SSGTBarnett

Thanks for answering my questions!

Ok, so I got my C&P and I am pretty sure after reading a lot of your guys/gals responses that I had a favorable C&P, my question is it looks like the examiner places me at a 10%? Is he the person who decides? I've made a copy of it and it will be attached here to see what you guys think. I have read that at times the VA low balls their first rating, anybody else have experience with that? Thanks for your time! LOCAL TITLE: C&P MENTAL DISORDER STANDARD TITLE: MENTAL HEALTH C & P EXAMINATION CONSULT DATE OF NOTE: JAN 13, 2016@10:00 ENTRY DATE: JAN 13, 2016@15:03:51 AUTHOR: RAY,CHRISTOPHER L EXP COSIGNER: URGENCY: STATUS: COMPLETED *** C&P MENTAL DISORDER Has ADDENDA *** Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: Phillip Russell Barnett 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: Posttraumatic stress disorder CONFIDENTIAL Page 4 of 20 ICD code: 309.81 Comments, if any: His clinical interview and test results are consistent with this diagnosis. Mental Disorder Diagnosis #2: Alcohol use disorder, severe ICD code: 303.90 Comments, if any: The veteran reported severe symptoms of this condition. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): None. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: When intoxicated he may exhibit mood lability and impaired social functioning. Such symptoms are also characteristic of PTSD and it is difficult to differentiate what portion of each symptom is attributable to each condition. 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 due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [X] No [ ] No other mental disorder has been diagnosed BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 5 of 20 If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: Due to shared symptoms, it is difficult to reliably differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI 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: 2. History BARNETT, PHILLIP RUSSELL BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 9 of 20 primary care physician and was seen in mental health (at the Columbus VA)." He acknowledged that he received mental health treatment after the military. He reported that the treatment "helped. I don't feel like harming myself or anything." He said he is not currently receiving mental health treatment. He stated that he had been prescribed citalopram "but I couldn't sleep on it at all." The following information is derived from his CPRS records. These records indicate that the veteran had contact in 2010 and 2011 with Dr. Minhas, a VA psychiatrist. The veteran indicated that he had taken citalopram through a primary care physician but went off of it because he felt he did not need it. During an appointment with Dr. Minhas on 2/28/11, he was experiencing bouts of depression and wanted to try the medication again. He was diagnosed by Dr. Minhas with Depression NOS and PTSD by history. He was prescribed citalopram. His CPRS records suggest that the veteran previously had contact with Dr. Haraburda, a VA psychologist. On 3/29/11 Dr. Haraburda provided the veteran with a diagnosis of PTSD. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): He denied any legal problems before the military. He stated that while in the military "I lost my staff Sergeant stripe for fighting with another NCO." He stated that this incident took place after his Iraq deployment. He denied receiving any criminal charges since leaving the military. e. Relevant Substance abuse history (pre-military, military, and post-military): Before the military he reported that he "smoked weed (marijuana) maybe twice." He added that he used "minimal" amounts of alcohol prior to the service. While in the military he did not report consuming illegal drugs. He acknowledged that while in the military he drank alcohol "maybe once a month when going out with friends." After the military he said two years ago "I smoked marijuana twice." Since the military, he reported that he has consumed alcohol. He said he drinks "maybe a BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 10 of 20 case of beer every three days. My wife and I will have a bottle of wine every few weeks or so." He noted that he has experienced increased tolerance to alcohol. He stated that at times he consumes more alcohol than expected. He reported that he has made some attempts to cut down on using alcohol. He said in the past his use of alcohol has negatively impacted relationships like with his first wife. He denied any negative impact of his alcohol use on his work. He added, "sometimes my wife (current) gets angry when I drink." He said he has driven his car shortly after consuming alcohol. f. Other, if any: He did not report any medical problems "other than obesity." He added that he takes no medications. 