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  • 14 Questions about VA Disability Compensation Benefits Claims


    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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The following is the index with links to the various Training and Fast Letters plus a few miscellaneous. These letters are not necessarily in the original formatting. I have tried to present them in an easy-to-read form instead of some forms as originally presented. Some of the paragraphs were WAAAAYYY too long. lol - HadIt.com Member fanaticbooks Something to be aware....Some of these letters may be rescinded, outdated, or otherwise no longer viable. I have still included them because sometimes they provide additional insight or just plain more information than the newest version. Use them wisely. The oldest letters will display at the bottom with the latest letters displayed at the top, all in sequential numbers. Coding of the letters... FL = Fast Letter TL = Training Letter First two numbers = last two digits of year of origin

Training Letters

Fast Letters

VHA Directives

VHA DIRECTIVE 2010-045 Introduction Of Disability Benefit Questionnaires (Dbqs) To Support The Compensation And Pension (C&P) Process (October 1, 2010) VHA Directive 2006-013 Qualifications for Examiners Performing Compensation and Pension (C&P) Mental Disorder Examinations (March 7, 2006)


Best Practice Manual for Posttraumatic Stress Disorder (PTSD)

Edited by Tbird
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Hello, I've been searching for FL 08-06 (Feb 27, 2008), its referenced in TL 10-07 section with The Rating Decision.  My claim for TDIU was deferred Feb 2012 and never given a formal rating.  It seems FL 08-06 (Feb 27, 2008) has disappeared.  Any help would be greatly appreciated, thank you.

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The Fast Letter 10-02 ( a Very important one because of the 120 day deadline) cannot be opened here:

This is the message I got and I could not find it anywhere else,except Carlie had posted it but someone today needed a pdf of it.

Here is the pdf below I made of the letter:

These Fast Letters are important...I hope others here are working.

And I hope this list is up to date.



Sorry, there is a problem

The page you are trying to access is not available for your account.

Error code: 2C171/1



VA FL 10-02 BVA Remands.pdf

Edited by Berta

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Here are some issued in 2013 that might not be here:

http://vetaffairs.sd.gov/veteransserviceofficers/Fast Letters.aspx

They are all important.

We used to have the wonderful help here of Fanaticbooks who helped Tbird prepare the FLs, TLs and Directives,

but she was dealing with a lot ,illness and grief- widow of veteran as I recall, and also she had to put up with that RUR trouble maker who picked on four of us women here for over a year until he finally left the site.I dont really know why she left. 

It would be great if someone could help Tbird get this list up to date.

