Jb21

I have been on that forum for some time. I posted over there as well but I respect all veteran opinions so I thought I would see if anyone here might have some advice. Thank you for you time. /JB

I am only asking because I will be provided an opportunity, before my entire package gets sent to a physical evaluation board and subsequently the VA rating board, to submit a rebuttal if I so choose. I am seeking advise and input as to how my DBQ reads and if I should do anything.

Hello all. Longtime lurker, first time poster. I have a few concerns about my recent C&P results. I am currently in the Ides process so I understand there are going to be differences. Any insight is appreciated though. I am trying to format it and remove PII, but I can not figure out how to get it spaced out so I will attempt to post and then edit. I have addressed a few concerns I have. Thank you for your time. Does the Veteran have a diagnosis of PTSD that conforms to DMS-5 criteria based on today's evaluation? [x ] Yes [ ] No If no diagnosis of PTSD, check all that apply: [ ] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [ ] Veteran does not have a mental disorder that conforms with DSM-5 Criteria [ ] Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire ICD code: 2. Current Diagnoses a. Mental Disorder Diagnosis #1: None ICD code: Comments, if any: see Remarks section of this report for additional information b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): hypertension, migraines, GERD, IBS, chronic fatigue, fibromyalgia ICD code: unknown Comments, if any: See med chart and Gen Med eval 3. Differentiation of symptoms a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [x ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [ ] No [x ] 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: c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [x ] Not shown in records reviewed Comments, if any: d. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [ ] No [x ] 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: 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. The all-powerful 50% social and occupation mark. The rest of this report along with my treatment notes seems to support deficiencies on most areas. I feel I should have been at the 70% mark. 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 [ ]No [x ]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: If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ]Yes [ ]No [x ]No diagnosis of TBI If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: 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 reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: SM is active duty, thus does not have a VA file. Current active duty records (Ahlta) were reviewed. Narsum was reviewed: Dr. Kaye; 8-1-14; SM's typed statement reviewed If no, check all records reviewed: [x] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Mi litary 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? [X] Yes [ ] No If yes, describe: see body of report 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): raised by both parents after divorce; 2 siblings. SM was close to family growing up. SM is not close to family currently. SM denied any history of child abuse. SM had good friends while he was growing up and played many sports. SM doesn't have any current friends. SM has been married 1.5 years. In free time, SM plays with dogs, spends time with wife, watches TV, chips golf balls in back yard. SM socializes daily at work, but has no friends and has infrequent contact with family. This makes me seem like I live a happy go lucky life, which I do not. If I was doing well I would not be in this process. My entire life revolves around survial, treatments and trying to rationalize thoughts of impending doom. This was the exact response I had when asked how I was doing. b. Relevant Occupational and Educational history (pre-military, military, and post-military): Highest level of education: some college classes; HS gpa 3.8 Prior to the military, SM worked in construction and fast food SM has been in the Navy for 9 years. Rate/MOS is FC; rank is E6. SM is currently on Limdu/PEB, not working in rate and is working as communications monitor. SM reported that performance on current job has been at least satisfactory. SM wants to farm*** after he gets out of the military if he is able. NMA describes I am not doing satisfactory. ***If I can recover enough, I would eventually like to live on a small farm for animal therapy, Isolation and mental challenge. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): SM denied any mental health problems or treatment prior to the military. SM first began psychiatric treatment in 2011. SM has been in treatment on and off since that time d. Relevant Legal and Behavioral history (pre-military, military, and post-military): Legal/behavioral problems while growing up: SM denied Legal/behavioral problems while in the military: SM denied Disciplinary action while in the military: --- NJP for DUI; referred to tx e. Relevant Substance abuse history (pre-military, military, and post-military): Substance abuse problems/treatment prior to the military: SM denied Substance abuse problems/treatment during the military: --- DUI; SARP level 1; drank a lot after first tour Current alcohol consumption: last drink was July 2013 f. Other, if any: 3. Stressors ------------ a. Stressor #1: SM was exposed to a total of 17 months of combat SM served in Iraq in support of OIF from 2007-2008 and GWOT from 2010-2011. Exposure was to frequent rocket and mortar attacks, small arms fire and casualties. During one particular incident in 2007. SM yada yada stressor yada …SM reported that he feels he was changed from that moment forward. Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [x ]Yes [ ]No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [ x]Yes [ ]No If no, explain: Is the stressor related to personal assault, e.g. military sexual trauma? [x ]Yes [ ]No If yes, please describe the markers that may substantiate the stressor. SM's report 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. 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. The diagnostic criteria for PTSD, referred to as Criteria A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DMS-5). 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 tramuatic 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] 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 ] 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] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [ x] The disturbance causes 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. 5. Symptoms ----------- For VA rating purposes, check all symptoms that apply to the Veterans diagnoses: [x ] Anxiety [x ] Panic attacks more than once a week [x ] Chronic sleep impairment Both my treatment records and this DBQ show significantly more symptoms. Should I be worried about this? 6. Behavioral Observations -------------------------- see Remarks section 7. 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: see Remarks section 8. Competency Is the Veteran capable of managing his or her financial affairs? [x ] Yes [ ] No If no explain: 9. Remarks, if any ------------------ VBA 2507 INDICATES THAT SM IS UNDERGOING PEB FOR THE FOLLOWING REFERRED PSYCHIATRIC CONDITIONS: ---- Anxiety Disorder NOS, PTSD VBA 2507 INDICATES THAT SM HAS FILED C&P CLAIM FOR THE FOLLOWING PSYCHIATRIC CONDITIONS: ---- sleep disorder, TBI, Per Ahlta note on 28May2014; Dr: "?The sailor reports that following IA deployment to Baghdad in 2007-2008, he developed symptoms found later to be consistent with a diagnosis of PTSD: nightmares of traumatic events, avoidance of discussing details of trauma except in treatment, avoidance of and discomfort in crowded spaces like large stores this hospital, reduced sense of a positive future, emotional numbing in relationships that led to the break-up of his engagement, increased startle response to loud noises like fireworks, a few fistfights in those first couple of years which was out of character for him, and trouble sleeping (delayed onset, nightmares, thrashing about or acting out while asleep). He began to drink for the first time and rapidly became a very heavy user, reporting that he consumed the equivalent of 18-24 beers daily on at least 6 days per week, beginning in 2008 and continuing through 2012. He had a DUI in 20009 which led to NJP and to a Level 1 SARP referral, but he says that he did not apply himself to that program and did not attempt to cut back until 2012 when his now-wife asked him to. He tapered his usage over several months and now reports that his last drink was in SEP13. As a result of the self-taper he denies any physical withdrawal symptoms but began to have re-emergence of the more distressing emotional/behavioral symptoms, and for that reason brought himself to treatment in Sigonella. To his knowledge neither his alcohol use nor his PTSD symptoms led to any noticeable impairment of work function. If this was true my NMA would have said that, but it doesn’t. Should this worry me? He reports that treatment has been helpful, and that the most important factor in his semi-recovery has been learning better how to communicate what he is thinking and feeling with his wife, with his treaters, and with his peers. He believes that he has made good progress (he declines to try to quantify this) but wants to continue that work. The patient denies any history of suicidal attempts or generally destructive behaviors. However, he admits to a period of cutting on his arms and legs from about the time of alcohol tapering to the time that he began CPT treatment in Germany in SEP13. He also admits to occasional suicidal thoughts of "maybe my wife would be better off without me", but denies any history of intent to die or plan to die. He admits to violence in fistfights as noted above during the 2008-2010 period?." MSE: SM was appropriately dressed and neatly groomed. SM was alert and