degenerative arthritis Lower Back C&P plus backpay and neuropathy questions

[OffGridGrunt]

I recently finished a series of C&Ps for various conditions and I was hoping to get some input on just what exactly it all means - I was wondering what if any kind of rating might I be looking at? Is there a possibility for getting back pay? What can I do (possibly in an appeal) to do more to strengthen my case? At this point my case should be done with the gathering evidence phase (I can't check because ebenefits is being weird). All C&P's are done and everything that needed to be turned in is (I hope).

The first C&P/DBQ I'd like assistance with is my claim for "Lower Back Condition". Originally I had claimed "chronic lower back pain" only to later find out that really isn't a thing and thus I was denied. When I went in for this most recent exam the reviewing doctor first went to my C-File and saw that I had claimed "chronic lower back pain" back in 2004. He then went into my military treatment record and found considerable amounts of treatment records for several issues in my lumbar spine and beyond. "They should have connected you back in 2004" he said to me. Sufficed to say that his positive first impressions put me a little more at ease with the C&P (which normally turns me into an anxious, nervous wreck).

I've now gained access to the DBQ and would like any information that you well informed folks could provide. I've cut it down as much as I thought I could. If a question is missing and/or option is missing assume it wasn't checked. All non-pertinent information I cut out and did some heavy editing as far as formatting goes. Here it is:

                     Back (Thoracolumbar Spine) Conditions

                       Disability Benefits Questionnaire

    Indicate method used to obtain medical information to complete this document:

    [X] In-person examination

   

    Evidence review

    ---------------

    Was the Veteran's VA claims file (hard copy paper C-file) reviewed?

    [X] Yes   [ ] No

   

           If yes, list any records that were reviewed but were not included in the Veteran's VA   

claims file:

   

       VA medical records.

     

    1. Diagnosis

    ------------

    Does the Veteran now have or has he/she ever been diagnosed with a thoracolumbar spine (back) condition?

    [X] Yes   [ ] No

 

    Thoracolumbar Common Diagnoses:

      [ ] Ankylosing spondylitis

      [X] Lumbosacral strain

      [ ] Degenerative arthritis of the spine

      [ ] Intervertebral disc syndrome

      [ ] Sacroiliac injury

      [ ] Sacroiliac weakness

      [ ] Segmental instability

      [ ] Spinal fusion

      [ ] Spinal stenosis

      [ ] Spondylolisthesis

      [ ] Vertebral dislocation

      [ ] Vertebral fracture

 

         Diagnosis #1:  LS strain, chronic, with LLE radiculopathy

         Date of diagnosis:  2000s

       

    2. Medical history

    ------------------

    a. Describe the history (including onset and course) of the Veteran's thoracolumbar spine (back) condition (brief summary):

During military service, the Veteran did develop chronic left     lower back pain with radiation down the left buttock to the calf. On 6/10/2003, an MRI of the LS spine was performed with the following findings: Broad based posterior/central disc bulging at L4-5 without associated neural impingement.

            After service discharge in 2004, the Veteran continued with     intermittent lower back and LLE problems. Repeat lumbar MRi in 2009 was read as normal.

            Currently he continues with chronic daily left lower back pain with LLE weakness and paresthesias. He is taking Ibuprofen and has a TENS unit as needed. He deniesbowel/bladder/sexual dysfunction related to his lower back.

b. Does the Veteran report flare-ups of the thoracolumbar spine (back)?

    [X] Yes   [ ] No If yes, document the Veteran's description of the flare-ups in his or her own words:

          Increased pain and stiffness

    c. Does the Veteran report having any functional loss or functional impairment of the thoracolumbar spine (back) (regardless of repetitive use)?

    [X] Yes   [ ] No If yes, document the Veteran's description of functional loss or functional impairment in his or her own words.

          Stiffness/LLE radiculopathy

    3. Range of motion (ROM) and functional limitation

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

    a. Initial range of motion

   

      [X] Abnormal or outside of normal range

     

          Forward Flexion (0 to 90):           0 to 75 degrees

          Extension (0 to 30):                     0 to 20 degrees

          Right Lateral Flexion (0 to 30):     0 to 30 degrees

          Left Lateral Flexion (0 to 30):      0 to 30 degrees

          Right Lateral Rotation (0 to 30):    0 to 30 degrees

          Left Lateral Rotation (0 to 30):     0 to 30 degrees

          If abnormal, does the range of motion itself contribute to a functional loss? [ ] Yes (please explain)   [X] No

      Description of pain (select best response):        

Pain noted on exam on rest/non-movement

      If noted on exam, which ROM exhibited pain (select all that apply)?

