jaszper

Update Just checked ebennies, it's showing me at a total of 80% now with 70% for ptsd. It's got my effective date weird tho. Does anyone know how they come up with that. Either way the fight is over and I'm glad to be done with it. It's been right at a week since my original email. Just goes to show that the system can work.

Update I just received a call from the RO's office. They were asking me about my employment. I let them know about my situation and they said they will be including a form for IU. They let me know that I got a favorable decision but won't talk numbers until I get my BBE. I'm curious what the rating will be but I'm just grateful that this is hopefully over. Thank you to everyone on this site for all the knowledge and support they I have been given.

So I have been in the claim/appeals process since early 2010. Like a lot of us have had happen, it has been a pretty heartbreaking and maddening experience. So fast forward to 3 a.m. yesterday morning. I'm doing my nightly ritual of can't sleep and end up on this forum. I've been reading about the success people have had with emailing the higher ups in the v.a. system. I decided it's worth a shot but not really expecting anything to happen. So I sent Allison Hickey a short email explaining my situation. In less than 3 hours I received a response from her saying she will look into it. Less than an hour later I get another email from Chris Marshall (Portland VA director) saying he will look into it and call me later that day. Well less than 12 hours from my original email I get a phone call from the director of the Portland office. He thanked me for my service and let me know he understands my frustration with the system. He told me that a DRO will make a decision on my case Monday and I can expect to hear back from him later next week. I'm still in shock that I received a call period, let alone from the director himself. I have been reading about the success everyone has had but honestly never expected anything to come from one simple email. If you are having an issue that you feel warrants it I would highly recommend that you send that simple email.

Thank you both for the kind words of encouragement. Gastone: I was represented by a vso until I moved about 1 1/2 years ago. Since then the only contact I've had with an organization was to file my form 9. My main confusion comes from what caused this new c&p exam. At the time I filed the nod I don't remember filing the police report that seems to be the new evidence. I honestly don't know how long the va has had the report that seems to be what caused the relook. The police report along with a bad c&p (it stated I had ptsd but didn't contain the words at least as likely as not) are what the reviewers stated the reason was for the relook. At least that's how I understand what I'm reading. I can post the c&p again if that would clear up the confusion. So how can I tell if they are treating the police report as new and material? Hopefully it is new and material and will finish this thing off. I did file my form 9 on 07/2014 then I randomly get a call for a new c&p on 09/2014. I'm hoping that this was all caused by them realizing they made a mistake with the first denial but I'm honestly so confused I don't know where to start.

Thanks for the responses. My only concern is that the new set of eyes is going to take so long. I was hoping that since the DRO requested the c&p he would look at it sooner.

I have asked a few questions about my claim already and will try and not repeat myself here. My main question is whether or not a C&P exam brought on by new evidence (which i'm pretty sure they already had) could help speed along my claim. As in they would make a decision soon after the C&P, or is it just another delay tactic. I filed my Form 9 in July and received my new C&P in August. In the C&P report they stated it was brought on by new evidence. I just called the number associated with the DRO on the C&P report and they told me I was waiting on a review by the DRO. So basically Im just asking for a glimmer of hope it could be soon rather than another 3-5 years.

Thanks for the response. I was actually denied my ptsd claim almost 3 1/2 years ago. That's why I thought this was my re eval. But who knows. The lady that did my c&p said I should hear something in 6-8 weeks. So heres hoping. It's annoying that my ebennies says that but not a big deal. It sounds like it's common for it to be messed up.

So I had my ptsd c&p exam on the 24th of August. I'm assuming it was for my PTSD review. I was hoping to hear something by now but no such luck. My question is that all my ebennies shows on my appeal info is "no info". It gives my appeal date be that's it. Had anyone seen this or know of a way to fix it? I've put in an iris but no response to two of them. Thanks in advance for any and all help.

I know the timelines of the va vary. But is it feasible to hear something in the near future. I have a lot of friends that heard something about 6-8 weeks after the final c&p. I'm just wondering if it will be different because this was a review.

The VA does have my new address thankfully. I'm hopeful for this claim but I'm trying not to get to excited. I've been burned by them for the last 4 years so I'm a little jaded. My original claim was put in 55 months ago. Will the back pay go back that far?

I put in a NOD after I got my first denial letter. I don't know when the accident report came into play. I received my latest denial letter which prompted me to file a form 9. Then out of the blue I get a call about a c&p exam. The exam I posted was the results of that. I don't know if a DRO prompted it or not. I recently moved so I lost contact with the VSO I was working with. I'm trying to keep up with all of my letters but it get confusing for me. I will find my latest denial letter and post what they said about my denial in the letter. One of my questions is if I get the rating will it help me to get MH treatment beyond what I'm getting?

