[Mental Health C&p Advocate]

Excellent points and great advice. I'm so glad you brought your friend yogi995!

When I was a C&P psychologist, if the veteran was accompanied by a family member or friend, I always asked the vet if they wanted me to interview him or her. At least 75% of the time they said "Yes", and about 90% or more of the time the spouse's information helped me to better understand the nature and severity of the veteran's PTSD and/or other mental disorder, i.e., if I had not spoken with the family member or friend, I probably would have underestimated the severity of the veteran's condition, for all the reaons you guys explained so well above.

By the way, I just stumbled acroos a really good article on "What to Expect at Your C&P Exam" on the Swords to Plowshares website. It sounds familiar to me (I wonder if they got it from someone else), but it's very good advice nonetheless (it's very consistent with what you all advised and pointed out in your posts). The article is at:

http://www.swords-to-plowshares.org/2012/09/27/compensation-and-pension-examinations/

(I am not affiliated with Swords to Plowshares)

All the Best,

Joey

[Ptsd C&p Exam Results]

No, what she said about your Other Specified Trauma or Stressor Related Disorder (also called "partial PTSD", "subthreshold PTSD", or "subsyndromal posttraumatic stress syndrome") was:

The condition claimed was at least as likely as not (50% or greater probability)

The legal wording required for these medical opinions is confusing. The part in parentheses is usually easier to understand, i.e., "50% or greater probability" in your case. So, she's saying several things:

1. Your current posttraumatic stress symptoms don't quite meet full criteria for PTSD, but they do meet the criteria for subthreshold PTSD, which in DSM-5 terminology is called Other Specified Trauma or Stressor Related Disorder. (DSM-5 is the diagnostic guide mental health professionals must use in C&P exam reports.)
   
2. She essentially said "Yes" to the question, "Was the veteran's Other Specified Trauma or Stressor Related Disorder incurred during military service?"
   
3. She said she does not think your more recent depressive and generalized anxiety symptoms are related to your subthreshold PTSD, i.e., only the amount of social and occupational impairment caused by your subthreshold PTSD is compensable. She estimated that half your problems are caused by subthreshold PTSD, and half are caused by whatever she put for Diagnosis #1 (you did not include that part of your report in your post, so I don't know what that diagnosis is).
   
4. She checked off the summary statement ("Occupational and social impairment with occasional decrease in work efficiency...") that corresponds with a 30% disability rating.
   
5. You did not include which items she checked off on the "Symptoms List" (Section II, Number 5 of the report). The VBA Raters focus on that more than the summary statement.
   
6. If the items she checked off on the Symptoms List also correspond with the 30% disability rating (you can find which symptoms correspond with which disability rating levels in the General Rating Formula for Mental Disorders - search the board, I know it's posted in at least one or two places on this site), then overall that's your level, BUT she said that your service-related condition (subthreshold PTSD) causes half of that impairment and the other half is not service-related. So, theoretically, you would qualify for a 15% disability rating, except that there is no such rating for mental disorders (it's 0%, 10%, 30%, 50%, 70%, or 100% only).
   
7. In most cases like this that I've seen the VBA Rater gives the benefit of the doubt to the veteran and would rate at 30%. But if you want more precise guesstimates regarding your probable disability rating, you need to post that Symptoms List because if she checked off a whole bunch of symptoms than you're likely to receive a higher disability rating.
   
8. Also remember that the C&P exam report is important, but it is not the only basis for your disabilitiy rating. The VBA Rater will also review your medical records, especially mental health treatment notes and primary care notes; any statements you or family members or friends submitted; your service medical records; and any other relevant evidence. For example, the VBA Rater might decide that there is solid evidence that all your mental disorders are service connected, i.e., the Rater disagrees with the C&P examiner's opinion on that point. The Rater makes the decision.

Good luck!

All the Best,

Joey

[Tbi (I-Tbi) C&p Progress Notes]

I agree with harleyman - other than your self-report, I do not see any evidence for a traumatic brain injury. Please note that I do not mean to imply anything about your self-report. I'm referring to the VBA's perspective, i.e., in a retrospective report nearly 20 years after the claimed head injury, the vet says he was unconscious for 30 minutes. Contemporaneous emergency room records report no loss of conscious, no head injury, and refer only to a shoulder injury. One of the cardinal rules of medicolegal evaluations and adjudication is that, all other things being equal, a contemporaneous report is considered to be much more probative (stronger evidence), than a retrospecitve report many years later.

~ Joey

[Psychology C&p Exam Consult Progress Notes]

On the other hand, if the psychologist had said that the sleep problems, mild attention problems, mild anergia (low energy), and amotivation (lack of motivation) were due to undiagnosed undiagnosed illness or unexplained chronic multi-system illness caused by exposure to toxins during the Gulf War, those symptoms might have then been 'subtracted' from the PTSD symptom list, and he could end up not receiving a service connection for PTSD.

~ Joey

[C&p Mental Health]

That is the descriptor for the 30% rating level for mental disorders. But it also depends on what symptoms the examiner checked off on the symptoms checklist (Section 2 on the DBQ, I forget what number it is). Symptoms and functional impairment noted by our treating doctors or therapists can also be important. In general, more weight is given to occupational impairment since the entire disability benefits program is based on a veteran's loss of average earnings capacity. However, some Raters, at least from what I've seen, grant higher ratings based on social impairment, even when the vet has a strong work history with no performance problems on the job.

