gohan4202

ok got the results in today my precentage stayed at 70 and when i looked at what evidence was considered they left out all my social security stuff for depression and anxity i dont have ptsd on ssd but when the va included mdd as secondary i believe they should have considered the social security award. any thoughts on this

3. PTSD Diagnostic Criteria 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). 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 #5 - other symptoms. Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in one or more of the following ways: _X_ Directly experiencing the traumatic event(s) __ Witnessing, in person, the traumatic event(s) as they occurred to others __ 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 effect of the dream are related to the traumatic event(s). __ 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). __ Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). __ 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: __ 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. __ 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. __ 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 H: _X_ The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: The veteran denied current SI/HI. He admits to a history of vague SI without any plan or intent to act. The veteran reported he would not harm himself. He notes that he has reduced his risk by disabling the firing mechanisms on guns in his home, and reports only his spouse has access to a firearm. The veteran does have ongoing risk factors such as ongoing mental health problems, a history of military deployment, and some occasional feelings of losing hope etc. He does however report a desire to keep working to improve things, and states he has a good rapport with his provider --------. The veteran also denied any prior suicidal attempts, and stated no current desire to harm self or others. He is future oriented, speaking about intent to continue psychotherapy. He has been hospitalized once when he was in the military, though the veteran stated that he did not know the context of this. The veteran is help seeking and has some hope for improvement. The veteran was provided with the veteran's crisis hotline and advised to call 911 or go to the ER for any medical or mental health emergencies. He agreed to do so should the need arise. The veteran is considered sustainable as an outpatient at this time. _X_ Depressed mood _X_ Anxiety _X_ Suspiciousness __ Panic attacks that occur weekly or less often __ 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 __ Mild memory loss, such as forgetting names, directions or recent events __ Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks __ Memory loss for names of close relatives, own occupation, or own name _X_ Flattened affect __ Circumstantial, circumlocutory or stereotyped speech __ Speech intermittently illogical, obscure, or irrelevant __ Difficulty in understanding complex commands __ Impaired judgment __ Impaired abstract thinking __ Gross impairment in thought processes or communication _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 work-like setting _X_ Inability to establish and maintain effective relationships __ Suicidal ideation __ Obsessional rituals which interfere with routine activities _X_ Impaired impulse control, such as unprovoked irritability with periods of violence __ Spatial disorientation __ Persistent delusions or hallucinations __ Grossly inappropriate behavior __ Persistent danger of hurting self or others _X_ Neglect of personal appearance and hygiene __ Intermittent inability to perform ADLs, including maintaining minimal personal hygiene __ Disorientation to time or place Behavioral Observations: MOOD: "pretty rattley" (meaning anxious) AFFECT: flat ORIENTATION: fully oriented APPEARANCE: disheveled, wearing wrinkled white t-shirt and pants BEHAVIOR: cooperative THOUGHT PROCESSES: coherent THOUGHT CONTENT: logical and goal-directed DELUSIONS/HALLUCINATIONS: none elicited 5. Other symptoms Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No If yes, describe: 7. Competency Is the Veteran capable of managing his or her financial affairs? _X_ Yes __ No If no, explain: __________________________ 8. Remarks, if any: This evaluation was scheduled because the veteran filed a claim for an increase in his service connection for Posttraumatic Stress Disorder. Evidence considered for today's evaluation includes review of vet's VBMS record, review of vet's electronic VA medical record, and vet's self-report during today's clinical interview. Based on this information vet currently meets DSM-5 criteria for diagnoses of (1) PTSD, (2) Major Depressive Disorder, and (3) Unspecified Personality Disorder As noted above, with regard to PTSD symptoms, the veteran reports that he regularly has intrusive thoughts about his traumatic event, and this tends to be accompanied by distress related to guilty cognitions about his role in that event. He has nightmares about combat themes a few nights per week, and struggles to go back to sleep after waking. He tends to avoid talking about his experiences in Iraq, and avoids most activities particularly those which would require him to leave the home. He notes that he experiences strong anxiety coupled with lability when encountering others and while driving, thus chooses to avoid most things altogether. He experiences persistent negative thoughts about himself and others, and has few personal relationships as he typically feels the need to avoid being around other people. Irritability is notable, and it is the opinion of this examiner that a portion of his irritability is related to PTSD, but that the level of his irritability/lability/interpersonal problems is strongly contributed to by his diagnosed personality disorder. The veteran notes that he feels consistently on guard when out of the home, and often loses out on sleep because he hears noises that he feels the need to check on, or he feels the need to check door or window locks. He has also noted ongoing problems with concentration where his mind tends to wander sometimes in the midst of a conversation. Additionally, it was noted that the veteran was noticeably startled during the exam when something was dropped loudly in the hallway outside the exam room, and he noted that he tends to react strongly to startling noises. Outside of his experience of nightmares, the veteran experiences chronic problems with sleep onset and maintenance. The veteran's symptoms of Major Depressive Disorder include low energy, lack of interest in activities, sleeping problems, decreased appetite, psychomotor retardation, feelings of worthlessness, and problems with concentration. The veteran reports that he has consistently felt this way for several years. He notes that in addition to the anxiety noted above, he has low energy on account of poor sleep and his judgment of his own abilities as being of low value. He reports that he tends to feel that due to his limits in going out of the home with his spouse (due to anxiety issues noted above), this makes him worthless and feels more depressed as a result. His low energy and his feelings of worthlessness further compound his lack of interest in activities, and can contribute to additional negative cognitions which impact his sleep. With regard to the diagnosis of Unspecified Personality Disorder, the veteran continues to have problems regulating his emotions, as was noted during his last examination. Although some emotional regulation issues are commonly associated with PTSD, the problems detailed by the veteran would be considered more significant than is typically seen with PTSD alone. In particular he notes affective instability and lability, problems with angry outbursts towards others which commonly result in him destroying property, difficulty regulating his emotions effectively, and pervasive negative perceptions about himself and others above which would be accounted for by PTSD and depression alone. As noted above, the various symptoms of these conditions combine to produce a significant level of impairment in the veteran's functional abilities.

