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Reduction in Work Due to Dr's Recommendation

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seejeremy

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So my doctor mentioned this week that I may need to attend a residential DBT program somewhere for about 6 weeks.  Has anyone here attended one of these, and if so what was it like?

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  • 3 weeks later...

Hi everyone.  The results of my C&P exam are available and I would like to know what you think?  I am currently rated at 70% for MDD, not permanent and total yet.  I am worried about the bold part where the doctor says that my symptoms cannot be traced to one mental health diagnosis.  With no longer being able to work a full time schedule, I'm hoping to get permanent and total just for my peace of mind.  I apologize in advance and thank you all for any insight you can provide.

Mental Disorders (other than PTSD and Eating Disorders) Disability Benefits Questionnaire

a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)?

[X] Yes[ ] No ICD code: 300.4

If the Veteran currently has one or more mental disorders that conform to DSM-5 criteria, provide all diagnoses:

Mental Disorder Diagnosis #1: Pervasive Depressive disorder ICD code: 3004 (F34.1)

Mental Disorder Diagnosis #2: Generalized Anxiety Disorder ICD code: 300.02 (F41.1)

Mental Disorder Diagnosis #3: Unspecified Persoanlity disorder ICD code: 301.9 (F60.9)

b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided.

2. Differentiation of symptoms -- a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes[ ] No
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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: The Veteran's Persistent Depressive Disorder, Generalized Anxiety disorder, and Unspecified Personality Disorder produced some overlapping symptoms and it is impossible to distinguish the proportion of each symptom attributable to each diagnosis.

c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes[ ] No[X] Not shown in records reviewed

3. 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 deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood

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: The Veteran's Persistent depressive Disorder, Generalized Anxiety disorder, and Unspecified Personality Disorder produce overlapping effects such that the relative portions of social and occupational impairment cannot be differentiated.

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

Clinical Findings: -- 1. Evidence review -- 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 no, check all records reviewed: [X] Military service treatment records [X] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [X] Department of Defense Form 214 Separation Documents [X] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other:

b. Was pertinent information from collateral sources reviewed? [ ] Yes[X] No 2. History -- 

a. Relevant Social/Marital/Family history (pre-military, military, and post-military): Veteran has remained married to his wife, daughter is 16 years old and is driving, and Son is 20 years old. Veteran went to Washington State and is back. Veteran does not interact socially and does not go to church.

b. Relevant Occupational and Educational history (pre-military, military, and post-military): Working part time at XXXX as a manager starting this week. Veteran worked at XXXX, left in July 2015, returned to XXXX in November 2015. Veteran started online classes in May 2015 and dropped out in September 2015.

c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Veteran denied a family history of mental illness. Veteran maternal uncle committed suicide. Veteran is in treatment with Dr. XXXXXX and is prescribed Wellbutrin, hydroxyzine, and divalproex. Veteran has a history of hospitalization for suicidal behavior. He has fleeting passive suicidal thoughts but no plan. Veteran said thoughts of his family prevent any plans or intent.

d. Relevant Legal and Behavioral history (pre-military, military, and post-military): Denied new e. Relevant Substance abuse history (pre-military, military, and post-military): Veteran denied a family history of alcoholism or drug abuse. Veteran reported a personal history of alcohol use but denied alcoholism and no longer drinks. f. Other, if any: No response provided.

3. Symptoms -- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Panic attacks that occur weekly or less often [X] Mild memory loss, such as forgetting names, directions or recent events [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting

Behavioral observations: Mental Status: Veteran wa s cooperative. Veteran was casually groomed and dressed. Veteran answered questions appropriately. Veteran was oriented to person, place, and time. Veteran's eye contact and psychomotor activity was within normal limits. Veteran's rate of speech was within normal limits and his thought processes were linear and goal directed. Veteran demonstrated mild anxiety symptoms. Veteran's mood was mildly depressed and anxious and Veteran's affect was congruent with his mood. Veteran's thought content did not demonstrate evidence of delusions or hallucinations. Veteran's recent and remote memories appeared to be within normal limits as evidenced by his ability to report his treatment history, treating providers, and medications. Veteran earned a 28/30 on the MOCA. Insight and judgment appeared to be within normal limits. Veteran convincingly denied current suicidal ideations or homicidal ideations but reported a history of a suicidal overdose and recent passive suicide thoughts. Veteran reported thoughts of his family prevent suicide.