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  • Similar Content

    • By Togore101
      Hello everyone I am new to the site. And I recent submit a the dbq for an increase for my PTSD and I trying to understand it but im just not getting it. So I figured would ask you all. Below is what the examiner put in the record.
      Review Post Traumatic Stress Disorder (PTSD)
      Disability Benefits Questionnaire
      Name of patient/Veteran: =========
      Is this DBQ being completed in conjunction with a VA 21-2507, C&P
      [X] Yes [ ] No
      SECTION I:
      1. Diagnostic Summary
      Does the Veteran now have or has he/she ever been diagnosed with PTSD?
      [X] Yes [ ] No
      ICD Code: F43.1
      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):
      No response provided.
      3. Differentiation of symptoms
      a. Does the Veteran have more than one mental disorder diagnosed?
      [ ] Yes [X] No
      c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?
      [ ] Yes [ ] No [X] Not shown in records reviewed
      4. Occupational and social impairment
      a. Which of the following best summarizes the Veteran's level of
      and social impairment with regards to all mental diagnoses? (Check only
      [X] Occupational and social impairment with reduced reliability and
      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
      of the occupational and social impairment indicated above is caused by
      [ ] Yes [ ] No [X] No diagnosis of TBI
      Clinical Findings:
      1. Evidence Review
      Evidence reviewed (check all that apply):
      [X] VA e-folder (VBMS or Virtual VA)
      [X] CPRS
      Evidence Comments:
      DATE OF NOTE: MAR 05, 2018
      CHIEF COMPLAINT: "same old same old"
      Veteran is here for 6 week follow up for PTSD, Alcohol Use Disorder,
      unspecified, episodic. At last appointment, low dose venlafaxine was
      added, aripiprazole, prazosin, and melatonin were continued.
      He reports symptoms are about the same. His wife is pregnant with twins,
      so he is trying to minimize arguments at home. He worries he will not be
      able to connect with the babies, because he struggled so much with his
      daughter and points to her persistence as the reason they are close now.
      He see no change in sleep, remains irritable, and more hypervigilant due
      To recent car break ins on his street. He has cut down on drinking, and
      denies any binges since last appointment. He continues to have fleeting
      SI, but denies intent. He often has thoughts of hurting others, but
      strongly denies acting on the thoughts. No recent hallucinations. He
      does talk to himself when he is trying to work something out, but denies
      hearing voices other than his own. It can be embarrassing as coworkers and wife
      have caught him.
      DSM 5 Diagnostic Impression
      Alcohol Use Disorder, Unspecified, episodic
      1. Decrease irritability and anger- does not interfere with home or work
      life more than one time per month, ongoing, improving
      2. Improve feeling of connection with others- enjoying and developing
      relationships, ongoing, no change
      3. Decrease avoidance of social situations/crowds- can tolerate Wal Mart,
      enjoy outings with family, ongoing, no change
      4. Improve sleep- no difficulty falling asleep, sleep 6 to 8 hours
      nightly, ongoing, worsening
      reviewed records and discussed options
      - increasing venlafaxine to 75 mg
      - continuing aripiprazole, prazosin, and melatonin
      - suggested individual supportive counseling at the Vet Center after Dr.
      Bhatia leaves.
      - monitoring labs at next appointment
      - Will continue to follow closely. RTC 6 weeks/PRN
      2. Recent History (since prior exam)
      a. Relevant Social/Marital/Family history:
      Last C&P PTSD DBQ May 2016
      Lives in Moncks Corner, SC with wife of 9 years and daughter age 4.
      Daily routine: Lay down for bed 2100. Will fall asleep 2300. Wake
      frequently. "I have to do certain things to calm down. I need my
      gun next to me. I have to check the house make sure its locked. Make sure
      the alarm is on. If I hear something, it wakes me right up and I have
      to check it out." +Nightmares, night sweats. "Sometimes
      I'm swinging and yelling and talking in my sleep, so my wife leaves for a different
      room. I wake up and she's not there and it freaks me out."
      melatonin for sleep, prazosin for nightmares. Abilify for PTSD.
      Diagnosed sleep apnea by sleep study in 2013, prescribed CPAP and is
      Relationship with wife: "We almost got divorced a few times. She
      didn't understand what was going on. She started reading up on it. The whole
      reason I went to mental health was because of her."
      Relationship with daughter: "She is scared of me. She has seen me
      Snap a few times. She is on guard. She doesn't know if I'm going
      to be up or down. She is my heart. She is the only thing that makes me feel
      normal." Will watch cartoons and read books together.
      Hobbies: play basketball, go to gym "but now I just sit in the
      House watch TV or just in the room." Likes anime.
      Support: father "he's been with me through everything."
      And is Veteran
      too, wife "but there is a wall there where I don't open
      b. Relevant Occupational and Educational history:
      Working for passport services for 3 years. "Its rough at times.
      There's a lot of people in there. They had to move my seat because I'm
      too jumpy. They moved it so I'm not around a lot of people. It is hard
      to focus. I have to use sticky notes. They have been pretty supportive.
      I've had good supervisors." Was counselled about days missing
      for work; "I had a blow up at my co-workers so they spoke to me about
      that." Miss 2-3 days per month. "When I get to work, I drive around the
      Building and if I see something I don't like, I just go home."
      Military history: E4, MP, Separated 2014, Honorable, Served about 6
      c. Relevant Mental Health history, to include prescribed medications and
      family mental health:
      Mental health treatment with prescriber and therapist. No history of
      hospitalizations. Was in group therapy "but I didn't like it."
      d. Relevant Legal and Behavioral history:
      "When I was in Japan I got us into trouble because of my alcohol
      abuse. I got into a car accident and hit 3 cars." Was sent to ADAP for
      anger and PTSD. A month ago got into a physical altercation with sister's
      boyfriend "I laid hands on him. So then I went to a hotel room and stayed there and
      then I went on a drink binge."
      e. Relevant Substance abuse history:
      Alcohol - "I abused it really bad. My PCM said it was affecting
      My liver." Was drinking4-5 25 oz beers, drink a bottle of liquor over
      The weekend. Now will drink 1-2 beers.
      Tobacco - 2-3/day
      Denies other substances.
      f. Other, if any:
      Current reported symptoms:
      Anger: "I black out and become very violent. I knock TVs off
      walls. My wife was ready to leave me."
      Triggers: "foggy day and rain." "Ignorant and stupid
      Social avoidance.
      "If a car is behind me too long, I start to think he is following
      me. There is a particular truck that I know and he gets too close to me. I
      got sick of it and one day I followed him home. I didn't do
      anything, but I blacked out mad. I knew I needed help."
      Flashbacks - "I was shopping with my wife, and this guy had a
      turban on his head and I thought I was back there. Its constant, its all the
      Hygiene - "My wife got on my because I went a week without washing
      And I didn't even realize it."
      Suicide - "I thought about driving into traffic at the light. One
      Time I sped up and got on railroad tracks when a train was coming. I
      thought, what am I doing? I went into store parking lot." Reports
      this occurred 2 weeks ago. "I keep a picture of my daughter in the car
      to keep me from [doing it]."
      3. PTSD Diagnostic Criteria
      Please check criteria used for establishing the current PTSD diagnosis. The
      diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual
      of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to
      combat, personal trauma, other life threatening situations (non-combat
      related stressors). 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 #6 - "Other
      Criterion A: Exposure to actual or threatened a) death, b) serious
      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
      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
      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
      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)