3. Stressors ------------ Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: -----------" 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 Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No b. Stressor #2: ---------- 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 Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No c. Stressor #3: ----------- 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? [ ] Yes [X] No 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. Buddy statements by Lorena Castro and Mr. Anderson. Medical records in 2003, that appear to document the assault. 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 #7 - 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 (DSM-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 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 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] 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. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 [X] Stressor #2 [X] Stressor #3 5. 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] Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] 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] Obsessional rituals which interfere with routine activities [X] Impaired impulse control, such as unprovoked irritability with periods of violence [X] Spatial disorientation [X] Grossly inappropriate behavior [X] Persistent danger of hurting self or others [X] Neglect of personal appearance and hygiene [X] Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene [X] Disorientation to time or place 6. Behavioral Observations -------------------------- The veteran has a behavioral flag on his chart, because according to the veteran he had "an episode" when he went to mental health, because "I felt like I was losing it, and they gave me an appointment in October." Apparently his "episode" was that he "became combative and went off" according to the veteran. When I looked into the chart, it became a little more clear as to why he had a behavioral flag--he threatened to bring a gun to this VA, if he was not given treatment. Because of the above event, the veteran was escorted to the appointment by VA police. I met for a moment with the veteran, in our lobby area, to try to gauge whether or not I could see him without the officer, and he agreed to cooperate to get this evaluation done. He did not become hostile, rude, or threatening, and this writer used her therapeutic tools, to know when to ask for more information, and when to back off, and give the veteran a few moments to calm himself, so that we could go on. Veteran is dressed in a sweat shirt, shorts, and tennis shoes. He wears glasses and short hair. His grooming today was adequate, but apparently there are times, when the veteran will not shower for multiple days--sometimes as long as a weeks. The veteran has tattoos all over his body. The veteran stated that he recognized that his tatoos have taken the place, of the cutting and burning he used to do. The veteran is very emotional, began to cry when he told me of his assault; being hit by the car (hit and run), and the gas attack threats in Iraq. He would try to calm himself down, but coping mechanisms were difficult for the veteran to use this day. At one point, he seemed to need a break, thus I suggested he just clear his head for a minute, and he went out and smoked a cigarette, and then came back inside. In this writer's opinion, the veteran had a difficult time during this evaluation, and was under considerable stress. It did not appear to this writer, as if the veteran was embellishing his report of the stressors, nor was he being dramatic. At the end of the interview, I asked him for a self-report of how he was doing, and he was "upset, exhausted, but felt okay to leave." I told him that he could call the "veteran's crisis line" which he had the number memorized. I also offered to take him over to triage, but he stated that he was okay to go home. He had someone picking him up, and said he would be okay. 7. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 8. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any -------------------------------------------------- CLAIMS FILE BEING SENT FOR REVIEW BY THE EXAMINER. VA CLAIMS FOLDER FORWARDED FOR VA EXAMINER REVIEW AND CLARIFICATION. Appeal Related Claim. Issue on appeal: Service connection for post-traumatic stress disorder. Veteran's Information: Name: Background: VA exam report of 10/19/10 diagnosed PTSD in relation to an in-service assault, the occurrence of which has not been conceded by the VA. During that examination the veteran also mentioned being struck by a vehicle in the fall of 2001. He has provided a copy of the accident report from the Richmond County Sheriff's Department which is of record (tabbed in c-file). In his PTSD report of 10/19/10 the VA examiner related veteran's PTSD to the unverified in-service event, but did not provide a medical opinion as to whether any of the veteran's PTSD is or is not "at least as likely as not" (50 percent or greater probability) attributable to the verified in-service hit and run vehicle accident. We are thus seeking clarification. Requested Medical Opinion: (1) VA examiner is asked to review the medical evidence of record (including treatment records from all VA medical facilities as noted in Virtual VA and CAPRI for this veteran) and then to provide a medical opinion as to whether veteran's current diagnosed mental health disability(s), to include PTSD and depression, is "at least as likely as not" (50 percent or greater probability) medically attributable to the in-service vehicle accident on 9/02/01 as noted in the accident report from Richmond County Sheriff's Department versus to other etiological factors. Please provide factual basis and medical rationale supportive of your opinion. (2) If more than one mental health disability is medically identified, please outline whether it is possible to medically separate the symptoms of each identified mental disorder, or whether the symptoms are inextricably intertwined and cannot be separated without resort to mere speculation. (3) Please discuss impact of veteran's mental health diagnoses on veteran's occupational functioning. Pertinent Evidence: Tab A: Veteran's service personnel and service treatment records Tab B: Veteran's statement(s) Tab C: Accident report from Richmond County Sherriff's Department Tab D: PTSD exam report of 10/19/10 Tab E: CAPRI records in Virtual VA Note: VA examiner is not limited in review to the above-mentioned records but is encouraged to review all evidence in the claims folder to make your mental assessment and medical opinion. Thank you. VA exam req; D.Kocarnik, Dec.Rev.Officer, PH: 503-412-4608. ========================================================================== ================ ***THIS EXAM WAS COMPLETED USING DSM-V AS THE BASIS FOR DIAGNOSTIC PURPOSES.