 and May 9, 2016. Veteran denied current auditory and visual hallucinations. He denied current suicidal and homicidal ideation, intent, or plan. Nonetheless, he was provided with Veterans Crisis Line information. Veteran was instructed to monitor symptoms, including emergence of suicidal or homicidal ideation, and to utilize this number, call 911, or go to nearest ER at closest hospital, in case of mental health emergency. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): Pre-military: Veteran denied legal and behavioral history. Military: Veteran reported he lost rank "for being late so many times." He denied receiving Article 15s. Post-military: Veteran denied legal and behavioral history. e. Relevant Substance abuse history (pre-military, military, and post-military): Pre-military: Veteran denied substance use including alcohol and cigarettes. Military: Veteran reported that he drank alcohol "like every weekend." He stated that he smoked cigarettes "just the weekends probably like six or seven cigarettes." Veteran denied use of other substances. Post-military: Veteran reported that he drinks "2 - 3 beers a week." He stated he is no longer smoking cigarettes. Veteran denied use of other substances. f. Other, if any: No response provided. 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: Veteran reported that he served in Kuwait and Iraq. He denied engaging in direct combat. Veteran reported, "We were, I was doing guard duty one night and we heard the patriotic missiles, there were SCUD missiles coming in," "cause we were near Camp Virginia," "and we had to put on MOPP [mission oriented protective posture] gear" "because there was blood pathogen in the air." He stated, "one of my friends getting killed" "something I heard about." "We saw some dead bodies on our way back from Iraq," "we were 50 miles close to border line, coming back to Kuwait." 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 --------------------------- No response provided 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Anxiety [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships 6. Behavioral Observations -------------------------- Veteran was alert and oriented x3. Dress was casual but appropriate. Attitude was cooperative and polite. Speech was clear, coherent, and relevant. Mood was "pretty good." Affect was consistent with mood and topics discussed. Thought processes were logical, linear, and goal-oriented. Thought content was WNL, with no signs or reports of A/V hallucinations, delusions, paranoia, or homicidal ideation/plan/intent. Veteran denied current suicidal ideation/plan/intent. Memory appeared intact. Judgment appeared adequate. 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 -------------------------------------------------- Please note that level of impairment is only based on Unspecified Trauma-and Stressor-Related Disorder and Major Depressive Disorder, in partial remission. Veteran has physical impairments, which were not assessed today. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. /es/ MARIA T Artiaga, PsyD Supervised Psychology Staff Signed: 05/31/2016 11:28 Receipt Acknowledged By: 06/05/2016 16:22 /es/ DESI A. VASQUEZ, PHD SUPERVISORY PSYCHOLOGIST ------------------------------------------------------------------------- November 2016 2nd C&P Exam Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: Edgar Sandoval SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [ ] Yes [X] No If no diagnosis of PTSD, check all that apply: [X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [X] Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire: 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: unspecified trauma-and stressor-related disorder ICD code: F43.9 Mental Disorder Diagnosis #2: persistent depressive disorder ICD code: F34.1 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): deferred to medical 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: symptom overlap c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 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 [X] No [ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: symptom overlap 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 ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): He was born in Weslaco, Texas and raised in Alamo by his biological parents. He has one brother. He stated that his father was an alcoholic and would "talk down at [him]." He was also physically abusive. He got along with peers and teachers and played sports in school. The veteran was living with his wife, daughter, age two and 8-year-old son, but they separated and he is now living with a friend. He visits with his children regularly. He stated that he was arguing and irritable with his spouse and that he was "swearing" in front of his children. "I was getting mad for no reason." His mother died in a nursing home with stroke (09/2016) and his father died of "alcoholism" (10/2016). He stated the symptoms of depression have increased since they died. "The whole world's on top of me." He continues to coach softball with teenage girls on the weekends. Relationships were good in the military. b. Relevant Occupational and Educational history (pre-military, military, and post-military): He graduated high school with average grades. There were no learning or attentional problems. He worked part-time at a department store during his teenage years. He was active duty Army (2002-2005) with highest rank SPC and rank at discharge of PFC due to disciplinary problem. Discharge was honorable. He received GWOT, NDSM, Global war on terrorism expeditionary medal. He was in Southwest Asia (2004). Post-military, he received a certificate for medical Assistant (2015). He has been unemployed since February 2015 after having productivity problems in a position as heavy equipment operator. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): He did not report pre-military mental health issues or family history of psychiatric problems, though his father drank heavily. Records indicate he was admitted to John Randolph Medical Center in January 2005 with "depression." Recent VA records show he has been receiving mental health treatment for trauma-related disorder and depression since January 2016. He has received both group and individual therapy. The veteran stated that symptoms of depression have been increased since his parents died 1-2 months ago. Currently, he reports symptoms of depression including feelings of guilt, decreased pleasure and interest in activities, decreased energy, irritability, tiredness, and problems sleeping. He stated that he feels guilty for not being with his parents anymore or with his family. He reports symptoms of trauma- and stressor- related disorder including occasional distressing dreams or intrusive memories, reactions to cues in the environment (seeing people with Middle Eastern clothing"), decreased interest in activities, irritability, hypervigilance, and problems sleeping. Medications: Buspirone, lisinopril. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): none e. Relevant Substance abuse history (pre-military, military, and post-military): 6-pack of beer per month. f. Other, if any: No response provided. 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: Feeling that his life was threatened during deployment with danger of being killed. 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: Seeing "dead bodies" when coming back from Iraq. 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: Hearing that one of his SM friends was killed. 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 Criterion 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 Criterion 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 violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. 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] 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: No response provided. 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] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. 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] 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] Chronic sleep impairment [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 -------------------------- MENTAL STATUS EXAMINATION Appearance: Casual, appropriate. Behavior: cooperative. Speech: WNL Mood/Affect: WNL, appropriate to content. Orientation: Oriented to all spheres. Cognitions: WNL, not formally tested. Safety: Danger to self/others? NO Safe to return home? YES Risk Factors assessment: [NO] Patient has current thoughts of hurting or killing themselves? [NO] Patient has current thoughts of hurting or killing someone else? [NO] Patient has is looking for a way to kill themselves or has a plan? [NO] Patient has taken actions to activate plan? [NO] Patient has history of compromised impulse control? Judgment: FAIR Insight: FAIR 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 -------------------------------------------------- Please comment on the effect of the Veteran's service connected disabilities on his or her ability to function in an occupational environment and describe any identified functional limitations. Please refrain from opining on if the veteran is unemployable or employable; instead focus and reflect on the functional impairments and how these impairments impact occupational and employment activities. Comment: The veteran is able to function independently and engage in activities of daily living. He is able to drive an automobile and research jobs or prepare for job interviews. However, symptoms of depression and trauma-and stressor-related disorder would negatively impact his motivation. Problems sleeping and tiredness may negatively impact performance and productivity. Irritability may cause interpersonal problems on the job. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. **************************************************************************** Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: Edgar Sandoval 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 MEDICAL OPINION SUMMARY ----------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: Does the Veteran have a diagnosis of (a) unspecified trauma and stressor related disorder with major depressive disorder that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) friend killed in action during service? b. Indicate type of exam for which opinion has been requested: DBQ PSYCH PTSD INITIAL TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. c. Rationale: STRs show treatment for depression during service (2005). He served in Southwest Asia, feared for his life and found out that a SM friend of his was killed in service. He currently reports symptoms of depression and trauma-and stressor-related disorder, such as irritability, low energy, problems sleeping, intrusive memories, distressing dreams, reactions to cues in the environment. ************************************************************************* /es/ Paul Loflin, PhD Clinical Psychologist Signed: 11/23/2016 12:21