3. Stressors ------------ 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) 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] 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). BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 12 of 20 [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 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] Reckless or self-destructive behavior. [X] Hypervigilance. [X] Exaggerated startle response. [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. BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 13 of 20 Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 [X] Stressor #2 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 6. Behavioral Observations -------------------------- The veteran was alert and oriented to person, place, the date, time, and situation. The veteran's clothing was appropriate to the situation and weather. He maintained appropriate eye contact. The veteran exhibited acceptable hygiene. His speech was within normal limits with regard to rate, rhythm and volume. He walked with a normal gait. The veteran was cooperative and actively participated in the evaluation procedures. His affect was appropriate to discussion. The veteran described his mood as "like crap." He noted that the anticipation of the current examination and "the Christmas season" tends to bother him. He added, "I associate that (Christmas) with going to the mall." He did not report thoughts of suicide or of harming others. He did not report nor were there clear indications of obsessions, compulsions, panic attacks, or manic symptoms. Regarding his mental content, the veteran's thought processes were linear. His associations were goal-directed. Although he is suspicious of crowds, there were no indications of delusions or hallucinations. Regarding ADLs, he reported that he keeps up with his personal hygiene. He stated that he is able to cook, clean, and complete other basic household chores. He said he does not feel like he does well in keeping up with chores, but he feels capable of doing them. He reported that he has a bank account and driver's license. His judgment in hypothetical situations is intact. He exhibits adequate abstract reasoning and comprehension. He was able to remember events from the past indicating no significant long term memory issues. He did not report concentration deficits and none were apparent in session. His intellectual functioning appears to be in the high average range based upon his BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 14 of 20 educational attainment and vocabulary. DSM-5 ASSESSMENT OF PTSD: CRITERIA A: EXPOSURE TO ACTUAL OR THREATENED DEATH, SERIOUS INJURY, OR SEXUAL VIOLENCE IN ONE (OR MORE) OF THE FOLLOWING WAYS: 1. DIRECTLY EXPERIENCING THE TRAUMATIC EVENT(S) 2. WITNESSING, IN PERSON, THE EVENT(S) AS IT OCCURRED TO OTHERS 3. LEARNING THAT THE TRUAMATIC EVENT(S) OCCURRED TO A CLOSE FAMILY MEMBER OR CLOSE FRIEND, IN CASES OF ACTUAL OR THREATENED DEATH OF A FAMILY MEMBER OR FRIEND, THE EVENT(S) MUST HAVE BEEN VIOLENT OR ACCIDENTAL. 4. EXPERIENCING REPEATED OR EXTREME EXPOSURE TO AVERSIVE DETAILS OF THE TRAUMATIC EVENT(S) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). These reports of traumatic stress would fulfill the requirement for Criteria A for a diagnosis of PTSD. SET OF DIAGNOSTIC CRITERIA B: PRESENCE OF ONE (OR MORE) OF THE FOLLOWING INTRUSION SYMPTOMS ASSOICATED WITH THE TRAUMATIC EVENT(S), BEGINNING AFTER THE TRAUMATIC EVENT(S) OCCURRED: CRITERIA B-1: RECURRENT, INVOLUNTARY AND INTRUSIVE DISTRESSING MEMORIES OF THE TRAUMATIC EVENT(S). He acknowledged unwanted thoughts about the trauma stressors "very often." He said such thoughts are intrusive. CRITERIA B-2: RECURRENT DISTRESSING DREAMS IN WHICH THE CONTENT AND/OR AFFECT OF THE DREAM ARE RELATED TO THE TRAUMATIC EVENT(S). He endorsed this symptom. He noted that the dreams have been "every night this past week." However, since he cannot recall the content of the dreams it is unclear if criteria for this symptom is met. CRITERIA B-3: 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.) He denied this symptom. CRITERIA B-4: INTENSE OR PROLONGED PSYCHOLOGICAL DISTRESS AT EXPOSURE TO INTERNAL OR EXTERNAL CUES THAT SYMBOLIZE OR RESEMBLE AN ASPECT OF THE TRAUMATIC EVENT(S). He reported that car doors slamming remind him of his trauma stressors. He stated that he gets bothered by large crowds. BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 15 of 20 CRITERIA B-5: MARKED PHYSIOLOGICAL REACTIONS TO INTERNAL OR EXTERNAL CUES THAT SYMBOLIZE OR RESEMBLE AN ASPECT OF THE TRAUMATIC EVENT(S). He said he wakes up from his dreams "covered in sweat." He added that his palms sweat when he is in large crowds. These descriptions of re-experiencing symptoms meet the requirement for Criteria B for PTSD. SET OF DIAGNOSTIC CRITERIA C: PERSISTENT AVOIDANCE OF STIMULI ASSOCIATED WITH THE TRAUMATIC EVENT(S), BEGINNING AFTER THE TRAUMATIC EVENT(S) OCCURRED, AS EVIDENCED BY ONE OR BOTH OF THE FOLLOWING: CRITERIA C-1: AVOIDANCE OF OR EFFORTS TO AVOID DISTRESSING MEMORIES, THOUGHTS, OR FEELINGS ABOUT OR CLOSELY ASSOCIATED WITH THE TRAUMATIC EVENT(S). He noted that he avoids conversations, memories, and thoughts about the trauma