*** *** This report was written using voice recognition software, therefore, words may appear that either sound like the real word, or are similar in terms of spelling. __________________________________________________________________________ _________________ -------------------------------------------------------------------------- ---------------- Current Service Connection Status at the time of this evaluation: Lower leg condition-->10% Scars-->0% Clavicle, scapula, impairment of these regions-->10% Limited flexion of the thigh-->10% Limited flexion of the knee-->10% -------------------------------------------------------------------------- ----------------- BRIEF MEDICAL HISTORY: FROM CPRS "Leg hurts on a daily basis,constant reminder of what happened." "Head hurts a lot." Chronic alcoholism in remission. Polysubstance abuse. Olecranon bursitis Tobacco use Knee pain Non-specific reaction on the skin. VITAL SIGNS:98.4, 89, 16, 115/62. Pain=4. Wt is 192.6. Ht=68 inches. MEDICATIONS: Psychotropic medications include: Prazosin Citalopram Abilify -------------------------------------------------------------------------- ----------------- FAMILY HISTORY: Father: He is alive (he does not see him). Mother:Adoptive mother is alive (he does not see her). Brothers:NONE Sisters:Does not see biological sister or adoptive sisters. Children: He has visitation with his children, but feels like he is unable to enjoy the time with them. -------------------------------------------------------------------------- ---------------- STR's in Record: ALL STR'S REVIEWED -------------------------------------------------------------------------- ----------------- NEW INFORMATION PROVIDED BY THIS VETERAN TO INITIATE A SECOND C&P EXAMINATION: Proof of the veteran being hit and run, by a vehicle, during the military. -------------------------------------------------------------------------- ----------------- INFORMED CONSENT: Pursuant to providing the veteran was an informed consent, he was informed that the purpose of the current examination was to obtain information related to his claim for service-connection, for PTSD. In addition, this writer explained to the veteran that this C&P appointment, is not a traditional psychological examination or psychotherapy session, where the content is kept confidential, as my report, will be uploaded into his electronic (CPRS) file, and eventually it will be examined by a rating officer, at VBA, who will make the final decision as to whether or not he has a service-connected disability, and if so, the rating associated with that disability. I also told him, that if he wants a copy of the report, he can go to ROI to obtain one, or it can be downloaded through Myhealthevet, if he is registered and authenticated for this service. I also explained that our meeting today, does not represent a traditional doctor/patient relationship, as I am only seeing him for the examination, and then my contribution, to his case, will be completed. He stated that he understood all of these conditions, and wished to move forward with the examination. I further explained that the information in this report could be subject to public disclosure, if he should appeal his claim at the federal level. Other limitations to confidentiality were discussed with regard to: 1) danger to self/other, 2) and/or information regarding child abuse, and 3) elder abuse. The veteran voiced understanding and acceptance of this information and consented to participate in the examination. -------------------------------------------------------------------------- ----------------- Identifying Information: The veteran is a 30 year old, divorced, Caucasian man, who presented to this writer, for a Compensation and Pension Examination for PTSD. This is not the first C&P exam for this veteran--he had a previous C&P examination, but was denied compensation or pension for PTSD, because the stressors could not be verified. The veteran was on time for his appointment. He was dressed in casual but clean clothing, and his grooming and hygiene was adequate, although he stated that there are days that he does not shower or take care of his basic hygiene. He looked older his stated age of 30. He had dark circles under his eyes, and looked very tired. He said that he has not been sleeping well, but last night was especially bad, as he knew that he would have to talk about his stressors again, and how he has such a backlash, after he talks about them--this is one of the reasons that he wants to get into therapy. When he entered the evaluation room, he sat closest to the door, and was very cooperative. He would stop and listen, if there was noise in the hallway, though I did not see him fully startle, though a certain times this was reported by the veteran to happen. The veteran appeared to be embarrassed about having to arrive by escort from the police. -------------------------------------------------------------------------- ----------------- MENTAL STATUS/EMOTIONAL STATE: The veteran was alert and oriented X4. He could attend to, and concentrate on a task at hand, without difficulty today, although there are times when he must read a paragraph more than once, or he forgets to do something, so that concentration has been an ongoing issue, according to the veteran. He could calculate (when asked questions that required for him to add/subtract in his head), do serial 7's, and he could abstract. abstract. In general, his memory seemed to be intact, for example when I asked him to repeat sentences, numbers (backwards and forwards), or words. However, on delayed recall, the veteran could not recall the words he was asked to remember, and he was not helped by categorical hints. He had an above average vocabulary, and intellectual functioning was estimated in a range of high average, as well. He could name four presidents: Clinton, Reagan, Washington, Jefferson, and Lincoln. His general fund of information was intact, and comparable with someone in his own age group. He could spell the word "WORLD" backwards and forwards without difficulty. He could repeat 7 digits forwards and 4 backwards. He could repeat both simple and complex sentences after this writer said them: "No ifs ands or buts" (simple) and "The beginning movement revealed the composer's intention" (complex). Mr. McClenan had a depressed and anxious mood, and his affect was full in range, and congruent to the topic at hand. He denied suicidal or homicidal ideation today, but does have SI and HI regularly. Insight and judgment appeared within fair. Impulse control today was intact; he was not at immediate risk for self-harm or the harm of others, when he left the C&P clinic on the day of the examination. He was reminded about the Veteran's crisis line; the triage system here at SORCC, and suggested that he get in touch with his PCP and Mr. Hines, LCSW, who he last saw for mental health issues. He said that he has called multiple times, but did not receive a call back, and said that this lack of help, was what caused the problem that led to the "behavioral flag" because he told scheduling, that he was considering suicide by shooting himself, and was considering drinking August 22, 2014), and was only offered an appointment in October. He denied mood swings, mania, or any type of cycling in terms of his mood. He demonstrated psychomotor activity, which was within normal restless and anxious. The veteran's spontaneous speech was clear and coherent, and showed no evidence of thought disorder or psychotic processes. There was no paranoia, no ideas of reference, no delusions, and no hallucinations. There was no evidence of depersonalization, derealization, or dissociations. His thinking and speech appeared linear, goal-oriented, and contained cause and effect/hypothetical relationships. His speech appeared normal in terms of rate, rhythm, and volume, without pressure or severe intensity, until he would talk about the stressors, and then he began loud, tearful, and had difficulty controlling his emotions. As mentioned, at the conclusion of the occupational history, he had to leave for a few minutes, and take a break with a cigarette, so that he could continue on with the evaluation. There was no word blocking, anomia, or evidence of Wernicke's or Broca's aphasia. In addition, he could remember 4:4 words on immediate recall, but 0:4 on delayed recall. His auditory sequencing appeared intact; he could listen and process commands, carrying them out, for example, touching his nose, clapping his hands, and stomping his foot on the ground, when requested to do so. The veteran denied any eating disorders--there is no purging/binging/restricting. He denied symptoms of psychosis. ///////////////////////////// Other Diagnoses in the chart: ///////////////////////////// ///////////////// Bipolar Disorder: ///////////////// In addressing the diagnosis of Bipolar, he stated that he has been aware of this diagnosis, but "cannot agree with the whole manic thing." He said that he "most definitely has depression, but that the most manic I get is having an okay day, instead of a totally shitty day." He stated that sometimes when he drank or used Meth, he might seem manic, or feel euphoric, but there is not a natural tendency to feel happy, and certainly, he is not euphoric, nor are there regular cyclical moods that are up and down. He stated that he "ups" are never as high, as his downs are down. He denied mania, hypomania, and still does not agree with the diagnosis of Bipolar disorder. ////////////////////////// Major Depressive Episode: ///////////////////////// The veteran has been diagnosed under DSM-IV with MDD, secondary to PTSD in his C&P done by Dr. Sashkin 10-27-10. At this time, since DSM-V was not in use yet, MDD secondarily related to PTSD, was often diagnosed separately. Under DSM-V, the depression is often seen as a progression of the PTSD, and is covered under criterion "D" negative emotions and cognitions--thus this writer incorporated the MDD diagnosed in the previous PTSD C&P, into the diagnosis of PTSD. //////////////////// Chemical Dependency: /////////////////// The veteran has been diagnosed with alcohol dependency, Methamphetamine dependency, and polysubstance dependency, in the C-file. The veteran has been clean and sober since 11-10-2007. He attends meetings regularly with his significant other. He has a sponsor (who is also a veteran), and he is working the steps of AA to remain clean and sober. Since he has been clean and sober since 2007, he is not diagnosed formally at this time, as an active disorder(s)--as when using the date of 2007, he would be considered in "full sustained remission" with regard to chemical dependency. //////////////////////// Traumatic Brain Injury: /////////////////////// From what I can determine, the veteran had claimed at one time, to be suffering from TBI, from either the car hitting him, or the attack he suffered in Germany. In the narrative, provided to the veteran on 03-16-2011, he was denied TBI, and this writer does not have any additional information to add to the denial, in such a way as to justify a diagnosis of TBI. This writer is not credentialed to provide a TBI I or II examination, and thus the denial on the above date, for TBI, is upheld by this writer, since an exam for TBI was not completed. In quoting that narrative, "your service treatment records are completely negative for any treatment of complaints or treatment for or diagnosis of any head injury. No medical evidence has been submitted which provides for any sort of etiology of a head injury while in the service." ///////////////////////////////// Borderline Personality Disorder: //////////////////////////////// There is evidence, that the veteran could have a personality disorder, and the cutting and burning of his body, when he was in his teens and early adulthood, and the taking of the pills at military school, certainly lend evidence for a diagnosis of a personality disorder. Personality disorders, especially borderline personality disorder, can be related to early life deprivation, abandonment, and what is referred to as "developmental lesions." The veteran was removed from his biological mother, and was raised by an single father (who was alcoholic), and sometimes hit the veteran (although the veteran stated that he was not assaulted or beaten by his father), and he was later adopted by his father's second wife, with whom the veteran stated that he never really felt connected. Given the early life situation in his family, and his young adult behavior, it is very likely that the veteran has Borderline personality disorder. Daniel Sorensen, NP, mentioned in his 8-22-14 note, that the veteran came to the attention of mental health because he threatened to bring a gun to the VA, if he could not receive treatment. In his note, he stated: "30 year old male with borderline personality disorder, with symptoms partially managed with medications. He saw Mr. Hines, LCSW, on 8-13-14, and at that time was presenting with mania, and pressured speech. He talked about being suspicious of his significant other, and checking her email and phone; it is well known that those afflicted with Borderline personality disorder, due to poor object relations in early life, can be suspicious, believe that their partner is unfaithful, and pathological jealousy is often the result. This can be especially true, if the patient has been left in the early years of life, by a parent or close caretaker--this was the case with the veteran. His evaluation on 10-27-10, by Dr. Shaskin, stated that an Axis II personality disorder was deferred. -------------------------------------------------------------------------- ----------------- Psychological Testing:N/A __________________________________________________________________________ _________________ /////////////////// Referral Question: /////////////////// Does the veteran have PTSD related to the in-service stressor (the MVA), in 9-2-01? ///////////////////// Clinical Formulation: ///////////////////// The veteran was hit by a car in the military, when he was only 17 years old. He has reexperiencing, avoidance, negative cognition and mood, and s/s of hyperarousal. ///////// Opinion: //////// It is at least as likely as not that the veteran's PTSD is related to the event in the service where he was hit by a car. He also described feeling scared that he was going to die in Iraq, from gassing threats, and the fear of chemical weapons. This particular stressor is related to the fear of hostile military and terrorist acts; the car/mva is not related to the fear of hostile military and terrorist acts. THere was a third event, where the veteran was assaulted along with his friend soldier ----------. There are statements by Mr. --------, and a buddy statement by ---------- , corroborating the assault, thus there is PTSD related to this incident as well, but it is related to fellow soldiers assaulting him, and not d/t hostile military or terrorist acts. It is less likely than not, that the veteran's borderline personality disorder is d/t the service, and more likely than not related to his early life experiences; abandonment by his mother, and a family of deprivation, where his early needs were not met adequately. //////////////////////////////////// Occupational and social functioning: The veteran describes being unable to work, and having a very limited social life, that basically consists of his significant other, and one friend. He stated that he does not see his family, nor does he go out and socialize with others. In terms of work, there does appear to be a problem with the veteran having difficulty getting along with others. He has yelled at staff, and customers, and believes that it is just a matter of time, before he "is let go again." He stated that he cannot work around others, and even when he was supposed to be working night shift, so that he could avoid working with others, he was placed on day shirt, and could not get along with others. If the veteran worked in a position where he did not have to interact with others, and had minimal supervision, he could probably continue working. He said that he wants to work, but needs help, that he has not received. He said: "I don't want to take the xxxxxxx pills; I want help--I need treatment. I want to work, and have a good life, but I need help." /////////////////////////////////// DIAGNOSTIC IMPRESSION: 309.81 PTSD related to his service (accident where he was hit by a car; assault by other soldiers, after coming back from Iraq, and the fear of hostile military and terrorist acts (most feared by the veteran was the fear of gassing). //////////////////////////////////////// 301.83 Borderline Personality disorder: not related to his service. /////////////////////////////////////// If you have any questions, or I can clarify anything in the examination, please call me; I am always happy to discuss my findings with you. Thank you