~ Joey

[Mental Health C&p Results, Any Opinions Appreciated.]

I expect you will be rated at 70% with IU or actually rated at 100%.MOre likely at the 79% because the examiner did not say you were totally unable to work.

My understanding is that even if an examiner opines that a veteran suffers from total occupational and social impairment, if he or she does not have any of the signs or symptoms listed in the Rating Formula, that in most cases his or her disability will not be rated at 100%. If I'm wrong about that, please let me know (I endeavor to keep an open mind and promptly admit when I'm wrong! )

Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication persistent delusions or hallucinations grossly inappropriate behavior persistent danger of hurting self or others intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene) disorientation to time or place memory loss for names of close relatives, own occupation, or own name. [38 CFR § 4.130 - General Rating Formula for Mental Disorders]

~ Joey

[Former Va C&p Psychologist]

Hello,

From the title of your post I am going to assume your in the mental health field. I was wondering what the difference between 50 / 70 / 100 % PTSD ratings are. I've read the social disorders but, from a mental health side how do you determine the difference?

I'm not sure if this is what you're looking for - please let me know.

38 CFR § 4.130 - Schedule of ratings—mental disorders.

General Rating Formula for Mental Disorders

0%

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 10% 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 continuous medication

30%

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events)

50%

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect circumstantial, circumlocutory, or stereotyped speech panic attacks more than once a week difficulty in understanding complex commands impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks) impaired judgment impaired abstract thinking disturbances of motivation and mood difficulty in establishing and maintaining effective work and social relationships

70%

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation obsessional rituals, which interfere with routine activities speech intermittently illogical, obscure, or irrelevant near-continuous panic or depression affecting the ability to function independently, appropriately and effectively impaired impulse control (such as unprovoked irritability with periods of violence) spatial disorientation neglect of personal appearance and hygiene difficulty in adapting to stressful circumstances (including work or a worklike setting) inability to establish and maintain effective relationships

100%

Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication persistent delusions or hallucinations grossly inappropriate behavior persistent danger of hurting self or others intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene) disorientation to time or place memory loss for names of close relatives, own occupation, or own name.

[Former Va C&p Psychologist]

Awesome forum!

Thank you for your service and your sacrifices all you veterans--and family members!

- Joey

[Mental Health C&p Results, Any Opinions Appreciated.]

My WAG: 50% for sure; 70% a good possibility; doc says you're IU, so combined with your SC physical disabilities, IU should be a slam dunk. Report would have been even better if examiner had described exactly how symptoms interfere with occupational functioning, but that probably won't matter.

[C&p In 2 Days ( I'm A Wreck ) Help Please]

I've seen a few cases of 'hazing' that were pretty brutal. Plus, keep in mind that everyone is different and something you might have shrugged off could be traumatic to another guy (e.g., if he had been abused bad as a kid).

For the OP: I'd suggest seeking counseling if you haven't already, as you deserve the help, and some support during the claims process would be good too.

Re: your claim, crucial ingredients for a successful personal assault claim in my experience include:

1) A top-notch Veterans Service Officer (Representative);

2) Letters from anyone who knew you before and after the assault describing changes in your personality and functioning that they observed--the more details and descriptions, the better;

3) the vet is in treatment and working hard to get better (as opposed to going to psych treatment 'to establish your claim'--good examiners can usually tell the difference);

4) have reviewed the "behavioral markers" for MST claims, which can also be noted for other personal assault claims, made notes on any possible documents that would provide evidence for such markers and did everything possible to obtain those records, including all SMR's (psych records are often kept separately and are not sent to VBA) and personnel records;

5) 'tells it like it is' without exaggerating or embellishing, *and* not minimizing or holding back emotions when talking to therapists, docs, and C&P examiner;

6) asks for support from family and friends and religious/spiritual advisor, if that is important for the individual;

7) if it applies, brings spouse, partner, family, or friend who can help describe current symptoms (just in laymen's terms) and behaviors [some examiners are given so little time to do exams, that they can't interview others, and some are just jerks who refuse b/c they are lazy--but there are many good examiners who find such 'collateral interviews to be very helpful].

If you get a bad examiner, immediately after the exam, write down (or dictate to a friend or tape recorder), everything about the exam, especially any rude, condescending, or belittling questions or comments the examiner made; if he/she seemed familiar with with your history (if not, record specific things that gave you that impression); how long the interview was, etc.

Remember you can always appeal. Get a crackerjack attorney who specializes in veterans law if you need to appeal. [They write "Attorney Case" in your C-file if you have retained counsel, which tells you something. ;-)

Hang tough!

- Joey

[Results Of My Mental Health Exam]

The RO will often ask for a MH exam if you claim insomnia, since it is a symptom of many MH disorders. Usually it's good for the vet b/c MH disorders are rated separately, so if you have one you didn't know you had, as in your case, you can end up with a possible bump up in your total percentage (depending on how the 'VA math' works out).

I'd give 2:1 odds it'll be 10%.

Joey