stressors. He stated, for example, that he avoids conversations with his wife about what happened. CRITERIA C-2: AVOIDANCE OF OR EFFORTS TO AVOID EXTERNAL REMINDERS (PEOPLE, PLACES, CONVERSATOINS, ACTIVITIES, OBJECTS, SITUATIONS) THAT AROUSE DISTRESSING MEMORIES, THOUGHTS, OR FEELINGS ABOUT OR CLOSELY ASSOCIATED WITH THE TRAUMATIC EVENT(S). He reported avoiding large crowds of people. He added that he does not "go to fireworks" or "loud bars." The veteran does report avoidance symptoms that would fulfill the requirement for Criteria C for PTSD. SET OF DIAGNOSTIC CRITERIA 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: CRITERIA D-1: 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). He can remember well what happened, so criteria is not met. CRITERIA D-2: 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 BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 16 of 20 whole nervous system is permanently ruined.") He stated that he feels like "I can't trust anyone at all." CRITERIA D-3: PERSISTENT, DISTORTED COGNITIONS ABOUT THE CAUSE OR CONSEQUENCES OF THE TRAUMATIC EVENT(S) THAT LEAD THE INDIVIDUAL TO BLAME HIMSELF/HERSELF OR OTHERS. He denied this symptom. CRITERIA D-4: PERSISTENT NEGATIVE EMOTIONAL STATE (e.g., fear, horror, anger, guilt, or shame). He stated that he feels guilty "that I wasn't doing more at the time of the trauma stressors. He added that he has persistent fears of crowds. CRITERIA D-5: MARKEDLY DIMINISHED INTEREST OR PARTICIPATION IN SIGNIFICANT ACTIVITIES. He reported that he does some lifting but does not engage in many activities. He noted a lack of interest in engaging in other activities. CRITERIA D-6: FEELINGS OF DETACHMENT OR EXTRANGEMENT FROM OTHERS. He reported that he does not talk to "anybody from the military anymore." However, he stated that he talks to people at work. His test results are suggestive of a tendency to avoid social interactions with others. Criteria is considered met. CRITERIA D-7: PERSISTENT INABILITY TO EXPERIENCE POSITIVE EMOTIONS (e.g., inability to experience happiness, satisfaction, or loving feelings). He reported that he is able to have positive feelings toward his children. However, his wife has told him "I'm the most emotionally unavailable person she's met." He said he thinks this was different prior to his Iraqi deployment. Criteria is met. The veteran reported symptoms that meet Criteria D for PTSD. SET OF DIAGNOSTIC CRITERIA 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: BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 17 of 20 CRITERIA E-1: IRRITABLE BEHAVIOR AND ANGRY OUTBURSTS (WITH LITTLE OR NO PROVOCATION) TYPICALLY EXPRESSED AS VERBAL OR PHYSICAL AGGRESSION TOWARD PEOPLE OR OBJECTS). He said he is doing better in controlling his anger. CRITERIA E-2: RECKLESS OR SELF-DESTRUCTIVE BEHAVIOR He stated that he has engaged in some drinking and driving. CRITERIA E-3: HYPERVIGILANCE He endorsed this symptom. He reported, "I always look at people's eyes and hands. I have also checked window locks and door locks twice a night." CRITERIA E-4: EXAGGERATED STARTLE RESPONSE He reported that he gets easily startled by sudden noises like fireworks. He added that sudden movements bother him. CRITERIA E-5: PROBLEMS WITH CONCENTRATION He denied having concentration deficits. CRITERIA E-6: SLEEP DISTURBANCE (e.g., difficulty falling or staying asleep or restless sleep). He reported that he has been experiencing sleep deficits and has only been getting 4-5 hours of sleep at night. He noted that he has problems with getting to and staying asleep. The veteran reported symptoms that meet Criteria E for PTSD. CRITERIA F: DURATION OF THE DISTURBANCE (CRITERIA B, C, D, AND E) IS MORE THAN ONE MONTH Criteria is met. CRITERIA G: THE DISTURBANCE CAUSES CLINICALLY SIGNIFICANT DISTRESS OR IMPAIRMENT IN SOCIAL, OCCUPATIONAL, OR OTHER IMPORTANT AREAS OF FUNCTIONING. The veteran endorsed significant distress. The veteran reported social impairment associated with his mental health symptoms. The veteran did not report recent occupational impairment related to his mental health symptoms. CRITERIA H: THE DISTURBANCE IS NOT ATTRIBUTABLE TO THE PHYSIOLOGICAL EFFECTS OF A SUBSTANCE (e.g., medication, alcohol) OR ANOTHER MEDICAL CONDITION. The disturbance is not attributable to the physiological effects of a BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 18 of 20 substance or another medical condition. He indicated that he has experienced PTSD symptoms even in the absence of using alcohol or recovering from its effects. 