ptsd 100% Ptsd Rating That I Don't Want

[Koalabiter]

WARNING, LONG POST

I'll go ahead and clear the air here; I know this is going to upset a lot of Veterans that have been seeking a strong rating and have been denied. My apologies, I'm not trying to sound ungrateful here.

Here's the situation:

I am a full-time educator who has been working for several months (successfully). I was at a 50% PTSD rating for the the past four years, but recently went in for my re-evaluation. Terrified of the outcome and possible reduction, I went in prepared; I had my list of symptoms, I wrote down the worst days I've had recently, and I was open and honest with the evaluator. Today, I received notice that my rating for PTSD and depression has been raised to 100%.

The money would be nice. I have a family and am expecting another child soon, but I still don't want this rating.

I need to work. Structure and implied hierarchies rule my life. I have a routine that I daily and any deviation from this ruins the entire day. If they took my job away, I would genuinely lose it. . .

Here are the reasons I want to lose this rating:

1. I'm terrified of losing my routine and know full well that a new one wouldn't be good for me. The paycheck from the VA would be more than I could make at my job (teachers have a salary ladder) until about five years from now. If I have this much money coming in, I'll get stuck in a rut that I will never break free from.

2. I'm terrified about coming to grips with my condition. Yes, I have some problems. No, I don't think they are severe enough to warrant this decision. I'm able to work. I need to work. If I don't contribute something to the world then I'm lost. I know Vets who cannot function in daily society, and I'm not one of them. I don't want to take away from the people who really need this benefit.

3. I'm worried what others think. Yes, I know it's shallow, but I spend the majority of my time analyzing others. One of my conditions is that I've lost the ability to respond well socially; I'm emotionally numb unless I'm chemically altered. With a 50% rating, my friends, family (and possibly employers) think I've got a "little baggage." With 100%, I doubt they could ever look at me the same. Those that love me will question whether I'm going to do something drastic, and those who don't will judge me and may think I'm faking.

I'm grateful that the VA took the time and genuinely listened to me, but I think they're overdone it. Can anyone tell me how to rectify this situation? I don't want benefits I don't believe I'm entitled to. I don't want the VA to think I inflated my condition for profit, and I don't want to lose the one thing that keeps me from crawling into a hole (job).

How long can i continue to work before they come after me? I'd at least like to finish up the school year. If I break contract (even though it would be for good reason) I would really destroy my chances of ever teaching again. It's a small town, who would hire me after that?

Thanks for all the help.

[john999]

Just put the 100% money aside and keep working. If the VA had granted me 100% when I really had a chance to rehab myself I would have kissed the ground.

[OEFMP]

Hey guys I'm going to piggy back alittle off this forum. But I was wondering if anyone could maybe give me a ballpark figure from my PTSD C&P exam? Thanks in advance.

1. Diagnostic Summary

---------------------

Does the Veteran have a diagnosis of PTSD that conforms to DMS-5 criteria

based on today's evaluation?

[X] Yes [ ] No

2. Current Diagnoses

--------------------

a. Mental Disorder Diagnosis #1: PTSD

ICD code: F43.1

b. Medical diagnoses relevant to the understanding or management of the

Mental Health Disorder (to include TBI): See below.

Comments, if any: CPRS indicates 30% service-connection for:

IMPAIRED HEARING (0%-SC)

PARALYSIS OF MEDIAN NERVE (10%-SC)

TINNITUS (10%-SC)

LUMBOSACRAL OR CERVICAL STRAIN (10%-SC)

PARALYSIS OF SCIATIC NERVE (10%-SC)

LIMITED FLEXION OF FOREARM (0%-SC)

Computerized records indicate:

Knee pain

Tobacco Dependence

Overweight

Tinnitus, Subjective

Elevated Liver Function Tests

Lumbar Radiculopathy

Degen Disc Dis, Lumbar

Hearing loss

Low Back Pain

3. Differentiation of symptoms

------------------------------

a. Does the Veteran have more than one mental disorder diagnosed?

