Motherof3

I am trying to get expedited for several reasons: - PTSD/MDD is getting worse - Robbing Paul to pay Peter by over drafting; DAV just paid utility bill for this month. - I am literally locked in my apartment all day because I am surrounded by drug dealers and thieves who have no problem having people drive up in my drive way to purchase. I have pictures. And the dealers don't even live in complex. They all converge here to deal and go home at night. Can DAV assist in contacting RO to move decision along? Already had medical C&P to address increase to existing conditions.

Question. ' - filed for PTSD October 2010 - current 70% approved December 2011 (50%) PTSD - filed for IU January 2012 - denied increase/IU end of October 2012. - filed NOD December 11, 2012 - claim date changed to December 11, 2012 - C&P exam May 23, 2013; submitted to RO May 28, 2013 with MDD added as secondary to PTSD and recommendation for Unemployability. Also have VocRehab statement of Infeasability. - moved from Gathering to Preparation for Decision May 31, 2013 - I am officially over 180 days (actually 1 1/2 years I say) With all that said: 1) Why is claim date changed with NODs, 2) Upon completion, will retro pay be for December 2012 and I have to fight for January 2012? 3) note: yes, I do have an attorney and they state (no matter what date, they will be fighting for 100% retro pay from my initial file date of October 2010. Because I was homeless and worse off than 50% back then) So, please feel free to submit your thoughts and/or recommendations. By the way, Social Security claim denied twice and now in appeal. I want to request an On The Record Review Decision using my C&P exam, VocRehab Infeasability, Psychiatrist/Therapist Questionnaires.

Dependents equal additional money.

We have apparently travelled/lived same areas. I lived in Morrow and Rex, GA before here. Contemplating returning to GA after this is over.

I think I must not be looking at iris wrong. Can't find an option to send email or ask a question.

HALLELUJAH JESUS. My hope is strengthened. I am so happy for you. I was just about to vent about my eBenefits showing "Claim information not available at this time" again. I really need a breakthrough Lord.

WOW! VA needs to get real. They, themselves just announced last month that there is no cure for PTSD and it is permanent. Ironically my initial approval at 50% PTSD states permanent. I am waiting on decision for increase now. C&P Psych, my Psych, therapist and Voc Rehab all say I cannot work or attend school. In Preparation for Decision limbo.

I too am glad I found this site. I've been feeling like I had no one who understood what I'm going through, even when I try explaining. So I just shut up. CONGRATULATIONS TO EVERYONE WHO HAVE FINALLY RECEIVED THEIR FAVORABLE DECISIONS! HOOAH! To Tonio, your words of motivation and love of God is refreshing. God is in charge.

I mean the C&P examiner's support. When I get 100%, I will find a private doctor for primary care. VA doctors are comfortable being negative because they don't have to worry about building clientele to survive.

Yes ma'am. That's what I told my primary care doctor yesterday. She makes me more depressed every time I see her. I was so surprised that she supports increase. I could tell she had read my medical records thoroughly. My initial diagnosis said PTSD was "permanent" and all the professionals finally agreed and announced recently that "there is no cure for PTSD". But VA and SSA still want to make us beg for what we've earned in a horrible way. Know what I mean?

Thanks. I have attorneys for both. Can't wait for some peace. This process adds tremendously to my stress level.

