Jroocan

I opted in (without invitation) and vets.gov has my RAMP initiation. My legacy appeal closed (now that it's in RAMP). Supplemental lane is the route I chose. I will post updates when available.

I can get in without a problem but when I click on "check status" for my appeal it loads a page that shows an old closed appeal.. Nothing about my active appeal. Just says DRO review blah blah blah

Vets can voluntarily opt in starting today, April 1st, 2018. Im calling first thing in the am. https://cck-law.com/news/rapid-appeals-modernization-program-ramp-open-to-all-veterans-april-

The VA is allowing veterans that are eligible for RAMP to opt-in voluntarily effective April 1, 2018! I'll be the first one calling Peggy tomorrow to get set up. Time is up. Move it or lose it I say. What's one more appeal if it comes to it. Better than sitting for who knows when. Good luck all. https://cck-law.com/news/rapid-appeals-modernization-program-ramp-open-to-all-veterans-april-

Hello, just a quick update. I completed (yesterday) 35 day inpatient substance abuse program at VA Great Lakes in North Chicago and just had day 1 of 49 inpatient PTSD program today. Very intense so far. My claim was closed July 27th and notification letter mailed July 29th but still no packet in my mailbox. Ebenefits still shows a 70% rating. My question is: if I am approved for Unemployability will it still say 70% ? I'll keep waiting for now. I had my first trauma group earlier today and it was very exhausting. But we are riding therapeutic horses today so that should help!

Thanks and I will try. What if I receive a denial or something that says I need to respond in thirty days and I am away and miss it? Am I dead in the water?

Well, beautiful people, I am on my way to North Chicago for substance abuse inpatient then transitioning same day to PTSD inpatient. Will be gone for 3 months. I will update if I hear anything on my claim. Still in the "gathering of evidence" phase.

Berta, I received a mild TBI diagnosis from my doctor at the VA clinic after doing several tests and exams. I have the medical records for it (paper copies) I never claimed TBI the most recent C&P examiner said I have no diagnosis of TBI...however, the examiner from my C&P last year stated I do (verified by my medical records that he reviewed) so many inconsistencies i think i deserve a new C&P. But what do I know?

Broncovet, the information you provided helps to ease my worry. Thank you big time! Gastone, ? Sadly, I am preparing myself for a lengthy fight if a reduction is what it comes too. I've contacted Dr. Valette (thanks Berta for the recommendation) and he charges $1400.00 flat fee. My fiancé was in the exam room with me and she said the examiner was very passive-aggressive. She had her mind made up on me before she saw me. Her report was mostly filled out on the computer screen (my fiancé was reading it bc she sat directly behind her in front of the screen). Her questions were mostly about my alcohol use, nothing to do with PTSD. And only one question about my last job. Her wording of statements are accusatory and misrepresentations of the facts. She was set out to negate everything from my c&p last year that gave an increased rating. This is really upsetting me. She is saying I don't have PTSD or that is minimal and brought on by my drinking. If only she had a day in my life...

Thanks Navy. Will post more when I find out new information. Shopping around for a doc to arm me with an IMO. Any ideas on going rates? Never thought I'd have to take out a loan for something like this.

This is the c&p from last year that increased me to 70% from 50%. Nothing has improved. 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 -------------------- a. Mental Disorder Diagnosis #1: PTSD, CHRONIC, SEVERE Mental Disorder Diagnosis #2: MAJOR DEPRESSIVE DISORDER, RECURRENT, MODERATE TO SEVERE Mental Disorder Diagnosis #3: ALCOHOL USE DISORDER IN EARLY REMISSION b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): NEUROLOGICAL PROBLEMS, INCLUIDING SEIZURES; BEING EVALUATED. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes[ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes[X] No[ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: DEPRESSION AND ALCOHOL PROBLEMS ARE OFTEN PART OF PTSD'S SYMPTOM COMPLEX &, IN THIS CASE, THEY SHOULD BE CONSIDERED AS PART OF VETERAN'S PTSD. THEY ARE MENTIONED ABOVE DUE TO THEIR SEVERITY. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [X] Yes[ ] No[ ] Not shown in records reviewed Comments, if any: MR SOROKA HAD A 2ND LEVEL TBI EVALUATION DONE 11/16/12. EXAMINER CONCLUDED THERE WAS A HISTORY OF TBI, BUT THAT CURRENT CLINICAL SYMPTOMS WERE CONSISTERNT WITH BEHAVIORAL HEATH FACTORS SUCH AS PTSD & DEPRESSION, d. 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: SYMPTOMS ATTRIBUTABLE TO MENTALHEALTH DIAGNOSES & NOT TBI 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 deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes[X] No[ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: SEE ABOVE COMMENTS 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? [X] Yes[ ] No[ ] No diagnosis of TBI If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: NONE ARE ATTRIBUTABLE TO 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? [ ] Yes[X] No Was the Veteran's VA claims file (hard copy paper C- file) reviewed? [ ] Yes[X] No 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 [X] 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 [X] Other: NO DOCUMENTS WERE AVAILABLE IN VBMS FOR THIS VETERAN. HOWEVER, HIS MEDICAL/TREATMENT RECORDS AT THE VARIOUS VAs WERE AVAILABLE AND REVIEWED IN VISTA WEB. b. Was pertinent information from collateral sources reviewed? [X] Yes[ ] No If yes, describe: VETERAN'S FIANCEE WAS PRESENT & SHE BOTH CORROBORATED HIS ACCOUNT & ADDED PERTINENT INFORMATION 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: MR SOROKA'S LIFE SINCE HIS PRIOR C&P EXAM (1/01/06) HAS BEEN PRIMARILY DOMINATED BY INCARCERATIONS AND RESIDENTIAL TREATMENT PROGRAMS (SEE SECTIONS BELOW FOR DETAILS). IN '06-'07 VETERAN WAS INVOLVED WITH A WOMAN WHO WAS ALSO A PROBLEM DRINKER. THEIR RELATIONSHIP WAS CHARACTERIZED BY FREQUENT FIGHTS & PHYSICAL ACTING OUT. VETERAN ARRESTED TWICE FOR DOMESTIC VIOLENCE. HE ENTERED HIS PRESENT SIGNIFICANT OTHER RELATIONSHIP (AMBER) IN '11; THEY HAVE AN ALMOST 1 YO DAUGHTER & NOW LIVE TOGETHER. SHE HAS HAD A STEADYING & POSITIVE AFFECT ON HIM--"BLESSED TO HAVE HER IN MY LIFE...SHE'S SAVED ME ALOT OF TIMES." HE'S BECOME DEPENDENT ON HER. SHE ADMITS THAT THEY'VE HAD "ROUGH PATCHES...HE HAS GOOD DAYS & BAD DAYS, ESPECIALLY FEB TO MAY (BEST FRIEND WAS KILLIED & MOTHER DIED WHILE HE WAS IN PRISON)." MR SOROKA WATCHES DAUGHTER WHILE AMBER IS AT WORK (NURSE); WHEN BABY IS UPSET, HE GETS UPSET, WHICH MAKES SITUATION MORE TENSE; HE FREQUENTLY ENDS UP YELLIN G AT BABY. HE ALSO GETS UPSET AT AMBER, VERBAL FIGHTS & OCCASSIONALLY HAS PUSHED HER. HE SAYS HE'S MAKING AN ATTEMPTS TO "TAKE MY ANGER OUT ON THINGS NOT PEOPLE"; CONSEQUENTLY THERE ARE A NUMBER OF HOLES IN THE WALLS. SAYS HE ONLY HAS ONE FRIEND; NO INTERESTS OR OUTSIDE ACTIVITIES, STAYS HOME & PLAYS WITH BABY; TRIES TO AVOID EVEN FAMIY GET TOGETHERS; WATCHES TV, ON INTERNET WITH FACEBOOK & E-MAILS. b. Relevant Occupational and Educational history: GOING TO ILLINOIS VALLEY COMMUNITY COLLEGE- WORKING ON AN ASSOCIATES DEGREE SINCE '06; DOES GOOD COUPLE CLASSS THEN FAILS DUE TO POOR CONCENTRATION, ABSENTEEISM DUE TO ANXIETY ATTACKS & DEPRESSION. INTERMITTED JOBS--WAITER IN QUAD CITIES, GOODWILL BUT FIRED FOR MISCONDUCT & ALTERCATIONS WITH COWORKERS. PROBLEMS WITH AUTHORITY--HATED SUPERVISORS. gOODWILL WAS ACCOMDATING ORIGINALLY BUT THEN WANTED HIM TO BE USUALY STAFF ACTIVITIES; GOT IN TROUBLE OVER ANXIETY WHEN TOLD TO WORK THE FLOOR. MORE UPSET WHEN MOTHER DIED; ACTED OUT AND EVEN AT HOME. MORE RECENTLY, A BACKGROUND CHECK FOR WALMART SHOWED HISTORY OF 7 FELONIES, SO HE WASN'T HIRED. c. Relevant Mental Health history, to include prescribed medications and family mental health: PREVIOUS C&P PTSD EXAM (1/01/06) DIAGNOSED PTSD,CHRONIC WITH DEPRESSION, ALCOHOL DEPENDENCE IN EARLY REMISSION, & GAF = 61. THE EXAM WAS DONE WHILE VETEAN WAS IN THE RESIDENTIAL SUBSTANCE ABUSE TREATMENT PROGRAM (SATP) AT DANVILLE VA; WHILE THERE HE WAS INVOLVED IN THEIR PTSD TRACT ALSO. AFTER COMPLEATING THE PROGRAM, HE RETURNED HOME TO BLOOMINGTON, BUT RELAPSED & RETURNED TO THE SATP THE SUMMER OF '07. HE APPLIED TO THE RESIDENTIAL PTSD PROGRAM AT THE TOPEKA VA, BUT WAS INCARCERATED BEFORE ATTENDING. AFTER A CORRECTIONAL BOOT CAMP PROGRAM IN '10, VETERAN ENROLLED IN MENTAL HEALTH AT THE CORAVILLE CBOC (PART OF OMAHA VA'S NETWORK) AND THEN TRANSFERED TO THE LA SALLE CBOC AFTER MOVING TO PERU, IL. HIS INITIAL DIAGNOSES IN 8/21/12 WERE PTSD, MAJOR DEPRESSIVE DISORDER, ALCOHOL DEPENDENCE, & GAF = 50. BESIDE SUPPORTIVE THERAPY/MEDICATION MANAGEMENT, MR SOROKA BEGAN PROLONGED EXPOSURE THERAPY FOR HIS PTSD; THAT WAS SO SO UPSETTING (CONFIRMED BY HIS FIANCEE) THAT HE DISCONTINUED IN 2/07/13. HE WAS ADMITTED TO HINES' 2S PSYCHIATRIC UNIT 3/13 WITH DIAGNOSES OF PTSD, ALCOHOL DEPENDENCE WITH AGGRESSIVE BEHAVIOR, DEPRESSION, & GAF= 25; DISCHARGED 4/13/13 WITH GAF IMPROVED TO 58. HE CONTINUES WITH OUTPATIENT TREATMENT AT LA SALLE CBOC; HAS VERY GOOD RAPPORT WITH DR LIM; MOST RECENT APP'T WAS 4/16/15; PRESCRIBD TRAZODONE, KLONOPIN, GABAPENTIN, & NALTRAXONE, WHICH HAS REDUCED HIS CRAVING FOR ALCOHOL & RESULTED IN HIS LONGEST PERIOD OF SOBRIETY OUT SIDE A HOSPITAL OR PRISON. d. Relevant Legal and Behavioral history: ARRESTED NUMEROUS TIMES--AGGRAVATED BATTERY ON POLICE '07 &'10. JAILED 10 TIMES FOR 2 DOMESTIC BATTERY & NUMEROUS BAR FIGHTS; ALSO 3 DUIs. ALL COURT CASES FINISHED; POROLE FINISHED. e. Relevant Substance abuse history: SAEE TREATMENT HISTORY ABOVE. USUALLY RELAPSES SOON AFTER OUT OF TREQTMENT. CURRENTLY HAS GONE A MONTH WITHOUT DRINK (NALTRAXONE WORKING PRETTY WELL). STILL SMOKING MARIJAUNA ONCE WEEK, BUT NOT SINCE FEBURARY. CLAIMS NO OTHER STREET DRUGS. 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 #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) [X] Witnessing, in person, the traumatic event(s) as they occurred to others [X] Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the 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 aggression toward people or objects. [X] Hypervigilance. [X] Exaggerated startle response. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks more than once a week [X] Chronic sleep impairment [X] Flattened affect [X] Difficulty in understanding complex commands [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] Suicidal ideation [X] Obsessional rituals which interfere with routine activities [X] Impaired impulse control, such as unprovoked irritability with periods of violence [X] Neglect of personal appearance and hygiene 5. Behavioral Observations: --------------------------- TEARFUL THROUGHOUT EXAM INTERVIEW 6. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes[X] No 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes[ ] No 8. Remarks, (including any testing results) if any: --------------------------------------------------- CONTINUE MR SOROKA'S SC PTSD. HIS FUNCTIONING SINCE PRIOR EXAM HAD DETEIORATED, BUT CURRENTLY SHOWS SOME IMPROVEMENT; HOWEVER PRONOSIS IS EXTREMELY GUARDED SINCE HIS HISTORY SINCE PRIOR EXAM SHOW NO ABILITY TO SUSTAIN IMPROVED FUNCTIONING OUTSIDE OF STRONGLY STRUCTURED SETTINGS