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 -------------------------------------------------- Assessment Results: The MMPI-2-RF was administered to measure symptom patterns associated with particular classes of psychopathology and as a measure of feigning. The veteran's profile is valid and interpretable. His MMPI-2-RF profile is similar to individuals who report feeling anxious. Such individuals tend to experience intrusive ideation, sleep difficulties including nightmares, significant anxiety, and PTSD. The veteran reported a lack of emotional experiences. Such individuals tend to experience significant problems with anhedonia, lack interests, are pessimistic, and complain about depression. According to his test results, he reported significant past and current substance abuse. Such individuals have a history of problematic use of alcohol or drugs and engage in sensation-seeking. They also may have had legal problems as a result of substance abuse. Interpersonally, he reported not enjoying social events and avoiding social situations. He also indicated disliking people and being around them. Such individuals tend to be asocial, introverted, emotionally restricted, and have difficulty forming close relationships. His MMPI-2?2?RF results suggest that he should be evaluated for cluster C personality disorders, disorders associated with social avoidance such as avoidant personality disorder, schizoid personality disorder, substance use-related disorders and anxiety-related disorders, including PTSD. Opinion & Rationale: It is my opinion, with reasonable psychological certainty, that it is more likely than not (greater than a 50% probability) that his Posttraumatic stress disorder with secondary depressive symptoms resulted from his Iraqi BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 19 of 20 trauma stressors. My opinion is based upon my clinical experience and expertise, a review of the veteran's CPRS records, a review of his VBMS records, the results of a clinical interview, and the veteran's test results. The veteran showed no signs of significant exaggeration or feigning of mental disorder symptoms on objective testing, during the interview, or when comparing his self-report to the evidence of record. There are no known major traumatic stressors other than what happened during his military service that could explain his PTSD symptoms. There appears to be a direct link between his PTSD symptoms and his trauma stressors experienced in Iraq. Of note is that the veteran is experiencing anhedonia and mild sadness, which are considered secondary to his PTSD because of the temporal relationship between the onset of the symptoms and his trauma stressors. Also, a persistent negative mood state is considered to be consistent with a diagnosis of PTSD. The veteran's CPRS records suggest that a prior mental health treatment provider has diagnosed him with PTSD. His social avoidance found in his testing is likely associated with his PTSD condition rather than a personality disorder. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. /es/ CHRISTOPHER RAY PHD ABPP Psychologist, C&P Signed: 01/13/2016 15:03 01/13/2016 ADDENDUM STATUS: COMPLETED The veteran's C&P exam was completed in CAPRI. The procedure codes are 99456 and 96101. /es/ CHRISTOPHER RAY PHD ABPP Psychologist, C&P Signed: 01/13/2016 15:04 END OF MY HEALTHEVET PERSONAL INFORMATION REPORT

Ok, so I got my C&P and I am pretty sure after reading a lot of your guys/gals responses that I had a favorable C&P, my question is it looks like the examiner places me at a 10%? Is he the person who decides? I've made a copy of it and it will be attached here to see what you guys think. I have read that at times the VA low balls their first rating, anybody else have experience with that? Thanks for your time! LOCAL TITLE: C&P MENTAL DISORDER STANDARD TITLE: MENTAL HEALTH C & P EXAMINATION CONSULT DATE OF NOTE: JAN 13, 2016@10:00 ENTRY DATE: JAN 13, 2016@15:03:51 AUTHOR: RAY,CHRISTOPHER L EXP COSIGNER: URGENCY: STATUS: COMPLETED *** C&P MENTAL DISORDER Has ADDENDA *** Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: Phillip Russell Barnett 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: Posttraumatic stress disorder BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 4 of 20 ICD code: 309.81 Comments, if any: His clinical interview and test results are consistent with this diagnosis. Mental Disorder Diagnosis #2: Alcohol use disorder, severe ICD code: 303.90 Comments, if any: The veteran reported severe symptoms of this condition. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): None. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: When intoxicated he may exhibit mood lability and impaired social functioning. Such symptoms are also characteristic of PTSD and it is difficult to differentiate what portion of each symptom is attributable to each condition. 