             Forward Flexion, Extension

     Is there objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine (back)?

      [X] Yes   [ ] No If yes, describe including location, severity and relationship to condition(s):

 There is localized tenderness over the bilateral paralumbar muscles and the left SI joint and left sciatic notch.

             b. Observed repetitive use:

         Is the Veteran able to perform repetitive use testing with at least three repetitions?

[X] Yes   [ ] No

         Is there additional loss of function or range of motion after three repetitions?

[ ] Yes   [X] No

    c. Repeated use over time

         Is the Veteran being examined immediately after repetitive use over time?

      [ ] Yes   [X] No    

          If the examination is not being conducted immediately after repetitive use over time:

          [X] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time.

            

      Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time?

      [ ] Yes   [ ] No   [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain:

          Not currently flared up.

             d. Flare-ups

       Is the exam being conducted during a flare-up? [ ] Yes   [X] No

               If the examination is not being conducted during a flare-up:

          [X] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups.

Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups?

      [ ] Yes   [ ] No   [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain:

          Not currently flared up.

    e. Guarding and muscle spasm

         Does the Veteran have guarding or muscle spasm of the thoracolumbar spine (back)?

[X] Yes   [ ] No

    

      Muscle spasm:

         [X] Not resulting in abnormal gait or abnormal spinal contour

       

   Provide description and/or etiology:

         Left lower back muscle spasm is noted today. Localized tenderness:

         [X] Not resulting in abnormal gait or abnormal spinal contour

      Guarding:

         [X] None

    f. Additional factors contributing to disability

      In addition to those addressed above, are there additional contributing factors of disability?  Please select all that apply and describe:

[X] None

         4. Muscle strength testing

    --------------------------

    a. Rate strength according to the following scale:

      0/5 No muscle movement

      1/5 Palpable or visible muscle contraction, but no joint movement

      2/5 Active movement with gravity eliminated

      3/5 Active movement against gravity

      4/5 Active movement against some resistance

      5/5 Normal strength

    

       Hip flexion: 

        Right: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5      [ ] 0/5

        Left:  [ ] 5/5   [X] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5  [ ] 0/5

      

      Knee extension:

        Right: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5  [ ] 0/5

        Left:  [ ] 5/5   [X] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5  [ ] 0/5

      

      Ankle plantar flexion:

        Right: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5  [ ] 0/5

        Left:  [ ] 5/5   [X] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5  [ ] 0/5

      

      Ankle dorsiflexion:

        Right: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5  [ ] 0/5

        Left:  [ ] 5/5   [X] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5  [ ] 0/5

      

      Great toe extension:

        Right: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5  [ ] 0/5

        Left:  [ ] 5/5   [X] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5  [ ] 0/5

      

    b. Does the Veteran have muscle atrophy?

      [ ] Yes   [X] No

    

    5. Reflex exam

    --------------

    Rate deep tendon reflexes (DTRs) according to the following scale:

   

      0  Absent

      1+ Hypoactive

      2+ Normal

      3+ Hyperactive without clonus

      4+ Hyperactive with clonus

      Knee:

        Right: [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+

        Left:  [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+

      

      Ankle:

        Right: [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+

        Left:  [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+

      

    6. Sensory exam

    ---------------

    Provide results for sensation to light touch (dermatome) testing:

   

      Upper anterior thigh (L2):

        Right: [X] Normal   [ ] Decreased   [ ] Absent

        Left:  [X] Normal   [ ] Decreased   [ ] Absent

      

      Thigh/knee (L3/4):

        Right: [X] Normal   [ ] Decreased   [ ] Absent

        Left:  [X] Normal   [ ] Decreased   [ ] Absent

      

      Lower leg/ankle (L4/L5/S1):

        Right: [X] Normal   [ ] Decreased   [ ] Absent

        Left:  [ ] Normal   [X] Decreased   [ ] Absent

      

      Foot/toes (L5):

        Right: [X] Normal   [ ] Decreased   [ ] Absent

        Left:  [ ] Normal   [X] Decreased   [ ] Absent

      

      7. Straight leg raising test

    ----------------------------

    Provide straight leg raising test results:

      Right: [X] Negative   [ ] Positive   [ ] Unable to perform

      Left:  [ ] Negative   [X] Positive   [ ] Unable to perform

 

    8. Radiculopathy

    ----------------

    Does the Veteran have radicular pain or any other signs or symptoms due to radiculopathy?