If it is reduced and I file a NOD for an appeal, is it reduced effective on the date they determine and I'm without my original rating the whole length of appeal until final decision is made? I'd imagine so.

Berta, thanks for input. The examiner handpicked specific information from my doctors notes, trying to get contradictions or ammo for a decreased rating. I initiated treatment before my arrest for driving on a revoked license but she picked the June 6th appointment.

I had a c&p last April and went from 50 to 70%. Had a c&p exam last week (TDIU) and I do not think it is an accurate representation of my disability. The lady diagnosed me with antisocial personality disorder (never had that before) and said my PTSD is basically non existent as long as I'm sober. ??? This is a terrible report (in my opinion) but any other thoughts on it? SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes[ ] No ICD Code: F43.20 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: ALCOHOL USE DISORDER ICD Code: F12.20 Comments, if any: THIS IS VET'S MAIN AND MOST DISABLING CONDITION. Mental Disorder Diagnosis #2: ANTISOCIAL PERSONALITY DISORDER ICD Code: F60.2 Comments, if any: VET HAS 8 FELONIES INCLUDING 4 COUNTS OF AGGRAVATED BATTERY OF POLICE OFFICERS IN 2007 AND 2010, DOMESTIC BATTERY IN 2007, CRIMINAL DAMAGE TO GOVT PROPERTY IN 2010, CRIMINAL DAMAGE TO STATE PROPERTY IN 2006, AND AGGRAVATED DUI (3RD) IN 2006. HE HAS BEEN INCARCERATED IN STATE PRISONS TWICE AND IS FACING JAIL TIME AT HIS NEXT COURT DATE. Mental Disorder Diagnosis #3: PTSD ICD Code: F43.20 Comments, if any: PCL-5 TOTAL SCORE TODAY WAS 65 SUGGESTING MODERATE PTSD SYMPTOMS. HE HAS NOT BEEN COMPLIANT WITH MEDICATION OR MH TREATMENT AND HAD IMPROVED PTSD SYMPTOMS IN THE PAST WHEN MEDICATED AND ATTENDING TREATMENT MORE REGULARLY. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [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 and discuss whether there is any clinical association between these diagnoses: ALCOHOL USE DISORDER - CONTINUED EXCESSIVE USE OF ALCOHOL DESPITE SOCIAL AND LEGAL CONSEQUENCES, DEPRESSED AND ANXIOUS AFFECT, DECREASED MEMORY, POOR JUDGMENT, DECREASED MOTIVATION, INTERPERSONAL DIFFICULTY, DIFFICULTIES IN A WORK SETTING, IMPULSE CONTROL DIFFICULTIES, DECREASED CONCENTRATION, PERSISTENT NEGATIVE COGNITIONS, IRRITABILITY, ANGER OUTBURSTS, INSOMNIA, DECREASED INTEREST. ANTISOCIAL PERSONALITY DISORDER - CONTINUED CRIMINAL ACTS WITH 8 FELONIES AND REPEATED INCARCERATION, CONNING OTHERS FOR PERSONAL PROFIT, IMPULSIVITY, IRRITABILITY, AGGRESSIVENESS, RECKLESS DISREGARD FOR SAFETY OF SELF OR OTHERS, CONSISTENT IRRESPONSIBILITY WITH REPEATED FAILURE TO HONOR FINANCIAL OBLIGATIONS, LACK OF REMORSE, INTERPERSONAL DIFFICULTY IN THE WORKPLACE, POOR JUDGMENT. PTSD - FLASHBACKS, NIGHTMARES, AVOIDANCE, EMOTIONAL NUMBING, HYPERVIGILANCE, SUSPICIOUSNESS. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes[X] No[ ] Not shown in records reviewed Comments, if any: TBI EXAM DATED 5/18/15 DID NOT DIAGNOSE TBI BUT PTSD AND ALCOHOL DEPENDENCE 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 reduced reliability and productivity 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: ALCOHOL USE DEPENDENCE, SEVERE - SOCIAL AND OCCUPATIONAL IMPAIRMENT IN MOST AREAS INCLUDING SCHOOL, FAMILY RELATIONSHIPS, INTERPERSONAL RELATIONS, WORK, MOOD, JUDGMENT AND IMPULSE CONTROL. ANTISOCIAL PERSONALITY DISORDER - SOCIAL AND OCCUPATIONAL IMPAIRMENT IN MOST AREAS INCLUDING SCHOOL, FAMILY RELATIONSHIPS, INTERPERSONAL RELATIONS, WORK, MOOD, JUDGMENT AND IMPULSE CONTROL. PTSD - REDUCED RELIABILITY AND PRODUCTIVITY. 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 (hard copy paper C-file) reviewed? [ ] Yes[X] No 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 [X] 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 [X] Other: CP PTSD REVIEW EXAM DATED 4/30/15 WAS ALSO REVIEWED. b. Was pertinent information from collateral sources reviewed? [X] Yes[ ] No If yes, describe: VET'S FIANCEE AMBER ACTIVELY PARTICIPATED IN TODAY'S EXAM. BOTH WERE TEARFUL DURING THE EXAM. 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: MR Xxxx IS A 3X YEAR OLD SINGLE, UNEMPLOYED, CAUCASIAN MALE VETERAN OF THE MARINE CORPS WHO SERVED IN IRAQ AND IS 70% SC FOR PTSD. SINCE HIS LAST C&P PTSD EXAM ON 4/30/15, HE CONTINUES TO BE SINGLE BUT LIVES WITH HIS FIANCEE AND THEIR 2 YEAR OLD DAUGHTER IN A HOME THAT THEY RECENTLY PURCHASED. HE DESCRIBED THEIR RELATIONSHIP AS CATASTROPHIC SINCE "I CAN'T EVER DO ANYTHING RIGHT". HE SAID THEY ARGUE CONSTANTLY BUT PUT ON A HAPPY FACE WHEN AROUND HER FAMILY. HE SAID SHE IS WORN OUT FROM DEALING WITH HER PTSD. HIS 2/3/16 SW NOTE INDICATED THAT HE CHEATED RECENTLY ON HIS FIANCEE AND THAT STRAINED THEIR R ELATIONSHIP. HE HAD ALTERCATIONS WITH HER FAMILY MEMBERS. IN 10/15, VET WAS ARRESTED AFTER ASSAULTING AMBER'S STEP-FATHER, PUNCHING HIM NUMEROUS TIMES IN THE FACE AND CAUSING A BLACK EYE. CHARGES WERE DROPPED. HE MAINTAINS CONTACT WITH HIS SISTER WHO IS IN THE ARMY AND IN KANSAS. HIS FATHER LIVES AN HOUR AWAY BUT HAS LITTLE TO DO WITH THEM, TAKES THEM TO DINNER AND LEAVES. VET FEELS VERY DISTANT FROM HIS DAD. HIS MOTHER DIED NEARLY 8 YEARS AGO WHILE HE WAS INCARCERATED AND VET CONTINUES TO GRIEVE FOR HER. HE HAS SOCIAL MEDIA CONTACT WITH MILITARY FRIENDS. HE HAS ONE FRIEND THAT HE MET WHEN HE WORKED AT GOOD WILL. VET CALLS HIM TO TAKE HIM TO VA APPOINTMENTS. VET CURRENTLY LIVES IN XXXX, IL IN A HOME THAT HE AND HIS FIANCEE RECENTLY PURCHASED. HE MET ONE NEIGHBOR BUT GENERALLY HE KEEPS TO HIMSELF. HE SAID HE HAS AN AWESOME RELATIONSHIP WITH HIS 2 YEAR OLD DAUGHTER HALEY, BUT HE HAS HAD EXTREME VIOLENT BEHAVIOR IN FRONT OF HER. HE HAS YELLED AT HER AND FEARS THAT HE WILL LOSE HER IF THINGS DON'T WORK OUT WITH AMBER. IT HURTS HIM TO SEND HER TO DAYCARE RECENTLY BECAUSE HE WOULD PREFER TO TAKE CARE OF HER. A DCFS CHILD ENDANGERMENT CASE WAS FOUNDED IN 2/16 AFTER VET WAS VIOLENTLY ASSAULTING HIS FIANCEE'S STEPFATHER IN FRONT OF THE CHILD. WHILE VET STATED THAT HE HAS NO/FEW