      the following:
      [X] Persistent and exaggerated negative beliefs or
      expectations about oneself, others, or the world (e.g.,
      am bad,: "No one can be trusted,: "The world is
      dangerous,: "My whole nervous system is permanently
      [X] Persistent, distorted cognitions about the cause or
      consequences of the traumatic event(s) that lead 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.
      [X] Persistent inability to experience positive emotions
      (e.g., inability to experience happiness, satisfaction,
      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)
      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] Reckless or self-destructive behavior.
      [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] The duration of the symptoms described above in Criteria
      B, C, and D are more than 1 month.
      Criterion G:
      [X] The PTSD symptoms described above cause 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.
      4. Symptoms
      For VA rating purposes, check all symptoms that actively apply to the
      Veteran's diagnoses:
       [X] Depressed mood
      [X] Anxiety
      [X] Suspiciousness
      [X] Chronic sleep impairment
      [X] Mild memory loss, such as forgetting names, directions or recent
      [X] Flattened affect
      [X] Impaired judgment
      [X] Disturbances of motivation and mood
      [X] Difficulty in adapting to stressful circumstances, including work or
      worklike setting
      [X] Suicidal ideation
      [X] Impaired impulse control, such as unprovoked irritability with
      of violence
      [X] Neglect of personal appearance and hygiene
      5. Behavioral observations
      Veteran was open and forthright with no evidence of exaggeration or
      feigning symptoms. Affect blunted. Minimal eye contact. Speech regular
      rate, tone, volume. Thought process linear, logical, goal directed.
      Thought content absent for delusions, hallucinations, paranoia or HI.
      Endorses SI with no active plan, but drove car onto train tracks last
      week. Discussed safety, crisis line, Veteran has MHC appointment next
      week. Veteran reports safety to return home today.
      6. Other symptoms
      Does the Veteran have any other symptoms attributable to PTSD (and other
      mental disorders) that are not listed above?
      [ ] Yes [X] No
      7. Competency
      Is the Veteran capable of managing his or her financial affairs?
      [X] Yes [ ] No
      8. Remarks, (including any testing results) if any:
      PCL-5 score 72, indicating probable diagnosis of PTSD.
      Veteran continues to meet criteria for PTSD. He reports social
      withdrawal, sleep problems, memory problems, irritability, anger that is both verbal
      and physical, suicidal thoughts. He has work accommodations because of
      his PTSD symptoms. He misses several days of work a month because of his
    • By bc0311
      I'm new to this site, and somewhat novice with claims as I've ignored them since my discharge in 2012, but I have some questions that I've yet to find answers for that hopefully someone can help me with:
      In a nutshell, my story is I did my four years, two hellish combat tours to Afghan, got out in 2012, immediately filed my claims for a few disabilities like back and shoulder issues and got a 40% rating total. I've since not looked back as none of that concerns me. My issue now is that I was sent to a mandatory PTSD screening during one of my visits that year, and the examiner kind of went about the thing blase, and although I did tell her most of my traumatic experiences, she gave me 0% for "Combat PTSD not related to military service" as it says in their justification, whatever that means. I don't think they even attempted to listen to me as my experiences were extraordinarily traumatic and have been a detriment to my mental health and quality of life since. And yet I now have an effective date of a PTSD claim from day of discharge 6 years ago for 0%, says it right on eBenefits. I think you know where I'm going with this...
      After 6 years of dealing with a slew of issues related to PTSD, I decided this week to start looking into trying to re open the case. My questions for you are.... Would I be entitled to any back pay if I could prove that I've suffered from PTSD since then, and that they made their original decision in error? And if so, how could I go about receiving the exact paper work / medical records from that one specific screening I had in 2012? I've looked everywhere and I don't really know how to navigate either of these situations... 
      Thanks a lot!
    • By tazntaylr
      I have been working with a VSO to file my claim. I am currently in the process of gathering information. Only thing, file for MST with PTSD or file PTSD. VSO was hung up on the sexual part of MST.
      Was in service 1991-2000. In 1995 was involved with a female soldier, who also was involved with another male (married) soldier. After an exercise and the last night sleeping together she asked me to kill his wife. After the second time I went to CID and wore a wire twice. While the Article 32 hearing was going on she was let out of pre-trial and started harassing me, being around me. I was moved from my company to another, and ultimately to the brigade HQ (rear detachment). Brigade HQ was deployed then. Both the female soldier and male soldier were other than honorable discharged, but I was exiled for a year. Not the same after. As I was getting out in 1999 I learned that she had asked other people in the unit to kill me. I was seen at a Vet center into 2000.
      Same time as the Article 32, my chain of command was trying to discipline me for an Article 15/court martial. The incident was with the female soldier (before she had asked me) and was on a trumped up charge. Even had the 1st sergeant threatened me in his office about "if he could not get me on that charge he would find another". After my time in Brigade HQ I returned to almost a new unit, only 5% knew me. All I wanted was out, but he harassed me every day to change my mind and go to the promotion board. Would not even let anyone drive me to airport to PCS.
      It took my wife to point out that when I get harassed or witness it at work that I am affected by it. I am currently being seen for it by the Vet center I was seen at before. The vet center had listed me as PTSD and marked as military trauma. 
      Also, I don't have anything from that time as I was not in a good place and as a 26 year old did not want the reminders in my barracks room. So if anyone knows how to get the CID or JAG records I am all ears.
    • By anxiousinMD
      Hello and TYIA for any responses and for reading my long post.
      BLUF: I would appreciate some insight or just plain ol speculatin on why the VA raters would submit me for a lumbar strain increase (that I didn’t submit for) while working on my current claim? Also, are secondary conditions disqualified in the 60% calculation for SMC Housebound? I know it says the 60% must be separate from the 100% condition, but how does this work if I’m on IU, with secondary conditions? 
      I’m probably overthinking at 4am but why would they submit me for an increase for a condition when I didn’t ask them, and the increase has no bearing on the final rating due to VA math, unless it qualifies me for SMC, or they believe I should be qualified. I’ve never raised the issue of SMC and I’m still learning about it trying to figure out my claim, and I know they are supposed to do due diligence, but that’s not my first hunch since that’s why I’m still in this process.
      History: I filed a claim in 2015 for PTSD increase and TDIU, was granted increase in 2016 to 70% PTSD, denied TDIU. Combined, 80% with other SC conditions. BBE/VSO said I was denied increase to 100% even though I had a nexus statement from a psychologist saying total social and occupational impairment, at least as likely as not, etc., but they said because I was still employed (I was on long term disability leave but not yet “terminated” and yes they had the relevant evidence through my employer and insurance), and my VA treating provider’s opinion took precedence who didn’t feel my symptoms quite qualified me for total of course, though he‘s a CRNP versus a psychologist and I don’t think he even knows me. I thought they were supposed to take the rating and credentials that favor the Veteran but never mind me. I also survived and was approved for Social Security and life insurance premium waivers during this period without having to appeal, with the same medical information and evidence, with the same VA SC conditions, even coming from VA docs and providers.