    [X] Yes   [ ] No

   

    a. Indicate symptoms' location and severity (check all that apply):

   

      Constant pain (may be excruciating at times)

        Right lower extremity: [X] None   [ ] Mild   [ ] Moderate  [ ] Severe

        Left lower extremity:  [X] None   [ ] Mild   [ ] Moderate   [ ] Severe

      Intermittent pain (usually dull)

        Right lower extremity: [X] None   [ ] Mild   [ ] Moderate  [ ] Severe

        Left lower extremity:  [ ] None   [X] Mild   [ ] Moderate   [ ] Severe

      Paresthesias and/or dysesthesias

        Right lower extremity: [X] None   [ ] Mild   [ ] Moderate  [ ] Severe

        Left lower extremity:  [ ] None   [X] Mild   [ ] Moderate  [ ] Severe

      Numbness

        Right lower extremity: [X] None   [ ] Mild   [ ] Moderate [ ] Severe

        Left lower extremity:  [ ] None   [X] Mild   [ ] Moderate  [ ] Severe

 

    b. Does the Veteran have any other signs or symptoms of radiculopathy?

      [ ] Yes   [X] No

    

    c. Indicate nerve roots involved: (check all that apply)

   

      [X] Involvement of L4/L5/S1/S2/S3 nerve roots (sciatic nerve)

    

            If checked, indicate:  [ ] Right   [X] Left   [ ] Both

          

    d. Indicate severity of radiculopathy and side affected:

   

        Right: [X] Not affected   [ ] Mild   [ ] Moderate   [ ] Severe

      

        Left:  [ ] Not affected   [X] Mild   [ ] Moderate   [ ] Severe

      

    10. Other neurologic abnormalities

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

    [ ] Yes   [X] No

    12. Assistive devices

    ---------------------

    [ ] Yes   [X] No

 

    13. Remaining effective function of the extremities

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

    [X] No

    14. Other pertinent physical findings, complications,    conditions, signs,

symptoms and scars

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

    a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [X] Yes   [ ] No     If yes, describe (brief summary):

Vital signs are stable; Lungs are clear; Heart is without m/g/r; Abdomen is soft, and without masses or organomegaly or     tenderness; Genitalia are normal, no hernias or testicular lesions, the testicles and epididymii are tender to touch bilaterally;

    b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to

the treatment of any conditions listed in the Diagnosis Section above?

      [ ] Yes   [X] No

    

    15. Diagnostic testing

    ----------------------

    a. Have imaging studies of the thoracolumbar spine been performed and are the results

available?

      [X] Yes   [ ] No

    

          If yes, is arthritis documented?

             [ ] Yes   [X] No

           

    b. Does the Veteran have a thoracic vertebral fracture with loss of 50 percent or more of height?

      [ ] Yes   [X] No

    

    c. Are there any other significant diagnostic test findings and/or results?

      [X] Yes   [ ] No

    

          If yes, provide type of test or procedure, date and results (brief summary):

             Repeat lumbar MRI has been ordered and is currently pending; when completed and reported, I will review it and add any additional comments as indicated.

           

    16. Functional impact

    ---------------------

    Does the Veteran's thoracolumbar spine (back) condition impact on his or her ability to work?

      [X] Yes   [ ] No

    

          If yes describe the impact of each of the Veteran's thoracolumbar spine (back) conditions providing one or more examples:

The Veteran's current lower back condition would limit his ability to perform repetitive heavy lifting, pushing or pulling.

            17. Remarks, if any:

    --------------------

    The Veteran is claiming service connection for a lower back condition.

    Opinion: It is as least as likely as not that the Veteran's current lower back condition is proximately due to or caused by military service.     Rationale: The C file was reviewed.

    The STRs do document a two year history in 2002 of chronic lower back pain with LLE radiculopathy. This is also noted on separation exam in 2004. I was able to elicit the same symptoms ongoing today, as well as to confirm this on phyiscal examination.

 

    Repeat lumbar MRI has been ordered since the last study was in 2009; when completed and reported, I will review it and add any additional comments as indicated. Thus, the service connection is substantiated.