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 due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [X] No [ ] No other mental disorder has been diagnosed BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 5 of 20 If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: Due to shared symptoms, it is difficult to reliably differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI 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: 2. History BARNETT, PHILLIP RUSSELL BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 9 of 20 primary care physician and was seen in mental health (at the Columbus VA)." He acknowledged that he received mental health treatment after the military. He reported that the treatment "helped. I don't feel like harming myself or anything." He said he is not currently receiving mental health treatment. He stated that he had been prescribed citalopram "but I couldn't sleep on it at all." The following information is derived from his CPRS records. These records indicate that the veteran had contact in 2010 and 2011 with Dr. Minhas, a VA psychiatrist. The veteran indicated that he had taken citalopram through a primary care physician but went off of it because he felt he did not need it. During an appointment with Dr. Minhas on 2/28/11, he was experiencing bouts of depression and wanted to try the medication again. He was diagnosed by Dr. Minhas with Depression NOS and PTSD by history. He was prescribed citalopram. His CPRS records suggest that the veteran previously had contact with Dr. Haraburda, a VA psychologist. On 3/29/11 Dr. Haraburda provided the veteran with a diagnosis of PTSD. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): He denied any legal problems before the military. He stated that while in the military "I lost my staff Sergeant stripe for fighting with another NCO." He stated that this incident took place after his Iraq deployment. He denied receiving any criminal charges since leaving the military. e. Relevant Substance abuse history (pre-military, military, and post-military): Before the military he reported that he "smoked weed (marijuana) maybe twice." He added that he used "minimal" amounts of alcohol prior to the service. While in the military he did not report consuming illegal drugs. He acknowledged that while in the military he drank alcohol "maybe once a month when going out with friends." After the military he said two years ago "I smoked marijuana twice." Since the military, he reported that he has consumed alcohol. He said he drinks "maybe a BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 10 of 20 case of beer every three days. My wife and I will have a bottle of wine every few weeks or so." He noted that he has experienced increased tolerance to alcohol. He stated that at times he consumes more alcohol than expected. He reported that he has made some attempts to cut down on using alcohol. He said in the past his use of alcohol has negatively impacted relationships like with his first wife. He denied any negative impact of his alcohol use on his work. He added, "sometimes my wife (current) gets angry when I drink." He said he has driven his car shortly after consuming alcohol. f. Other, if any: He did not report any medical problems "other than obesity." He added that he takes no medications. 3. Stressors ------------ 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) 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] 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). BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 12 of 20 [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 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] Reckless or self-destructive behavior. [X] Hypervigilance. [X] Exaggerated startle response. [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. BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 13 of 20 Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 [X] Stressor #2 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 6. Behavioral Observations -------------------------- The veteran was alert and oriented to person, place, the date, time, and situation. The veteran's clothing was appropriate to the situation and weather. He maintained appropriate eye contact. The veteran exhibited acceptable hygiene. His speech was within normal limits with regard to rate, rhythm and volume. He walked with a normal gait. The veteran was cooperative and actively participated in the evaluation procedures. His affect was appropriate to discussion. The veteran described his mood as "like crap." He noted that the anticipation of the current examination and "the Christmas season" tends to bother him. He added, "I associate that (Christmas) with going to the mall." He did not report thoughts of suicide or of harming others. He did not report nor were there clear indications of obsessions, compulsions, panic attacks, or manic symptoms. Regarding his mental content, the veteran's thought processes were linear. His associations were goal-directed. Although he is suspicious of crowds, there were no indications of delusions or hallucinations. Regarding ADLs, he reported that he keeps up with his personal hygiene. He stated that he is able to cook, clean, and complete other basic household chores. He said he does not feel like he does well in keeping up with chores, but he feels capable of doing them. He reported that he has a bank account and driver's license. His judgment in hypothetical situations is intact. He exhibits adequate abstract reasoning and comprehension. He was able to remember events from the past indicating no significant long term memory issues. He did not report concentration deficits and none were apparent in session. His intellectual functioning appears to be in the high average range based upon his BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 14 of 20 educational attainment and vocabulary. DSM-5 ASSESSMENT OF PTSD: CRITERIA A: EXPOSURE TO ACTUAL OR THREATENED DEATH, SERIOUS INJURY, OR SEXUAL VIOLENCE IN ONE (OR MORE) OF THE FOLLOWING WAYS: 1. DIRECTLY EXPERIENCING THE TRAUMATIC EVENT(S) 2. WITNESSING, IN PERSON, THE EVENT(S) AS IT OCCURRED TO OTHERS 3. LEARNING THAT THE TRUAMATIC EVENT(S) OCCURRED TO A CLOSE FAMILY MEMBER OR CLOSE FRIEND, IN CASES OF ACTUAL OR THREATENED DEATH OF A FAMILY MEMBER OR FRIEND, THE EVENT(S) MUST HAVE BEEN VIOLENT OR ACCIDENTAL. 