SSGTBarnett

January 18, 2016

Thanks for answering my questions!

January 18, 2016

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

January 18, 2016

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