continued may 2016 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: [X] Military service treatment records [ ] Military service personnel records [X] Military enlistment examination [ ] Military separation examination [X] Military post-deployment questionnaire [X] Department of Defense Form 214 Separation Documents [X] Veterans Health Administration medical records (VA treatment records) [X] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [X] Other: VHA medical record (CPRS) and VA e-folder (VBMS records) were reviewed. There was no physical C-File available as all documents were available in e-folder per C&P exam instructions. 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): Pre-military: Veteran was born in Weslaco, Texas and raised in Alamo, Texas. He was raised by both parents and grew up with a brother. Veteran described his childhood as "okay, my mom was a stay at home mother, my dad worked, and was also an alcoholic, always talking down to me and hitting my older brother when he was drunk." Veteran reported that he got along with other children and teachers while growing up. He participated in baseball and football while in school. Military: Veteran reported that he got along "pretty good" with other soldiers. Post-military: Veteran lives with his spouse and two children, seven year-old son and one year-old daughter. Veteran and his wife have been married since 2005. He described his relationship with his wife as "married, have our ups and downs." Veteran described his relationship with his children as "nice." He spends most of his time with his daughter. His hobby is to "coach a travel selected team for softball." He stated he spends time with friends "on the weekends" barbecuing. b. Relevant Occupational and Educational history (pre-military, military, and post-military): Pre-military: Veteran obtained a high school degree from Pharr-San Juan-Alamo High School. He reported that his grades were average and denied having any learning or attention problems. Military: Veteran served active duty in the Army from April 17, 2002 to April 16, 2005. MOS: 92F, Petroleum Supply Specialist. Rank at Discharge: E-3. Discharge: Honorable. Veteran was awarded the Army Lapel Button, National Defense Service Medal, Global War on Terrorism Expeditionary Medal, Global War on Terrorism Service Medal, Army Service Ribbon. Veteran served in Southwest Asia from February 7, 2004 to August 24, 2004. Post-military: Veteran completed a certificate for medical assistant in 2015 from Southern Careers Institute. Veteran is current unemployed; he was last employed February 2015. Veteran stated he was a heavy equipment operator for the city of Donna from December 2014 to February 2015. He stated he was fired because his "director told [him] [his] position was no longer needed." He denied having disciplinary problems at this job. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Pre-military: Veteran denied mental health history including hospitalizations for mental health problems. Veteran reported that his father was "always drinking alcohol." Military: Veteran stated that he was diagnosed with depression "January 2004." He reported that he was hospitalized for two weeks at John Randolph hospital in Virginia. Veteran reported, "When I came back from my tour in 2004, I woke up one morning and decided to cut my wrist with my Gerber knife. Then I realized what the hell I was doing, I drove myself to the local hospital in Virginia." Veteran denied seeing anyone wounded, killed or dead during deployment when he completed September 2, 2003 Post-Deployment Health Assessment. He did endorse feeling like he was in great danger of being killed. Veteran denied having little interest in doing things, feeling depressed, nightmares, avoidance behavior, hypervigilance, and feeling detached from others. He reported that his health in general was "very good." According to Report of Consultation from John Randolph Medical Center dated January 19, 2005, Veteran was "admitted to psychiatric services with depression." According to the Behavioral Health Initial Assessment from John Randolph Medical Center dated January 15, 2005, "He is in the process of getting divorced from his wife who lives in Texas. He said that he has been feeling stressed since this past weekend and yesterday he held a knife in his hand and wanted to hurt himself. He reported feeling depressed, having decreased energy, decreased appetite, decreased sleep. He has been having some flashbacks and nightmares about the war in Iraq." Post-military: Veteran is prescribed Buspirone and Fluoxetine; he stated he is compliant with psychotropic medication. Veteran attended primary care mental health integration initial appointment on January 19, 2016. He then attended mental health initial evaluation on February 10, 2016. Veteran attended VPTT Consult on February 23, 2016. He was no-show to follow-up appointment for VPTT on May 2, 2016 and May 9, 2016. Veteran denied current auditory and visual hallucinations. He denied current suicidal and homicidal ideation, intent, or plan. Nonetheless, he was provided with Veterans Crisis Line information. Veteran was instructed to monitor symptoms, including emergence of suicidal or homicidal ideation, and to utilize this number, call 911, or go to nearest ER at closest hospital, in case of mental health emergency. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): Pre-military: Veteran denied legal and behavioral history. Military: Veteran reported he lost rank "for being late so many times." He denied receiving Article 15s. Post-military: Veteran denied legal and behavioral history. e. Relevant Substance abuse history (pre-military, military, and post-military): Pre-military: Veteran denied substance use including alcohol and cigarettes. Military: Veteran reported that he drank alcohol "like every weekend." He stated that he smoked cigarettes "just the weekends probably like six or seven cigarettes." Veteran denied use of other substances. Post-military: Veteran reported that he drinks "2 - 3 beers a week." He stated he is no longer smoking cigarettes. Veteran denied use of other substances. f. Other, if any: No response provided. 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: Veteran reported that he served in Kuwait and Iraq. He denied engaging in direct combat. Veteran reported, "We were, I was doing guard duty one night and we heard the patriotic missiles, there were SCUD missiles coming in," "cause we were near Camp Virginia," "and we had to put on MOPP [mission oriented protective posture] gear" "because there was blood pathogen in the air." He stated, "one of my friends getting killed" "something I heard about." "We saw some dead bodies on our way back from Iraq," "we were 50 miles close to border line, coming back to Kuwait." 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 --------------------------- No response provided 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Anxiety [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships 6. Behavioral Observations -------------------------- Veteran was alert and oriented x3. Dress was casual but appropriate. Attitude was cooperative and polite. Speech was clear, coherent, and relevant. Mood was "pretty good." Affect was consistent with mood and topics discussed. Thought processes were logical, linear, and goal-oriented. Thought content was WNL, with no signs or reports of A/V hallucinations, delusions, paranoia, or homicidal ideation/plan/intent. Veteran denied current suicidal ideation/plan/intent. Memory appeared intact. Judgment appeared adequate. 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 -------------------------------------------------- Please note that level of impairment is only based on Unspecified Trauma-and Stressor-Related Disorder and Major Depressive Disorder, in partial remission. Veteran has physical impairments, which were not assessed today. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. /es/ MARIA T Artiaga, PsyD Supervised Psychology Staff Signed: 05/31/2016 11:28 Receipt Acknowledged By: 06/05/2016 16:22 /es/ DESI A. VASQUEZ, PHD SUPERVISORY PSYCHOLOGIST -------------------------------------------------------------------------

back in may 2016 my C&P exam for ptsd C&P MULTIPLE EXAM STANDARD TITLE: C & P MULTIPLE EXAM NOTE DATE OF NOTE: MAY 26, 2016@13:00 ENTRY DATE: MAY 31, 2016@11:28:11 AUTHOR: ARTIAGA,MARIA T EXP COSIGNER: URGENCY: STATUS: COMPLETED Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: Edgar Julian Sandoval SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [ ] Yes [X] No If no diagnosis of PTSD, check all that apply: [X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [X] Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire: 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Unspecified Trauma-and Stressor-Related Disorder ICD code: F43.9 (309.9) Comments, if any: Veteran's symptoms did not meet full diagnostic criteria for PTSD. Intrusive symptoms associated with traumatic stressor were sporadic, with intrusive thoughts and memories occurring "like two, three times in the past four months." Criteria was not met for negative alterations in cognitions and mood and marked changes in arousal and reactivity related to reported traumatic events. Symptoms reported by Veteran during today's, May 26, 2016, C&P Examination did meet DSM-5 diagnostic criteria for Unspecified Trauma-and Stressor-Related Disorder. Mental Disorder Diagnosis #2: Major Depressive Disorder, in partial remission ICD code: F33.41 (296.35) Comments, if any: According to November 9, 2005 C&P Evaluation, Veteran was diagnosed with Major Depression, Recurrent, Severe without Psychotic Traits. Please refer to this document for further information. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): obstructive sleep apnea; hypertension Comments, if any: Veteran has been diagnosed with obstructive sleep apnea; he stated he is not compliant with use of CPAP. He stated he uses CPAP "probably like three times a week." Please refer to Veterans Health Administration medical records (VA treatment records) for more information related to physical conditions. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: It is not possible to differentiate what portion of each symptom is attributable to each diagnosis due to the overlap in symptoms including occasional loss of interest in activities and irritability. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [X] Not shown in records reviewed 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 [X] No [ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: Veteran reported that he experiences irritability with family members including his wife and son. It is not possible to differentiate what portion of each symptom is attributable to each diagnosis due to the overlap in symptoms including occasional loss of interest in activities and irritability. 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

I WAS DENIED SLEEP APNEA IT WAS NOT SERVICE CONNECTED BUT YET I HAVE A CPAD MACHINE GIVING BY THE VA

FOR MY IU I DID SUBMITT A FORM TO MY LAST EMPLOYER TO FILL OUT AND I SENT IT TO THE VA IN JULY.