I had my C&P Exam for PTSD Increase 23 May 2013.. EBenefits moved from Gathering Information to preparation for Decision 31 May 2013. Current SC: 50% PTSD, 30% Migraines, 10% Hypertension, 10% sinusitis. C&P exam went well, I think. I just need someone's opinion. Below is my exam. I deleted personal stuff. Thanks in advance. SECTION I: ---------- 1. Diagnostic Summary --------------------- This section should be completed based on the current examination and clinical findings. Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes[ ] No If yes, continue to complete this Questionnaire. If no diagnosis of PTSD, and the Veteran has another Axis I and/or II diagnosis, then continue to complete this Questionnaire and/or the Eating Disorders Questionnaire. 2. Current Diagnoses -------------------- a. Diagnosis #1: PTSD, chronic ICD code: 309.81 Indicate the Axis category: [X] Axis I [ ] Axis II Comments, if any: THE VETERAN'S PTSD HAS ALREADY BEEN ACCEPTED AS SERVICE CONNECTED. THE VETERAN REPORTS AND EXHIBITS MORE IMPAIRMENT THAN HER 50% RATING INDICATES. INDIVIDUAL UNEMPLOYABILITY: THE IMPACT OF PTSD WITH MDD ON BOTH ACTIVE AND SEDENTARY EMPLOYMENT IS: -concentration difficulties with short term memory impairment render her unable to effectively study and/or learn new skills -low energy and amotivation render her unable to effectively study and/or learn new skills -low frustration tolerance render her unable to handle the stress of being challenged in academic and occupational settings -anxiety, fear, and anger when put in an inferior position render her unable to effectively work with supervisors, bosses, and/or teachers due to mood swings and emotional outbursts -irritability renders her unable to effectively interact with co-workers, clients, and/or fellow students Diagnosis #2: MDD, recurrent, severe without psychotic features ICD code: 296.33 Indicate the Axis category: [X] Axis I [ ] Axis II Comments, if any: THE VETERAN'S MDD IS MORE LIKELY THAN NOT SECONDARY TO THE STRESS OF LIVING WITH PTSD AND THE MANNER IN WHICH IT HAS NEGATIVELY IMPACTED HER LIFE. Diagnosis #3: ICD code: Indicate the Axis category: [ ] Axis I [ ] Axis II Comments, if any: Diagnosis #4: ICD code: Indicate the Axis category: [ ] Axis I [ ] Axis II Comments, if any: If additional diagnoses, describe (using above format): b. Axis III - medical diagnoses (to include TBI): See TVHS record and medical C&P examination ICD code: Comments, if any: c. Axis IV - Psychosocial and Environmental Problems (describe, if any): low social support, health, unemployment, limited financial resources d. Axis V - Current global assessment of functioning (GAF) score: 45-50 Comments, if any: 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes[ ] No If yes, complete the following question: 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: There is overlap between the symptoms of PTSD and MDD. If yes, list which symptoms are attributable to each diagnosis: c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes[ ] No[X] Not shown in records reviewed Comments, if any: If yes, complete the following question: d. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes[ ] 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: If yes, list which symptoms are attributable to each diagnosis: 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) [ ] No mental disorder diagnosis [ ] A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication [ ] Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication [ ] 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 [ ] Occupational and social impairment with reduced reliability and productivity [ ] Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood [X] Total occupational and social impairment 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: There is overlap between the symptoms of PTSD and MDD. As such, it is not possible to ascertain the extent to which each condition individually contributes to her current impairment without resorting to speculation. If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: 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 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: If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence review ------------------ If any records (evidence) were reviewed, please list here: is a 52-year-old, female veteran who is currently 50% service connected for PTSD. The following is a review/increase C&P examination to address the veteran's contention that an increased rating is warranted. All available records were reviewed, including the veteran's TVHS record, Vista Web records, and Virtual VA records. He last C&P examination for PTSD was conducted in 8/2011. The emphasis of the present examination will be on how the veteran has fared since that time. 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: The veteran's TVHS record documents that she was homeless as of 11/2011. She had been living in Arkansas with her family until approximately 9/2011 but decided to move to Clarksville because living near her family of origin had become unhealthy. Moreover, she had lost her job in Arkansas. She is documented to have been staying at a friend's apartment as of 11/7/2011. She was experiencing difficulty finding employment at that time. The veteran's psychosocial difficulties are documented to have worsened in a 11/8/2012 SWS note as follows: "Veteran reports she has been having a really hard time coping with her limited resources, lack of support, lack of transportation, environment she lives around, and difficulty coping with feeling alone. Veteran reports she is doing a little better but having a hard time getting her needs met because of lack of support and decline of her benefits. Veteran has had to cancel appointments because of having not transportation. She reports she has trouble making ends meet with her money and then trouble having food because there is only so much a person can take on a bus. She was very tearful, reports feeling very sad, stays afraid of people around her, and now has her son living with her with no job or means of supporting himself and this just make things worse." Her psychiatrist was concerned enough about her psychosocial impairment and associated mental health symptoms that psychiatric hospitalization was recommended on 12/14/2012. The veteran declined hospitalization at that time and did not exhibit enough risk of harm to self or others to warrant involuntary hospitalization. The veteran reported that she has some casual friends. However, she pulls away from people whenever she feels that they are getting too close. She stated that she is unable to trust anyone. The veteran denied incidents of physical aggression over the past year. However, she acknowledged having verbal outbursts. She stated that she often snaps at people and then feels guilty about having done so. b. Relevant Occupational and Educational history: The veteran has not been gainfully employed since her last C&P examination in 8/2011. The following is documented in a 5/16/2013 SWS note with regard to her occupational functioning: "Vocational rehab tells her she is unable to work