4. EXPERIENCING REPEATED OR EXTREME EXPOSURE TO AVERSIVE DETAILS OF THE TRAUMATIC EVENT(S) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). These reports of traumatic stress would fulfill the requirement for Criteria A for a diagnosis of PTSD. SET OF DIAGNOSTIC CRITERIA B: PRESENCE OF ONE (OR MORE) OF THE FOLLOWING INTRUSION SYMPTOMS ASSOICATED WITH THE TRAUMATIC EVENT(S), BEGINNING AFTER THE TRAUMATIC EVENT(S) OCCURRED: CRITERIA B-1: RECURRENT, INVOLUNTARY AND INTRUSIVE DISTRESSING MEMORIES OF THE TRAUMATIC EVENT(S). He acknowledged unwanted thoughts about the trauma stressors "very often." He said such thoughts are intrusive. CRITERIA B-2: RECURRENT DISTRESSING DREAMS IN WHICH THE CONTENT AND/OR AFFECT OF THE DREAM ARE RELATED TO THE TRAUMATIC EVENT(S). He endorsed this symptom. He noted that the dreams have been "every night this past week." However, since he cannot recall the content of the dreams it is unclear if criteria for this symptom is met. CRITERIA B-3: 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.) He denied this symptom. CRITERIA B-4: INTENSE OR PROLONGED PSYCHOLOGICAL DISTRESS AT EXPOSURE TO INTERNAL OR EXTERNAL CUES THAT SYMBOLIZE OR RESEMBLE AN ASPECT OF THE TRAUMATIC EVENT(S). He reported that car doors slamming remind him of his trauma stressors. He stated that he gets bothered by large crowds. BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 15 of 20 CRITERIA B-5: MARKED PHYSIOLOGICAL REACTIONS TO INTERNAL OR EXTERNAL CUES THAT SYMBOLIZE OR RESEMBLE AN ASPECT OF THE TRAUMATIC EVENT(S). He said he wakes up from his dreams "covered in sweat." He added that his palms sweat when he is in large crowds. These descriptions of re-experiencing symptoms meet the requirement for Criteria B for PTSD. SET OF DIAGNOSTIC CRITERIA C: PERSISTENT AVOIDANCE OF STIMULI ASSOCIATED WITH THE TRAUMATIC EVENT(S), BEGINNING AFTER THE TRAUMATIC EVENT(S) OCCURRED, AS EVIDENCED BY ONE OR BOTH OF THE FOLLOWING: CRITERIA C-1: AVOIDANCE OF OR EFFORTS TO AVOID DISTRESSING MEMORIES, THOUGHTS, OR FEELINGS ABOUT OR CLOSELY ASSOCIATED WITH THE TRAUMATIC EVENT(S). He noted that he avoids conversations, memories, and thoughts about the trauma stressors. He stated, for example, that he avoids conversations with his wife about what happened. CRITERIA C-2: AVOIDANCE OF OR EFFORTS TO AVOID EXTERNAL REMINDERS (PEOPLE, PLACES, CONVERSATOINS, ACTIVITIES, OBJECTS, SITUATIONS) THAT AROUSE DISTRESSING MEMORIES, THOUGHTS, OR FEELINGS ABOUT OR CLOSELY ASSOCIATED WITH THE TRAUMATIC EVENT(S). He reported avoiding large crowds of people. He added that he does not "go to fireworks" or "loud bars." The veteran does report avoidance symptoms that would fulfill the requirement for Criteria C for PTSD. SET OF DIAGNOSTIC CRITERIA 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: CRITERIA D-1: 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). He can remember well what happened, so criteria is not met. CRITERIA D-2: 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 BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 16 of 20 whole nervous system is permanently ruined.") He stated that he feels like "I can't trust anyone at all." CRITERIA D-3: PERSISTENT, DISTORTED COGNITIONS ABOUT THE CAUSE OR CONSEQUENCES OF THE TRAUMATIC EVENT(S) THAT LEAD THE INDIVIDUAL TO BLAME HIMSELF/HERSELF OR OTHERS. He denied this symptom. CRITERIA D-4: PERSISTENT NEGATIVE EMOTIONAL STATE (e.g., fear, horror, anger, guilt, or shame). He stated that he feels guilty "that I wasn't doing more at the time of the trauma stressors. He added that he has persistent fears of crowds. CRITERIA D-5: MARKEDLY DIMINISHED INTEREST OR PARTICIPATION IN SIGNIFICANT ACTIVITIES. He reported that he does some lifting but does not engage in many activities. He noted a lack of interest in engaging in other activities. CRITERIA D-6: FEELINGS OF DETACHMENT OR EXTRANGEMENT FROM OTHERS. He reported that he does not talk to "anybody from the military anymore." However, he stated that he talks to people at work. His test results are suggestive of a tendency to avoid social interactions with others. Criteria is considered met. CRITERIA D-7: PERSISTENT INABILITY TO EXPERIENCE POSITIVE EMOTIONS (e.g., inability to experience happiness, satisfaction, or loving feelings). He reported that he is able to have positive feelings toward