oriented in all spheres and pleasant, cooperative and polite. Speech was spontaneous with normal rate, rhythm, tone, and volume. The patient's mood was anxious with WNL affect. Significant psychomotor abnormalities at present interview were : rapid gait, hand and leg shaking. Thought process was linear and logical; thoughts were goal-directed. Thought content was unremarkable for obsessions, compulsions or persecutory/grandiose delusions. The patient denied any auditory or visual hallucinations. Memory and cognition were grossly intact, however SM reported mild diffuse memory problems; no neuropsychological testing available in records at the time of current evaluation. SM denied any current or recent homicidal/suicidal ideation. Judgment was deemed good to fair. Insight was fair. Impulse control was fair. Intelligence was estimated to be at least in the average range. SM has disturbed sleep nightly. SM reported that he had a sleep study that indicated he had numerous abnormalities which included frequent awakenings, limb movements and should be referred to a neurologist, but that has not yet occurred. No diagnosis of any other anxiety disorder at the time of current evaluation as SM's symptoms are consistent with PTSD. R/o Substance Use Disorder, in Remission. SM denied any significant problems with Activities of Daily Living (e.g., shopping, self-feeding, bathing) due to mental health issues. I was asked if I could go get myself bread for a sandwich if I absolutely had to. I replied if it was a good day and no one there and I absolutely had to, I would attempt in those conditions. I have not been able to venture out alone, and my spouse has to both get groceries and cook dinner. I explained this to the doc but it has been left out. Another should I worry/get changed. Discussed purpose of the evaluation and limits of confidentiality with SM. SM was given the opportunity to ask questions and indicated understanding of these limits. SM consented to participation in this interview. Medical history and C-file were reviewed with a focus on psychiatric symptoms. Advised that SM can obtain a copy of the report from the VA at their discretion. Reader is referred to body of report where symptoms are delineated. SM is now on active duty and therefore has no "post military" stressors or post military employment history. Note: GAF is no longer applicable when diagnosing under DSM V criteria. Due to template restrictions, the remainder of this form is blank, there is no further information contained. My questions are what should I do in this situation? I feel this DBQ does not properly reflect my treatment and symptoms as I am unable to independently function, have no friends and simply cannot adapt to stressful circumstances.

Hello all. Longtime lurker, first time poster. I have a few concerns about my recent C&P results. I am currently in the Ides process so I understand there are going to be differences. Any insight is appreciated though. I am trying to format it and remove PII, but I can not figure out how to get it spaced out so I will attempt to post and then edit. I have addressed a few concerns I have. Thank you for your time. Does the Veteran have a diagnosis of PTSD that conforms to DMS-5 criteria based on today's evaluation? [x ] Yes [ ] No If no diagnosis of PTSD, check all that apply: [ ] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [ ] Veteran does not have a mental disorder that conforms with DSM-5 Criteria [ ] Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire ICD code: 2. Current Diagnoses a. Mental Disorder Diagnosis #1: None ICD code: Comments, if any: see Remarks section of this report for additional information b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): hypertension, migraines, GERD, IBS, chronic fatigue, fibromyalgia ICD code: unknown Comments, if any: See med chart and Gen Med eval 3. Differentiation of symptoms a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [x ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [ ] No [x ] 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: c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [x ] Not shown in records reviewed Comments, if any: d. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [ ] No [x ] 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: 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. The all-powerful 50% social and occupation mark. The rest of this report along with my treatment notes seems to support deficiencies on most areas. I feel I should have been at the 70% mark. 