or go to school and this frustrates her yet SS won't approve her for disability it makes no sense." applied for vocational rehabilitation in late 2012. Her mental health treatment team at the Clarksville VA Clinic filled out paperwork associated with her application. The following barriers to employment and/or successful participation in an academic program were documented: -inability to pace herself -minimal ability to maintain persistence/low frustration tolerance -trouble coming to work daily due to physical, personal, and emotional issues -mood swings and hypersensitivity affect her ability to effectively interact with others -difficulty making decisions; "markedly" limited social interaction ability -"markedly" limited concentration ability -"markedly" limited memory ability -side effect of mirtazapine is sedation, which can reduce productivity -incapable of even working in a "low stress" occupation vocational rehabilitation counselor informed her that she was too psychologically impaired to go to school or work at the present time. As such, her application was denied. The veteran expressed a great deal of discouragement, helplessness, and sadness about her occupational difficulties. c. Relevant Mental Health history, to include prescribed medications and family mental health: The veteran transferred her outpatient mental healthcare to the TVHS on 12/13/2011 after running out of her psychiatric medications that had been prescribed by her provider at the Memphis VAMC. She has been prescribed the following medications since transferring her care to the TVHS: -bupropion: d/c'ed 5/21/2012 -zolpidem: d/c'ed but not well documented when -mirtazapine: increased 6/7/2012; increased 11/30/2012; increased 12/14/2012; the veteran reported that she self d/c'ed mirtazapine many weeks ago The veteran has also received individual psychotherapy through the SWS since 7/9/2012. Appointments have been once monthly or less frequent. Her last session was on 5/16/2013. d. Relevant Legal and Behavioral history: Denied. e. Relevant Substance abuse history: f. Sentinel Event(s) (other than stressors): g. Other, if any: 3. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, referred to as Criteria A-F, are from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Criterion A: The Veteran has been exposed to a traumatic event where both of the following were present: [X] The Veteran experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. [X] The Veteran's response involved intense fear, helplessness or horror. [ ] No exposure to a traumatic event. Criterion B: The traumatic event is persistently reexperienced in 1 or more of the following ways: [X] Recurrent and distressing recollections of the event, including images, thoughts or perceptions [X] Recurrent distressing dreams of the event [X] Acting or feeling as if the traumatic event were recurring; this includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur on awakening or when intoxicated [X] Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event [X] Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event [ ] The traumatic event is not persistently reexperienced Criterion C: Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by 3 or more of the following: [X] Efforts to avoid thoughts, feelings or conversations associated with the trauma [X] Efforts to avoid activities, places or people that arouse recollections of the trauma [ ] Inability to recall an important aspect of the trauma [X] Markedly diminished interest or participation in significant activities [X] Feeling of detachment or estrangement from others [X] Restricted range of affect (e.g., unable to have loving feelings) [X] Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children or a normal life span) [ ] No persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness Criterion D: Persistent symptoms of increased arousal, not present before the trauma, as indicated by 2 or more of the following: [X] Difficulty falling or staying asleep [X] Irritability or outbursts of anger [X] Difficulty concentrating [X] Hypervigilance [X] Exaggerated startle response [ ] No persistent symptoms of increased arousal Criterion E: [X] The duration of the symptoms described above in Criteria B, C and D is more than 1 month. [ ] The duration of the symptoms described above in Criteria B, C and D is less than 1 month. [ ] Veteran does not meet full criteria for PTSD Criterion F: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. [ ] The PTSD symptoms described above do NOT cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. [ ] Veteran does not meet full criteria for PTSD 4. Symptoms ----------- For VA rating purposes, check all symptoms that apply to the Veterans diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [ ] Panic attacks that occur weekly or less often [ ] Panic attacks more than once a week [X] Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks [ ] Memory loss for names of close relatives, own occupation, or own name [ ] Flattened affect [ ] Circumstantial, circumlocutory or stereotyped speech [ ] Speech intermittently illogical, obscure, or irrelevant [ ] Difficulty in understanding complex commands [ ] Impaired judgment [ ] Impaired abstract thinking [ ] Gross impairment in thought processes or communication [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [ ] Inability to establish and maintain effective relationships [ ] Suicidal ideation [ ] Obsessional rituals which interfere with routine activities [ ] Impaired impulse control, such as unprovoked irritability with periods of violence [ ] Spatial disorientation [ ] Persistent delusions or hallucinations [ ] Grossly inappropriate behavior [ ] Persistent danger of hurting self or others [X] Neglect of personal appearance and hygiene [ ] Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene [ ] Disorientation to time or place 5. 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: -irritability/anger outbursts -concentration difficulties -amotivation; lethargy; stays in bed all day unless she is forced to leave her home -unable to enjoy anything in life -significantly reduced appetite with a 30 pound weight loss -increased urges to resume drinking alcohol to self-medicate -feelings of worthlessness -discouragement and hopelessness about the future 6. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes[ ] No If no, explain: 7. Remarks, if any: ------------------- INDIVIDUAL UNEMPLOYABILITY: THE IMPACT OF PTSD WITH MDD ON BOTH ACTIVE AND SEDENTARY EMPLOYMENT IS: -concentration difficulties with short term memory impairment render her unable to effectively study and/or learn new skills -low energy and motivation render her unable to effectively study and/or learn new skills -low frustration tolerance render her unable to handle the stress of being challenged in academic and occupational settings -anxiety, fear, and anger when put in an inferior position render her unable to effectively work with supervisors, bosses, and/or teachers due to mood swings and emotional outbursts -irritability renders her unable to effectively interact with co-workers, clients, and/or fellow students