i am rated 70% for ptsd and just had a candp for increase it reads ptsd to include mdd. i have social security for depression and anxity will that be considered since they are trying for increase because when i filed for tdiu it was denied two times even tho they said they condsidered my social security award. now with that said when i filed for the tdiu all they looked at was the ptsd and not the mdd. denile was because i couldnt give proof i couldnt work. i guess my question is, since the candp for ptsd to include mdd, will my social securty award hold any more weight then it did the first time. and what could happen from this point

reasforden.pdf

the ssdi is not soley for ptsd but for depression and anxity. also i was granted ssdi while still in a transition unit within the army dunno how but it was possible. i did file a nod and was denied a second time so iv since then enlisted the help of a lawyer.

Yeah I know what you mean i was on ssdi before I ever left the army they rated me for depression and anxiety wich are secondary to my ptsd. Haven't worked in 5 yrs and had my teachers tell me to drop college classes because of always galling asleep due to med and then the anger caused a lot of problems I hardly ever leave home due to a phobia of driving. They said I didn't show proof I couldn't work but how can I have proof if im not working and on social security lol. Whole thing just blows my mind

also im on ssdi for depression and anaxity any thoughts on this if i can get iu. was denied last year for it (RECENT EXAM) As noted above, with regard to PTSD symptoms, the veteran reports that he regularly has intrusive thoughts about his traumatic event, and this tends to be accompanied by distress related to guilty cognitions about his role in that event. He has nightmares about combat themes a few nights per week, and struggles to go back to sleep after waking. He tends to avoid talking about his experiences in Iraq, and avoids most activities particularly those which would require him to leave the home. He notes that he experiences strong anxiety coupled with lability when encountering others and while driving, thus chooses to avoid most things altogether. He experiences persistent negative thoughts about himself and others, and has few personal relationships as he typically feels the need to avoid being around other people. Irritability is notable, and it is the opinion of this examiner that a portion of his irritability is related to PTSD, but that the level of his irritability/lability/interpersonal problems is strongly contributed to by his diagnosed personality disorder. The veteran notes that he feels consistently on guard when out of the home, and often loses out on sleep because he hears noises that he feels the need to check on, or he feels the need to check door or window locks. He has also noted ongoing problems with concentration where his mind tends to wander sometimes in the midst of a conversation. Additionally, it was noted that the veteran was noticeably startled during the exam when something was dropped loudly in the hallway outside the exam room, and he noted that he tends to react strongly to startling noises. Outside of his experience of nightmares, the veteran experiences chronic problems with sleep onset and maintenance. The veteran's symptoms of Major Depressive Disorder include low energy, lack of interest in activities, sleeping problems, decreased appetite, psychomotor retardation, feelings of worthlessness, and problems with concentration. The veteran reports that he has consistently felt this way for several years. He notes that in addition to the anxiety noted above, he has low energy on account of poor sleep and his judgment of his own abilities as being of low value. He reports that he tends to feel that due to his limits in going out of the home with his spouse (due to anxiety issues noted above), this makes him worthless and feels more depressed as a result. His low energy and his feelings of worthlessness further compound his lack of interest in activities, and can contribute to additional negative cognitions which impact his sleep. With regard to the diagnosis of Unspecified Personality Disorder, the veteran continues to have problems regulating his emotions, as was noted during his last examination. Although some emotional regulation issues are commonly associated with PTSD, the problems detailed by the veteran would be considered more significant than is typically seen with PTSD alone. In particular he notes affective instability and lability, problems with angry outbursts towards others which commonly result in him destroying property, difficulty regulating his emotions effectively, and pervasive negative perceptions about himself and others above which would be accounted for by PTSD and depression alone. As noted above, the various symptoms of these conditions combine to produce a significant level of impairment in the veteran's functional abilities. 3. PTSD Diagnostic Criteria 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). 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 #5 - other symptoms. Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in one or more of the following ways: _X_ Directly experiencing the traumatic event(s) __ Witnessing, in person, the traumatic event(s) as they occurred to others __ 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 effect of the dream are related to the traumatic event(s). __ 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). __ Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). __ 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: __ 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. __ 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. __ 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 H: _X_ The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: The veteran denied current SI/HI. He admits to a history of vague SI without any plan or intent to act. The veteran reported he would not harm himself. He notes that he has reduced his risk by disabling the firing mechanisms on guns in his home, and reports only his spouse