      Of course I appealed the rating and TDIU denial (they can decide) in 2016. I also submitted a new claim for secondaries to PTSD, and in my fog, with that claim an increase for PTSD and TDIU, even though I already had those on appeal. I believe I read or was told somewhere (or maybe my brain made it up) that if I submitted new evidence, the raters could look back at the effective date and could EED to the original claim if the evidence shows and close the appeal. Or, they could approve me from the date of the new claim and the appeal could deal with the stuff before that. But what they did was what they are apparently supposed to do (according to Peggy and the VSOs): defer the appeal related claims to the appeal. DOH.
      Current Status: Early this month my claim progressed and I was granted an increase to 30% for IBS secondary to my 70% PTSD, and since I had a pre-existing 10% for nerve condition and 20% for lumbar strain, that brought me to 90%. My claim never went to complete and I never got the BBE, ebenefits bounced around from gathering of evidence to pending decision approval within days of my last C&P (I had one for PTSD and one for IBS). I’m not sure why they would give me a C&P for PTSD if they are deferring that part of my claim to appeal as I was told. Maybe they’re just giving me a checkup because my 30 appointments and inpatient stays and shock treatments over the past year weren’t enough medical evidence.
      I learned of the increase bc I got a small retro and my ebenefits letters and disabilities changed within days, but the claim stayed open. I found out by calling Peggy and VSO that it’s due to an increase for my lumbar strain that someone in the rating chain put in. I do have plenty of evidence in my medical records that show my back is also crap. I got sent to a C&P for my lumbar strain and now I wait in GOE. The C&P examiner, Peggy, VSOs specifically say I was submitted for an increase for my back, not a review. BTW, in ebenefiits in the disabilities section, the PTSD increase is still open, the TDIU disappeared, the IBS is rated, and the lumbar strain doesn’t appear. Yes, I know ebenefits is unreliable and I should find something else to do, but compulsively logging into ebenefits is an activity quite similar to playing a slot machine for me. Every 1 in 10000000 logins I might get a glimmer of hope, and it keeps me going lol.
      I Wonder: What difference does it make if I’m rated 20% or 30% for my lumbar strain? Why would this be raised since my overall rating won’t change from 90% either way? Trust me, I AM NOT COMPLAINING AND I AM GRATEFUL, anything they do (and they have been getting faster and more Vet-friendly it seems) positive for the Veteran that saves future agony and torture is an appreciated blessing. It would help in the future in qualifying for SMC, but I don’t qualify with the math now. Just wondering if they don’t have enough to do over there, because in the future I’d probably have to get another C&P. Also, I would have to have another condition at 30% for that math to work out, and I pray nothing else worsens enough for that to happen.
      Does “separate” mean it can’t affect the same body system or it can’t be a secondary condition? Because with secondaries, I could potentially qualify for SMC, and therefore the VA rater would be setting me up for success. Otherwise, it just seems like extra work for them when they could close my case and get their quota numbers and help another Vet...again, not complaining but whoever is on my file seems to be thorough regardless.
      I know they could be doing anything over there, and I’m glad they’re working on my claim, but just for s&g I’d appreciate any guesses or suggestions, and any help clarifying the SMC Housebound math thing please.
      Thank you all.
    • By hawkfire27
      Please delete
    • By Stick Slinger
      I was never diagnosed in service with OSA. I weigh 220 and I am 6' tall. I am rated at 70% for PTSD and the meds I take add to the OSA. I had my personal Dr. and the Psychiatrist I see both write letters to support that the meds I take add to and cause the OSA. My Dr filled out the DBQ and sent it in as well. I had a failed sleep study results sent in  with my claim. I also have documentation I sent it that back up the fact that OSA is tied to PTSD and is aggravated by PTSD. Then sleeping with the prescribed CPAP machine adds to the PTSD. Just curious if anyone has ever won this claim? I am going to appeal but wanted to get any advise here first if someone has any to share.. not sure if there is anyone who has gone this route before and won?
    • By kent101
      I see now the VA is using ecstasy on Veterans saying it helps cure mental illness. Ecstasy causes some major brain damage. The VA Hospital forcefully did lobotomies on 2000 WW2 Veterans and ruined their lives.
      Roman Tritz’s memories of the past six decades are blurred by age and delusion. But one thing he remembers clearly is the fight he put up the day the orderlies came for him.
      “They got the notion they were going to come to give me a lobotomy,” says Mr. Tritz, a World War II bomber pilot. “To hell with them.”
      The orderlies at the veterans hospital pinned Mr. Tritz to the floor, he recalls. He fought so hard that eventually they gave up. But the orderlies came for him again on Wednesday, July 1, 1953, a few weeks before his 30th birthday.
      This time, the doctors got their way.
      The U.S. government lobotomized roughly 2,000 mentally ill veterans—and likely hundreds more—during and after World War II, according to a cache of forgotten memos, letters and government reports unearthed by The Wall Street Journal. Besieged by psychologically damaged troops returning from the battlefields of North Africa, Europe and the Pacific, the Veterans Administration performed the brain-altering operation on former servicemen it diagnosed as depressives, psychotics and schizophrenics, and occasionally on people identified as homosexuals.
      The VA doctors considered themselves conservative in using lobotomy. Nevertheless, desperate for effective psychiatric treatments, they carried out the surgery at VA hospitals spanning the country, from Oregon to Massachusetts, Alabama to South Dakota.
        Roman Tritz talks about the scars from his lobotomy.  
      The VA’s practice, described in depth here for the first time, sometimes brought veterans relief from their inner demons. Often, however, the surgery left them little more than overgrown children, unable to care for themselves. Many suffered seizures, amnesia and loss of motor skills. Some died from the operation itself.
      Mr. Tritz, 90 years old, is one of the few still alive to describe the experience. “It isn’t so good up here,” he says, rubbing the two shallow divots on the sides of his forehead, bracketing wisps of white hair. 
      The VA’s use of lobotomy, in which doctors severed connections between parts of the brain then thought to control emotions, was known in medical circles in the late 1940s and early 1950s, and is occasionally cited in medical texts. But the VA’s practice, never widely publicized, long ago slipped from public view. Even the U.S. Department of Veterans Affairs says it possesses no records of the lobotomies performed by its predecessor agency.
      Musty files warehoused in the National Archives, however, show VA doctors resorting to brain surgery as they struggled with a vexing question that absorbs America to this day: How best to treat the psychological crises that afflict soldiers returning from combat.
        Between April 1, 1947, and Sept. 30, 1950, VA doctors lobotomized 1,464 veterans at 50 hospitals authorized to perform the surgery, according to agency documents rediscovered by the Journal. Scores of records from 22 of those hospitals list another 466 lobotomies performed outside that time period, bringing the total documented operations to 1,930. Gaps in the records suggest that hundreds of additional operations likely took place at other VA facilities. The vast majority of the patients were men, although some female veterans underwent VA lobotomies, as well.
      Lobotomies faded from use after the first antipsychotic drug, Thorazine, hit the market in the mid-1950s, revolutionizing mental-health care.
      The forgotten lobotomy files, military records and interviews with veterans’ relatives reveal the details of lives gone terribly wrong. There was Joe Brzoza, who was lobotomized four years after surviving artillery barrages on the beaches at Anzio, Italy, and spent his remaining days chain-smoking in VA psychiatric wards. Eugene Kainulainen, whose breakdown during the North African campaign the military attributed partly to a childhood tendency toward “temper tantrums and [being] fussy about food.” Melbert Peters, a bomber crewman given two lobotomies—one most likely performed with an ice pick inserted through his eye sockets.
      And Mr. Tritz, the son of a Wisconsin dairy farmer who flew a B-17 Flying Fortress on 34 combat missions over Germany and Nazi-occupied Europe.