MY LAST C&P EXAM 11-22-2016 SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): He was born in Weslaco, Texas and raised in Alamo by his biological parents. He has one brother. He stated that his father was an alcoholic and would "talk down at [him]." He was also physically abusive. He got along with peers and teachers and played sports in school. The veteran was living with his wife, daughter, age two and 8-year-old son, but they separated and he is now living with a friend. He visits with his children regularly. He stated that he was arguing and irritable with his spouse and that he was "swearing" in front of his children. "I was getting mad for no reason." His mother died in a nursing home with stroke (09/2016) and his father died of "alcoholism" (10/2016). He stated the symptoms of depression have increased since they died. "The whole world's on top of me." He continues to coach softball with teenage girls on the weekends. Relationships were good in the military. b. Relevant Occupational and Educational history (pre-military, military, and post-military): He graduated high school with average grades. There were no learning or attentional problems. He worked part-time at a department store during his teenage years. He was active duty Army (2002-2005) with highest rank SPC and rank at discharge of PFC due to disciplinary problem. Discharge was honorable. He received GWOT, NDSM, Global war on terrorism expeditionary medal. He was in Southwest Asia (2004). Post-military, he received a certificate for medical Assistant (2015). He has been unemployed since February 2015 after having productivity problems in a position as heavy equipment operator. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): He did not report pre-military mental health issues or family history of psychiatric problems, though his father drank heavily. Records indicate he was admitted to John Randolph Medical Center in January 2005 with "depression." Recent VA records show he has been receiving mental health treatment for trauma-related disorder and depression since January 2016. He has received both group and individual therapy. The veteran stated that symptoms of depression have been increased since his parents died 1-2 months ago. Currently, he reports symptoms of depression including feelings of guilt, decreased pleasure and interest in activities, decreased energy, irritability, tiredness, and problems sleeping. He stated that he feels guilty for not being with his parents anymore or with his family. He reports symptoms of trauma- and stressor- related disorder including occasional distressing dreams or intrusive memories, reactions to cues in the environment (seeing people with Middle Eastern clothing"), decreased interest in activities, irritability, hypervigilance, and problems sleeping. Medications: Buspirone, lisinopril. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): none e. Relevant Substance abuse history (pre-military, military, and post-military): 6-pack of beer per month. f. Other, if any: No response provided. 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: Feeling that his life was threatened during deployment with danger of being killed. 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: Seeing "dead bodies" when coming back from Iraq. 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: Hearing that one of his SM friends was killed. 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 Criterion 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 Criterion 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 violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. 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] 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: No response provided. 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] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. 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] 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] Chronic sleep impairment [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 -------------------------- MENTAL STATUS EXAMINATION Appearance: Casual, appropriate. Behavior: cooperative. Speech: WNL Mood/Affect: WNL, appropriate to content. Orientation: Oriented to all spheres. Cognitions: WNL, not formally tested. Safety: Danger to self/others? NO Safe to return home? YES Risk Factors assessment: [NO] Patient has current thoughts of hurting or killing themselves? [NO] Patient has current thoughts of hurting or killing someone else? [NO] Patient has is looking for a way to kill themselves or has a plan? [NO] Patient has taken actions to activate plan? [NO] Patient has history of compromised impulse control? Judgment: FAIR Insight: FAIR 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 -------------------------------------------------- Please comment on the effect of the Veteran's service connected disabilities on his or her ability to function in an occupational environment and describe any identified functional limitations. Please refrain from opining on if the veteran is unemployable or employable; instead focus and reflect on the functional impairments and how these impairments impact occupational and employment activities. Comment: The veteran is able to function independently and engage in activities of daily living. He is able to drive an automobile and research jobs or prepare for job interviews. However, symptoms of depression and trauma-and stressor-related disorder would negatively impact his motivation. Problems sleeping and tiredness may negatively impact performance and productivity. Irritability may cause interpersonal problems on the job. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. **************************************************************************** Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: Edgar Sandoval 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 MEDICAL OPINION SUMMARY ----------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: Does the Veteran have a diagnosis of (a) unspecified trauma and stressor related disorder with major depressive disorder that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) friend killed in action during service? b. Indicate type of exam for which opinion has been requested: DBQ PSYCH PTSD INITIAL TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. c. Rationale: STRs show treatment for depression during service (2005). He served in Southwest Asia, feared for his life and found out that a SM friend of his was killed in service. He currently reports symptoms of depression and trauma-and stressor-related disorder, such as irritability, low energy, problems sleeping, intrusive memories, distressing dreams, reactions to cues in the environment. ************************************************************************* /es/ Paul Loflin, PhD Clinical Psychologist Signed: 11/23/2016 12:21 -------------------------------------------------------------------------

HEY GASTONE, GOOD EVENING I SUBMIT A CLAIM FOR PTSD BACK IN O5 WHEN THE VA DOCTOR DIAGNOSED ME WITH PTSD, BUT THE VA DENIED ME FOR PTSD IN 06, NOW THAT I HAVE MY RECORDS AND EVEN MY LAST C&P EVAULATION IT SAYS I HAVE PTSD, Posttraumatic Stress Disorder (ICD-9-CM 309.81) Date/Time Entered: 16 May 2005 @ 1200 Location: VA S. Texas Health Care System Status: ACTIVE Provider: BARREIRO,MARIBEL B Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: Edgar Sandoval SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [ ] Yes [X] No If no diagnosis of PTSD, check all that apply: [X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [X] Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire: 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: unspecified trauma-and stressor-related disorder ICD code: F43.9 Mental Disorder Diagnosis #2: persistent depressive disorder ICD code: F34.1 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): deferred to medical 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: symptom overlap c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 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 [X] No [ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: symptom overlap 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

HI EVERYONE THIS IS MY FIRST POST I DO IN HERE, I AM OIFAND OEF VETERAN, I GOT OUT THE SERVICE IN 2005, I WENT TO THE VA FOR THE FIRST TIME IN 2006, MY PRIMARY DOCTOR DIAGNOSED ME WITH PTSD BACK IN 2006. VA HAS ME AT 80% RATING. I HAD TWO SEPRATE C&P EXAM ONE IN SEPTEMBER 2016 AND ONE ON NOVEMBER 22, 2016, THE ONE FOR SEPTEMBER THE PYSCHIATRIST TOLD ME THAT I HAD PTSD, AND VA SAYS I DONT HAVE PTSD, BUT I WAS FIRST DIAGNOSED IN 2006, SO MY LAST C&P EXAM THE PYSCHIATRIST WROTE ON MY NOTES THAT I HAVE PTSD, MY QUESTION IS WILL I GET A RETRO FROM 2006 OR 2016... bilateral hearing loss 40% unspecified trauma and stressor related disorder with major depressive disorder (previously addressed as major depression) 50% bilateral hearing loss 40% hypertension 10% tinnitus 10%

HELLO EVERYONE MY NAME IS EDGAR I SERVED IN THE ARMY FROM 2002-2005. I AM CURRENTLY AT 80% RATE, RECENTLY IN JULY I GOT AWARED 80% FOR unspecified trauma and stressor related disorder with major depressive disorder (previously addressed as major depression) 50% bilateral hearing loss 40% hypertension 10% tinnitus 10% I have been unemployed since 2015 and when i was awared the 80% in July 2016 the DAV sent me a letter that i could apply for TDIU so i called the DAV and told them that i have not been working since Febuary 2015, i went ahead and submitted a claim for TDIU VA received my claim in July 29, 2016. I had two C&P exams done one in September 2016 and one in November 2016, the first C&P exam was a psychairatrist was at a doctors office that was set up by QTC, that doctor did my evaluation and stated that i have symptom of PTSD, and he recommened me to follow up on this, so then in November my other C&P exam was with the VA doctor there the VA doctor did the evaluation and this is what he put. Please comment on the effect of the Veteran's service connected disabilities on his or her ability to function in an occupational environment and describe any identified functional limitations. Please refrain from opining on if the veteran is unemployable or employable; instead focus and reflect on the functional impairments and how these impairments impact occupational and employment activities. Comment: The veteran is able to function independently and engage in activities of daily living. He is able to drive an automobile and research jobs or prepare for job interviews. However, symptoms of depression and trauma-and stressor-related disorder would negatively impact his motivation. Problems sleeping and tiredness may negatively impact performance and productivity. Irritability may cause interpersonal problems on the job. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. \