his children. However, his wife has told him "I'm the most emotionally unavailable person she's met." He said he thinks this was different prior to his Iraqi deployment. Criteria is met. The veteran reported symptoms that meet Criteria D for PTSD. SET OF DIAGNOSTIC CRITERIA 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: BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 17 of 20 CRITERIA E-1: IRRITABLE BEHAVIOR AND ANGRY OUTBURSTS (WITH LITTLE OR NO PROVOCATION) TYPICALLY EXPRESSED AS VERBAL OR PHYSICAL AGGRESSION TOWARD PEOPLE OR OBJECTS). He said he is doing better in controlling his anger. CRITERIA E-2: RECKLESS OR SELF-DESTRUCTIVE BEHAVIOR He stated that he has engaged in some drinking and driving. CRITERIA E-3: HYPERVIGILANCE He endorsed this symptom. He reported, "I always look at people's eyes and hands. I have also checked window locks and door locks twice a night." CRITERIA E-4: EXAGGERATED STARTLE RESPONSE He reported that he gets easily startled by sudden noises like fireworks. He added that sudden movements bother him. CRITERIA E-5: PROBLEMS WITH CONCENTRATION He denied having concentration deficits. CRITERIA E-6: SLEEP DISTURBANCE (e.g., difficulty falling or staying asleep or restless sleep). He reported that he has been experiencing sleep deficits and has only been getting 4-5 hours of sleep at night. He noted that he has problems with getting to and staying asleep. The veteran reported symptoms that meet Criteria E for PTSD. CRITERIA F: DURATION OF THE DISTURBANCE (CRITERIA B, C, D, AND E) IS MORE THAN ONE MONTH Criteria is met. CRITERIA G: THE DISTURBANCE CAUSES CLINICALLY SIGNIFICANT DISTRESS OR IMPAIRMENT IN SOCIAL, OCCUPATIONAL, OR OTHER IMPORTANT AREAS OF FUNCTIONING. The veteran endorsed significant distress. The veteran reported social impairment associated with his mental health symptoms. The veteran did not report recent occupational impairment related to his mental health symptoms. CRITERIA H: THE DISTURBANCE IS NOT ATTRIBUTABLE TO THE PHYSIOLOGICAL EFFECTS OF A SUBSTANCE (e.g., medication, alcohol) OR ANOTHER MEDICAL CONDITION. The disturbance is not attributable to the physiological effects of a BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 18 of 20 substance or another medical condition. He indicated that he has experienced PTSD symptoms even in the absence of using alcohol or recovering from its effects. 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 -------------------------------------------------- Assessment Results: The MMPI-2-RF was administered to measure symptom patterns associated with particular classes of psychopathology and as a measure of feigning. The veteran's profile is valid and interpretable. His MMPI-2-RF profile is similar to individuals who report feeling anxious. Such individuals tend to experience intrusive ideation, sleep difficulties including nightmares, significant anxiety, and PTSD. The veteran reported a lack of emotional experiences. Such individuals tend to experience significant problems with anhedonia, lack interests, are pessimistic, and complain about depression. According to his test results, he reported significant past and current substance abuse. Such individuals have a history of problematic use of alcohol or drugs and engage in sensation-seeking. They also may have had legal problems as a result of substance abuse. Interpersonally, he reported not enjoying social events and avoiding social situations. He also indicated disliking people and being around them. Such individuals tend to be asocial, introverted, emotionally restricted, and have difficulty forming close relationships. His MMPI-2?2?RF results suggest that he should be evaluated for cluster C personality disorders, disorders associated with social avoidance such as avoidant personality disorder, schizoid personality disorder, substance use-related disorders and anxiety-related disorders, including PTSD. Opinion & Rationale: It is my opinion, with reasonable psychological certainty, that it is more likely than not (greater than a 50% probability) that his Posttraumatic stress disorder with secondary depressive symptoms resulted from his Iraqi BARNETT, PHILLIP RUSSELL CONFIDENTIAL Page 19 of 20 trauma stressors. My opinion is based upon my clinical experience and expertise, a review of the veteran's CPRS records, a review of his VBMS records, the results of a clinical interview, and the veteran's test results. The veteran showed no signs of significant exaggeration or feigning of mental disorder symptoms on objective testing, during the interview, or when comparing his self-report to the evidence of record. There are no known major traumatic stressors other than what happened during his military service that could explain his PTSD symptoms. There appears to be a direct link between his PTSD symptoms and his trauma stressors experienced in Iraq. Of note is that the veteran is experiencing anhedonia and mild sadness, which are considered secondary to his PTSD because of the temporal relationship between the onset of the symptoms and his trauma stressors. Also, a persistent negative mood state is considered to be consistent with a diagnosis of PTSD. The veteran's CPRS records suggest that a prior mental health treatment provider has diagnosed him with PTSD. His social avoidance found in his testing is likely associated with his PTSD condition rather than a personality disorder. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. /es/ CHRISTOPHER RAY PHD ABPP Psychologist, C&P Signed: 01/13/2016 15:03 01/13/2016 ADDENDUM STATUS: COMPLETED The veteran's C&P exam was completed in CAPRI. The procedure codes are 99456 and 96101. /es/ CHRISTOPHER RAY PHD ABPP Psychologist, C&P Signed: 01/13/2016 15:04 END OF MY HEALTHEVET PERSONAL INFORMATION REPORT