 

12/23/2015 ADDENDUM                      STATUS: COMPLETED

The Veteran underwent a lumbar MRI on 12/21/2015 with the following findings:

L3-4:    Mild facet arthrosis with minimal posterior disc bulge

L4-5:    Mild facet arthrosis with minimal posterior disc bulge

L5-S1:   Mild facet arthrosis with minonal posterior disc bulge

 

------END-------

 

          Any help interpreting this would be greatly appreciated. The "service connection is substantiated" is pretty straight forward. I'm curious whether or not I have a chance at getting the SC backdated to my original claim. It seems to me (a total non expert) that the evidence is there to support it. I am also curious about whether or not I can refute some of the conclusions that this doctor came to. While an awesome C&P doctor a back expert he is not. Since the writing of the C&P I had a chiropractor evaluation who found several more things than this doctor did. I'm curious if any of it will be enough to make a 10% difference when the rating comes down.

 

In addition I am curious if within my C&P as well as the most recent chiro consult if there isn't evidence for a possible future claim for nerve pain in my lower body. "Many times spinal conditions have other conditions that contribute to the severity of the spinal condition. For example, many spine conditions also cause radiculopathy. These secondary conditions can sometimes be independently ratable." In my C&P I believe I meet all these conditions. I am diagnosed with lumbosacral strain - chronic, as well as Lower Left Extremity radiculopathy. In addition the C&P also diagnosed me with LLE weakness and paresthesias.

 

The following is a list of conditions that the Chiropractor diagnosed me with just 8 days after the C&P doctor finalized his report.

 

----------Chiropractic Evaluation--------------

LOCAL TITLE: PM&R CHIROPRACTOR CONSULT RESULT                  
STANDARD TITLE: PHYSICAL MEDICINE REHAB CONSULT

DATE OF NOTE: DEC 31, 2015@11:04 

 

Midback pain: medial scapula, left worse than right

Quality: Burning (small area "about the size of a dime")

Radiating: Patient Denies

0-10: 9/10

Timing: Intermittent

Worse: working in a "hunched" or bent over position.

Better: Standing up /stretching

Low Back Pain: Thoraco-lumbar and lower L4-5-S1.

Quality: Dull/Ache/sometimes sharp/Throbbing

Radiating: buttock/thigh and foot ("tasered"), left worse than right

0-10: 6-7/10

Timing: Intermittent

Worse: Standing/coughing while bent over

Better: changing positions/activities

 

Trunk ROM:

       Flexion:Mod dec                 Pain:Severe

       Extension:Mild dec              Pain:No pain

       Rotation:Mild dec               Pain:No pain

       Lateral Flexion:Mild dec        Pain:No pain

Muscle Atrophy: No

Seated SLR:                             Positive L

Supine SLR:                             Positive R (low back pain)

Hip hyperextension test:                Positive R

Kemps test:                             Negative R L

 

Spinous Process Tenderness: T3-7, L2,3, Right SI

Myofascial Tenderness: Bilateral Rhomboids, Thoraco-lumbar paraspinals

bilaterally.

Lumbar MRI 12/21/2015

    Impression:

      1. Mild facet arthrosis and minimal disc bulges of the lower lumbar spine without thecal sac or neuroforaminal stenosis.

 

Oswestry Disability Index Questionnaire

Section 1 -- Pain Intensity:  2. The pain is moderate at the moment.

Section 2 -- Personal Care (Washing, Dressing, etc.):  2. It is painful to look after myself and I am slow and careful.

Section 3 -- Lifting:   2. Pain prevents me lifting heavy weights off the floor, but I can manage if they are conveniently placed e.g. on a table.

Section 4 -- Walking:  1. Pain prevents me walking more than 1 mile.

Section 5 -- Sitting:   3. Pain prevents me from sitting more than one-half hour.

Section 6 -- Standing:  2. Pain prevents me from standing for more than 1 hour.

Section 7 -- Sleeping:  2. Because of pain, I have less than 6 hours sleep.

Section 8 -- Sex Life (if applicable): N/A

Section 9 -- Social Life:  3. Pain has restricted my social life, and I do not go out very often.

Section 10 -- Traveling:  2. Pain is bad but I manage journeys over two hours.

DISABILITY INDEX SCORE: 38%

 

Segmental Dysfunction: L3LP, RPIN, RAI_Sacrum, T3LP, T5LP

 

Assessment:

1. Lumbar: Segmental dysfunction

2. Lumbar: strain

3. Pelvic: Segmental dysfunction

4. Sacrum: Segmental Dysfunction

5. Thoracic: Segmental dysfunction

 

Alright. If you've made it this far thanks for taking the time to read this massive wall of text. If you have some information or experience to offer let me thank you in advance!

[pwrslm]

Fwd flexion 0-75 deg.

 

This is what you will be rated on for you back.