FRIENDS, HIS 6/6/16 PSYCHIATRIST NOTE INDICATED THAT HE GOES OUT TO BARS DRINKING WITH FRIENDS. b. Relevant Occupational and Educational history: VETHAS BEEN ATTENDING COLLEGE CLASSES SINCE 2006 COMMUNITY COLLEGES AND FAILED 3 CLASSES LAST SEMESTER BUT PASSED HIS MATH CLASS. HE HAS BEEN TRYING TO GET HIS ASSOCIATE'S DEGREE FOR THE PAST 10 YEARS AND HOPES TO GET A DEGREE IN SOCIAL WORK EVENTUALLY. HIS GPA IS LESS THAN 1.0. HE TOOK 3 ONLINE CLASSES WHICH HE FAILED BUT PASSED THE MATH CLASS IN THE CLASSROOM CLASS. HE DIDN'T ASSOCIATE WITH TEACHERS OR OTHER STUDENTS. VET LAST WORKED FULL TIME AT GOOD WILL INDUSTRIES FROM 2/13 TO 4/15, WAS PROMOTED TO KEYHOLDER, THEN WAS TERMINATED IN 4/15. REASONS FOR THE TERMINATION WERE UNCLEAR BUT DOCUMENTS FROM WORK INDICATED THAT HE HAD LOUD VERBAL ALTERCATION WITH A COWORKER IN 1/14, WAS ABSENT 8 TIMES IN 12 MONTHS AND WORKED 3 PARTIAL SHIFTS BY 12/14, AND POINTED HIS FINGER AT COWORKERS CAUSING TENSION AT WORK ON 12/18/14. THERE WAS NO OTHER DOCUMENTATION OF WORK PROBLEMS SUBMITTED TO INDICATE WHY HE WAS TERMINATED IN 4/16. HE HAS HAD NO OTHER PAID WORK SINCE 4/15. MH NOTES INDICATED THAT HE WAS NOT LOOKING FOR EMPLOYMENT BUT WAS GOING TO COLLEGE FULL TIME AND WATCHING HIS YOUNG DAUGHTER WHILE HIS WIFE WORKED. THERE WAS NO EVIDENCE THAT HE HAD APPLIED FOR WORK BUT HIS 8 FELONIES, LOSS OF DRIVER'S LICENSE (SINCE 2006), 3RD DUI(IN 2010), AND CONTINUED CRIMINAL BEHAVIOR ARE LIKELY TO INTERFERE WITH OBTAINING WORK. VET'S MH NOTES REPEATEDLY NOTE THAT HE IS ONLY VIOLENT AND AGGRESSIVE WHEN DRINKING. THERE WAS NO EVIDENCE IN TODAY'S EXAM OR IN REVIEW OF VET'S MH RECORDS SINCE 2006 THAT HIS PTSD WAS EVER SEVERE ENOUGH, BY ITSELF, TO PREVENT HIM FROM OBTAINING OR MAINTAINING SUBSTANTIALLY GAINFUL EMPLOYMENT. c. Relevant Mental Health history, to include prescribed medications and family mental health: SINCE 4/15, HE HAS BEEN FOLLOWED BY SHAWN SLAGLE, SW AND DR LIM, PSYCHIATRIST AT THE LASALLE CBOC. HE HAS NOT BEEN COMPLIANT WITH TREATMENT AND WAS TOLD BY HIS SW ON 2/3/16 THAT NOT GETTING TREATMENT FOR HIS PTSD IS THE PROBLEM, NOT HIS PTSD. HE DID NOT SEE HIS PSYCHIATRIST FROM 10/26/15 UNTIL 6/6/16 AND LAST FILLED ALL HIS MH MEDICATIONS IN 2/16. HE ONLY CONTACTED HIS PSYCHIATRIST IN 11/15 AND 12/15 WHEN HE NEEDED FORMS DOCUMENTING HIS TREATMENT FOR COURT DATES. HE RETURNED TO MH ON 6/6/16 DUE TO HAVING A COURT DATE ON 6/30/16 THAT WILL DECIDE WHETHER HE GOES TO JAIL OR RESIDENTIAL TREATMENT. HE DID NOT SEE HIS SW FOR INDIVIDUAL THERAPY BETWEEN 6/15 AND 2/16, MISSING SEVERAL APPOINTMENTS. HE APPLIED FOR ADMISSION TO LOVELL'S SDTU PROGRAM (RESIDENTIAL TRAUMA TREATMENT) BUT WAS TOLD THAT HE HAD TO COMPLETE SUBSTANCE ABUSE TREATMENT FIRST SINCE HIS SUBSTANCE USE WAS STILL HIGH. HE HAS BEEN ENCOURAGED TO ENTER THE SDTU AT LOVELL VAMC BY HIS SW SINCE 8/27/12 BUT HAS REFUSED AND NOT FOLLOWED THROUGH. A PHONE INTERVIEW WITH THE SDTU WAS HELD ON 5/3/16 AND VET WAS REFERRED TO THE MHRRTP TO TREAT HIS ADDICTIONS BEFORE ADDRESSING TRAUMA WORK. HIS ADMISSION TO THE SDTU IS DELAYED UNTIL HE COMPLETES ADDICTIONS TREATMENT. HE HAS AN INTERVIEW WITH THE MHRRTP PROGRAM ON 6/20/16. CURRENTLY, HE WILL BE TAKING DULOXETINE AND TRAZODONE FOR HIS PTSD AND NALTREXONE FOR ALCOHOL CRAVINGS. THEY WERE ORDERED ON 6/7/16 BUT VET HAS NOT RECEIVED THEM YET. HE STOPPED TAKING MH MEDS AFTER 2/16 AND DIDN'T REORDER MEDICATIONS AFTER THEY RAN OUT. HE WENT TO ILLINOIS VALLEY COMMUNITY HOSPITAL ER WHEN INTOXICATED ON 10/25/15 AND WANTED TO TRANSFER TO 2S AT HINES BUT VET INSISTED ON A PRIVATE BED. WHEN HE WAS TOLD THEY COULDN'T GUARANTEE A PRIVATE BED, VET REFUSED TO GO. HE WAS DISCHARGED FROM THE COMMUNITY HOSPITAL AFTER A FEW HOURS OF OBSERVATION. VET CLEARLY DID BETTER WITH PTSD SYMPTOMS WHEN HE WAS NOT DRINKING, ACCORDING TO MULTIPLE MH NOTES. HE HAD GOOD RESPONSE TO MH MEDICATIONS BUT STOPPED TAKING THEM OR DIDN'T TAKE THEM AS PRESCRIBED. HE OFTEN SEEKS OUT MH TREATMENT WHEN HE IS IN LEGAL TROUBLE IN ORDER TO NOT FACE CONSEQUENCES FOR HIS ACTIONS. HE HAS USED HIS PTSD AND ALCOHOL USE DISORDER DIAGNOSES TO AVOID JAIL TIME. HE HAD NO SUICIDE ATTEMPTS OR PSYCHIATRIC HOSPITALIZATIONS IN THE PAST YEAR. IN FACT, HE HAD NO PSYCHIATRIC HOSPITALIZATIONS SINCE 3/13. IT IS IMPORTANT TO NOTE THAT VET HAS A GREAT DEAL OF MENTAL ILLNESS IN HIS FAMILY THAT WAS NOT NOTED ON PRIOR C&P PTSD EXAMS. HIS SISTER WAS HOSPITALIZED FOR DEPRESSION IN HIGH SCHOOL AND TAKES ANTIDEPRESSANTS, A COUSIN COMMITTED SUICIDE A FEW YEARS AGO OF A GSW TO THE HEAD (PER HIS 8/12 MH INTAKE NOTE), HIS PATERNAL AUNT AND UNCLE HAVE PSYCHIATRIC PROBLEMS, AND VET WAS A VICTIM OF PHYSICAL ABUSE ACCORDING TO HIS 7/6/06 SARP ASSESSMENT. d. Relevant Legal and Behavioral history: SINCE 4/15, VET WAS ARRESTED ON 11/28/15 AND CHARGED WITH BATTERY FOR HITTING AMBER'S STEPFATHER BUT THEY DROPPED THE CHARGES. HE WAS ARRESTED FOR DRIVING ON A REVOKED LICENSE IN 3/16. VET HAD 3 DUIS AND HAS NOT HAD A DRIVER'S LICENSE SINCE 2006. HE HAS A COURT DATE PENDING ON 6/30 REGARDING HIS LATEST OFFENSE. HE MAY GO TO JAIL OR MAY BE ALLOWED TO ENTER RESIDENTIAL TREATMENT. HE HAS HAD CHRONIC DIFFICULTY WITH BEING IN DEBT DUE TO HIS SUBSTANCE ABUSE, IMPULSE CONTROL, CREDIT CARDS AND LEGAL EXPENSES. e. Relevant Substance abuse history: SINCE 4/15, VET HAS DRANK EXCESSIVELY. HE WOULD LIKE TO DRINK EVERY NIGHT AND TRIES TO MANIPULATE AMBER TO BE ABLE TO DRINK. HE WILL DRINK A 6 PACK OR BOTTLE OF WINE PER SITTING. THEIR HOUSE IS 1 BLOCK AWAY FROM A BAR AND 2 BLOCKS FROM A CONVENIENT STORE. WHEN AMBER COMES HOME FROM WORK, THERE WILL BE ALCOHOL IN THE REFRIGERATOR OR EMPTY BOTTLES IN THE TRASH. HE STORMS OUT WHEN ARGUING WITH HER AND GOES TO THE BAR WHERE HE CONSUMES 6+ DRINKS. ALCOHOL WAS INVOLVED BEFORE VET BECAME VIOLENT WITH HER FATHER IN 11/15. HE PUSHED AMBER IN 10/15 WHEN SHE CALLED THE POLICE DURING HIS INTOXICATED RAGE. CURRENTLY, HE DRANK HEAVILY ON MEMORIAL DAY, BINGE DRINKS, THEN TRIES NOT TO DRINK. HE LAST DRANK LAST WEEK WHEN HE HAD 2 GLASSES OF WINE. VET SMOKES MARIJUANA OCCASIONALLY, 1-2 TIMES PER MONTH. ON 