[ ] Yes [X] No

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 reviewed?

[X] Yes [ ] No

[ ] Yes [X] No

2. History

----------

a. Relevant Social/Marital/Family history (pre-military, military, and

post-military):

Mr. XXXXX was born in Corpus Christi, TX and raised in TX and NV.

His parents never divorced. Mr. XXXXX has no siblings and has an

excellent relationship with his parents.

Mr. XXXXX's first marriage lasted from 2003-2005 and his

second

from 2007-2010. He remarried in 2010 and described his current

relationship as "rocky." Mr. XXXXX has four children and

described

the relationship with his children as also "rocky." He

currently lives

with his parents in XXXXX, NV. Income sources include the GI Bill and

current service-connection.

Mr. XXXXX enjoys target practice every couple of months. He rarely

socializes.

b. Relevant Occupational and Educational history (pre-military, military,

and

post-military):

Veteran completed a GED in 2003. Veteran noted that he was diagnosed

with Attention Deficient Disorder as a child.

Mr. XXXXX joined with the National Guard in 2004 and is currently

enlisted. MOS include infantry (11B), combat engineer (21B) and

military police (21B). Mr. XXXXX reported exposure to combat fire

(small arms, mortars, rockets, RPGs) in Afghanistan from 2011-2012.

His current rank is E-5.

c. Relevant Mental Health history, to include prescribed medications and

family mental health (pre-military, military, and post-military):

Interim Mental Health History:

Mr. XXXXX and his wife currently participate in marital counseling

at the XXXXX Vet Center. Mr. XXXXX also participates in individual

therapy with Dr. Krogh and group therapy targeted at PTSD symptoms.

Mr. XXXXX is also followed by Dr. Pai for psychiatric medication

management.

CPRS lists active medications as:

AMITRIPTYLINE TAB 50MG

PRAZOSIN CAP,ORAL 1MG

HydrOXYzine PAMOATE CAP,ORAL 25MG

GABAPENTIN CAP,ORAL 300MG

METHOCARBAMOL TAB 500MG

LAMOTRIGINE TAB,ORAL 25MG

DICLOFENAC TAB,EC 75MG

MORPHINE TAB,SA 15MG

-----------------------------------------------------------------------

--------------------

PTSD Symptoms:

Intrusive Thoughts - Mr. XXXXX reported intrusive thoughts

regarding stressor #1 on a weekly basis.

Sleep/Nightmares - Mr. XXXXX reported nightmares that occur on a

weekly basis.

Dissociative reactions - Denied.

Psychological/Physiological Reactions - Anxiety, heart palpitations

And perspiration.

Avoidance - Veteran tends to avoid thoughts and conversations

Regarding combat experience.

Difficulty Remembering - Denied.

Distorted expectations/beliefs/blame - Chronic self-blame and

suspiciousness.

Persistent negative emotion - Chronic anger.

Loss of Interest - Rarely participates in hobby activities.

Distant/Emotionally Numb - Rarely socializes.

Irritability - Irritability on a daily basis.

Self-destructive/reckless - Denied.

Hypervigilance/Startle - Mr. XXXXX often scans for environmental

threats and is easily startle by sudden noises.

Difficulty Concentrating - He has difficulty concentrating on mundane

tasks.

-----------------------------------------------------------------------

--------------------

d. Relevant Legal and Behavioral history (pre-military, military, and

post-military):

Veteran reported legal problems for failure to comply with a court

order.

e. Relevant Substance abuse history (pre-military, military, and

post-military):

Alcohol:

Pre military: Rarely.

During Military: Weekend binge drinking.

Post Military: Three beers/week.

3. Stressors

------------

a. Stressor #1: Exposure to combat fire.

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 #6 - 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 (DMS-5).

