arty1

Update I just spoke with my VSO after seeing a rating was made on ebenefits yesterday and she said my rating is staying the same!!! I had an unfavorable C&P exam and was worried about a reduction but fortunately it was not reduced. Thanks for everyone's help on here.

An update I guess. My claim has been in the "preparation for decision" phase since 3/25/14 and today a notice of "development letter sent" popped up. What does this mean? Edit: I got in touch with the 1-800 number and they said nothing was showing up so it must be a glitch or something.

Very happy for you!!!

Another question my wife pointed out. Some of the symptoms such as "Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks", "Difficulty in establishing and maintaining effective work and social relationships", "Impaired impulse control, such as unprovoked irritability with periods of violence", "Impaired judgment", "suicidal idealation" and a couple others fall under the moderate to severe range. It looks like the examiner put me in the mild range with "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" I had more moderate to sever symptoms than mild why would she put this? Which carries more weight with the rater? The list of symptoms or "Occupational and social impairment due to mild or transient symptoms etc." They almost seem to contradict themselves.

Good information. Thanks.

Also, is there a reason the examiner did not include a GAF score?

I actually got a doctor appointment while I was there for my c&p but can't be seen till June. I have plenty of meds left but I'm not sure if those are expired or not. Like someone said earlier, I think I am self medicating. Every time I went to group or individual therapy it seemed to make things worse and missing work to go to these was hurting me so I quit going. It's like a catch 22, I really want to work but can't afford to miss work for the therapy. I do need to get my drinking under control as it is not the right answers. Thanks everyone for all the helpful responses.

No to both those questions, at least for the last couple years.

She also has some information wrong. Like saying my wife works full time, she did, but had to go to part time because of my problems. She also made it sound like everything was fine at work even though I made it clear if it wasn't for my brother and dad I wouldn't have a job, they're managers there so I'm protected, I'd be fired for missing so much work. She was just so enamored about me drinking two nights before.

I think I'd be lucky to keep my 50%. I just don't understand, things got worse and not better. Just seemed like I was there for alcohol treatment, not a ptsd review. She really didn't even ask me about my ptsd which I thought was odd.

