ptsd Occupational and social impairment / Symptoms

[OIFX3]

Hello everyone I am new to this site and I was wondering if I could get some insight about my claim. I pulled up my C&P notes on a PTSD claim that I filled and was trying to match what the doctor wrote to my benefits expectations. It seems im mixed between 10% and 30%. Is there anybody that could give their opinion on why I should expect. Thanks!

 

 

 

 

1. Diagnostic Summary

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

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

based on today's evaluation?

[X] Yes [ ] No

2. Current Diagnoses

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

a. Mental Disorder Diagnosis #1: PTSD

Comments, if any:

At least as likely as not incurred in combat tours (3 x in Iraq

between 03 and 07); Purple Heart in first, and CAB in second. Cav

Scout

 

Mental Disorder Diagnosis #2: Panic Disorder

Comments, if any:

Recurring transient episodes of intense fear associated with

breathing difficulty, palpitation, perspiration

Mental Disorder Diagnosis #3: Unspecified Depressive Disorder

Comments, if any:

SYMPTOMS: Sadness; diminished energy and self esteem; symptoms

shared with PTSD - diminished sleep, hope, concentration,

interests

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

Mental Health Disorder (to include TBI): TBI and others

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:

See shared symptoms as above

c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?

[X] Yes [ ] No [ ] Not shown in records reviewed

d. 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:

The question with regards to impact of any TBI will be referred to

a TBI examiner to address

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 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 medication

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:

Depression (Prevalence of depression-PTSD co-morbidity:

implications for clinical practice guidelines and primary

care-based interventions. Campbell DG - J Gen Intern Med -

01-JUN-2007; 22(6): 711-8 ) and panic disorder (Co-morbid panic

attacks among individuals with posttraumatic stress disorder:

associations with traumatic event exposure history, symptoms, and

impairment. - Cougle JR - J Anxiety Disorder - 01-MAR-2010; 24(2):

183-8) frequently co-occur with PTSD. While each co-morbidity

further limits Vet's psychosocial functioning, gauging the

exclusive and adverse impact of each co-morbidity on Vet's

functioning separate from that of another is not feasible.

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 [X] No [ ] No diagnosis of TBI

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 question with regards to impact of any TBI will be referred to

a TBI examiner to address

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):

 in an intact family. Had good

childhood.

Keeps up with parents and a younger brother who all in the same town.

No conduct issues in childhood nor in service. Married for past 13

years to an LPN, and they have 2 sons - 6 and 2 yo. Good relationship

within family. Reclusive outside. Living in Waverly, TN with his

family

since separation from service in 2009

conduct issues in childhood nor in service. Married for past 13

years to an LPN, and they have 2 sons - 6 and 2 yo. Good relationship

within family. Reclusive outside. Living  with his

family

 

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

and

post-military):

EDUCATION: HS in 2002; associate degree in 2011.

MILITARY: Honorably served ARMY from 02 to 09; E5; Cav Scout for first

5 years and then transport coord. Other details as above.

Post service: Two long term jobs - first for 3 years as a storage desk

clerk; got tired. Current job for past 3 years as a chemical plant

operator. No negative feedback so far.

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

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

Connected with TVHS MH services as an outpatient

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

post-military):

N/A

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

post-military):

N/A

f. Other, if any:

N/A

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: 3 Iraqi tours - see other details in diagnostic section

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] Witnessing, in person, the traumatic event(s) as they

occurred to others

[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] Dissociative reactions (e.g., flashbacks) in which the

individual feels or acts as if the traumatic event(s)

were

recurring. (Such reactions may occur on a continuum,

with

the most extreme expression being a complete loss of

awareness of present surroundings).

[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] Inability to remember an important aspect of the

traumatic

event(s) (typically due to dissociative amnesia and not

to

other factors such as head injury, alcohol, or drugs).

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

anger, guilt, or shame).

[X] Persistent inability to experience positive emotions

(e.g., inability to experience happiness, satisfaction,

or

 

loving feelings.)

Criterion E: Marked alterations in arousal and reactivity associated with

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

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

of

the following:

[X] Irritable behavior and angry outbursts (with little or no

provocation) typically expressed as verbal or physical

aggression toward people or objects.

[X] Hypervigilance.

[X] Exaggerated startle response.

[X] Problems with concentration.

[X] Sleep disturbance (e.g., difficulty falling or staying

asleep or restless sleep).

Criterion F:

[X] Duration of the disturbance (Criteria B, C, D, and E) is

more than 1 month.

Criterion G:

[X] The disturbance causes clinically significant distress or

impairment in social, occupational, or other important

areas of functioning.

Criterion H:

[X] The disturbance is not attributable to the physiological

effects of a substance (e.g., medication, alcohol) or

another medical condition.

Criterion I: Which stressor(s) contributed to the Veteran's PTSD

diagnosis?:

[X] Stressor #1

5. Symptoms

-----------

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

Veteran's diagnoses:

[X] Depressed mood

[X] Anxiety

[X] Panic attacks more than once a week

[X] Chronic sleep impairment

[X] Mild memory loss, such as forgetting names, directions or recent

events

[X] Difficulty in adapting to stressful circumstances, including work or

a worklike setting

6. Behavioral Observations

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

No response provided.

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

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

No remarks provided.

NOTE: VA may request additional medical information, including additional

examinations if necessary to complete VA's review of the

Veteran's

application.

[OIFX3]

anybody?

[seminoles]

Have you looked up the rating criteria for PTSD?  I know mental health but not PTSD specifically and it is a separate set of questions, look up the rating criteria for PTSD and it should be fairly clear.

[silverdollar22]

I think your right in the ballpark with your guess.  This is the reason: 

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 medication

They said mild or transient which is in the range you said!  

[broncovet]

I agree with silver dollar.  It looks good as far as service connection, your doctor has documented a stressor in 3 tours in Iraq.  You have a current diagnosis.  Did you supply evidnece of a "in service event" or stressor?  Evidence of the stressor is sometimes reduced in wartime Vets.  

Assuming you have a "stressor" in your records, you can now turn to percentages.  

Your exam shows you are currently employed, and it does not show an occupational impairment.  

Based on this, and the mild symptoms, you are looking at 0 or 10 percent, with 30 percent the max, In my opinion.  If you are not employed, or if your PTSD affects your employment more than this doc indicated, you should seek to document this error.  

Edited September 20, 2016 by broncovet

[Buck52]

I believe this PTSD C&P Exam would warrant a 70% S.C. Rating.&

possibly 100% depends on the rater  if they fine tooth comb this report a 70%  if not a 100% The only discrepancy  is the examiner contradicted him/her self  with the TBI Diagnoses  ..at first he/she mention he does have a TBT Diagnoses...then further reading it says no TBI Diagnoses.

. Does the Veteran have a diagnosed traumatic brain injury (TBI)?

[X] Yes [ ] No [ ] Not shown in records reviewed

TBI?

[ ] Yes [X] No [ ] No diagnosis of TBI

Although this is ask in context about ability for social occupation.

There not suppose to use medications as a fact of to deny the social occupation and say he is able to work b/c of the prescribe medications.

jmo...................Buck

Edited September 20, 2016 by Buck52

[OIFX3]

Got my rating today. 30%