Criterion A: Exposure to actual or threatened a) death, b) serious

injury,

c) sexual violatrion, in one or more of the following ways:

[X] Directly experiencing the tramuatic 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 distressing memories, thoughts,

Or feelings about or closely associated with the traumatic event(s).

[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] Persistent and exaggerated negative beliefs or expectations about

oneself, others, or the world (e.g., "I am bad,: "No one

can be trusted,: "The world is completely dangerous,: "My whole

nervous system is permanently ruined").

[X] Persistent, distorted cognitions about the cause or consequences

Of the traumatic event(s) that lead to the individual to blame

himself/herself or others.

[X] Persistent negative emotional state (e.g., fear, horror, anger,

guilt, or shame).

[X] Markedly diminished interest or participation in significant

activities.

[X] Feelings of detachment or estrangement from others.

Criterion E: Marked alterations in arousal and reactivity associated with

the traumatic event(s), beginning or worsening after the

traumatic event(s) occurred, as evidenced by two (or more)

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.

5. Symptoms

-----------

For VA rating purposes, check all symptoms that apply to the Veterans

diagnoses:

[X] Depressed mood

[X] Anxiety

[X] Suspiciousness

[X] Panic attacks that occur weekly or less often

[X] Chronic sleep impairment

[X] Disturbances of motivation and mood

[X] Difficulty in establishing and maintaining effective work and social

relationships

6. Behavioral Observations

--------------------------

Mr. XXXXX arrived on time for his appointment. Grooming and hygiene

Were adequate. He was alert and cooperative throughout the examination.

Expressive speech was fluent; thought processes were logical. Veteran

described his mood as "frustrated and eager to get out of here";

affect was congruent with his mood state. He denied any suicidal/homicidal ideation,

plan, or intent. There were no indications of delusions, hallucinations or

other signs of frank psychosis. Insight and judgment were intact.

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, if any

------------------

Veteran completed the PCL-5, a self-report measure of PTSD and obtained a

56.

On the BDI-II, a self-report measure of depression, Veteran obtained a

34, suggesting severe depression. The BAI is a self-report measure of

anxiety; his score of 20 indicates moderate anxiety.

Veteran currently meets DSM 5 criteria for PTSD and currently

Participates in relevant mental health treatment at the XXXXX VAMC.

NOTE: VA may request additional medical information, including additional

examinations if necessary to complete VA's review of the Veteran's

application. Income sources include the GI Bill and current service-connection. Patient enjoys target practice every couple of months. He rarely socializes.

b. Relevant Occupational and Educational history (pre-military, military,

and post-military):

Veteran completed a GED in 2003. Veteran noted that he was diagnosed

with Attention Deficient Disorder as a child.

Patient joined with the National Guard in 2004 and is currently

enlisted. MOS include infantry (11B), combat engineer (21B) and

military police (21B). Patient reported exposure to combat fire

(small arms, mortars, rockets, RPGs) in Afghanistan from 2011-2012.

His current rank is E-5.

c. Relevant Mental Health history, to include prescribed medications and

family mental health (pre-military, military, and post-military):

Interim Mental Health History:

Patient and his wife currently participate in marital counseling

at the XXXXX Vet Center. Patient also participates in individual

therapy with Dr. XXX and group therapy targeted at PTSD symptoms.

Patient is also followed by Dr. XXX for psychiatric medication

management.

CPRS lists active medications as:

AMITRIPTYLINE TAB 50MG

PRAZOSIN CAP,ORAL 1MG

HydrOXYzine PAMOATE CAP,ORAL 25MG

GABAPENTIN CAP,ORAL 300MG

METHOCARBAMOL TAB 500MG

LAMOTRIGINE TAB,ORAL 25MG

DICLOFENAC TAB,EC 75MG

MORPHINE TAB,SA 15MG

-----------------------------------------------------------------------

--------------------

PTSD Symptoms:

Intrusive Thoughts - Patient reported intrusive thoughts

regarding stressor #1 on a weekly basis.