Went for a second c&p exam last week and I'm afraid it doesn't look good for me. Currently I'm 50% for PTSD and 10% for tinnitus. My first exam was back in '08 when I originally filed so I guess this exam was just a follow up. I'm an OIF 1 veteran if that makes a difference. Below are my exam notes. 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 ICD Code: 309.81 2. Current Diagnoses a. Mental Disorder Diagnosis #1: PTSD ICD Code: 309.81 Comments, if any: Based on DSM-5. VBMS and CPRS records reviewed. Based on today's review examination, the veteran continues to meet DSM diagnsotic criteria for PTSD. The veteran has reported a worsening of PTSD symptoms since his 2008 Initial examination, with additional stressors (highlighted in other sections of this examinaiton report). Veteran is currently prescribed psychotropic medications by his former VA-primary care provider, Dr. Shissler, who has since retired-veteran receives medications by mail. Veteran is not currently seen by VA mental health providers. Mental Disorder Diagnosis #2: Alcohol Intoxication ICD Code: 303.00 Comments, if any: Based on DSM-5. VBMS and CPRS records reviewed. Based on today's examination, the veteran currently meets DSM-5 diagnostic criteria for Alcohol Intoxication. The veteran's current substance-related and addictive disorders diagnosis is based on veteran's report of consuming 5-16oz bottles of beer less than 24hrs prior to this examination. In addition, veteran reported history of alcohol addiction and treatment through the VA-Baton Rouge South SATP with Dr. Reidwald. Veteran's current Alcohol Intoxication/Alcohol Dependence diagnosis is at least as likely as not (50/50chance) due to, or result of his PTSD diagnosis. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Dyslipidemia, deviated nasal septum, chronic maxillary sinusis, tinnitus, bilateral sensori hearing loss, hypertension, Comments, if any: Medical diagnoses taken from CPRS records. 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) If yes, list which symptoms are attributable to each diagnosis: Alcohol Intoxication- Recent ingestion of alcohol -Clinically significant/problematic behavioral/psychological changes associated with recent consumption of alcohol -One or more of the following sx onset with consumptions of/shortly after consumptions of alcohol: slurred speech, incoordination, unsteady gait, nystagmus, impaired attention/memory, stupor/coma -Sx are not attributable to another medical condition nor explained by another mental disorder PTSD -recurrent and intrusive memories and thoughts of the event -recurrent and disturbing dreams of the event -psychological reactivity -efforts to avoid conversations, thoughts, feelings, related to trauma -loss of interest or participation in activities -feelings of detachment or estrangement from others -emotional numbing -difficulty falling asleep/staying asleep -irritability/anger -difficulty concentrating -hypervigilence -exaggerated startle response -suicidal ideation -memory problems 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 occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] 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 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 overlap of affective and behavioral symptoms. 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 In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes[ ] No Was the Veteran's VA claims file reviewed? [X] Yes[ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: CPRS records reviewed. Attention was givent to the Veteran's Initial PTSD examination report, with Dr. Kodur, 8/18/08. Based on his Initial PTSD examination, the veteran met criteria for PTSD, and obtained a GAF score of 49, which suggested serious impairment in the veteran's social and occupational functioning at the time. If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [ ] Yes[X] No If yes, describe: 2. Recent History (since prior exam) a. Relevant Social/Marital/Family history: Veteran reported since his 2008 Initial examination, hw ans his Wife have had two children (ages 5, 2) and their 8yr old dog has died (December 2013). Veteran reported his Wife now works full-time, having weekend and night shift as a Nurse, and veteran provides most of the care and parenting for their children. Veteran reported he enjoys this responsibility, however at times this is stressful. Veteran reported his marriage is currently strained, due to his return to excessive drinking. Veteran reported he has attempted to "quit" several times, and has been successful for short periods of time. Veteran reported when drinking alcohol, he at times becomes argumentive with his Wife, and angry. Veteran reported at times, including within the past 24hrs prior to this appointment, he consumes 5-16oz containers of beer in one sitting, and this irritates his Wife. Veteran reported this is typically how arguments begin. Veteran reported his Wife has stopped communicating with him and gives him the silent treatment when he drinks now. Veteran reported this usually leads to him becoming angrier. Veteran reported last night, his Wife refused to talk to him. Veteran reported they have sought marital counseling in the past, and the counselor challenged him to not drink for 30 days, which he did. Veteran reported he does not feel his drinking is excessive or problematic, although he has been labeled a "functional alcoholic." Veteran expressed concerns for losing his family due to his excessive drinking at this time. Veteran reported alcohol helps him to cope with sx of PTSD including nightmares and unwanted thoughts, and stated these are issues his Wife does not understand. Veteran reported feeling supported by his family/parents, and they too have encouraged him to seek treatment for his excessive drinking, and to resume marital counseling. b. Relevant Occupational and Educational history: Veteran reported he continues to work as and Industrial Contractor along with his father and brother. Vetran reported doing this work since 2007, and denied having problems on the job. Vetran reported when he is stressed on the job, or experiences panic attacks, his family members are "understanding" and they allow him time to relax in his office. Veteran described having a panic attack some years ago on the job, in which his father drove him to the emergency room. Veteran reported feeling as though he were having a heart attack, and later after tests, he was told he suffered a panic attack. c. Relevant Mental Health history, to include prescribed medications and family mental health: Veteran reported he is not currently receiving mental health services. Veteran reported he is prescribed psychotropic medication, Citalopram, which was origianlly prescribed by his former VA primary care provider, Dr. Shissler. Veteran denied being referred to mental health, and stated his medications