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DSM-5

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Kelvin

Question

I had this done back in May, Im confused on if I have PTSD or Depression. Pls let me know what this is. XXXX (Took my name out)

 

Chief Complaint: Depression, intrusive thoughts Present Illness: 45-year-old veteran who is 80% SC overall but has no psychiatric disabilities. Had no history of mental health treatment until referred to a mental health social worker at the JACC with whom XXXX met on February 5th of this year. Social worker documented at that time: "Patient reported that he had been having dreams about an event that occurred while active duty off the coast of Africa. Patient reported that while aboard the USS Firebolt they came across a boat full of refugees that capsized as they were attempting to board the ship. He reported that a child was thrown to him from another crew member who was onboard a smaller patrol boat and he dropped the child into the water. He reported that he watched the child go under the boat. He reported he also witnessed a woman who was too weak to climb onboard the boat and he watched her go under the boat. He reported that he could have saved them

had he gone into the water, however the crew members had been given orders not to leave the boat. He reported that he had never talked to anyone about this

until last year when he told his spouse. This was the first time disclosing it to someone other than her. Patient reported that he had been isolating himself

from his spouse." XXXX was referred to the counselor at this clinic with whom he's met on three occasions and will be beginning IPT in the near future. XXXX continues to experience depressed mood, irritability, isolative

behaviors, intrusive thoughts, and occasional nightmares. His isolation stems more from his irritability than from avoidance of particular triggers, although he does admits having difficulty going to the beach. XXXX cites a number

of issues in his current relationship with his wife as they live with two teenagers who from his wife's previous marriage. XXXX and his wife differ on expectations from and discipline of the children which has caused more than

one verbal conflict. Finds himself more irritable at work as well which has led

to his being more verbally impulsive. Has never sought help for his mood in the

past and is not particularly clear why he sought help recently. Past Psychiatric History: No history of treatment prior to his evaluation in February. Denies history of SI/SA. Denies history of substance use. 

MENTAL STATUS EXAMINATION:

The veteran appeared well-developed, well-nourished, clean, and dressed appropriately. The veteran was alert and oriented in all spheres and able to establish rapport. Eye contact was adequately maintained and there was

no obvious psychomotor abnormality. Mood was "sad". Affect was reactive and congruent. Speech was fluent and normal in tone, rate and volume.

Thought processes were logical and goal-directed with intact associations.

There was no evidence of thought disorder or perceptual disturbances. There was no expressed delusional content. Suicidal and homicidal ideations were denied within the past thirty days and there has been no self-injurious behavior. Immediate, recent and remote memories were grossly intact as was attention and concentration. Insight was good. Judgment and impulse control were adequate.

DIAGNOSTIC IMPRESSION (DSM-5):

MDD, recurrent, mild Could certainly consider diagnosis of PTSD given XXXX's experience, although he doesn't exhibit the hypervigilance, exaggerated startle response, and their appears to have been elements in his history that would be more consistent with a major depressive disorder that has been ongoing for some time but perhaps exacerbated by his traumatic experiences. From a medication standpoint this distinction is not likely to be particularly important however. After discussion about various treatment options will provide trial of Sertraline, but XXXX was encouraged to remain engaged in the psychotherapeutic milieu.

PLAN:

Start Sertraline 50mg po daily

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You are diagnosed with MDD (depression).  The doc says you MAY also have PTSD, but the difference between depression and PTSD is not important in your treatment.  

Its also not an important difference in your disability rating, as PTSD and depression are rated the same by the symptoms, as are all mental health disorders.  

If you have an application for PTSD, I suggest you amend it to INCLUDE depression.  Its not your job to sort out whether you have PTSD or depression..that is the docs job.  

 4.130 Schedule of ratings - Mental disorders.

The nomenclature employed in this portion of the rating schedule is based upon the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (see § 4.125 for availability information). Rating agencies must be thoroughly familiar with this manual to properly implement the directives in § 4.125 through § 4.129 and to apply the general rating formula for mental disorders in § 4.130. The schedule for rating for mental disorders is set forth as follows:

9201 Schizophrenia
9202 [Removed]
9203 [Removed]
9204 [Removed]
9205 [Removed]
9208 Delusional disorder
9210 Other specified and unspecified schizophrenia spectrum and other psychotic disorders
9211 Schizoaffective disorder
9300 Delirium
9301 Major or mild neurocognitive disorder due to HIV or other infections
9304 Major or mild neurocognitive disorder due to traumatic brain injury
9305 Major or mild vascular neurocognitive disorder
9310 Unspecified neurocognitive disorder
9312 Major or mild neurocognitive disorder due to Alzheimer's disease
9326 Major or mild neurocognitive disorder due to another medical condition or substance/medication-induced major or mild neurocognitive disorder
9327 [Removed]
9400 Generalized anxiety disorder
9403 Specific phobia; social anxiety disorder (social phobia)
9404 Obsessive compulsive disorder
9410 Other specified anxiety disorder
9411 Posttraumatic stress disorder
9412 Panic disorder and/or agoraphobia
9413 Unspecified anxiety disorder
9416 Dissociative amnesia; dissociative identity disorder
9417 Depersonalization/Derealization disorder
9421 Somatic symptom disorder
9422 Other specified somatic symptom and related disorder
9423 Unspecified somatic symptom and related disorder
9424 Conversion disorder (functional neurological symptom disorder)
9425 Illness anxiety disorder
9431 Cyclothymic disorder
9432 Bipolar disorder
9433 Persistent depressive disorder (dysthymia)
9434 Major depressive disorder
9435 Unspecified depressive disorder
9440 Chronic adjustment disorder

General Rating Formula for Mental Disorders

  Rating
Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 100
Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. 70
Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 50
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 30
Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. 10
A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. 0
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While PTSD isn't a necessary component of a Clinical Depression DX, Depression seems to be always a component of a PTSD DX.

I trust you have, by now, filed a PTSD FDC, right? It will all come down to your VA PTSD C & P DBQ. All other (VA or Private MH Dr), DX of your current MH conditions, are Trumped by the PTSD C & P Dr's DX & DBQ.

From your above post, you certainly have MH issues. File the PTSD Claim, let the VA sort it out. An additional 30 or 50% SC for a MH issue, gets you to 90% SC. Does it really matter if it's the Depression alone or in conjunction with the PTSD?

FILE the PTSD FDC on Your E-Ben site TODAY!

Semper Fi

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The USS Firebolt was involved in numerous refugee situations.

This link for the crew list going back to late 1990s might have someone there you could contact, if needed, for a buddy statement.

http://navysite.de/crewlist/commandlist.php?commandid=520

 

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5 hours ago, Gastone said:

While PTSD isn't a necessary component of a Clinical Depression DX, Depression seems to be always a component of a PTSD DX.

I trust you have, by now, filed a PTSD FDC, right? It will all come down to your VA PTSD C & P DBQ. All other (VA or Private MH Dr), DX of your current MH conditions, are Trumped by the PTSD C & P Dr's DX & DBQ.

From your above post, you certainly have MH issues. File the PTSD Claim, let the VA sort it out. An additional 30 or 50% SC for a MH issue, gets you to 90% SC. Does it really matter if it's the Depression alone or in conjunction with the PTSD?

FILE the PTSD FDC on Your E-Ben site TODAY!

Semper Fi

I trust you have, by now, filed a PTSD FDC, right? No I have not and I did not know I could do that yet. I was under the impression that once I was done with the CBT I volunteered for then I should file. Should I talk to the VA Rep to schedule that for me?

From your above post, you certainly have MH issues. File the PTSD Claim, let the VA sort it out. An additional 30 or 50% SC for a MH issue, gets you to 90% SC. Does it really matter if it's the Depression alone or in conjunction with the PTSD? I just want to get the help I need really, I also thought that my traumatic event kind of amplified my depression.

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3 hours ago, Berta said:

The USS Firebolt was involved in numerous refugee situations.

This link for the crew list going back to late 1990s might have someone there you could contact, if needed, for a buddy statement.

http://navysite.de/crewlist/commandlist.php?commandid=520

 

Thank you Ms. Bertha, we were involved in the 2005 event. In this picture we had just pulled as many people onboard as we could. Im the one standing with my hands on my hips.

Firebolt.jpg

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The VA will provide whatever MH treatment you need, I was  70% PTSD, opted for Group Therapy rather than a Psychiatrist. After 2 1/2 yrs of weekly therapy, still had the PTSD issues but had a better understanding and ability to cope. About 6 gus fro my VA Group, still get together at the VMC Bi-Weekly for a couple hrs. A few of the 50% PTSD Nam Vets, are still seeing their VA Psychiatrists.

If I read your post's correctly, there are VA MH Treatment notes regarding your Depression DX with possible PTSD issues in your VMC Medical File, right. If so, do a PTSD FDC on your E-Ben site. Scan and attach copies of the MH Clinician notes to your claim. With a PTSD FDC filing, you can probably expect a C & P in a couple of months. Could have an actual Award within 9 mos.

Don't drag your feet, file the FDC, let the VA figure it out. Their the Pros, we're just Vets. We can attest to our symptoms but the PTSD DX is up to the C & P Psychiatrist or Clinical Psychologist PhD. It really doesn't matter what your other MH Clinicians DX'd you with.

Semper Fi

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