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Draggin'

Ptsd Exam...alcohol And Ocd Not Connected

Question

Hi all

I am applying for C&P. I have already been diagnosed with PTSD, major depression and alcohol dependance through my local VA outpatient psychiatry, with a GAF of 45. I went in for what I thought was a C&P exam for PTSD...only to have the examiner say it was for my sleep problems (nightmares, etc.). He did the full PTSD exam though (MMPI, etc). I guess this is necessary for sleep disorders??? He said that the PTSD info would be included on his report, even though this was not a scheduled C&P PTSD exam.

I just got my records and they say this...

Axis I - 1. PTSD (claimed sleep problems are considered part of this diagnosis)

2. Alcohol dependence

Axis II - OCD with some antisocial traits

Axis III - Multiple orthopedic problems, chronic pain, eye probelms, headaches, hearing loss, tinnitus, thyroid (all of these are in for claims/exams also)

Axis IV - Chronic health problems, marital discord

Axis V - GAF: 55-60

The MMPI-II test was interpretable although my f-scale t score was high at 83. He said I have PTSD, combat related as likely as not. But he said that the alcohol use and OCD were totally separate. That my PTSD only accounts for 30% of my new GAF.

Will they consider both GAF scores...and both diagnosis by the different psychiatrists? Each GAF score is recent. The alcohol use is DEFINATELY aggravated by the PTSD (can't sleep, need to escape). Is it possible that some of the OCD is related to the Army and the need to follow orders/direction precisely because it's a life or death situation. (I was a Cav Scout)

We're about to submit stressor letter (this Monday) and letters from my mother, wife, etc. Should my mother mention that I was not particular at all about things before I went to Iraq? The fact that I NEVER got into trouble and hardly drank before all of this was not taken into consideration also.

Just wondering what this all means and if there's anything else we can do over the next few days....or just wait for appeal time. We do have our VSO looking over the letters Monday as well. We're trying to get it all in ASAP before all of the other exams are done and results sent to VBA. Any ideas on percentage I could be expecting on the PTSD alone?

Thanks

Draggin'

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Welcome to Hadit.

Are you working?

If you are not working have you applied for SSD? If not you should.

Most who have PTSD also have secondary problems with either drugs or alcohol or both. Your exam may or may not be helpful to you at this time we need more info but on the face it is enough to get you rated in my opinion.

I have never heard of separating GAF's that is ridiculous.

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The stressor letter should be as detailed as possible. VA will have JSRRC check out the facts involved. (Joint Service Records Research Center)

The approximate date and place of the stressor event, any names of anyone else injured or killed in the event, any witnesses , and basically anything the JSRRC can find in the unit morning reports, and/or casualty list will help prove the stressor.

Alcohol dependency-if caused by a service connected condition (by medical evidence) which in turn causes a physical disabilioty- can be service connected as secondary regarding whatever it causes.

Say vet has PTSD and has cirrosis of liver due to self medication for many years after service with alcohol.

With a full medical rationale from a doctor, the veteran's cirrosis can be secondarily service connected to the PTSD.

Allen V. Principi.

Alcohol usage is a symptom of PTSD but the rating will be in regards to the overall disabling affect of the PTSD.

Here under the topic Schedule of Ratings is info as to how they will possibly rate your PTSD.

I say 'possibly' because it is difficult to try to determine what the VA will do.

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Actually, they are "supposed" to "assign" a GAF EVERY TIME you show for an appointment (mental-health-wise, anyway). When they go to rate you for a claim, these GAF's are supposed to be "averaged". Or, at least, that's the way I read the regs, and that is what they did with me (got a 45, I believe).

Actually I got a 9.5 for "degree of difficulty", based largely on the "Double-Back-Knee-Drop with a Twist", a 8.0 for artistic expression (that's for when I gagged and threw-up), and I was voted "most popular" in my High School class.

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That is the strangest C&P exam report I have seen for a while. OCD with anti-social traits....? What does that mean. OCD is a mental disorder, but anti-social traits point to a PD. I don't understand how this guy breaks down the GAF into parts. PTSD is the main Axis One disorder. I think the examiner is trying to leave room for the VA to make a PD diagnosis to account for some of the vets problems. The exam doctor is equivocating and that puts his whole exam in doubt. He says the alcoholism and OCD are not part of the PTSD diagnosis. That is strange and does not really make sense. What are the anti-social traits he is speaking about?

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Thanks

My responses are in blue...questions in bold. I did not include all questions from you all, but answered what I could.

"OCD with anti-social traits....? What does that mean. OCD is a mental disorder, but anti-social traits point to a PD." Unfortunately, my wife found out online that there is OCD and OCPD - obsessive complusive personality disorder. Although the doctor put Obesssive compulsive disorder on the report.

"I don't understand how this guy breaks down the GAF into parts. PTSD is the main Axis One disorder. I think the examiner is trying to leave room for the VA to make a PD diagnosis to account for some of the vets problems."

Online you can see everything the examiner is to cover ( http://www.vba.va.gov/bln/21/Benefits/exams/disexm43.htm -thanks to my wife again ). If you look down at letter J, it says, "A BVA REMAND may also request, in addition to an overall GAF score, that a separate GAF score be provided for each mental disorder present when there are multiple Axis I or Axis II diagnoses and not all are service- connected." So...yeah...he broke those bad boys up, considered the alcohol use and OCD had nothing to do with PTSD and were therefore not service-connected. Guess my GAF score for PTSD will be 66% higher??? Making me essentially as normal as my wife? NO WAY.

"He says the alcoholism and OCD are not part of the PTSD diagnosis." As I said above...he split those up and I have no idea why. I was never like this before. In fact, once I started taking what they gave me to help me sleep and it is one that actually works, I have quit drinking to help me sleep. We're going to my outpatient psychiatry this week and I will mention that...maybe this will help? Will VBA even see these notes this time around???

"What are the anti-social traits he is speaking about?"

All I got from that is that it was "difficult for me to build rapport during interview" and that I'm "mean and controlling with wife and children". I don't hang out with friends a lot...I stick with family. I'm depressed and embarassed (seriously, I've gained a lot of weight) because of how I am right now. I feel very anxious and don't want to deal with any additional crap...this whole VA thing is BS enough...guess this makes me anti-social???

"The stressor letter should be as detailed as possible. VA will have JSRRC check out the facts involved. (Joint Service Records Research Center) The approximate date and place of the stressor event, any names of anyone else injured or killed in the event, any witnesses , and basically anything the JSRRC can find in the unit morning reports, and/or casualty list will help prove the stressor." They already seem to have proof that I was in such situations due to where I was and when...it was even noted in the psych exam. But I am sending one in to describe those situations already described to docs, how I was before and how different I am now in the hopes that the alcohol and OCD stuff will be rolled in under PTSD.

"Are you working?" I am barely working as a server. I leave jobs before I get fired. I find a way out of work at least once a week. I cannot tolerate people over stupid crap. I have to work some, for financial purposes. I'm about to quit and attend school (will use GI Bill). Hopefully here I will be happier and not as hopeless about my future...at least I won't be a 29 year old server with a wife and 2 kids to take care of! It's more in my control. SSI will say if I can attend school, that I should be able to work.

Thanks again

Draggin'

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