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 [ ]No [x ]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: If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ]Yes [ ]No [x ]No diagnosis of TBI If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: 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 reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: SM is active duty, thus does not have a VA file. Current active duty records (Ahlta) were reviewed. Narsum was reviewed: Dr. Kaye; 8-1-14; SM's typed statement reviewed If no, check all records reviewed: [x] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Mi litary 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? [X] Yes [ ] No If yes, describe: see body of report 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): raised by both parents after divorce; 2 siblings. SM was close to family growing up. SM is not close to family currently. SM denied any history of child abuse. SM had good friends while he was growing up and played many sports. SM doesn't have any current friends. SM has been married 1.5 years. In free time, SM plays with dogs, spends time with wife, watches TV, chips golf balls in back yard. SM socializes daily at work, but has no friends and has infrequent contact with family. This makes me seem like I live a happy go lucky life, which I do not. If I was doing well I would not be in this process. My entire life revolves around survial, treatments and trying to rationalize thoughts of impending doom. This was the exact response I had when asked how I was doing. b. Relevant Occupational and Educational history (pre-military, military, and post-military): Highest level of education: some college classes; HS gpa 3.8 Prior to the military, SM worked in construction and fast food SM has been in the Navy for 9 years. Rate/MOS is FC; rank is E6. SM is currently on Limdu/PEB, not working in rate and is working as communications monitor. SM reported that performance on current job has been at least satisfactory. SM wants to farm*** after he gets out of the military if he is able. NMA describes I am not doing satisfactory. ***If I can recover enough, I would eventually like to live on a small farm for animal therapy, Isolation and mental challenge. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): SM denied any mental health problems or treatment prior to the military. SM first began psychiatric treatment in 2011. SM has been in treatment on and off since that time d. Relevant Legal and Behavioral history (pre-military, military, and post-military): Legal/behavioral problems while growing up: SM denied Legal/behavioral problems while in the military: SM denied Disciplinary action while in the military: --- NJP for DUI; referred to tx e. Relevant Substance abuse history (pre-military, military, and post-military): Substance abuse problems/treatment prior to the military: SM denied Substance abuse problems/treatment during the military: --- DUI; SARP level 1; drank a lot after first tour Current alcohol consumption: last drink was July 2013 f. Other, if any: 3. Stressors ------------ a. Stressor #1: SM was exposed to a total of 17 months of combat SM served in Iraq in support of OIF from 2007-2008 and GWOT from 2010-2011. Exposure was to frequent rocket and mortar attacks, small arms fire and casualties. During one particular incident in 2007. SM yada yada stressor yada …SM reported that he feels he was changed from that moment forward. Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [x ]Yes [ ]No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [ x]Yes [ ]No If no, explain: Is the stressor related to personal assault, e.g. military sexual trauma? [x ]Yes [ ]No If yes, please describe the markers that may substantiate the stressor. SM's report 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. 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. The diagnostic criteria for PTSD, referred to as Criteria A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DMS-5). 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 tramuatic 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] 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 ] 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] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [ x] The disturbance causes 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. 5. Symptoms ----------- For VA rating purposes, check all symptoms that apply to the Veterans diagnoses: [x ] Anxiety [x ] Panic attacks more than once a week [x ] Chronic sleep impairment Both my treatment records and this DBQ show significantly more symptoms. Should I be worried about this? 6. Behavioral Observations -------------------------- see Remarks section 7. 