4. Other symptoms -- Does the Veteran have any other symptoms attributable to mental disorders that are not listed above? [X] Yes[ ] No If yes, describe: Symptoms: Veteran reported hard time interacting with people and gets agitated very easily. Veteran said he is slow to interact and sees others realize it before he does. Veteran said he does not catch it until it is over. Veteran is cutting himself. Veteran feels he cannot work full time - sensory overload with people, stress, and responsibility. Feels his life will collapse and he will fall apart. He feels everything is his fault. His family is supportive and if they were not there he would be hospitalized. Veteran reported anxiety attacks. Veteran gave the example of going to Texas Road House, thinking he is Okay, then having sensory overload described as freaking out, shaking, heart pounding, and hyperventilating. Veteran reported depressive symptoms including minimal appetite but stable weight, low energy, apathy, low self-esteem, and poor concentration.

5. Competency -- Is the Veteran capable of managing his or her financial affairs? [X] Yes[ ] No 6. Remarks (including any testing results), if any: -- ADLs: Veteran gets up at 7am, gets ready and goes to work. Veteran works 3 days a week for an 8 hour day. The Veteran gets off work 5pm, after work goes home and does nothing. Feels every little thing gets him agitated. Veteran reads tablet, plays on computer, watches TV, HDTV. Typically they eat at 7pm, does not do much; watches TV and computer. Veteran goes to be about 10:15pm. Typically gets 5-6 hours of sleeping 24 hours. Veteran has a cpap. Wife cooks, all three clean, wife does laundry, AND they all shop. Veteran pays high school boys to cares for the yard. Veteran's wife typically pays most bills but Veteran checks to make sure wife pays bills and pays himself bills when wife is traveling for business.

PERTINENT RECORD REVIEW: Veteran's c-file was reviewed in VBMS DD 214

Doctor Name PhD FML form - Veteran is unpredictable - very effective worker one day and might struggle to maintain the next day.

VHCS: 7/22/16 Doctor Name PhD: Veteran's FML has been approved and he will be working part time.

7/13/16 Doctor Name MD: Veteran continues to be anxious, depressed, hopeless, and irritable. Veteran cut himself 3-4 times on thigh. Denied SI. Sleeps 4.5 hour, appetite and energy decreased. Living with wife and daughter. Working at Fortis College part time. Counseling with Dr. XXXX helping

7/6/16 Doctor Name PhD: Dx: Persistent Depressive Disorder, GAD, provisional Borderline PD.

4/20/16 Doctor Name PhD: Veteran continues to struggle with depressive symptoms, apathy, and passive SI.

2/10/16 Doctor Name PhD: Veteran reported feeling numb.

1/13/16 Veteran is very active as he works during the day and is involved in family events at night.

12/11/15 Doctor Name PhD: Veteran reported a dysfunctional childhood. Veteran described depression began in 2006 and anxiety in 2001. Veteran is working but when he becomes anxious he goes into the bathroom and hides.

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iMHO

70% Scheduler. Can't get TDIU and be working. VA doesnt rate based on different mental illnesses, only the symptoms. You're looking like you should get 70, but don't be horrified if you get Lowballed at 50% or even 30%. don't get yourself worked up over something that isn't a negative towards your claim. Service Connection and not pissing off the wrong VA Piss Ant is just as important as Knowing you're Owed.

Keep your Shield up, dig in, and realize that Truth is on your side, but unfortunately Time is on the VA's.

Good Luck

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I'm already rated 70%, so I'm thinking they won't lower it.  I initiated this claim hoping to get it rated as permanent and total.  I'm hoping that, at worst, my rating remains unchanged.  Anything here scream "permanent and total" or "not permanent and total"?

 

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If you were Schedular 100% you could be P&T and still work without any adverse VA action. You are not gonna get it. Facts is Facts, why would they lock in 70% Sch. for life when youz obviously working....you could still be "cured" at a future date.P&T is only available by law to those with a 100% rating, whether sched or TDIU.It removes the Sword of Damocles from over our heads who are worse off than you, but share your same Sched.%. Mean's you are so phUked up Schedularly that they know you would never improve based on your SC disabilitys and secondarys. P&T for me will be approved because I literally cant work, or educate myself, or generally be in Society. So, TDIU for my Appeal.my work history, SS Income Statement, Credit Reports, education and many many other things are going to be factored into my DRO Appeal. You can work, pay your bills, you won't break 70%scheduler unless you also have physical disabilitys. They only rate MH as the symptoms, not the etimology of the damage itself. People with multiple MH disorders like us be phUkt in that way.

Hope that helps

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Thanks. I'm already at 100%, because I have several other ratings.  The MDD is the only thing that is rated for "future exams."  Without the MDD I have 94% in ratings with no future exam.  I'm just hoping to get over the P&T hump.  

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