6/6/16, DR LIM REPORTED THAT HE USES IT 2-3 TIMES PER MONTH. HE HAS NOT ACTIVELY SOUGHT IT OUT RECENTLY AND LAST USED IT 2 WEEKS AGO. IT UPSETS AMBER SO HE TRIES NOT TO. IT IS IMPORTANT TO NOTE THAT VET'S 8/21/12 MH INTAKE NOTE AT HINES INDICATED THAT VET DRANK ALCOHOL SINCE 17 IN HIGH SCHOOL AND USED MARIJUANA SINCE AGE 16. HE BECOMES AGGRESSIVE AND VIOLENT WHEN HE IS INTOXICATED AND IT LEADS TO LEGAL PROBLEMS. HIS 7/1/06 ALCOHOL TREATMENT NOTE INDICATED THAT ALCOHOLISM WAS PREVALENT ON BOTH SIDES OF THE FAMILY, ACCORDING TO VET'S PARENTS. HIS FATHER AND MATERNAL UNCLE WERE ALCOHOLIC AND HIS MATERNAL UNCLE ABUSED DRUGS. VET ALSO USED COCAINE 10 TIMES, MOST RECENTLY IN 2010, AND USED MUSHROOMS, LSD AND ECSTASY SEVERAL TIMES IN 2006, ACCORDING TO HIS 8/12 MH INTAKE NOTE. ON 8/2/06, A BIOPSYCHOSOCIAL ASSESSMENT INDICATED THAT VET'S ALCOHOL AND DRUG USE INTERFERED WITH HIS SCHOOL PERFORMANCE. VET HAD A HISTORY OF ABUSING PRESCRIPTION NARCOTICS BUT SAID HE HAS NOT IN THE PAST YEAR. f. Other, if any: VET HAS ANNIVERSARY REACTIONS RELATED TO HIS FRIEND DYING IN IRAQ IN APRIL 2004, HIS MOTHER'S DEATH IN 5/08. HIS FIANCEE SAID SOMETHING ALWAYS HAPPENS IN THE SPRING WITH VET'S BEHAVIOR. 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) [X] Witnessing, in person, the traumatic event(s) as they occurred to others Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the 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 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 aggression toward people or objects. [X] Reckless or self-destructive behavior. [X] Hypervigilance. [X] Exaggerated startle response. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [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: --------------------------- VET ARRIVED EARLY FOR TODAY'S EXAM AND WAS ACCOMPANIED BY HIS FIANCEE AMBER. HE DISPLAYED DEPRESSED AFFECT DURING THE EXAM AND BECAME TEARFUL AT SEVERAL TIMES. SPEECH, BEHAVIOR, AFFECT, THOUGHT AND EYE CONTACT WERE OTHERWISE WITHIN NORMAL LIMITS. APPEARANCE, GROOMING AND HYGIENE WERE ACCEPTABLE. 6. 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: HE REPORTED PANIC ATTACKS WHERE HE FEELS ANGRY AND CAN'T CONTROL THINGS. THESE ARE ANGER ATTACKS, NOT ACTUAL PANIC ATTACKS. HIS FIANCEE NOTED THAT HE EATS EXCESSIVELY, EATING 28 WHITE CASTLE HAMBURGERS AND AN ENTIRE CAKE IN 2 DAYS. HIS WEIGHT FLUCTUATES AND HE EATS DURING THE NIGHT. H AVOIDS WATCHING THE NEWS, CONVERSATIONS ABOUT THE MILITARY, AND TELLING OTHERS THAT HE WAS A MARINE. HE HAS LOST INTEREST IN GOING OUT, DOING RECREATIONAL THINGS THAT DON'T INVOLVE DRINKING, AND GOING TO STATE PARKS. HE SLEEPS 4-5 HOURS WITH MEDICATION. 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes[ ] No 8. Remarks, (including any testing results) if any: --------------------------------------------------- MR Xxxx CONTINUES TO MEET CRITERIA FOR PTSD BUT HIS PTSD IS OF MODERATE SEVERITY, WHICH INDICATES A DECREASE IN SEVERITY SINCE HIS LAST C&P PTSD REVIEW EXAM IN 4/15. HIS PTSD CURRENTLY CAUSES REDUCED RELIABILITY AND PRODUCTIVITY IN A WORKPLACE SETTING. THERE WAS NO EVIDENCE IN TODAY'S EXAM OR IN REVIEW OF VET'S VA TREATMENT RECORDS SINCE 2006, THAT HIS PTSD WAS EVER SEVERE ENOUGH TO RENDER HIM UNABLE TO OBTAIN OR MAINTAIN SUBSTANTIALLY GAINFUL EMPLOYMENT. HE WAS ABLE TO KEEP THE SAME FULL TIME JOB FROM 2/13 TO 4/15 AND WAS PROMOTED TO KEYHOLDER AT GOOD WILL. THERE WAS NO EVIDENCE TO DOCUMENT THE REASON THAT HE LOST HIS JOB IN 4/15. HIS MH NOTES INDICATE THAT HE WAS NOT APPLYING FOR OTHER WORK BUT PLANNED TO GO TO COLLEGE FULL TIME AND WATCH HIS DAUGHTER WHILE HIS WIFE WORKED. HIS MOST DISABLING CONDITIONS ARE HIS ALCOHOL USE DISORDER AND ANTISOCIAL PERSONALITY DISORDER, WHICH CAUSE SOCIAL AND OCCUPATIONAL IMPAIRMENT IN MOST AREAS OF HIS LIFE INCLUDING WORK, SCHOOL, FAMILY RELATIONS, INTERPERSONAL RELATIONSHIPS, JUDGMENT, IMPULSE CONTROL, THOUGHT AND MOOD. THERE IS NO EVIDENCE TO SUGGEST THAT VET'S PERSONALITY DISORDER OR ALCOHOL USE DISORDER ARE RELATED TO THE MILITARY. VET WAS USING ALCOHOL AND CANNABIS SINCE AGE 17 AND 16 RESPECTIVELY, AND HAS A STRONG BIOLOGICAL PREDISPOSITION FOR A SUBSTANCE USE AND A MH DISORDER. HE HAS MULTIPLE FAMILY MEMBERS (INCLUDING HIS FATHER AND SISTER) WITH EITHER SUBSTANCE USE DISORDERS OR MH DISORDERS AND HAD A COUSIN COMMITTED SUICIDE BY GUNSHOT WOUND TO THE HEAD. THERE IS NO EVIDENCE TO SUGGEST THAT EITHER OF VET'S CONDITION WORSENED BEYOND THEIR EXPECTED PROGRESSION AS A RESULT OF MILITARY EXPERIENCES. ALTHOUGH VET HAS BEEN INVOLVED IN SUBSTANCE ABUSE AND MH TREATMENT AT THE VA SINCE 2006, MUCH OF HIS TREATMENT WAS PRECIPITATED BY LEGAL PROBLEMS INCLUDING HIS 3 DUIS AND MOST RECENTLY HIS ARREST FOR DRIVING ON A REVOKED LICENSE. HE ORIGINALLY CAME FOR ALCOHOL TREATMENT AT DANVILLE VA ON 6/30/06 AFTER GETTING 2 DUIS IN A 5 MONTH PERIOD. AT THE TIME, HE HAD A LARGE SOCIAL NETWORK OF FRIENDS WHO ABUSED ALCOHOL AND DRUGS, AND WAS EXPERIMENTING WITH COCAINE, ACID, ECSTASY AND MUSHROOMS, BESIDES DRINKING 12-15 BEERS PER NIGHT AND USING 2 GMS OF CANNABIS PER DAY. HIS 11/2/05 MH NOTE INDICATED THAT HE WAS DOING MUCH BETTER ON CELEXA FOR ANXIETY BUT HE STOPPED TAKING IT. HIS 10/26/15 PSYCHIATRIST NOTE INDICATED THAT HE ONLY GOT AGITATED WHEN INTOXICATED. DESPITE URGING FROM HIS SW TO GET RESIDENTIAL SDTU TREATMENT SINCE 8/12,VET HAS BEEN UNWILLING TO FOLLOW UP UNTIL NOW WHEN HE FACES JAIL TIME OR RESIDENTIAL TREATMENT. HIS MH NOTES INDICATE THAT HE DOES BETTER WHEN HE IS SOBER AND WHEN HE IS COMPLIANT WITH MH MEDICATION AND TREATMENT. IT IS LIKELY THAT VET WOULD BE ABLE TO MAINTAIN SUBSTANTIALLY GAINFUL FULL TIME EMPLOYMENT AND HEALTHIER RELATIONSHIPS IF HE REMAINED SOBER AND COOPERATED WITH TREATMENT ON A CONSISTENT BASIS. TODAY'S DIAGNOSES OF ALCOHOL USE DISORDER, ANTISOCIAL PERSONALITY DISORDER AND PTSD ARE BASED UPON DSM-5 CRITERIA AND ICD-10 CODING. /es/ KATHLEEN PARKER, PSY.D. Signed: 06/10/2016 17:12 ------------------------------------------------------------------------- ----------- END OF MY HEALTHEVET PERSONAL INFORMATION REPORT ----------