LOCAL TITLE: C&P EXAM STANDARD TITLE: C & P EXAMINATION NOTE DATE OF NOTE: SEP 24, 2014@09:30 ENTRY DATE: SEP 24, 2014@17:06:49 AUTHOR: SCHLIEVERT,KIMBERLY EXP COSIGNER: URGENCY: STATUS: COMPLETED Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [X] Yes [ ] No ICD code: 309.81 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD ICD code: 309.81 Comments, if any: Related to several traumatic events in the service, which are detailed below, in the stressor section. ***The veteran was questioned in detail, about his family life, growing up, because it stated that he had an "abusive family life." The record indicates that the veteran was "hit" as a child. When I questioned him, regarding this, he said he "father hit him a couple of time, and was careful to clarify that it was a "hit 2x I think" and not a beating or an assault. He does not appear to have the s/s of PTSD related to being hit, but does appear to have it, in relation to the events in the service, with being hit by a car; the gas threats in Iraq, and being assaulted in Germany when he got back from Iraq. For this reason, PTSD is diagnosed as service related, and not an aggravation of a condition, beyond the usual course of that disorder, by the service (i.e. because of his early life experiences of being hit). Mental Disorder Diagnosis #2: Borderline line personality disorder ICD code: 301.83 Comments, if any: Secondary to his early family life, that was led by a single alcoholic father, who sometimes hit the veteran, a mother than abandoned the family when the veteran was ages 2-3, and a childhood where he did not feel connected to his adoptive mother, and where there was deprivation. Personality Disorders: Personality disorders are usually related to developmental issues/lesions that occur in early childhood, and are both pervasive and long-standing throughout the life-span. A personality b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Please see the remarks section for a list of the CPRS problem list, and psychotropic medication, if prescribed. 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: PTSD: Re-experiencing; flashbacks; nightmares; intrusive thoughts; avoidance; physiological correlates (increased heart rate, diaphoresis, rapid breathing). Negative mood, affect, and cognitions; and s/s of hyperarousal, sleep disturbance, and guardedness. ------------------------------------------------ Borderline personality disorder: Personality Disorders: Personality disorders are usually related to developmental issues/lesions that occur in early childhood, and are both pervasive and long-standing throughout the life-span. A personality Veteran has s/s of emotional dysregulation. He has a hx of suicide gestures, cutting and burning. Hx of substance abuse. Hx of spending haphazardly. Jealousy, fear of being abandoned. Threatening to hurt others. Feelings of emptiness. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [X] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment 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? [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: It should be stated that this percentage is only an estimate, as I have not observed the veteran at work or in his social life, and therefore this is not an empirically driven statistic, but an attempt to quantify his disorders. PTSD=70% Borderline personality disorder=30% 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? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [X] Yes [ ] No If yes, describe: There was a buddy statement by ----------, that was brief, but stated that she remembers the veteran having a broken leg after he was attacked in Germany, when they were both stationed in the barracks. Also there was a buddy statement that talked about the assault on the veteran in Germany, after just returning from Iraq (in August 2003). He details the same information that was provided by the veteran, in discussing this stressor. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): FAMILY-OF-ORIGIN: LIST THE DIFFERENT FAMILY MEMBERS THAT WERE LIVING IN YOUR FAMILY HOME, AND WHAT CHILDHOOD WAS LIKE FOR YOU: The records indicates that the veteran grew up in a difficult family; his father was alcoholic, and the veteran often took care of him, when he was intoxicated. Also according to the record, the veteran's mother abandoned the family, when he was ages 2-3. The notes indicated that there is an older sister (approximately two years older), as well as step-sisters, and the veteran said they had typical sibling rivalry. The veteran was "removed from his birth mother" (10-29-13 Clinical Interview). He had an adoptive mother, that married his biological father, but he does not feel close to them. "I lost every relationship with everyone in the past year." When questions about his family life, the veteran described being raised by a single father (until he married the veteran's adoptive mother), who was alcoholic, an whom he had to sometimes care for, when he [the dad], was drunk. He had grandparents who he saw until he was aged 10-11. "I did not want for anything." The veteran indicated that there was some emotional abuse. He said that for the most part he was not fearful of his dad, nor did he worry about being in danger. He said that he was just aware, that when his dad drank, he had to "behave in a certain way." When asked for more information, he just tried to care for his dad, without upsetting him. The biological mother, was "out of pic by the time the veteran was ages 2-3. "My parents got divorced." He