Sleep/Nightmares - Patient reported nightmares that occur on a

weekly basis.

Dissociative reactions - Denied.

Psychological/Physiological Reactions - Anxiety, heart palpitations

And perspiration.

Avoidance - Veteran tends to avoid thoughts and conversations

Regarding combat experience.

Difficulty Remembering - Denied.

Distorted expectations/beliefs/blame - Chronic self-blame and

suspiciousness.

Persistent negative emotion - Chronic anger.

Loss of Interest - Rarely participates in hobby activities.

Distant/Emotionally Numb - Rarely socializes.

Irritability - Irritability on a daily basis.

Self-destructive/reckless - Denied.

Hypervigilance/Startle - Patient often scans for environmental

threats and is easily startle by sudden noises.

Difficulty Concentrating - He has difficulty concentrating on mundane

tasks.

-----------------------------------------------------------------------

--------------------

d. Relevant Legal and Behavioral history (pre-military, military, and

post-military):

Veteran reported legal problems for failure to comply with a court

order.

a. Stressor #1: Exposure to combat fire.

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 #6 - 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 (DMS-5).

Criterion A: Exposure to actual or threatened a) death, b) serious

[usdart]

WARNING, LONG POST

I'll go ahead and clear the air here; I know this is going to upset a lot of Veterans that have been seeking a strong rating and have been denied. My apologies, I'm not trying to sound ungrateful here.

Here's the situation:

I am a full-time educator who has been working for several months (successfully). I was at a 50% PTSD rating for the the past four years, but recently went in for my re-evaluation. Terrified of the outcome and possible reduction, I went in prepared; I had my list of symptoms, I wrote down the worst days I've had recently, and I was open and honest with the evaluator. Today, I received notice that my rating for PTSD and depression has been raised to 100%.

The money would be nice. I have a family and am expecting another child soon, but I still don't want this rating.

I need to work. Structure and implied hierarchies rule my life. I have a routine that I daily and any deviation from this ruins the entire day. If they took my job away, I would genuinely lose it. . .

Here are the reasons I want to lose this rating:

1. I'm terrified of losing my routine and know full well that a new one wouldn't be good for me. The paycheck from the VA would be more than I could make at my job (teachers have a salary ladder) until about five years from now. If I have this much money coming in, I'll get stuck in a rut that I will never break free from.

2. I'm terrified about coming to grips with my condition. Yes, I have some problems. No, I don't think they are severe enough to warrant this decision. I'm able to work. I need to work. If I don't contribute something to the world then I'm lost. I know Vets who cannot function in daily society, and I'm not one of them. I don't want to take away from the people who really need this benefit.

3. I'm worried what others think. Yes, I know it's shallow, but I spend the majority of my time analyzing others. One of my conditions is that I've lost the ability to respond well socially; I'm emotionally numb unless I'm chemically altered. With a 50% rating, my friends, family (and possibly employers) think I've got a "little baggage." With 100%, I doubt they could ever look at me the same. Those that love me will question whether I'm going to do something drastic, and those who don't will judge me and may think I'm faking.

I'm grateful that the VA took the time and genuinely listened to me, but I think they're overdone it. Can anyone tell me how to rectify this situation? I don't want benefits I don't believe I'm entitled to. I don't want the VA to think I inflated my condition for profit, and I don't want to lose the one thing that keeps me from crawling into a hole (job).

How long can i continue to work before they come after me? I'd at least like to finish up the school year. If I break contract (even though it would be for good reason) I would really destroy my chances of ever teaching again. It's a small town, who would hire me after that?

Thanks for all the help.

I am 100% P&T for PTSD and had the same types of concerns so I called Human Resources. I was told I do not have to disclose my percentage and only have to say 30% or more. In addition I was told the Company has several people with 100% that ARE working. As long as you are not unemployable. So now I am in good shape financially for the first time in my life. No more stressing to meet the bills and spouse arguing about money is a big stress reliever and is helping with my mental health.