      “They just wanted to ruin my head, it seemed to me,” says Mr. Tritz. “Somebody wanted to.”
      Counting the Patients
      A memo gives a partial tally of lobotomized veterans and warns of medical complications. A note about documents:
      Yellow highlighting has been added to some documents. The names of patients not mentioned in these articles have been redacted, along with other identifying details. All other marks are original.   The VA documents subvert an article of faith of postwar American mythology: That returning soldiers put down their guns, shed their uniforms and stoically forged ahead into the optimistic 1950s. Mr. Tritz and the mentally ill veterans who shared his fate lived a struggle all but unknown except to the families who still bear lobotomy’s scars.
      Mr. Tritz is sometimes an unreliable narrator of his life story. For decades he has meandered into delusions and paranoid views about government conspiracies.
      He speaks lucidly, however, about his wartime service and his lobotomy. And his words broadly match official records and interviews with family members, historians and a fellow airman.
      It isn’t possible to draw a straight line between Mr. Tritz’s military service and his mental illness. The record, nonetheless, reveals a man who went to war in good health, experienced the unrelenting stress of aerial combat—Messerschmitts and antiaircraft fire—and returned home to the unrelenting din of imaginary voices in his head.
      During eight years as a patient in the VA hospital in Tomah, Wis., Mr. Tritz underwent 28 rounds of electroshock therapy, a common treatment that sometimes caused convulsions so jarring they broke patients’ bones. Medical records show that Mr. Tritz received another routine VA treatment: insulin-induced temporary comas, which were thought to relieve symptoms.
      ‘Anxious to Start’
      The VA hospital in Tuskegee, Ala., asks permission to perform lobotomies. To stimulate patients’ nerves, hospital staff also commonly sprayed veterans with powerful jets of alternating hot and cold water, the archives show. Mr. Tritz received 66 treatments of high-pressure water sprays called the Scotch Douche and Needle Shower, his medical records say.
      When all else failed, there was lobotomy.
      “You couldn’t help but have the feeling that the medical community was impotent at that point,” says Elliot Valenstein, 89, a World War II veteran and psychiatrist who worked at the Topeka, Kan., VA hospital in the early 1950s. He recalls wards full of soldiers haunted by nightmares and flashbacks. The doctors, he says, “were prone to try anything.”
    • By FAVet777
      Thanks for reading this. I have been trying to find all the information that I can about getting re-examined. So I thought I would start here and I did my research on here. I am rated at 70% for PTSD with Major Depression Disorder long with a few other claims that rounds out to 80%. Ill mostly be disscussing my mental health award and not the others Since the that is my highest rating. My benefits where awarded in July of 2017 as far what e-benifits shows. that was my backpay date. In my award letter that I got in the mail it states for all my conditions even tinnitus that "since there is a likelihood of improvement, the assigned evaluation is not considered permanent and is subject to a future review examination". First let me state that I am beyond grateful of my award and I do not wish to try to try to increase my ratings or bring any attention to my file or profile with the VA. I am content with where I am at. I go to the VA every two weeks for my 1 on 1 with my Mental Health provider. So I am knocking out two birds with one stone as far as getting my treatment and showing the VA that I am seeking treatment. 
      Now...What are the circumstances of me getting Re-evualutated? Is it the luck of the draw and I might get randomly selected? I know plenty of people with lower ratings that are not TDIU or P&T that have been rated for over 4-5 years with no exams what so ever. Consider me being paranoid but I want to be Pre-emptive. Especially since my award letter clearly states that ALL my conditions "is subject to future review examination". When would the VA see that my condition has improved if it did? Would they get an alert from the VA Hospital that I am doing better? Or would it would it arise if i get selected for a review and they review my medical records? Like I said earlier im contempt at 80% and more than anything I just want to stay out of sight out of mind on the VA's raters radar and continue my treatment in peace. 
    • By Broken Cat
      I am in the process of putting together a claim package for mental health issues related to MST.  Try as I might, I cannot find a VSO with experience in my situation.  It's taken me years to accept that I need help and that I need to address this once and for all, so when I say that I cannot handle doing this twice (submitting a sub par claim and then doing appeals) I really mean it. From day to day, I vacillate between thinking my problems are actually other people's inability to cope OR feeling like there is no point to me and that I'm a burden.If it weren't for the whole not being able to pay bills and risking alienating my kids for all eternity, I'd be perfectly content letting the world turn while I hang out at home and being maladjusted and mean.
      In my perfect world, there would be a check list of things to submit for a fully developed claim. On this checklist, there would be a list of key phrases or high points that would help sway the decision makers into awarding adequate compensation. I haven't been able to find anyone that has had success doing this with a case like mine.  I have police reports from the MST.  I have trauma counseling records and AD medical records that clearly state a d/x for PTSD related to rape on X date. My counseling sessions identified dissociation behaviors, PTSD, and anxiety. One doctor even noted that I was combative and stated that I wished harm on my attackers. 
      Obviously, the Navy handled this clear cut case of rape, with evidence and my complete cooperation, like they do any scandal.  They buried it and came after me.  That might be a secondary stressor, but I've been warned that claiming a secondary stressor could hose up everything and to keep my mouth shut?  kind of amazing that the advice that is meant to help, sounds a lot like the advice that sent me careening out of control all those years ago.
      Anyhow, I survived, got married, got out, and went in and out of counseling.  Over the years, I've been diagnosed with PTSD, Chronic Depression, Chronic Adjustment Disorder, Agoraphobia, Generalized anxiety Disorder, and Dissociation Disorder.  I don't trust military medicine or the government, so most of my counseling was done through non-profit organizations and women's shelters. They're so secretive, that I felt it'd be safe to tell them what I went through and my statements wouldn't end up in the Navy's summary of Mishaps... again. So, I don't really have records of those, except for prescriptions that were reported to Tricare.   I do have my civilian medical records. It has page after page of doctors complaining that I broke down, was combative, emotional etc, etc.  I do have a few sessions with shrinks at MTFs in the last couple years. They were not keen on actual diagnostics, they just gave me the pills I asked for.
      I'm shopping shrinks to assess me and give diagnosis. I'm not sure I need a nexus letter, but I'm thinking it wouldn't hurt.  I have a letter from my ex boss describing how my work performance plummeted over the years and how he made accommodations to keep me on. I also have a letter from me, describing my bad days and my rituals to get through them. My husband and his best friend were witnesses to the fallout of my rape, in terms of the military's response to me.  They can verify in statements that I did report it and go into counseling. They can also verify that I'm socially isolated and very codepenedent on them to meet new people or get involved in activities.  I don't have a single friend that they didn't make for me, first.  I do not know how to people. I don't have friends from work. I don't have "my own" friends from church. I don't even have people who like me well enough, and include me in things, without my husband and his best friend acting as intermediaries.  
      oh, I also have the most recent sentencing transcripts for the ringleader of my attackers.  The judge stated that he felt this dude was unrepentant and a monster. He cited his past sex crimes, "both in the record and that didn't make it to trial" and his history of convincing others to help him conceal his crimes.  If that's not a shout out from the bench, I don't know what is.