Just had the c&p on Friday and I am blown away as I just looked at the notes! Basically said I'm a drunk who doesn't have PTSD (anymore) and she diagnosed me with antisocial personality disorder?!? I've never had that diagnosis or even heard of it before. I think ink they are going to reduce my 70% ?? please help. SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes[ ] No ICD Code: F43.20 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: ALCOHOL USE DISORDER ICD Code: F12.20 Comments, if any: THIS IS VET'S MAIN AND MOST DISABLING CONDITION. Mental Disorder Diagnosis #2: ANTISOCIAL PERSONALITY DISORDER ICD Code: F60.2 Comments, if any: VET HAS 8 FELONIES INCLUDING 4 COUNTS OF AGGRAVATED BATTERY OF POLICE OFFICERS IN 2007 AND 2010, DOMESTIC BATTERY IN 2007, CRIMINAL DAMAGE TO GOVT PROPERTY IN 2010, CRIMINAL DAMAGE TO STATE PROPERTY IN 2006, AND AGGRAVATED DUI (3RD) IN 2006. HE HAS BEEN INCARCERATED IN STATE PRISONS TWICE AND IS FACING JAIL TIME AT HIS NEXT COURT DATE. Mental Disorder Diagnosis #3: PTSD ICD Code: F43.20 Comments, if any: PCL-5 TOTAL SCORE TODAY WAS 65 SUGGESTING MODERATE PTSD SYMPTOMS. HE HAS NOT BEEN COMPLIANT WITH MEDICATION OR MH TREATMENT AND HAD IMPROVED PTSD SYMPTOMS IN THE PAST WHEN MEDICATED AND ATTENDING TREATMENT MORE REGULARLY. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [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 and discuss whether there is any clinical association between these diagnoses: ALCOHOL USE DISORDER - CONTINUED EXCESSIVE USE OF ALCOHOL DESPITE SOCIAL AND LEGAL CONSEQUENCES, DEPRESSED AND ANXIOUS AFFECT, DECREASED MEMORY, POOR JUDGMENT, DECREASED MOTIVATION, INTERPERSONAL DIFFICULTY, DIFFICULTIES IN A WORK SETTING, IMPULSE CONTROL DIFFICULTIES, DECREASED CONCENTRATION, PERSISTENT NEGATIVE COGNITIONS, IRRITABILITY, ANGER OUTBURSTS, INSOMNIA, DECREASED INTEREST. ANTISOCIAL PERSONALITY DISORDER - CONTINUED CRIMINAL ACTS WITH 8 FELONIES AND REPEATED INCARCERATION, CONNING OTHERS FOR PERSONAL PROFIT, IMPULSIVITY, IRRITABILITY, AGGRESSIVENESS, RECKLESS DISREGARD FOR SAFETY OF SELF OR OTHERS, CONSISTENT IRRESPONSIBILITY WITH REPEATED FAILURE TO HONOR FINANCIAL OBLIGATIONS, LACK OF REMORSE, INTERPERSONAL DIFFICULTY IN THE WORKPLACE, POOR JUDGMENT. PTSD - FLASHBACKS, NIGHTMARES, AVOIDANCE, EMOTIONAL NUMBING, HYPERVIGILANCE, SUSPICIOUSNESS. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes[X] No[ ] Not shown in records reviewed Comments, if any: TBI EXAM DATED 5/18/15 DID NOT DIAGNOSE TBI BUT PTSD AND ALCOHOL DEPENDENCE 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 reduced reliability and productivity 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: ALCOHOL USE DEPENDENCE, SEVERE - SOCIAL AND OCCUPATIONAL IMPAIRMENT IN MOST AREAS INCLUDING SCHOOL, FAMILY RELATIONSHIPS, INTERPERSONAL RELATIONS, WORK, MOOD, JUDGMENT AND IMPULSE CONTROL. ANTISOCIAL PERSONALITY DISORDER - SOCIAL AND OCCUPATIONAL IMPAIRMENT IN MOST AREAS INCLUDING SCHOOL, FAMILY RELATIONSHIPS, INTERPERSONAL RELATIONS, WORK, MOOD, JUDGMENT AND IMPULSE CONTROL. PTSD - REDUCED RELIABILITY AND PRODUCTIVITY. 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 (hard copy paper C-file) reviewed? [ ] Yes[X] No 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 [X] 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 [X] Other: CP PTSD REVIEW EXAM DATED 4/30/15 WAS ALSO REVIEWED. b. Was pertinent information from collateral sources reviewed? [X] Yes[ ] No If yes, describe: VET'S FIANCEE AMBER ACTIVELY PARTICIPATED IN TODAY'S EXAM. BOTH WERE TEARFUL DURING THE EXAM. 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: MR JUSTIN AARON SOROKA IS A 33 YEAR OLD SINGLE, UNEMPLOYED, CAUCASIAN MALE VETERAN OF THE MARINE CORPS WHO SERVED IN IRAQ AND IS 70% SC FOR PTSD. SINCE HIS LAST C&P PTSD EXAM ON 4/30/15, HE CONTINUES TO BE SINGLE BUT LIVES WITH HIS FIANCEE AND THEIR 2 YEAR OLD DAUGHTER IN A HOME THAT THEY RECENTLY PURCHASED. HE DESCRIBED THEIR RELATIONSHIP AS CATASTROPHIC SINCE "I CAN'T EVER DO ANYTHING RIGHT". HE SAID THEY ARGUE CONSTANTLY BUT PUT ON A HAPPY FACE WHEN AROUND HER FAMILY. HE SAID SHE IS WORN OUT FROM DEALING WITH HER PTSD. HIS 2/3/16 SW NOTE INDICATED THAT HE CHEATED RECENTLY ON HIS FIANCEE AND THAT STRAINED THEIR R ELATIONSHIP. HE HAD ALTERCATIONS WITH HER FAMILY MEMBERS. IN 10/15, VET WAS ARRESTED AFTER ASSAULTING AMBER'S STEP-FATHER, PUNCHING HIM NUMEROUS TIMES IN THE FACE AND CAUSING A BLACK EYE. CHARGES WERE DROPPED. HE MAINTAINS CONTACT WITH HIS SISTER WHO IS IN THE ARMY AND IN KANSAS. HIS FATHER LIVES AN HOUR AWAY BUT HAS LITTLE TO DO WITH THEM, TAKES THEM TO DINNER AND LEAVES. VET FEELS VERY DISTANT FROM HIS DAD. HIS MOTHER DIED NEARLY 8 YEARS AGO WHILE HE WAS INCARCERATED AND VET CONTINUES TO GRIEVE FOR HER. HE HAS SOCIAL MEDIA CONTACT WITH MILITARY FRIENDS. HE HAS ONE FRIEND THAT HE MET WHEN HE WORKED AT GOOD WILL. VET CALLS HIM TO TAKE HIM TO VA APPOINTMENTS. VET CURRENTLY LIVES IN LASALLE, IL IN A HOME THAT HE AND HIS FIANCEE RECENTLY PURCHASED. HE MET ONE NEIGHBOR BUT GENERALLY HE KEEPS TO HIMSELF. HE SAID HE HAS AN AWESOME RELATIONSHIP WITH HIS 2 YEAR OLD DAUGHTER HALEY, BUT HE HAS HAD EXTREME VIOLENT BEHAVIOR IN FRONT OF HER. HE HAS YELLED AT HER AND FEARS THAT HE WILL LOSE HER IF THINGS DON'T WORK OUT WITH AMBER. IT HURTS HIM TO SEND HER TO DAYCARE RECENTLY BECAUSE HE WOULD PREFER TO TAKE CARE OF HER. A DCFS CHILD ENDANGERMENT CASE WAS FOUNDED IN 2/16 AFTER VET WAS VIOLENTLY ASSAULTING HIS FIANCEE'S STEPFATHER IN FRONT OF THE CHILD. WHILE VET STATED THAT HE HAS NO/FEW FRIENDS, HIS 6/6/16 PSYCHIATRIST NOTE INDICATED THAT HE GOES OUT TO BARS DRINKING WITH FRIENDS. b. Relevant Occupational and Educational history: VETHAS BEEN ATTENDING COLLEGE CLASSES SINCE 2006 COMMUNITY COLLEGES AND FAILED 3 CLASSES LAST SEMESTER BUT PASSED HIS MATH CLASS. HE HAS BEEN TRYING TO GET HIS ASSOCIATE'S DEGREE FOR THE PAST 10 YEARS AND