did not have visitation with his mother; "she did not come back into my life, until later on, and only for a short period of time." As a child, he said that he talked to her once, and saw her once (ages 2-12). At 23, he saw her again. INTACT, BROKEN, OR BLENDED FAMILY?Broken WHAT DID YOUR FATHER DO FOR WORK? "He did not do much; he ran a pro-shop and driving range "for awhile." The veteran stated that his grandfather was wealthy, and left his father property, that he sold, and they were able to get by. WHAT DID YOUR MOTHER DO FOR WORK?IDK. TERATOGENS IN UTERO: Does not know if he was exposed to any teratogens during the prenatal period. PREGNANCY AND BIRTH:"IDK if it was normal or complicated. HOW WAS DISCIPLINE HANDLED IN YOUR FAMILY? The records indicated "he was hit as a kid," and the veteran verified this, but it happened two times, and was not a regular occurrence. The veteran was in sort of a role reversal with the dad, in that he would sometimes care for him, rather than the father caring for the children. RELATIONSHIPS WITH FAMILY NOW? Stated that he is not seeing any of his biological/childhood family. ANY HX OF ABUSE (PHYSICAL, EMOTIONAL/MENTAL, SEXUAL, NEGLECT)? ***The records indicated "he was hit as a kid." As per above, "dad would get drunk and hit me a couple of times; it was not an assault, nor was it a beating." 10-29-13 Clinical Interview: He had an "abusive childhood" and made his first suicide attempt at 14 y.o.a.. The veteran stated that this was not an actual suicide attempt; he was being somewhat reckless and took a bunch of pills (someone else's, and drank cough medicine). RELATIONSHIPS AS A YOUTH? "I had a decent amount of friends--I was fairly popular. I would "hang out at other friend's houses, rather than having them come to my house." He described himself as "outgoing." RELATIONSHIPS IN THE MILITARY? In the early phase of his military career, he had good friends (i.e. as close as you can have in basic and AIT). "My relationships did not get strained until right after we got back--it got weird. I was drinking a lot." During the military, socializing was okay up to a point--after I hit by car, and then when I came back from Iraq--there was a definite downslide, in terms of friendships." RELATIONSHIPS AFTER THE MILITARY? "Married and divorced once, because his wife "was a civilian and normal; she refused to see my issues as anything but weakness. I wanted to go to American Lake, for treatment, and she said "no you don't need it. We divorced over it." "It [the divorce] made me sad because of my kids-I wanted them to grow up in a fully parented family, instead of broken family. As time goes by, I think it is a good thing (that he is not there, but misses his children). Two are his biological kids, and one other child, he has been in her life "since she was a year old." He stated that the first thing his ex did, was tell her daughter that the veteran wasn't her father, and she [the child] was devastated. CURRENT LIVING SITUATION? Lives with a s/o. The relationship is "okay. We have set routines, that we have to do to function as a couple." Their routines have to do with AA, counseling, medication [he is medicated, she is not]. His significant other "suffers from PTSD." He said that they have the benefit of understanding that they have PTSD and they "understand what it takes for them to function normally. We have broken up 4-5 times in the last year." "Our relationship now, has somewhat stabilized. It is strained but it works." ***The veteran eluded to his significant other having a C&P, but there was no bilateral discussion between the veteran and I, of anything having to do with his significant other, other than what he told this writer, about their relationship, in terms of functionality. The veteran referred to her as his "significant other." b. Relevant Occupational and Educational history (pre-military, military, and post-military): EDUCATION AND WORK HISTORY: DEVELOPMENTAL MILESTONES:"I have no idea." ANY DOCUMENTED LEARNING DISABILITIES:"I was a smart as--denied learning disabilities. SCHOOL YEARS: "I did not start getting into trouble until the 7th and 8th grades. At that time, I was being disruptive." He described his school performance as: "fairly successful--extremely smart; I could do work if I wanted to." High School was at a military academy--"where I thrived until I xxxxxx off." When asked if anything in particular occurred to disenchant him with this school, but he said: "I cannot think of what started this for me." He stated that he "took a bunch of pills and cough syrup." Does not believe he was actively suicidal, nor does he consider this to be an actual attempt. "Math scared the shit out of me. I liked the science and history--both made sense. With regard to "Abstract thinking," he stated: "I was good at it, but I did not like it, so he tried not to do it." Has always had the ability to do well if he wanted. He stated: "I have a 10th grade education." DETENTION/SUSPENSIONS/EXPULSIONS FROM SCHOOL? Yes. First time was when he was asked to leave military school for excess demerits. The second time was d/t the event, where he took the different pills, as "they frowned on that." Cutting and burning his skin--that was later in life--in my late teens and early 20's. "It was attention grabbing and it also was relieving," in terms of stress. He has tried to engage in "a lot of introspection--trying to figure myself out, for a several years now--and that is what is real about it." He stated that he realized at some point, that