_____

"It is as least as likely as not" that the Veteran's current lower back condition is proximately due to or caused by military service.     Rationale: The C file was reviewed.

    The STRs do document a two year history in 2002 of chronic lower back pain with LLE radiculopathy. This is also noted on separation exam in 2004. I was able to elicit the same symptoms ongoing today, as well as to confirm this on phyiscal examination.

_____

Flexion measures more than 60° but less than 90°= 10%

 

You should get another DBQ on the neuropathy issue. 

Edited January 4, 2016 by pwrslm

[OffGridGrunt]

Ya after pouring through all my medical records and doing massive amounts of googling the CFR I was pretty sure I was on to something in regards to the neuropathy. I'm a day away from moving across the country so not really sure where that's going to leave me as far as trying to continue my claim. Unfortunately my VSO told me to go ahead and hit the "decide my claim now" option on ebenefits.

So I'm going from Texas to Michigan. I'm not sure how that will work. Can I even reopen the claim to add more stuff onto it like the secondary neuropathy issues? Do I try and get my claim moved up to Michigan mid stream or do I leave it in Texas and try and pull the strings from up North?

This is my fourth claim and somehow I always manage to foul them up one way or the other. I felt pretty good about the whole thing, especially after my C&P Doc basically told me he's going to SC me and/or increase me for everything I claimed. Now I'm feeling like I screwed up.

[pwrslm]

Adding new conditions as secondary would take your claim off FDC (if you have it as fully developed claim) and add few more months at a minimum while they collect their info and schedule another DBQ.

Moving is a loose screw in the mix.  Run it like it was no different, don't ask to have it moved at this point.  If I were you, just hit the button, wait and get it completed.  After you get to Michigan, put in the claim for neuropathy as a secondary condition.  Screwing around between TX and MI with a new DBQ would be a major pain.

Before you do anything, soon as you get into EBenefits, (when its back up) sign in another intent to file to preserve dates as soon as you can.  Use that for your secondary claim after you settled in MI and after your original claim from TX is complete (and you have the decision in hand).

It is possible that the RO will pick up on the new condition. If they do, you have to keep your eyes on the ball so that if they do try to put in a C&P for your neuropathy, you can jump in and keep them in line.  Miss the C&P and they deny deny deny....

Just my 2 cents.

 

Edited January 4, 2016 by pwrslm

[OffGridGrunt]

That great advice I really appreciate it. I agree about just letting this claim go through. I know it's not a good way to live but  I have a lot riding on this Claim. In addition to getting SC'd for this lower back condition, I'm also getting SC'd for testicular issues secondary to chronic kidney stones. In addition I'm getting an increase for an issue with my foot. (I'll be posting all these C&Ps over the next few days). Lastly I have an increase for PTSD in the works. I'm currently SC'd at 30% for PTSD.

That being said I've just finished 3 months of inpatient substance abuse, 3 months of inpatient trauma therapy, and 2 months of inpatient PTSD program. I am really hoping that that gets me some traction with the rater as the examiner absolutely shredded me in my C&P. Honestly that DBQ is truly a masterpiece of contradiction and incompetency.

She says that my ptsd hasn't gotten worse, that I don't rate an increase and that my ptsd symptoms are just issues with substance abuse and MDD. Meanwhile she attributes all but 2 of the 24 DSM-5 PTSD criteria to.... My PTSD. Oh I just gotta show ya lol!

Review Post Traumatic Stress Disorder (PTSD)
Disability Benefits Questionnaire
SECTION I:

---------------------
1. Diagnostic Summary
 --------------------

Does the Veteran now have or has he/she ever been diagnosed with PTSD?   

[X] Yes[ ] No
  2. Current Diagnoses:
    -------------------
Mental Disorder Diagnosis #1: PTSD

Mental Disorder Diagnosis #2: Cannabis Use Disorder, In Early Remission, In a Controlled Environment

Mental Disorder Diagnosis #3: Alcohol Use Disorder, In Early Remission, In a Controlled Environment

Mental Disorder Diagnosis #4: Inhalant Use Disorder, In Early Remission, In a Controlled Environment

Alright I'm definitely not proud of the huffing. All I can say is that my life had fallen to pieces. My wife took my kids and left me while I was getting the car fixed overnight. She filed false abuse charges against me to keep me from the kids. I'm no saint but I never abused my wife or my kids. Up until this moment I hadn't had a drink in 5 years... Just smoked pot. Also I think this would be a good time to put what my actual working diagnosis list for a little bit of contrast. This list was pulled straight off my myhealthevet file and reflects 9 months of inpatient treatment. I can't help but feel like this lady was snowballing me.