HOPES TO GET A DEGREE IN SOCIAL WORK EVENTUALLY. HIS GPA IS LESS THAN 1.0. HE TOOK 3 ONLINE CLASSES WHICH HE FAILED BUT PASSED THE MATH CLASS IN THE CLASSROOM CLASS. HE DIDN'T ASSOCIATE WITH TEACHERS OR OTHER STUDENTS. VET LAST WORKED FULL TIME AT GOOD WILL INDUSTRIES FROM 2/13 TO 4/15, WAS PROMOTED TO KEYHOLDER, THEN WAS TERMINATED IN 4/15. REASONS FOR THE TERMINATION WERE UNCLEAR BUT DOCUMENTS FROM WORK INDICATED THAT HE HAD LOUD VERBAL ALTERCATION WITH A COWORKER IN 1/14, WAS ABSENT 8 TIMES IN 12 MONTHS AND WORKED 3 PARTIAL SHIFTS BY 12/14, AND POINTED HIS FINGER AT COWORKERS CAUSING TENSION AT WORK ON 12/18/14. THERE WAS NO OTHER DOCUMENTATION OF WORK PROBLEMS SUBMITTED TO INDICATE WHY HE WAS TERMINATED IN 4/16. HE HAS HAD NO OTHER PAID WORK SINCE 4/15. MH NOTES INDICATED THAT HE WAS NOT LOOKING FOR EMPLOYMENT BUT WAS GOING TO COLLEGE FULL TIME AND WATCHING HIS YOUNG DAUGHTER WHILE HIS WIFE WORKED. THERE WAS NO EVIDENCE THAT HE HAD APPLIED FOR WORK BUT HIS 8 FELONIES, LOSS OF DRIVER'S LICENSE (SINCE 2006), 3RD DUI(IN 2010), AND CONTINUED CRIMINAL BEHAVIOR ARE LIKELY TO INTERFERE WITH OBTAINING WORK. VET'S MH NOTES REPEATEDLY NOTE THAT HE IS ONLY VIOLENT AND AGGRESSIVE WHEN DRINKING. THERE WAS NO EVIDENCE IN TODAY'S EXAM OR IN REVIEW OF VET'S MH RECORDS SINCE 2006 THAT HIS PTSD WAS EVER SEVERE ENOUGH, BY ITSELF, TO PREVENT HIM FROM OBTAINING OR MAINTAINING SUBSTANTIALLY GAINFUL EMPLOYMENT. c. Relevant Mental Health history, to include prescribed medications and family mental health: SINCE 4/15, HE HAS BEEN FOLLOWED BY SHAWN SLAGLE, SW AND DR LIM, PSYCHIATRIST AT THE LASALLE CBOC. HE HAS NOT BEEN COMPLIANT WITH TREATMENT AND WAS TOLD BY HIS SW ON 2/3/16 THAT NOT GETTING TREATMENT FOR HIS PTSD IS THE PROBLEM, NOT HIS PTSD. HE DID NOT SEE HIS PSYCHIATRIST FROM 10/26/15 UNTIL 6/6/16 AND LAST FILLED ALL HIS MH MEDICATIONS IN 2/16. HE ONLY CONTACTED HIS PSYCHIATRIST IN 11/15 AND 12/15 WHEN HE NEEDED FORMS DOCUMENTING HIS TREATMENT FOR COURT DATES. HE RETURNED TO MH ON 6/6/16 DUE TO HAVING A COURT DATE ON 6/30/16 THAT WILL DECIDE WHETHER HE GOES TO JAIL OR RESIDENTIAL TREATMENT. HE DID NOT SEE HIS SW FOR INDIVIDUAL THERAPY BETWEEN 6/15 AND 2/16, MISSING SEVERAL APPOINTMENTS. HE APPLIED FOR ADMISSION TO LOVELL'S SDTU PROGRAM (RESIDENTIAL TRAUMA TREATMENT) BUT WAS TOLD THAT HE HAD TO COMPLETE SUBSTANCE ABUSE TREATMENT FIRST SINCE HIS SUBSTANCE USE WAS STILL HIGH. HE HAS BEEN ENCOURAGED TO ENTER THE SDTU AT LOVELL VAMC BY HIS SW SINCE 8/27/12 BUT HAS REFUSED AND NOT FOLLOWED THROUGH. A PHONE INTERVIEW WITH THE SDTU WAS HELD ON 5/3/16 AND VET WAS REFERRED TO THE MHRRTP TO TREAT HIS ADDICTIONS BEFORE ADDRESSING TRAUMA WORK. HIS ADMISSION TO THE SDTU IS DELAYED UNTIL HE COMPLETES ADDICTIONS TREATMENT. HE HAS AN INTERVIEW WITH THE MHRRTP PROGRAM ON 6/20/16. CURRENTLY, HE WILL BE TAKING DULOXETINE AND TRAZODONE FOR HIS PTSD AND NALTREXONE FOR ALCOHOL CRAVINGS. THEY WERE ORDERED ON 6/7/16 BUT VET HAS NOT RECEIVED THEM YET. HE STOPPED TAKING MH MEDS AFTER 2/16 AND DIDN'T REORDER MEDICATIONS AFTER THEY RAN OUT. HE WENT TO ILLINOIS VALLEY COMMUNITY HOSPITAL ER WHEN INTOXICATED ON 10/25/15 AND WANTED TO TRANSFER TO 2S AT HINES BUT VET INSISTED ON A PRIVATE BED. WHEN HE WAS TOLD THEY COULDN'T GUARANTEE A PRIVATE BED, VET REFUSED TO GO. HE WAS DISCHARGED FROM THE COMMUNITY HOSPITAL AFTER A FEW HOURS OF OBSERVATION. VET CLEARLY DID BETTER WITH PTSD SYMPTOMS WHEN HE WAS NOT DRINKING, ACCORDING TO MULTIPLE MH NOTES. HE HAD GOOD RESPONSE TO MH MEDICATIONS BUT STOPPED TAKING THEM OR DIDN'T TAKE THEM AS PRESCRIBED. HE OFTEN SEEKS OUT MH TREATMENT WHEN HE IS IN LEGAL TROUBLE IN ORDER TO NOT FACE CONSEQUENCES FOR HIS ACTIONS. HE HAS USED HIS PTSD AND ALCOHOL USE DISORDER DIAGNOSES TO AVOID JAIL TIME. HE HAD NO SUICIDE ATTEMPTS OR PSYCHIATRIC HOSPITALIZATIONS IN THE PAST YEAR. IN FACT, HE HAD NO PSYCHIATRIC HOSPITALIZATIONS SINCE 3/13. IT IS IMPORTANT TO NOTE THAT VET HAS A GREAT DEAL OF MENTAL ILLNESS IN HIS FAMILY THAT WAS NOT NOTED ON PRIOR C&P PTSD EXAMS. HIS SISTER WAS HOSPITALIZED FOR DEPRESSION IN HIGH SCHOOL AND TAKES ANTIDEPRESSANTS, A COUSIN COMMITTED SUICIDE A FEW YEARS AGO OF A GSW TO THE HEAD (PER HIS 8/12 MH INTAKE NOTE), HIS PATERNAL AUNT AND UNCLE HAVE PSYCHIATRIC PROBLEMS, AND VET WAS A VICTIM OF PHYSICAL ABUSE ACCORDING TO HIS 7/6/06 SARP ASSESSMENT. d. Relevant Legal and Behavioral history: SINCE 4/15, VET WAS ARRESTED ON 11/28/15 AND CHARGED WITH BATTERY FOR HITTING AMBER'S STEPFATHER BUT THEY DROPPED THE CHARGES. HE WAS ARRESTED FOR DRIVING ON A REVOKED LICENSE IN 3/16. VET HAD 3 DUIS AND HAS NOT HAD A DRIVER'S LICENSE SINCE 2006. HE HAS A COURT DATE PENDING ON 6/30 REGARDING HIS LATEST OFFENSE. HE MAY GO TO JAIL OR MAY BE ALLOWED TO ENTER RESIDENTIAL TREATMENT. HE HAS HAD CHRONIC DIFFICULTY WITH BEING IN DEBT DUE TO HIS SUBSTANCE ABUSE, IMPULSE CONTROL, CREDIT CARDS AND LEGAL EXPENSES. e. Relevant Substance abuse history: SINCE 4/15, VET HAS DRANK EXCESSIVELY. HE WOULD LIKE TO DRINK EVERY NIGHT AND TRIES TO MANIPULATE AMBER TO BE ABLE TO DRINK. HE WILL DRINK A 6 PACK OR BOTTLE OF WINE PER SITTING. THEIR HOUSE IS 1 BLOCK AWAY FROM A BAR AND 2 BLOCKS FROM A CONVENIENT STORE. WHEN AMBER COMES HOME FROM WORK, THERE WILL BE ALCOHOL IN THE REFRIGERATOR OR EMPTY BOTTLES IN THE TRASH. HE STORMS OUT WHEN ARGUING WITH HER AND GOES TO THE BAR WHERE HE CONSUMES 6+ DRINKS. ALCOHOL WAS INVOLVED BEFORE VET BECAME VIOLENT WITH HER FATHER IN 11/15. HE PUSHED AMBER IN 10/15 WHEN SHE CALLED THE POLICE DURING HIS INTOXICATED RAGE. CURRENTLY, HE DRANK HEAVILY ON MEMORIAL DAY, BINGE DRINKS, THEN TRIES NOT TO DRINK. HE LAST DRANK LAST WEEK WHEN HE HAD 2 GLASSES OF WINE. VET SMOKES MARIJUANA OCCASIONALLY, 1-2 TIMES PER MONTH. ON 6/6/16, DR LIM REPORTED THAT HE USES IT 2-3 TIMES PER MONTH. HE HAS NOT ACTIVELY SOUGHT IT OUT RECENTLY AND LAST USED IT 2 WEEKS AGO. IT UPSETS AMBER SO HE TRIES NOT TO. IT IS IMPORTANT