[vet201060]

If you read the rating for mental condition and also the CFR that goes along with them then you can still work. It is based on what is expected of the average person. However, if you work they may decide to reduce you if you dont show the same symptoms and show improvement. It does not say you have to quit working at all. I am having a hard time but I still continue working with a 100% rating. I just make sure and tell them the truth when they ask me questions. They know that I work so it is untrue to say that you cant work with a 100% scheduler mental rating.

[Sgt Savage]

During Vietnam, I served with the Rangers which period originated my PTSD tho it had supplement help from other wars.  I encourage you not to petition to reduce your PTSD rating in that not only the financial support will be valuable to you but such a rating might save you from unemployment someday.  Doctors decided how severe your PTSD was and it may not always be that severe but you can bet, if it is chronic, you will have many reoccurrences during your lifetime and you may need the support if your teaching supervision want to let you go.  Also if you disclose your condition, someone may choose you the first to go in a budget reduction or downsizing. While the latter should not be done, it will be difficult to prove that "they" discriminated.  I have a 100% PTSD rating since 2013, w/Special Monthly Compensation since Dec 2015, with unemployability since 2002, 70% PTSD since 1990 and 10% PTSD since 1980.  Although I had a regular nonmedical retirement in 2002 and went on 100% the next day, my last few years of employment was stressful and not as productive as earlier.  First of all, it is no one's business in your employment hierarchy to inquire about your health problems or substance of your VA claim as long as you can productive handle your work.  If you can not satisfactorily do the work, then that is another matter but they may still be required to give you accommodation so you can remain employed.  I too was a college teacher in the evening for many years but in 1990 I noticed my mind not being able to recall the substance of what I had taught many times so I quit that job and I was also an Army reserve officer with excellent ratings until after my 20th year to qualify for retirement.  Because I had become overweight for the first time, I was sent for a medical board and the two repeated physical examination boards which both unanimously recommended that I be retired for PTSD.  But the Walter Reed disability retirement agency would not permit that and reduced my rating down to 10% and that forced me out.You may recall all the horror stories that the military faced from t3here about their discharges but mine was pre 9/11 and the military never tried to correct those injustices.   Nevertheless,I made it to my 30th employment year and retired from the civil service.  Now I generally remained silent about my PTSD for most of those years since I did not want to face discrimination and suspicion of being unable to do my work. PTSD through life comes and goes in up and down cycles.  Numerous times I disclosed my PTSD treatment when supervisors would know that something was not right in Dodge City with me.  I did not have to do that but when the supervisor sees you constantly going on sick call for an undisclosed medical appointment or if PTSD symptoms squeak out in the work day, there needed to be an explanation.  Also a few times I had to go for hospitalized treatment or had to have a doctor's note to take off a few weeks to recover.  They had a right to know why I did not show up for work.  Fortunately, I worked for some good people who I trusted and who unofficially accommodated me during some periods.  Still I was not always happy  when the people I served did not follow my advice since they discounted my "PTSD" opinions.  The first supervisor that I had to disclose to was a non-vet and someone who did not support me.  Thereafter the next job I disclosed when I was able to "hide out" at the job when I was in a PTSD slumber at work but I did outstanding work overall.  The next job I got mad when my EAP counselor disclosed my PTSD to my supervisor.  (Others were concerned about me)  I did disclose to my chief admin person working for me since he was a SGM in the Army and could help me through the periods.  Lastly, I was transferred from a job that was ending to another supervisor at another location by my higher chain.  They did not disclose tho I suspected wrongly that they did.  However, my last three years were barely functionable at times.  My last year I disclosed to my office that I was disabled from PTSD in a special meeting moderated by the EAP psychologist.  I did not make it to retirement before I was hospitalized for an extended period during which I did retire.  I am enjoying my retirement but I earned it.  I did have help from some pretty good people.

Edited March 22, 2016 by Sgt Savage
left out the word "it"