has access to a firearm. The veteran does have ongoing risk factors such as ongoing mental health problems, a history of military deployment, and some occasional feelings of losing hope etc. He does however report a desire to keep working to improve things, and states he has a good rapport with his provider --------. The veteran also denied any prior suicidal attempts, and stated no current desire to harm self or others. He is future oriented, speaking about intent to continue psychotherapy. He has been hospitalized once when he was in the military, though the veteran stated that he did not know the context of this. The veteran is help seeking and has some hope for improvement. The veteran was provided with the veteran's crisis hotline and advised to call 911 or go to the ER for any medical or mental health emergencies. He agreed to do so should the need arise. The veteran is considered sustainable as an outpatient at this time. _X_ Depressed mood _X_ Anxiety _X_ Suspiciousness __ Panic attacks that occur weekly or less often __ 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 __ Mild memory loss, such as forgetting names, directions or recent events __ Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks __ Memory loss for names of close relatives, own occupation, or own name _X_ Flattened affect __ Circumstantial, circumlocutory or stereotyped speech __ Speech intermittently illogical, obscure, or irrelevant __ Difficulty in understanding complex commands __ Impaired judgment __ Impaired abstract thinking __ Gross impairment in thought processes or communication _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 work-like setting _X_ Inability to establish and maintain effective relationships __ Suicidal ideation __ Obsessional rituals which interfere with routine activities _X_ Impaired impulse control, such as unprovoked irritability with periods of violence __ Spatial disorientation __ Persistent delusions or hallucinations __ Grossly inappropriate behavior __ Persistent danger of hurting self or others _X_ Neglect of personal appearance and hygiene __ Intermittent inability to perform ADLs, including maintaining minimal personal hygiene __ Disorientation to time or place Behavioral Observations: MOOD: "pretty rattley" (meaning anxious) AFFECT: flat ORIENTATION: fully oriented APPEARANCE: disheveled, wearing wrinkled white t-shirt and pants BEHAVIOR: cooperative THOUGHT PROCESSES: coherent THOUGHT CONTENT: logical and goal-directed DELUSIONS/HALLUCINATIONS: none elicited 5. Other symptoms Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No If yes, describe: 7. Competency Is the Veteran capable of managing his or her financial affairs? _X_ Yes __ No If no, explain: __________________________ 8. Remarks, if any: This evaluation was scheduled because the veteran filed a claim for an increase in his service connection for Posttraumatic Stress Disorder. Evidence considered for today's evaluation includes review of vet's VBMS record, review of vet's electronic VA medical record, and vet's self-report during today's clinical interview. Based on this information vet currently meets DSM-5 criteria for diagnoses of (1) PTSD, (2) Major Depressive Disorder, and (3) Unspecified Personality Disorder (OLD EXAM) significant functional impairment. The veteran maintains few meaningful interpersonal relationships, and is largely socially isolated. Although he is currently enrolled in college, his mental health symptoms have led to difficulties with attendance and getting along with other students. Vet has not held a job since his discharge from the military, and he states that he has not sought out employment due to his fear of the problems his irritability might cause in a work setting (particularly if confronted by a rude supervisor). Regarding the question of unemployability: Based upon today's evaluation it is less likely than not (less than 50% probability) that the veteran's symptoms of PTSD render him unable to secure or maintain substantially gainful employment. The veteran has not attempted to work since his discharge from the military, and as such, there is no clear evidence that his symptoms would render him entirely incapable of working in any context. Vet reported difficulties with concentration and irritability within an educational setting; however, it is likely that were the veteran to obtain a job which provided him with an optimal environment (e.g. a secure setting with good visibility) and job duties (e.g. an isolative position requiring little interaction with coworkers or customers) he would be able to function within an occupational setting. It should also be noted that the veteran's symptoms are not well-managed at present partially due to his unwillingness to engage meaningfully in treatment. He takes his medications sporadically and recent psychotherapy notes indicate that although his therapist has encouraged the veteran to begin working on useful coping strategies (particularly aimed at reducing irritability and anger outbursts) the veteran has shown little interest in doing so. It should also be noted that a good deal of vet's functional impairment does appear to be attributable to his personality disorder symptoms. His emotional lability and extreme irritability (greater than what is typically reported by individuals suffering from PTSD alone) reportedly result in a good deal of interpersonal difficulty. Further, vet's rigid and negativistic beliefs about himself and others also result in lessened engagement in activities and treatment that would likely lead to some relief from his Axis I symptomology. It is important to point out that all personality disorders, by definition, are longstanding mental health conditions representing an enduring pattern of behavior and symptoms that can often be traced back to childhood or adolescence. A review of vet?s original mental health C&P exam reveals that the veteran endured substantial physical and emotional abuse during childhood, and was suffering from various mental health symptoms (e.g. self-harm, mood fluctuations) prior to his enlistment in the military. this is from my last e