TO NOTE THAT VET'S 8/21/12 MH INTAKE NOTE AT HINES INDICATED THAT VET DRANK ALCOHOL SINCE 17 IN HIGH SCHOOL AND USED MARIJUANA SINCE AGE 16. HE BECOMES AGGRESSIVE AND VIOLENT WHEN HE IS INTOXICATED AND IT LEADS TO LEGAL PROBLEMS. HIS 7/1/06 ALCOHOL TREATMENT NOTE INDICATED THAT ALCOHOLISM WAS PREVALENT ON BOTH SIDES OF THE FAMILY, ACCORDING TO VET'S PARENTS. HIS FATHER AND MATERNAL UNCLE WERE ALCOHOLIC AND HIS MATERNAL UNCLE ABUSED DRUGS. VET ALSO USED COCAINE 10 TIMES, MOST RECENTLY IN 2010, AND USED MUSHROOMS, LSD AND ECSTASY SEVERAL TIMES IN 2006, ACCORDING TO HIS 8/12 MH INTAKE NOTE. ON 8/2/06, A BIOPSYCHOSOCIAL ASSESSMENT INDICATED THAT VET'S ALCOHOL AND DRUG USE INTERFERED WITH HIS SCHOOL PERFORMANCE. VET HAD A HISTORY OF ABUSING PRESCRIPTION NARCOTICS BUT SAID HE HAS NOT IN THE PAST YEAR. f. Other, if any: VET HAS ANNIVERSARY REACTIONS RELATED TO HIS FRIEND DYING IN IRAQ IN APRIL 2004, HIS MOTHER'S DEATH IN 5/08. HIS FIANCEE SAID SOMETHING ALWAYS HAPPENS IN THE SPRING WITH VET'S BEHAVIOR. 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) [X] Witnessing, in person, the traumatic event(s) as they occurred to others Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the 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 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 aggression toward people or objects. [X] Reckless or self-destructive behavior. [X] Hypervigilance. [X] Exaggerated startle response. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [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: --------------------------- VET ARRIVED EARLY FOR TODAY'S EXAM AND WAS ACCOMPANIED BY HIS FIANCEE AMBER. HE DISPLAYED DEPRESSED AFFECT DURING THE EXAM AND BECAME TEARFUL AT SEVERAL TIMES. SPEECH, BEHAVIOR, AFFECT, THOUGHT AND EYE CONTACT WERE OTHERWISE WITHIN NORMAL LIMITS. APPEARANCE, GROOMING AND HYGIENE WERE ACCEPTABLE. 6. 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: HE REPORTED PANIC ATTACKS WHERE HE FEELS ANGRY AND CAN'T CONTROL THINGS. THESE ARE ANGER ATTACKS, NOT ACTUAL PANIC ATTACKS. HIS FIANCEE NOTED THAT HE EATS EXCESSIVELY, EATING 28 WHITE CASTLE HAMBURGERS AND AN ENTIRE CAKE IN 2 DAYS. HIS WEIGHT FLUCTUATES AND HE EATS DURING THE NIGHT. H AVOIDS WATCHING THE NEWS, CONVERSATIONS ABOUT THE MILITARY, AND TELLING OTHERS THAT HE WAS A MARINE. HE HAS LOST INTEREST IN GOING OUT, DOING RECREATIONAL THINGS THAT DON'T INVOLVE DRINKING, AND GOING TO STATE PARKS. HE SLEEPS 4-5 HOURS WITH MEDICATION. 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes[ ] No 8. Remarks, (including any testing results) if any: --------------------------------------------------- MR JUSTIN SOROKA CONTINUES TO MEET CRITERIA FOR PTSD BUT HIS PTSD IS OF MODERATE SEVERITY, WHICH INDICATES A DECREASE IN SEVERITY SINCE HIS LAST C&P PTSD REVIEW EXAM IN 4/15. HIS PTSD CURRENTLY CAUSES REDUCED RELIABILITY AND PRODUCTIVITY IN A WORKPLACE SETTING. THERE WAS NO EVIDENCE IN TODAY'S EXAM OR IN REVIEW OF VET'S VA TREATMENT RECORDS SINCE 2006, THAT HIS PTSD WAS EVER SEVERE ENOUGH TO RENDER HIM UNABLE TO OBTAIN OR MAINTAIN SUBSTANTIALLY GAINFUL EMPLOYMENT. HE WAS ABLE TO KEEP THE SAME FULL TIME JOB FROM 2/13 TO 4/15 AND WAS PROMOTED TO KEYHOLDER AT GOOD WILL. THERE WAS NO EVIDENCE TO DOCUMENT THE REASON THAT HE LOST HIS JOB IN 4/15. HIS MH NOTES INDICATE THAT HE WAS NOT APPLYING FOR OTHER WORK BUT PLANNED TO GO TO COLLEGE FULL TIME AND WATCH HIS DAUGHTER WHILE HIS WIFE WORKED. HIS MOST DISABLING CONDITIONS ARE HIS ALCOHOL USE DISORDER AND ANTISOCIAL PERSONALITY DISORDER, WHICH CAUSE SOCIAL AND OCCUPATIONAL IMPAIRMENT IN MOST AREAS OF HIS LIFE INCLUDING WORK, SCHOOL, FAMILY RELATIONS, INTERPERSONAL RELATIONSHIPS, JUDGMENT, IMPULSE CONTROL, THOUGHT AND MOOD. THERE IS NO EVIDENCE TO SUGGEST THAT VET'S PERSONALITY DISORDER OR ALCOHOL USE DISORDER ARE RELATED TO THE MILITARY. VET WAS USING ALCOHOL AND CANNABIS SINCE AGE 17 AND 16 RESPECTIVELY, AND HAS A STRONG BIOLOGICAL PREDISPOSITION FOR A SUBSTANCE USE AND A MH DISORDER. HE HAS MULTIPLE FAMILY MEMBERS (INCLUDING HIS FATHER AND SISTER) WITH EITHER SUBSTANCE USE DISORDERS OR MH DISORDERS AND HAD A COUSIN COMMITTED SUICIDE BY GUNSHOT WOUND TO THE HEAD. THERE IS NO EVIDENCE TO SUGGEST THAT EITHER OF VET'S CONDITION WORSENED BEYOND THEIR EXPECTED PROGRESSION AS A RESULT OF MILITARY EXPERIENCES. ALTHOUGH VET HAS BEEN INVOLVED IN SUBSTANCE ABUSE AND MH TREATMENT AT THE VA SINCE 2006, MUCH OF HIS TREATMENT WAS PRECIPITATED BY LEGAL PROBLEMS INCLUDING HIS 3 DUIS AND MOST RECENTLY HIS ARREST FOR DRIVING ON A REVOKED LICENSE. HE ORIGINALLY CAME FOR ALCOHOL TREATMENT AT DANVILLE VA ON 6/30/06 AFTER GETTING 2 DUIS IN A 5 MONTH PERIOD. AT THE TIME, HE HAD A LARGE SOCIAL NETWORK OF FRIENDS WHO ABUSED ALCOHOL AND DRUGS, AND WAS EXPERIMENTING WITH COCAINE, ACID, ECSTASY AND MUSHROOMS, BESIDES DRINKING 12-15 BEERS PER NIGHT AND USING 2 GMS OF CANNABIS PER DAY. HIS 11/2/05 MH NOTE INDICATED THAT HE WAS DOING MUCH BETTER ON CELEXA FOR ANXIETY BUT HE STOPPED TAKING IT. HIS 10/26/15 PSYCHIATRIST NOTE INDICATED THAT HE ONLY GOT AGITATED WHEN INTOXICATED. DESPITE URGING FROM HIS SW TO GET RESIDENTIAL SDTU TREATMENT SINCE 8/12, VET HAS BEEN UNWILLING TO FOLLOW UP UNTIL NOW WHEN HE FACES JAIL TIME OR RESIDENTIAL TREATMENT. HIS MH NOTES INDICATE THAT HE DOES BETTER WHEN HE IS SOBER AND WHEN HE IS COMPLIANT WITH MH MEDICATION AND TREATMENT. IT IS LIKELY THAT VET WOULD BE ABLE TO MAINTAIN SUBSTANTIALLY GAINFUL FULL TIME EMPLOYMENT AND HEALTHIER RELATIONSHIPS IF HE REMAINED SOBER AND COOPERATED WITH TREATMENT ON A CONSISTENT BASIS. TODAY'S DIAGNOSES OF ALCOHOL USE DISORDER, ANTISOCIAL PERSONALITY DISORDER AND PTSD ARE BASED UPON DSM-5 CRITERIA AND ICD-10 CODING. /es/ KATHLEEN PARKER, PSY.D. Signed: 06/10/2016 17:12 ------------------------------------------------------------------------- ----------- END OF MY HEALTHEVET PERSONAL INFORMATION REPORT ----------