he has gone from cutting/burning his skin to tatoos. "Tatoos are the same thing (the pt said), but they allow me to get the stress out, without cutting or burning." He has not engaged in self-injurious behavior since his mid-20's. TRADE SCHOOLS: NONE COLLEGE: None that was successful. I have tried 4 times. I had panicked, the frist time he tried to go (pulse increases, diaphoretic palms, and rapid breathing, and dizziness). He felt if he went to school, something bad would occur. Tried to go to college through vocational rehab--online, but he stated that his PTSD was interfering, with him trying to learn things on the computer. He stated that they "wanted him to have all these specific things in place, for him to continue school--VA counseling (individual and/or group), and medication. He began to cry, and said: "I honestly don't know if I could do it, even with those things in place, but in any case, they weren't in place." The veteran stated that he has a behavioral flag because of going in and being desperate to get help from mental health, and then the scheduler only could give him an appointment in October. He said: "That is why I lost it--I am a head case [how he refers to his PTSD], and now I have to have my little shadow (his police escort)." EMPLOYMENT: "I have tried to get a few different jobs. They did not work out because I get combative with staff and customers. I would either freak out and not go to work. Or if I did go to work, something would happen, and the day would get ruined to the point that he could not stay, without blowing up on staff or a customer." This happened often, and eventually he and his ex, agreed it would be best for him to be a stay at home dad." Since coming to White City, he "started to work, and had to quit one job." He works currently and "can get combative, or I forget things." He stated further: "I was supposed to be on night shift, and that was perfect--so that he did not have to be around others." He stated that he was seriously assaulted, in the military, and therefore, "cannot be around males, especially alpha males." "I almost had to quit yesterday," after he "almost got physical with one of the clients. I xxxxxxx wanted to kill him. Who knows how long this will last--maybe another two xxxxxxx weeks. 4-6 months is usually my limit, when everything starts to fall all apart." "I work the "on track dad's program. I have almost 7 years of sobriety. I think it is a good time, unless I get furious, but then he needs to not be there. He talked about the level of irritability he has, and how: "I can go from thinking I want to kill him, to planning it, and then wanting to do it." I questioned the veteran very throroughly, to make sure that there wasn't an intended victim, or an absolute plan of action, to hurt someone. Instead, he just tries to monitor himself, and if he gets bad [i.e. wanting to get into a verbal or physical altercation], he must removed himself from the situation. He is sure that this will happen in the future, where he becomes angry and has to remove himself from the situation. "Sometimes it doesn't take much, if someone looks weird at me, I feel like I want to go after him." "If I could get some treatment, to xxxxxxx make this go away--I would. I don't want to feel like that! I tried to get help, and they give me a date a month out, and now I have my little shadow to deal with [the escort officer], whenever I need to come here. WHAT DO YOU DO FOR SELF-CARE/FUN/HOBBIES CURRENTLY? "NONE." c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): ======================================================================= ==================== Any psychiatric evaluations, treatment, or psychotropic medications BEFORE the military? CD?Denied. Outpatient? (Note from 10-29-13 Clinical Interview): He had an "abusive childhood" and made his first suicide attempt at 14 y.o.a. (1999 in military school). With regard to this event, he stated that he was not suicidal, but instead, just took a bunch of pills, and cough medicine--I was not trying to kill myself, but my school still did not appreciate it." He was found by staff at the military school. Medications?Denied. Inpatient?Denied. ***He also engaged in "self-injury" when he was a teen, and indicated the last time he did this was in his 20's (10-29-13 Clinical Interview). ======================================================================= ==================== Any psychiatric evaluations, treatment, or psychotropic medications DURING the military? CD? ADAPT C (for alcoholism)--"I checked myself in." Outpatient? Denied Medications?Denied Inpatient?Denied Any suicide attempts?Denied ======================================================================= ==================== Any psychiatric evaluations, treatment, or psychotropic medications AFTER the military? CD? Here at WCO, although he was sober at the time, and was here more for PTSD tx and homelessness, not for SATP. Outpatient? He stated that he has asked for treatment multiple times: "The damn doctors--it is so stupid. The only thing they did when I had episode, was what they always do--they threw more pills at me. I want treatment. I want to talk about what happened. Presently taking Celexa; Lamotrogine, and Abilify." Medications? See above. Inpatient?Denied psychiatric hospitalization. Suicidal Attempts?Denied. Current SI/HI?Denied right now. He "thinks about it often, but stated: There is a difference between having an idea about it, and having an intention to do it." He does not want to get to this point, but feels like he could. ***NOTE:VETERAN HAS A DISRUPTIVE BEHAVIOR FLAG*** 5-11-04: Veteran was evaluated, and said that he "was afraid of everything." During this examination it was mentioned that the veteran had some type of hx that included OCD, and feeling paranoid. 