sapper6

Team: I had filed my claim early May 2014 and just got my VA letter. I have had some massive struggles at work and home but I do work part-time, this is in my records. The part-time work keeps me sane and from shooting myself!. And yet, after my C&P, the VA just granted me 100% for PTSD, 30% for nephrolithiasis (kidney stones - this has really sucked), and 20% for hypertension (not controlled by meds). However, the award letter states the following: You are not considered to be permanently disabled due to your service-connected disabilityes at this time because you are scheduled for a future reduction in rating on: Oct 01, 2019. I am unsure how to interpret this, I am really hoping that I can get my life back and be able to get my earnings back to my pre-service days. Does this mean that I will get 100% PTSD until Oct 01, 2019 ? Or would they look at this before and I have to go through the painful C&P process again ? What if I decide to move to someplace cheaper like Mexico and don't get the VA exam notification on time? I know they can reevaluate anytime but how realistic is it before 2019 ? All 3 of the conditions have the same language. How should I approach this ? I am afraid to even touch this money out of fear the government will ask for it back, etc. Thank you in advance for all your help. V/r, Sapper6

I wish I could, my wife is sick and we need the insurance. So I have to do whatever it takes to keep family together though it is consuming me from the inside. I sleep 2-3 hours a night, I have been through several PTSD programs and sleep therapy, only marginal improvement. Thanks for all your help guys, I will let you know if/when I hear back on the claim.

Thank you for your insights, I am glad you have all this experience here to count on. I just want my life back, I am really shamed to be so broken when I was the first one to the fight every single time. I really don't want P&T or 100%, I just want access to care so I can have my life back. I had a much better life before this, P&T could not come close to my civilian compensation, I just want to go back to where I was and it seems like a mirage right now.

I am unfortunately working only half-time and they are really trying to push me out. Unsure how long the job will last. I am struggling every day and I show up at work about 4 hours before anyone else shows up since I cannot sleep at night and I get to avoid people and stressors. Sadly, If this is how rest of my life is going to shape up, I would rather die.

Please take a look at this, everything I do has been tainted by PTSD. I really hope it gets better, everything is so dark and hopeless. I have tried counseling, meds, etc. nothing seems to take it away. I have never filed for anything including unemployment and am embarrassed to do this but I have no safety net and I seem to be failing and flailing at life. I hope I get some kind of SC so I can continue to get medical care. I appreciate your time in taking a look at this and sharing your opinion on it. Thank you. ========================================================================= Date/Time: 22 Sep 2014 @ 0900 Note Title: C&P EXAMINATION Location: DALLAS TX, VAMC Signed By: MCMANUS,John Scott Co-signed By: MCMANUS,John Scott Date/Time Signed: 22 Sep 2014 @ 0949 ------------------------------------------------------------------------- LOCAL TITLE: C&P EXAMINATION STANDARD TITLE: C & P EXAMINATION NOTE DATE OF NOTE: SEP 22, 2014@09:00 ENTRY DATE: SEP 22, 2014@09:49:34 AUTHOR: MCMANUS,CHRISTOPHER EXP COSIGNER: URGENCY: STATUS: COMPLETED Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: John Joe Doe 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 due to Military Service ICD code: 309.81 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [X] No 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] Total occupational and social impairment 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 c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence review ------------------ In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: ------------------------- Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes [ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [ ] Yes [X] No If 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 [X] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [ ] Yes [X] No 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): Married 22 years with two children; wife with schizophrenia. Impaired relationship given his avoidance, isolation, and emotional lability. Reports preference for isolation along with marked hypervigilance and suspiciousness of others' motives given his war experiences. b. Relevant Occupational and Educational history (pre-military, military, and post-military): Master's degree in computer science; was in PhD program for electrical engineering. Thirty year career in technology field; currently only able to work half-time for XXXX Corporation, a Exxon vendor, responsible for selling technology to Exxon. Marked occupational impairment given frequent emotional and physiological reactions to trauma reminders and distrust and suspiciousness of others at work; reports feeling ostracized and labeled as "a crazy vet," prompting his superiors to interview others to replace him and push him out. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The Veteran denies symptoms prior to service. Reports seeking help for symptoms in service at Camp XXXX at his superior's suggestion; however, states that the major in Texas National Guard at the help center felt that "you all are just trying to get a handout" and needed to "suck it up" and therefore allegedly turned them away. Currently, compliant with VHSO MHC individual therapy and medication management (Sertraline and Divaloprex); has also completed 12 week CPT class and is going to a sleep group. 9/17/14 IT note reported he had presented for an emergency visit due to his perception that his son was a potential threat and resulting assault; he came to his senses and knew he needed to see someone about the incident. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): N/A e. Relevant Substance abuse history (pre-military, military, and post-military): N/A f. Other, if any: DD 214 indicates receipt of CAB and having served in imminent danger area. 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: In July 2010, the Veteran's unit was clearing numerous IED's and he witnessed aftermath consisting of severe carnage of dead bodies and burning vehicles. Sobbing as he recounts feeling that he had "failed people" and his getting to the scene too late had cost people their lives. 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: In May 2013, the Veteran was driving into XXXX to meet military officials when suicide bombers struck them killing 14 people, some of whom were officials he was going to meet. 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: In April 2013, engaged in two small arms firefights within a week; subsequently awarded CAB. 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 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 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] 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] 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] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks [X] Flattened affect [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] Inability to establish and maintain effective relationships [X] Suicidal ideation 6. Behavioral Observations -------------------------- The Veteran presents appropriately dressed with good grooming and hygiene. Cooperative and polite, yet markedly emotional and labile when discussing military stressors; had to compose himself numerous times. Visibly anxious at being here. 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: Feelings of worthlessness and inadequacy. Addendum to suicidal ideation: reports persistent thoughts of a passive nature without intent; states that he has informed his MHC therapist about these thoughts. 8. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any -------------------------------------------------- There appears to be a nexus between the Veteran's PTSD and identified markers, given absence of symptoms prior to service and development of symptoms post service. Thus, PTSD is more than likely as not the result of or caused by military service. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. /es/ John Scott MCMANUS, PhD PSYCHOLOGIST Signed: 09/22/2014 09:49 -------------------------------------------------------------------------