Thanks. I went over my last C&P that was done April 2015 for my PTSD increase (50 to 70%). I'm hoping the examiner reviews that also bc it seems to me like it's an easy decision in regards to my TDIU claim (C&P is tomorrow). The examiner put that I have extreme difficulty in maintaining employment due to SC PTSD and other notes he wrote seem to be in my favor. From then to now things have only gotten worse. Just hope I don't clam up and minimize like I always do. Sucks being stubborn when it comes to this. My fiancé is coming so she will help me speak up and address the pertinent details.

Good info! I just checked his notes and there is no mention of my competence in ability to manage funds. It was sidebar conversation and I didn't think he would include it but ya never know so I'm glad to have checked. Thanks.

I am the sole owner of my checking account and I was deemed competent to handle my funds last year when they asked at a C&P exam. I have my fiancé who I trust to handle my funds if it had to come to it but that is not a route I want to take ? I think I'll be fine but the nerves are having a field day with me today.

Tomorrow is the day of c&p...quick question to your comment about handling own funds. To me this seems like a no brainier and yes I do manage my funds...but in an appointment with my social worker he said (off the record) that if it were up to him rating me he would deem me either 100 P&T or TDIU and incompetent to manage funds. He said reason is that my poor impulse control and decision making would be damaging to a large lump sum of any backpay. so question is: why does it matter in an unemployment claim? I can handle my bills and money but that doesn't mean I'm able to secure gainful employment.

Yes full work up was done and shows I have seizure activity in my frontal lobe and two small deviations elsewhere...brain stem protrudes through spinal area a bit but she said its of no concern. I have a mild tbi documented in my file but never did a claim. Yes the seizure disorder is undiagnosed (no seizures prior to last year when I had six) and am on daily medication for them. My neuro doc just retired which is sad because she was lovely, a really nice lady. I was on driving restriction for a year bc of the seizures. Made it difficult to find work and such. Just a mess.

Thanks Berta. I have not applied for SSD nor Voc Rehab. My care team at VA clinic put in referrals or consults for inpatient residential treatment at the VA hospital in North Chicago, just waiting on an admission date once they conduct the phone interview on June 20th. Already been accepted to PTSD program but they referred me to Substance Abuse program also so they want me to do that first then seamless transition into PTSD program. 92 day inpatient, I'm ready! My employer was Goodwill, of two years. They hired me knowing I'm a service connected veteran and made several accommodations at the workplace for me to help avoid certain stressors or at least lessen them. Those accommodations vanished after a couple weeks as they "got used to me" and treated me like everyone else. It was tough but I stuck it out and they forced me to do counseling at an outside facility after my 5 day suspension before I could return to work. I started having seizures (undiagnosed by va neuro) and I was placed on limited duty by Doctor. Employer said they have no limited duty jobs for me so I had to burn my pto and vacation until I was cleared..wasn't cleared so they called me and said I was fired (no reason given)

Greetings ladies and gentlemen, I received a 70% rating for PTSD from last years increase when it was at 50%. I've been unemployed for over a year since being fired for several aggressive angry outbursts related to stressors tied to my PTSD. Filed for TDIU May 11th of 2016 and I have a C&P scheduled for June 10th of 2016. What the heck can I expect at a TDIU c&p? I sent in all of my formal write-ups and suspension paperwork from my previous employer as well as buddy statements from coworkers who witnessed my behavior and how my work performance was affected due to PTSD. I have tried multiple times to have HR from my previous employer fill out the VA-form requesting employment info but they have not cooperated with me. Won't return calls or emails. Even sent them the form but nothing gets back to me. I fear that will hurt me and also be I'm clean shaven and well dressed (I'm ocd about my appearance by it seems as if it's the only thing I can control). I stay home taking care of my daughter but she goes to daycare a couple times a week to give me a break. It gets too much at times. Should that be mentioned ? I just thought my claim is moving fast and not sure if that is good or bad ? Any thoughts? Thanks for all you do. It is greatly appreciated.

Great info, thank you! Ive been at 70% for quite some time but unemployed due to SC for over a year. I kept thinking I would get employed and earn more than what TDIU pays but I have not even landed a job interview since my last termination (due to outbursts and absences related to SC. Three write ups in a year and forced to do counseling before I could return to work.) just a mess. I have the TDIU form filled out on Ebeneifts but haven't submitted it yet bc I'm at a stand still trying to get my previous employer to fill out the other form. HR won't cooperate and my managers won't provide statements stating how my work performance was while employed. I worked at a Goodwill sorting clothes and work If the cash register but it was too much. They made accommodations for me knowing my PTSD but it didn't help much. I'm honestly scared to file for TDIU bc I don't think I deserve it, or I don't want to accept the fact that PTSD controls me so much that I cannot keep gainful employment. I was a rock star in the Marines; even after 11 years it's a hard pill to swallow.

Thanks for the reply. And prompt at that! I am SC at 70% for PTSD. I think it sounds too good to be true bc I can see people scamming treatment for monetary gain. But if a veteran is out of work they are missing their earnings and I've been told it is TDIU they give if after 21 days consecutive stay in VA facility. Even heard a guy say while he was in St. Cloud's program a rep was helping veteran patients fill and submit the forms. Some were paid immediately after treatment. Trying to weigh out options. I'll take out a loan if need be bc I NEED this treatment; not just for me but my kid deserves a healthy father.

I've scoured the forums looking for this info but I missed it if it exists. Real quick brothers and sisters, After ten years of dodging inpatient treatment for PTSD (service-connected) I've finally decided to say hi to my demons and I leave in a couple weeks (North Chicago). Is it true that the VA provides 100% comp rate after 21 days of inpatient/hospital stay? I find it hard to believe. I do not work and am the primary care provider for my toddler. Daycare will cost $980 for the 49 days I'm away in treatment (35 exactly since no weekends at daycare). Huge financial burden and I don't want to have to cancel treatment due to childcare. I want to focus on treatment as opposed to worrying about bills and child care expenses while I'm away. Is there a claim or paperwork I need to file if it is good to go? backpayable? Many info is greatly appreciated (goes without saying) have a wonderful weekend.