4-2008 (Per pt report), the veteran stated that he had suicidal ideation with a plan. 10-20-08 "Came to get off medications." 9-17-13 TBI--has not been dx with it. Has a hx of anxiety, OCD, and depression. Audit C was negative for alcohol use. 9-19-13 Spiritual Assessment: Assembly of God as a youth, but the veteran indicated that the church made him feel bad about himself. Has attended Catholic, Protestant, and Buddhist places of worship. He has an adoptive mother and a father (biological?) that are supportive of him (at this point they are no longer talking-->9-24-14). "Feels God gives him anxiety when he is making a bad decision. Does not believe that he is punished by God." 9-13-13: "He is a candidate for DCHV, but all the beds are full at this time." The veteran admitted to anxiety; sleep disturbance, but there is no paranoia; depression; no SI; no hallucinations, and he was alert and oriented. 9-25-13: PTSD scrEen positive (SCORE OF 4), Anhedonia and depression--yes, nearly every day. History by veteran report includes: bipolar disorder; MDD: PTSD and Borderline p.d.o. Denies psychiatric hospitalization(s). There is a history of fights, as a civilian (10-15), and in the military. Fight were often while he was intoxicated. In the record it indicated that the veteran denied that this had happened since 2007 (when he became clean and sober). Has organized thoughts, without unusual content. No AH or VH. No delusions. I&J fair. He was divorced by his spouse, and although it saddens him, he "knows it is for the best." The veteran stated: "I am a determined and hard worker." Memory was found to be intact. Seeking psychiatric care for PTSD and homelessness. Talked about discharging to Waldport, where his children live. 11-9-13 Dx with PTSD, chronic by Sylvia Green. Also Alcohol and stimulant abuse (both in late full remission). He was not dx on Axis II (characterological disorder). 2-19-14 Suicide screen negative, except for the question having to due with "previous suicide attempt(s), which he answered as yes. 2-20-14 Regular discharge from the SATP program. 8-13-14: "Actively suicidal, was going to put a pistol in his mouth last night." d. Relevant Legal and Behavioral history (pre-military, military, and post-military): ANY LEGAL HX? CHILDHOOD? Ended up using drugs one time, brought home by PD. Does not remember charges. ADULTHOOD? "Yes, but always alcohol related." There were assaults--some reported and some not--Disorderly conduct; Drunk in public. "Just me acting out. Any time I drink I get violent." MILITARY LEGAL HX? Picked up a few times-alcohol related. MISDEMEANOR OFFENSES: FELONIES: DUI'S:One 2006. DOMESTIC VIOLENCE: JAIL TIME: PRISON TIME: STATE HOSPITAL TIME?: CHARGES EXPUNGED FROM RECORD? e. Relevant Substance abuse history (pre-military, military, and post-military): SUBSTANCE ABUSE HISTORY: CLEAN AND SOBER DATE:11-10-2007 HOW MANY CD PROGRAMS AND WHERE?In ADAPT C in the Army. Tx in 2007 and 2008 outpatient. He also took "Living environment training." He goes to AA meetings, has a sponsor who is also a veteran and is working the steps. He has seen him go to the mmeting, but be unable to stay. He walks in and it is a feeling, or someone looking at him, and the only place it is a safe haven. I think about drinking latels, and I did not used to do this for a long time. This is why he was adament about getting help. ON bare edge sometomes. I can barely function. WHEN DID THE VETERAN BEGIN USING TOBACCO? WHAT IS HIS/HER USE OF TOBACCO NOW? 1 ppd. Quit for 13 months. "I was crazy to start again." WHEN DID THE VETERAN BEGIN USING ALCOHOL? WHAT IS HIS/HER USE OF ALCOHOL NOW? "Enough to put me into liver failure." 30 pk beer, and depending on upwards of a pint as well. 11-10-2007. WHEN DID THE VETERAN BEGIN USING CANNABIS? WHAT IS USE OF CANNABIS NOW? DOES THE VETERAN HAVE A MEDICAL CANNABIS CARD? NO WHEN DID THE VETERAN BEGIN USING STIMULANTS? WHAT IS HIS/HER USE OF STIMULANTS NOW? 11-10-. "I liked Meth, but it was not my thing--I like drinking much more." OTHER ILLICIT DRUG USE: WHEN DID THE VETERAN BEGIN USING OPIATES? WHAT IS THE VETERAN'S USE OF OPIATES NOW? (THIS CAN BE EITHER RX MEDICATION OR USE OF ILLICIT OPIATES): MISCELLANEOUS INFORMATION ABOUT CHEMICAL DEPENDENCY: Alcohol Use Disorders Identification Test Consumption (AUDC) Date Given: 06/06/2014/Gender: Male-Score: 0 points, which is a negative result. 1. How often did you have a drink containing alcohol in the past year? Never 2. How many drinks containing alcohol did you have on a typical day when you were drinking in the past year? Not asked (patient reports no drinking in past year) 3. How often did you have six or more drinks on one occasion in the past year? Not asked (patient reports no drinking in past year) f. Other, if any: Previous PTSD examination performed by Dr. Sashkin,Ph.D. 10-27-10 The veteran was diagnosed with PTSD by this clinician. AXIS I: PTSD ACIS I: Depressive disorder secondary to the PTSD. AXIS II: Deferred. AXIS III: PLease see medical file. AXIS IV: Psychosocial stressor--scoial AXIS V: 45

I tried to post my c&p exam but apparently my post was to long. Is there a specific part I can post to help with my questions?

I have a paper copy of the notes but I don't know how to get a digital copy. Any advice?