      Anyhow, I guess my question is, has anyone here done a fully developed MST claim with multiple bullet points for anxiety, phobia, ptsd, and depression, and get 100% or at least, a high enough rating to qualify for unemployability?  Without having to go through appeals and lawyers?  Was a police report enough, even if the military dropped it?  Should I give the C&P my evidence, letters, and my personal statement too? I'm sure I have 1000 more questions,  but I'm mostly looking for someone who has done what I'm trying to do.
    • By nova
      New here. Found the community through google. I'm still learning to navigate the site, so please bear with me. Searching got me in the right direction but not close enough.
      I was recently diagnosed with Service connected PTSD through the VA. I have not done a C&P exam yet. On the same day I was diagnosed with obstructive sleep apnea through a VA sleep study. I've read that there is a slim chance to connect my sleep apnea as a secondary to my PTSD. My VA psych Dr said they aggrevate each other, but a pulmonologist opinion would have more power than his. I've seen some advice from other members talking about letter templates, DBQs and supporting articles. However, I haven't been able to find them here. 
      I've scheduled a civilian Dr. appointment with a pulmonologist in about 2 week and would like to come prepared with any information I can.
      Any help would be greatly appreciated. 
    • By kent101
      I'm reading this VA Citation :NR 1231506 and the VA is saying that because a Veteran with PTSD is getting improvement from his psychiatric medication, that he's showing less symptoms because of it, that he is having his rating reduced from 70% to 30% for PTSD. The VA did reverse the reduction at the BVA. Is this still something to worry about? At a C&P exam does the Veteran have to make it clear that the medication is the reason for improvements and needed to sustain them?   
      Citation NR: "
      An October 2009 VA medical record reflects that the Veteran reported that the medication he had been prescribed helped with ability to be out in public and that, while leery about being around people, he could go out in public much more easily. His mood overall was good, and he indicated that he continued to enjoy dining out with his wife and stopping by the VFW to socialize with friends. The examiner assigned a GAF score of 76-80".  
      Over at Veteran's Law Blog it says
      "As an example, say a Veteran has been able to service-connect Irritable Bowel Syndrome (DC 7319).
      Undiagnosed, the symptoms of IBS might be a component of Gulf War Illness
      With prescribed medication, our hypothetical Veteran’s condition moderates from a severe form of the disease to a milder form.
      The severe form of IBS is rated at 30% and the moderate form of IBS is rated by the VA at 10%.
      Let’s say the VA gives the Vet a rating of 10%, claiming that the Veteran’s medication limits her symptoms.
      Is that 10% rating correct?
      No . The Diagnostic Criteria in the VA Rating Schedule for Irritable Bowel Syndrome does not specifically list the effects of medication.
      Therefore, the VA is not allowed to consider the relief it provides when determining the degree of disability.
      Has this happened to you?
      When have you seen the VA use “improvement due to medication” as an excuse to give a lower rating"?
    • By PAR
      I filed a claim for PTSD back in 2014 and then had my C&P. At the C&P the outside VA examiner asked multiple questions and focused on my upbringing (which was good) and my Father almost insinuating that my MST really is from my Father. When I left there I was completed traumatized because of the line of questioning and that he didn't even ask about my military time and shortly after I was denied. At the same time I had already been diagnosed by my VA Mental health Dr and through a MST coordinator. I got the denial shortly after and because I was so upset just did nothing since I didn't want to go through it again. I still went to the VA for treatment and then 2017 I requested an increase for my TBI. They scheduled a C&P and I went and the VA this time and within 4 weeks I was went from 10% TBI to 70% for TBI/PTSD making my overall rating 100%.  A few days ago,  I received my narrative and  I immediately requested my original claim of PTSD reopened requesting an effective date change to my original claim that was denied . My question is that because I did nothing from 2014-2017 will they deny or is there anything I can do to have my effective date changed since the first C&P went so wrong.
    • By MF6
      I separated from active duty service in the Air Force with in 2010 and had undiagnosed non-combat military connected PTSD with alcohol use in remission (According to my VA disability paperwork which puts me at 50% for ptsd.) This was granted the beginning of last year. I recently put in to have my discharge upgraded to honorable from general and have yet to hear back from them. (E-benefits say maybe I'll hear about it early February 2018.)
      There were a few selfmedicated incidents with alcohol that happened while I was active duty that resulted in going into a civilian rehabilitation facility, a perscription to an antidepressant, and a lot of suicidal ideation I recently admitted in my paperwork to the review board that I was afraid to admit to my command because they would do things like write someone up for a sunburn (destruction of government property), or purposefully keep spouses apart by writing one up for something they didn't do and keep them from going during their significant others' PCS (because someone else did it to them for five years and "they turned out fine"(There was no way to prove otherwise.)).
      I was recently reading about medical retirement from the military. It's a little confusing. I was wondering if there was a way to submit for reconsideration and medically retire from the military after separation?
    • By MikeT
      Hello all,
      Q: Is there somewhere besides the JSRRC that would keep Marine Corps helicopter accident records.
      I was diagnosed (by the VA) with PTSD related to a helicopter accident that I was in in the late 80's.  I prepared and submitted a PTSD claim that includes details of the accident as well as a buddy statement from someone involved in the investigation of the accident.  In my claim I requested assistance from the VA in checking the JSRRC for the related records to prove the accident and my involvement as I did not have the date of the incident.  I requested that the VA (and JSRRC) look in 60 day increments during the 1986-1987 years. They denied my claim because they stated they could not locate the incident.  Thanks for any and all assistance.  Mike
    • By Diablopup
      I've been having issues for years but didn't even realize for a long time they were related to my time in service (88-92).  I just pushed the feelings down deep inside and avoided thinking about it.  When I finally went to a civilian Dr for my depression back in 2003/2004 I was put on every drug available but nothing worked for long.  When I lost my job and went back to school to get an associates degree I had to find a way to continue treatment so i started going to the VA.  Problem is while I would sometimes be honest with my Dr about how I was feeling, other times I would deny currently suffering.  I didn't want to appear weak, especially if it was a woman treating me.  I know that my fault, partly because of how I was raised and partly due to my time in the Marines.  Depending on who saw me, their DX differed.  My primary care Dr and a social worker suspected PTSD, but the Psychiatrists DX was MDD and SAD.  Finally after I graduated college and started a new job I lost the ability to cope and had trouble concentrating and handling the stress.  I was let go and spiraled out of control.  For the past 3 years now I havn't worked and I only leave my house every couple weeks to buy groceries late at night or to visit my Dr at the VA (if I don't end up canceling or missing my appt due to feeling sick at the thought of leaving the house).  I finally decided to apply for compensation as my family who has been supporting me has reached their financial limit.  I hoped for the best as I now know I really have a horrible problem and need help to survive and not end up under a bridge somewhere.  I will post the C & P examiners exam results now and hope someone can find something to help me with my next step.  Also he references several other mental health evaluations.  I will post those as replys to myself as this is going to be a LONG post.  I will only be editing out my and the examiners name, everything else I will leave in.  I know now I can't get help if I leave out information.  Thank you for any advice in advance.  
      Semper Fi
      Initial Post Traumatic Stress Disorder (PTSD)
      Disability Benefits Questionnaire
      SECTION I:
         1. Diagnostic Summary
         Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria
         based on today's evaluation?
         [ ] Yes   [X] No
         If no diagnosis of PTSD, check all that apply:
            [X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under
                DSM-5 criteria
            [X] Veteran has another Mental Disorder diagnosis.  Continue to complete
                this Questionnaire and/or the Eating Disorder Questionnaire:

         2. Current Diagnoses
         a. Mental Disorder Diagnosis #1: Major Depressive Disorder
                ICD code: F33.1
                Comments, if any:
                   Less likely than not due to, caused by, or incurred during military
                   Military records indicate no treatment for this condition and
                   discharge physical exam indicated no mental health problems.  The
                   veteran did not have any mental health treatment until many years
                   after military service.

            Mental Disorder Diagnosis #2: Social Anxiety Disorder
                ICD code: F40.10
                Comments, if any:
                   Less likely than not due to, caused by, or incurred during military service.
                   Military records indicate no treatment for this condition and
                   discharge physical exam indicated no mental health problems.  The
                   veteran did not have any mental health treatment until many years
                   after military service.

            Mental Disorder Diagnosis #3: Attention Deficit/Hyperactivity Disorder
                ICD code: F90.0
                Comments, if any:
                   Less likely than not due to, caused by, or incurred during military service.
                   Military records indicate no treatment for this condition and
                   discharge physical exam indicated no mental health problems.  The
                   veteran did not have any mental health treatment until many years
                   after military service.
                   Furthermore, ADHD, by its very definition and nature, begins in
                   childhood, and his not caused by any external events.

         b. Medical diagnoses relevant to the understanding or management of the
            Mental Health Disorder (to include TBI): GERD, history of headaches,
            history of neck pain

         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:
                   Due to symptom overlap and multidirectional interactions among the
         c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?
            [ ] Yes   [X] No   [ ] Not shown in records reviewed
         4. Occupational and social impairment
         a. Which of the following best summarizes the Veteran's level of 
            and social impairment with regards to all mental diagnoses? (Check only
            [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: Due to symptom overlap and multidirectional interactions among the disorders.
           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
         Evidence reviewed (check all that apply):
         [X] VA e-folder (VBMS or Virtual VA)
         [X] CPRS
         [X] Other (please identify other evidence reviewed):

               The vet brought a copy of his recent Statement in support of claim
               which was on his smart phone screen.  This examiner reviewed that.  It
               had not been submitted yet to the Regional office.  The veteran also
               brought in a wooden plaque with a Marine Corps Meritorious Mast award
               on it dated 12/14/1989 indicating that he was involved in capturing an
               intruder on their base in the Philippines as part of their patrol.         

         2. History
         a. Relevant Social/Marital/Family history (pre-military, military, and
               This veteran has had a number of past mental health evaluations here 
      at the VA.  Please see the 12/16/2011 psychology evaluation, the 4/272012
               psychiatry intake, and the 10/17/2016 psychology mental health
               treatment plan for details of his history.

               The veteran is 47 and is divorced since 2001 (past records noted above
               suggest this seems to have had little to do with his mental health
               issues). His last relationship ended in 2012 he reported today that she apparently had another man already lined up, as she was dating him just a couple days after they broke up.  He reported no current/recent relationship. He reported he really has not been getting out much at
               all - says he does not like himself and reported he worries others will judge and talk about him. He says he is watchful and on guard for
               others' negative evaluations.  He resides alone, with his small dog.  Mother and brother are 2 hours away in XXXXXXX.  He has little contact,
               avoiding her alot and her possible questions about his job hunt. He used to play some online gaming and still does, but only occasionally.
               No groups, clubs, organizations or church. No close individual friends.  He reported no other recreation/leisure. He says he sleeps on the 
      couch since his relationship breakup about 5 years ago, as the bed reminds him of her. He says his sleep schedule is widely varied and he will do alot of daytime sleeping, watches some TV.  He only rarely goes to the store and does so late at night so as to avoid other people and their
               perceived judgement.  He reports he has had little motivation to attend to household tasks and becomes easily overwhelmed and thus avoids or
               procrastinates.  As a result, he reports there are many empty grocery bags laying around, and he simply piles the mail on the kitchen table.
               Part of that may also be  due to avoiding what might be in the mail.  He reports he keeps phone ringer off so as to avoid contact from the
               bill collectors.  He says he owes $50,000 in school loans and years ago put $20,000 of his girlfriend's school loans on his credit card and
               cannot pay fully. It seems his attempt at coping is through avoidance, which then adds to the problems he has.

               The veteran enlisted into the Marine Corps and served August 1988 to
               August 1992.  He rose to an E4 rank and had an honorable discharge.  
      He served time both in the Philippines and in the Persian Gulf during the
               Desert storm/desert shield..  His MOS was mortars.
               His statement in support of claim seen on his cell phone screen today
               listed two events, one of which he reported occurred in the 
      Philippines in May 1990.  He says he and his girlfriend at the time work in the
               marketplace and then went to a bar down the street.  Not too long
               afterwards, he and others in the bar found out that two airman had 
      been shot in the market area where he had been not long before.  This
               examiner notes that while this could be an upsetting or shocking bit 
      of information to find out, the veteran did not experience any actual
               trauma.  He did not witness the shooting and was not even aware of it
               until being told shortly after it occurred. The second incident he
               reported was from February 1991 in Kuwait and reported that they took
               small arms fire at one point and also took enemy mortar fire and they
               were in a mortar battle.  He felt the enemy mortars were getting
               closer, as close as 50 yards away, until the enemy position was
               neutralized.  This event would meet DSM?five trauma criteria for PTSD.
               Other VA notes also refer to the veteran being next to a man who 
      almost committed suicide, but a sergeant apparently prevented it.  This would
               also not meet trauma criteria as nothing actually happened.  There was
               no trauma witnessed, and the veteran himself was not in significant
               threat. The veteran today said he really wanted to have a career in 
      the USMC, but also noted that the reason he actually got out was due to a
               Reduction In Force at that time.  
         b. Relevant Occupational and Educational history (pre-military, military, 
               This veteran has had a number of past mental health evaluations here 
               the VA.  Please see the 12/16/2011 psychology evaluation, the 4/272012
               psychiatry intake, and the 10/17/2016 psychology mental health
               treatment plan for details of his history.

      Vet reported today that he has had mental health treatment in the
               private sector starting about 2003/2004 regarding ADHD and was placed
               on Adderal as well as a number of antidepressants.

               He started here at the VAMC in 2011, dealing with issues of ADHD,
               Depression and Anxiety (particularly Social Anxiety). He has seen
               psychiatry, psychology and social work at various times since then, up
               until the preseent. 

               He also had Neuropsychological testing on 10/14/2011 regarding an ADHD

               Psychiatry records indicate medication has not been all that effective
               regarding his depression and social anxiety. 
               He currently is treated with Adderal for ADHD and recently was
               (re)started on escitalopram.

               He has also been in and out of psychotherapy for the above conditions. 

               This examiner notes that the previous evaluations noted above assessed
               for PTSD but indicated he did not meet criteria.