#1)Chronic post-traumatic stress disorder (SCT 313182004)

#2)Posttraumatic stress disorder (SCT47505003)

#3) Anxiety (SCT 48694002) - symptom of PTSD

#3) Depressive disorder (SCT 35489007) - symptom of PTSD

#4) Insomnia (SCT 193462001) - symptom of PTSD

#5) Psychophysiologic insomnia (SCT 425832009) - symptom of PTSD

#6) Cannabis dependence (SCT 85005007)

#7) Alcohol dependence (SCT 66590003)

 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?
       [X] Yes[ ] No[ ] Not applicable (N/A)

    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 with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation.
    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?
       [X] Yes[ ] No[ ] No other mental disorder has been diagnosed
If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: Symptoms of PTSD and substance use contribute to social and occupational impairment. However, symptoms of PTSD have not increased in severity since the veteran's last C&P exam in 2013.

A quick side note A: I've been in a treatment facility for almost a year now, I'm pretty sure my "substance abuse" isn't contributing to my issues, and B: I smoke pot. I don't even drink. Why do I smoke pot because it helps with my PTSD as well as a laundry list of other issues. In addition to that I had a prescription for it. That being said I've been "clean" for a year now. So...  now that she's basically said I barely have PTSD, let's get on to the next section.

 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 Criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 - "Other symptoms".
   
       Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in one or more of the following ways:
                   [X] Directly experiencing the traumatic event(s)
       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 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] Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently  ruined").
                   [X] Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead to 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, 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 ggression 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.

That last one is my favorite! There are a few more gems to go though.

 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.......

    8. Remarks, (including any testing results) if any:
    --------------------------------------------------
      Psychological Testing:

      A test of response bias specifically related to PTSD symptoms was administered to the veteran during this examination to assess the credibility of his self report. The name of this measure is withheld in this report in order to protect the integrity of the test. This test was specifically standardized on a sample of veterans applying for financial        remuneration for a claim of disability resulting from PTSD.  The veteran's score on this test was below the established cutoff, indicating that his performance was consistent with individuals responding in a valid manner. As such, he did not appear to be intentionally exaggerating signs and symptoms of PTSD or attempting to appear worse off that he actually is.

 

Ahh what a finish eh? I think she should spend less time worrying about my credibility and a little more about hers. I'm hoping that whoever rates my PTSD takes what she says with a grain of salt and also takes time to look at the 1200 pages of treatment records I've added to my medical record in the last year as well as thehe weakly psychologist appointments, 20 page typed trauma narrative, the countless notes that were put in on my behalf. I hope they also see the weekly PCL-5s averaging between 65 and 72, the by weekly CAPs averaging around 66, the PHQ9 score of 23, the gad-7 score of 20. If they don't take all that into consideration I guess I'll have plenty to throw at 'em when it comes time for an appeal.

World Health Organization Disability Assessment Schedule 2.0

Cognition: 75

Mobility: 12

Self-care: 70

Getting along: 83

Life activities (household): 100

Life activities (work/school): 85

Participation: 79

Summary: 70

[pwrslm]

When I got out, I was well on the road to alcoholism.  I cut the drug use out because they started piss testing when I was in my 2nd year in the Army.  I stopped because I was giving the cups out and running the log with the names of the guys in the companies that got tested.

My consumption increased steadily, went from beer to the hard stuff, eventually, about 9 years post discharge it all snowballed, I was drinking about 2 liters of Vodka every day and them some.  Quitting was the hardest thing I ever did.  I have been clean and sober for 23 years in Feb 2016.

I would not suppose to know the thoughts that went through the mind of your wife.  Her instinct to protect the children must have been the one thing that she acted on, for her to fear someone she loved that much.  By the Grace of God, my life turned around, and I hope that yours does as well.  I have been married for 35 years this month.

I cant talk to much on the PTSD issue, that's not one of my areas of expertise you could say.  Wait for one of the other Sr Vets here to comment for you on that issue.

 

Edited January 4, 2016 by pwrslm

[Berta]

I opined on the PTSD exam you posted in another thread here.

http://community.hadit.com/topic/65204-helphope-for-a-bad-cp-is-all-lost-hope-i-get-a-good-rater/

Also the examiner found you were not capable of handling your funds.

You might well get some retro back to the recent date of the back claim,but only a CUE claim, if a CUE was made in that decision,, would get you more retro back to the older denied claim.

You have 2 major problems with the PTSD C & P exam results.