Thanks Buck, he never said anything about it not being his decision, so I will remain hopeful that he understood how I've been affected by this. Do you know the website his findings will be able to be viewed, he said it but for the life of me I cannot remember.

Today I went for my PTSD C&P, the overall exam went well I felt, the examiner spent about 1.5 hours speaking with me which is more time than I had expected. At the end the examiner had me go into an empty conference room and fill out a MMPI-2-RF on pen and paper, I was not prepared to take a written test, as I had mostly read that these exams are speaking with another person, but all in all it wasn't horrible. My questions are, is this common practice to give an MMPI for PTSD? All I can find on the internet is that this test is used to diagnose other mental disorders and not PTSD although it can be used to diagnose anxiety and depression which I am also claiming. Also, the examiner didn't make clear which claim he was assessing for, I was under the assumption that there would be different C&P's for each claim? Or do they group all the mental disorders into one C&P? Thanks for your guys help! Oh also, the examiner stated I could see his findings in about two weeks online, does anybody know where I would find this?

Thanks for your response Berta. I have not continued treatment in the past, but have seriously considered returning because I do not seem to be getting any better, and quite frankly I feel much worse in the past 6-8 months than I did a year ago. As far as an LOD being completed, I am pretty sure there was. I went to multiple medical board hearings on drill weekends prior to being medically discharged. But I will find out for sure, as I have sent away for my PMRs. Also today I went to my local VA where I had first established treatment and received my medical records from them. The diagnosis given to me then was PTSD (status active, SC Unkown, Exposure none), Anxiety disorder, and depression (the status, SC, and Exposure are the same as the PTSD diagnosis) this was diagnosed 15March2011, 4 months prior to my DC. Does this aid me in my claim?

Thank you for responding, the proof shouldn't be hard to find since it was the cause of my discharge. Up until a month or so ago when I began researching what was needed to file I didn't think I'd ever file. It was only after a retired Sergeant Marjor and I had a discussion and he quite simply told me that I was silly not to apply, basically saying the same thing you said. Thanks again, this group seems to really take pride in helping, someday I hope to return this to a young vet in my shoes.

Hello all, first a short introduction. I served in the Air National Guard for 10 years, of which I volunteered/activated under title 10 active duty orders for 8 of the 10 years I served. During my final year in the service I began seeing a psychiatrist at my local VA, after many visits I was diagnosed with PTSD, it was advised at that time by the psychiatrist that I speak with my commander and medical personnel at my duty station on my next drill weekend. Long story short I was discharged two years short of completing my contract with a diagnosis of PTSD. This was in 2011. My questions: 1. It has been three years since my discharge, does the VA not look favorably on those who file claims so long after being discharged? I didn't file because I felt and still feel that there are others who are much more deserving of these benefits than myself. 2. I have been reading over the past week or so about some people advising to not tell the VA about their alcohol use, while others I have read say to be completely upfront with every issue, should I be upfront or avoid answering questions about my current situation with regards to this? 3. How long should I expect it to take for my claim to be processed? 4. Lastly, I have been prescribed medications post diagnosis yet decided personally not to continue taking them, nor have I continued going to the VA to seek treatment. Am I required to attend therapy sessions or take medications if I want to obtain a service connected disability rating? Thanks to all of you who respond, and I am sorry for being so long winded. I am sure I will have questions to follow up with, during my journey to get this taken care of. Regards