               Those evaluations also indicated that the veteran's depression
               condition really worsened in recent years following the breakup of his
               long-term relationship about five or six years ago, though a little 
      bit before that there was some increased depression.  Furthermore, those
               evaluations also indicate the veteran has felt that he always has
               tended to be rather anxious and depressed with low self-esteem.  The
               records indicate a history of a very strict and harsh, verbally
               abusive, father as well as a history of being bullied in school, 
      though did not get any mental health services.  Curiously, VA social work
               notes from more recent times such as 5/18/2017, seem to describe the
               social anxiety as being caused by or started in the military, related
               to harsh treatment by a corporal.  This is not likely accurate given
               the previous treatment notes described in the first paragraph above
               that indicate a long history of this type of feeling even in his 
      youth, as well as more recent onset/worsening of symptoms just a few years 
      ago following the relationship breakup.
         d. Relevant Legal and Behavioral history (pre-military, military, and
               This veteran has had a number of past mental health evaluations here 
      at the VA.  Please see the 12/16/2011 psychology evaluation, the 4/272012
               psychiatry intake, and the 10/17/2016 psychology mental health
               treatment plan for details of his history.

         e. Relevant Substance abuse history (pre-military, military, and
               This veteran has had a number of past mental health evaluations here 
      at the VA.  Please see the 12/16/2011 psychology evaluation, the 4/272012
               psychiatry intake, and the 10/17/2016 psychology mental health
               treatment plan for details of his history.

         f. Other, if any:
         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: Small arms fire and mortar battle in Gulf War
               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
               [ ] 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

            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] No criterion in this section met.

            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] No criterion in this section met.

            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] No criterion in this section met.

            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] No criterion in this section met.

            Criterion F:
                        [X] No criterion in this section met.

            Criterion G:
                        [X] No criterion in this section met.

            Criterion H:
                        [X] No criterion in this section met.

            Criterion I: Which stressor(s) contributed to the Veteran's PTSD
                         No response provided.
         5. Symptoms
         For VA rating purposes, check all symptoms that actively apply to the
         Veteran's diagnoses:
            [X] Depressed mood
            [X] Anxiety
            [X] Disturbances of motivation and mood
            [X] Difficulty in establishing and maintaining effective work and social
            [X] Difficulty in adapting to stressful circumstances, including work or 
                worklike setting

         6. Behavioral Observations
         The veteran's affect was broad, though mood appeared dysphoric and anxious.
         He was quite talkative and animated at times.  He was polite and 
         Eye contact and behavior were normal.

         7. Other symptoms
         Does the Veteran have any other symptoms attributable to PTSD (and other
         mental disorders) that are not listed above?
            [X] Yes   [ ] No
                If yes, describe:
                   The veteran has a history of attention deficit/hyperactivity
                   disorder (ADHD), inattentive type.  Please see the DSM?five as well
                   as the neuropsychological testing from 10/14/2011 for details of
                   such symptoms.
         8. Competency
         Is the Veteran capable of managing his or her financial affairs?
            [X] Yes   [ ] No
         9. Remarks, (including any testing results) if any
            The exam request form states/asks:

            "Exams on this request: 
            DBQ INITIAL PTSD

            ** Status of request: 
            Pending, reported to MAS

            DBQ PSYCH PTSD Initial

            The following contentions need to be examined:

            Active duty service dates:
            Branch: Marine Corps
            EOD: 08/02/1988
            RAD: 08/01/1992

            DBQ PSYCH PTSD Initial:
            Please review the Veteran's electronic folder in VBMS and state that it 
            was reviewed in your report.

            TYPE OF MEDICAL OPINION REQUESTED: Direct service connection
            OPINION: Direct service connection

            Does the Veteran have a diagnosis of (a) PTSD that is at least as likely 
            as not (50 percent or greater probability) incurred in or caused by (the) 

            Combat Action Ribbon during service?

            Rationale must be provided in the appropriate section. Your review is not 

            limited to the evidence identified on this request form, or tabbed in the 

            claims folder. If an examination or additional testing is required, 
            obtain them prior to rendering your opinion.


            NOTE:  Your (examiner) review of the record is NOT restricted to the 
            evidence listed below.  This list is provided in an effort to assist the 
            examiner in locating potentially relevant evidence.

            STORM AND DESERT SHIELD  dated 06/27/2017

            If more than one mental disorder is diagnosed please comment on their 
            relationship to one another and, if possible, please state which symptoms 
            are attributed to each disorder.

            If your examination determines that the Veteran does not have diagnosis 
            of PTSD and you diagnose another mental disorder, please provide an 
            opinion as to whether it is at least as likely as not that the Veteran's 
            diagnosed mental disorder is a result of an in-service stressor related 


            As noted above, this veteran does not appear to meet criteria for PTSD,
            lacking sufficient number, frequency, and severity of symptoms to warrant
            such a diagnosis.  The veteran does have depression and anxiety (mainly
            social anxiety) and ADHD conditions described above, though it is this
            examiner's opinion that they are less likely due to, caused by, or
            incurred during military service for the reasons noted above.

            Today, the veteran denied any delusions or hallucinations.  There are no
            panic attacks and no OCD.  He denied any suicidal or homicidal ideation.
            He says that he knows if he were ever to kill himself, it would hurt his
            mother significantly and he would did not want to do that.  He does 
      report frequently being in a low, sad and depressed mood.  He reported crying
            spells, decreased hope, low self-esteem, feeling easily overwhelmed,
            feeling "stuck" and self critical.  He described feeling depressed over
            various regrets he has in his life.  He also reported a lot of anxiety.
            Some of this is regarding his current life situation including financial
            difficulties, though a lot also appears to be related to socially related
            anxiety feelings.  He feels others judge and evaluate him in a negative
            manner.  He feels he just does not measure up and worries when others are
            looking at him, that they are thinking negative thoughts or critical
            thoughts about him.  This also creates not only emotional anxiety, but
            also physical symptoms such as nausea.  Regarding PTSD issues, the 
      veteran says he has sometimes dreamt that he is in the US Marine Corps but is out
            of shape.  He reported no recent issues with any actual trauma related
            nightmares.  He also says he has negatively dreamed recently about his
            most recent ex-girlfriend (from five years ago).  The veteran did not
            describe upsetting intrusive trauma memories nor severe distress at any
            particular cues.  The veteran does not appear to actually meet criteria
            for HYPERvigilance.  He seemed to deny his issues with anxiety around
            people have to do with actual fear for his physical safety.  This
            avoidance of people and public has to do more with worrying about their
            judging him.  He reports when driving he is aware of other cars and where
            people are around him, though this does not appear to be related to 
      trauma or represent any PTSD.  The veteran seems to describe having no real set
            sleep schedule and he will go to sleep at widely varying times.  He says
            he has some difficulty falling asleep but once he is asleep, he will 
      sleep for as long as 12-16 hours.  This may be related to his nonservice related
           anxiety/depression condition and his negative coping strategy of
      NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application.
      PhD Clinical Psychologist
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