continue to come to him via mail. Veteran reported he feels the medication helps him to not feel depressed, however, the medication does not prevent panic attacks, nor does it help him to sleep. Veteran reported he was previously seen at the VA-Baton Rouge South clinic in the SATP program by Dr. Reinwald in 2012. Veteran reported he completed the program, although he did not feel he had problems with alcohol at that time. Veteran denied history of inpatient hospitalization since his last examination. Veteran endorsed current sx to include increased tearfulness, sad/depressed mood, chronic sleep impairment, restlessness, increased nervousness, difficulty managing stress, increased memory problems, distractibility, increased panic attacks, difficulty in crowds and amongst people unknown to him, racing heart/pounding heartbeat, and increased use of alcohol and nicotine. Vetran denied thoughts of harming himself or others, however, reported at times he has become verbally aggressive when stressed or after drinking. Veteran reported increased nightmares, and described a mixture of real events along with events that had not occured in his nightmares. Veteran reported current fear of "being sent back to Iraq," at times. CPRS records indicate veteran was last seen at the VA Baton Rouge South Clinic in the SATP program in February 2012. Records indicate veteran was last seen in psychiatry by Ms. Joseph in March 2012 for medication management. Veteran has a diagnostic history to include Alcohol Dependence, PTSD, and Panic Disorder, NOS. d. Relevant Legal and Behavioral history: Veteran denied e. Relevant Substance abuse history: Veteran reported he was previously seen at the VA-Baton Rouge South clinic in the SATP program by Dr. Reinwald in 2012. Veteran reported he completed the program, although he did not feel he had problems with alcohol at that time. Veteran reported his marriage is currently strained, due to his return to excessive drinking. Veteran reported he has attempted to "quit" several times, and has been successful for short periods of time. Veteran reported when drinking alcohol, he at times becomes argumentive with his Wife, and angry. Veteran reported at times, including within the past 24hrs prior to this appointment, he consumes 5-16oz containers of beer in one sitting, and this irritates his Wife. Veteran reported this is typically how arguments begin. Veteran reported his Wife has stopped communicating with him and gives him the silent treatment when he drinks now. Veteran reported this usually leads to him becoming angrier. Veteran reported last night, his Wife refused to talk to him. Veteran reported they have sought marital counseling in the past, and the counselor challenged him to not drink for 30 days, which he did. Veteran reported he does not feel his drinking is excessive or problematic, although he has been labeled a "functional alcoholic." Veteran expressed concerns for losing his family due to his excessive drinking at this time. Veteran has history of Alcohol Dependence diagnosis. Veteran was last seen in the SATP program 2/6/12. f. Other, if any: No response provided. 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 #5 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in on or more of the following ways: [X] Directly experiencing the tramuatic 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 the traumatic event(s). [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 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] Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). [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] 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 aggression toward people or objects. [X] Reckless or self-destructive behavior. [X] Hypervigilance. [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 apply to the Veterans diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks that occur weekly or less often [X] Chronic sleep impairment [X] Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks [X] Impaired judgment [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 [X] Impaired impulse control, such as unprovoked irritability with periods of violence 5. Behavioral Observations: MSE: Veteran presented as a neatly and casually dressed 33yr old male with good hygiene and flat affect. Veteran stared at the Examiner, and noted to sit on the edge of the seat in the examination room. Veteran reported consuming 5-16-oz beers last night, and stated this led to problems and silent treatment at home. Vetran then became tearful, and reported fear of losing his family, due to difficulties related to alcohol dependence. Veteran reported consuming alcohol at this time on a daily basis. Veteran reported being able to participate in today's examination, however, and denied problems with comprehension of questions/interview at this time. Veteran denied thoughts of harming himself or others at this time. 6. Other symptoms Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes[X] N 7. Competency Is the Veteran capable of managing his or her financial affairs? [X] Yes[ ] No 8. Remarks, (including any testing results) if any: Based on DSM-5. VBMS and CPRS records reviewed. Based on today's review examination, the veteran continues to meet DSM diagnostic criteria for PTSD. The veteran has reported a worsening of PTSD symptoms since his 2008 Initial examination, with additional stressors (highlighted in other sections of this examination report). Based on today's examination, the veteran also currently meets DSM-5 diagnostic criteria for Alcohol Intoxication. The veteran's current substance-related and addictive disorders diagnosis is based on veteran's report of consuming 5-16oz bottles of beer less than 24hrs prior to this examination. In addition, veteran reported history of alcohol addiction and treatment through the VA-Baton Rouge South SATP with Dr. Reidwald. Veteran's current Alcohol Intoxication/Alcohol Dependence diagnosis is at least as likely as not (50/50chance) due to, or result of his PTSD diagnosis. Veteran is currently prescribed psychotropic medications by his former VA-primary care provider, Dr. Shissler, who has since retired-veteran receives medications by mail. Veteran was seen by NP Ms. Joseph, for medication management (3/2012), however no other appointments with MH since that time. Veteran is not currently seen by VA mental health providers. Sorry if that makes peoples head hurt. It just seems like the examiner wrote more about my drinking problem than a review of my symptoms. 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 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 This is what worries me, in my initial exam it was stated as severe, not mild. Im really worried about my rating being dropped, can someone help me decipher all this? If you need more info. from me about anything just let me know. thanks