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: see Remarks section 8. Competency Is the Veteran capable of managing his or her financial affairs? [x ] Yes [ ] No If no explain: 9. Remarks, if any ------------------ VBA 2507 INDICATES THAT SM IS UNDERGOING PEB FOR THE FOLLOWING REFERRED PSYCHIATRIC CONDITIONS: ---- Anxiety Disorder NOS, PTSD VBA 2507 INDICATES THAT SM HAS FILED C&P CLAIM FOR THE FOLLOWING PSYCHIATRIC CONDITIONS: ---- sleep disorder, TBI, Per Ahlta note on 28May2014; Dr: "?The sailor reports that following IA deployment to Baghdad in 2007-2008, he developed symptoms found later to be consistent with a diagnosis of PTSD: nightmares of traumatic events, avoidance of discussing details of trauma except in treatment, avoidance of and discomfort in crowded spaces like large stores this hospital, reduced sense of a positive future, emotional numbing in relationships that led to the break-up of his engagement, increased startle response to loud noises like fireworks, a few fistfights in those first couple of years which was out of character for him, and trouble sleeping (delayed onset, nightmares, thrashing about or acting out while asleep). He began to drink for the first time and rapidly became a very heavy user, reporting that he consumed the equivalent of 18-24 beers daily on at least 6 days per week, beginning in 2008 and continuing through 2012. He had a DUI in 20009 which led to NJP and to a Level 1 SARP referral, but he says that he did not apply himself to that program and did not attempt to cut back until 2012 when his now-wife asked him to. He tapered his usage over several months and now reports that his last drink was in SEP13. As a result of the self-taper he denies any physical withdrawal symptoms but began to have re-emergence of the more distressing emotional/behavioral symptoms, and for that reason brought himself to treatment in Sigonella. To his knowledge neither his alcohol use nor his PTSD symptoms led to any noticeable impairment of work function. If this was true my NMA would have said that, but it doesn’t. Should this worry me? He reports that treatment has been helpful, and that the most important factor in his semi-recovery has been learning better how to communicate what he is thinking and feeling with his wife, with his treaters, and with his peers. He believes that he has made good progress (he declines to try to quantify this) but wants to continue that work. The patient denies any history of suicidal attempts or generally destructive behaviors. However, he admits to a period of cutting on his arms and legs from about the time of alcohol tapering to the time that he began CPT treatment in Germany in SEP13. He also admits to occasional suicidal thoughts of "maybe my wife would be better off without me", but denies any history of intent to die or plan to die. He admits to violence in fistfights as noted above during the 2008-2010 period?." MSE: SM was appropriately dressed and neatly groomed. SM was alert and oriented in all spheres and pleasant, cooperative and polite. Speech was spontaneous with normal rate, rhythm, tone, and volume. The patient's mood was anxious with WNL affect. Significant psychomotor abnormalities at present interview were : rapid gait, hand and leg shaking. Thought process was linear and logical; thoughts were goal-directed. Thought content was unremarkable for obsessions, compulsions or persecutory/grandiose delusions. The patient denied any auditory or visual hallucinations. Memory and cognition were grossly intact, however SM reported mild diffuse memory problems; no neuropsychological testing available in records at the time of current evaluation. SM denied any current or recent homicidal/suicidal ideation. Judgment was deemed good to fair. Insight was fair. Impulse control was fair. Intelligence was estimated to be at least in the average range. SM has disturbed sleep nightly. SM reported that he had a sleep study that indicated he had numerous abnormalities which included frequent awakenings, limb movements and should be referred to a neurologist, but that has not yet occurred. No diagnosis of any other anxiety disorder at the time of current evaluation as SM's symptoms are consistent with PTSD. R/o Substance Use Disorder, in Remission. SM denied any significant problems with Activities of Daily Living (e.g., shopping, self-feeding, bathing) due to mental health issues. I was asked if I could go get myself bread for a sandwich if I absolutely had to. I replied if it was a good day and no one there and I absolutely had to, I would attempt in those conditions. I have not been able to venture out alone, and my spouse has to both get groceries and cook dinner. I explained this to the doc but it has been left out. Another should I worry/get changed. Discussed purpose of the evaluation and limits of confidentiality with SM. SM was given the opportunity to ask questions and indicated understanding of these limits. SM consented to participation in this interview. Medical history and C-file were reviewed with a focus on psychiatric symptoms. Advised that SM can obtain a copy of the report from the VA at their discretion. Reader is referred to body of report where symptoms are delineated. SM is now on active duty and therefore has no "post military" stressors or post military employment history. Note: GAF is no longer applicable when diagnosing under DSM V criteria. Due to template restrictions, the remainder of this form is blank, there is no further information contained. My questions are what should I do in this situation? I feel this DBQ does not properly reflect my treatment and symptoms as I am unable to independently function, have no friends and simply cannot adapt to stressful circumstances.