RAKMEDIC3/187

Good Morning, Today I checked my Ebenefits page and see that my claim has moved back to gathering evidence. I was expecting have it move forward to Notification. My Rate did increase from 50% PTSD to 70%PTSD though. Any thoughts on this??? Also, I had filed a new claim for IBS and it is now listed as Not Service Connected Related to Environmental Hazard in Gulf War... There is also a new claim listed for Alcohol Abuse and it says Deferred. Is this the reason that it is now back in the Gathering Evidence phase??? Im completely lost so any help or information would be appreciated. Thank you all for your help!!!

Thanks John, I applied for what i had thought to be a new claim for insomnia and alcohol. Turned out to be an increase... I was aggrevated with the psychiatrist that i see saying i would no longer get ambien. I guess i should have just asked for a new one instead. I also filed a new claim for IBS, that one is pretty sure to be a SC. The dr said so during exam however i do not know what the percentage will be. I dont really care as long as they finally address the issue instead of putting it off as a poor diet. The only percentage that i care about is my PTSD, like you said quality of life really sucks!!! I use to be really active and into everything but now not so much... The best I've felt in years was on a beach in the middle of nowhere with nobody around but that only lasted two weeks.

Below is a copy of what was in the evaluation. Any ideas as to how this will be rated? SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes[ ] No ICD Code: 309.81 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD, Chronic ICD Code: 309.81 Mental Disorder Diagnosis #2: Unspecified Depressive Disorder ICD Code: 311 Comments, if any: secondary to ptsd CONFIDENTIAL Page 4 of 26 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): IBS; DM; DJD; LBP; HYPOTHYROIDISM 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: Symptoms of PTSD/Depression overlap in areas of sleep disruption, irritability, isolation/withdrawal, avoidance, poor concentration & memory and cannot be further separated without speculation. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes[ ] No[X] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation 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 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: Symptoms of PTSD/Depression overlap in areas of sleep disruption, irritability, isolation/withdrawal, avoidance, poor concentration & memory and cannot be further separated without speculation. c. If a diagnosis of TBI exists, is it possible to differentiate what CONFIDENTIAL Page 5 of 26 portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes[ ] No[X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence review ------------------ In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: ------------------------- Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes[ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [ ] Yes[ ] No If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [ ] Yes[ ] No 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: Veteran is now 50% SC for PTSD. He is aged __________, married and resides in _________. He has two children ages _______________. Veteran described current family relationships as fairly close, however, CONFIDENTIAL Page 6 of 26 described moderate impairments in role functioning related to anger, irritability, limited stress/frustration tolerance, isolative and avoidant behavior, depression, demotivation, and sleep disruption. Veteran described current social functioning as "all I do is go to work and come home. I dont have any friends, now. I dont go out anywhere or do anything, so I guess, I have no interest in talking to people. I deal with enough in 8 hours at work. I just dont see the point in it." Veteran also described his usual recreational pursuits as "I just sit at home, I have dogs and pretty much all I do is sit with them..." b. Relevant Occupational and Educational history: Veteran is employed for ______________. He described it as a "desk job" and is employed there full time. He related how it is "an easy job, all I do is print out reports and I get to work from home alot, so its real easy. All I do is check dates on papers and make sure its on the computer. Not much too it." c. Relevant Mental Health history, to include prescribed medications and family mental health: Review of CPRS today shows veteran has rx for Wellbutrin 5mg; Lamictal 150mg, and has continued in psychiatric care at __________since 2011. His most recent visit was recorded on 14 MAY 2015, as follows by ___________ staff psychiatrist: "Pertinent symptoms: Patient seen in __________clinic today. He is working "just sit at a desk and answer a phone, do a lot of paperwork". He does not like his work. Mood "same as always". Sleep "not very good". Energy level "depends on the day". Appetite "fine"...He stated that he is compliant with lamictal...He said that he has job-related stress, and would like to start a medication for stress/anxiety...Substance use: alcohol use "been drinking alot, helps me relax after work". Use 4-5 big beers 3-4 times a week, no alcohol use x 3 weeks while on vacation, recommended limits of alcohol use discussed..." Veteran was today asked to describe any current symptoms or concerns related to his claim for SC of PTSD, and described the following: CONFIDENTIAL Page 7 of 26 CRITERION B-RELIVING/INTRUSION: Reliving traumatic events via periodic nightmares of factual traumatic events 3-4x weekly, typically with insomnia afterward and awakens with autonomic arousal/agitation. Veteran also experiences intense physiological and psychological distress in presence of cues associated with traumatic events, such as sudden loud noises, frustration in heavy traffic, (does not like cars being too close around him) CRITERION C-AVOIDANCE: Veteran described avoiding crowds, loud noises, war related movies or TV programs, heavy traffic. CRITERION D-NEGATIVE ALTERATIONS IN COGNITIONS AND MOOD: Veteran c/o frequent anxiety, worrying in excess, being easily overwhelmed, relaxing, feels tense most of the time, ongoing irritability with limited stress-frustration tolerance, frequent anger outbursts, confrontational behavior with without altercations, occasional panic attacks with SOB, sweating, agitation, urge to leave (fight or flight), sense of dread or impending doom, without avoiding going out due to fear of onset, lasting usually 15-30 minutes occuring about 1-2x weekly, and c/o frequent depression hallmarked by sadness, periods of hopelessness, without crying, guilt feelings about traumatic events, (says he thinks about what could have, should have or would have been if he could do it over) or SI/HI, but with fatigue, "some days I feel better, but usually I have to force myself to do anything..." with frequent periods of withdrawal, "My wife is always on my butt about everything, especially not wanting to do anything." He also c/o loss of interest in usual activities, "I used to be pretty outgoing, did all kinds of stuff, like I was big into going to the gym, riding my motorcycle alot, going to church, I had friends, now I just dont want to do anything..." He also c/o decreased libido, fluctuating appetite, and decreased motivation and apathy. CRITERION E-ALTERATIONS IN AROUSAL/REACTIVITY: Veteran also described how he feels like he has to watch everyone in public, poor sleep defined as a usual 1-2 hour variable latency, then wakes up "off and on" throughout the night, awakens at the slightest sound, and feels he has to get up and check his doors or windows at least 1x each night, and rarely gets more than 4-5 hours of sleep. CONFIDENTIAL Page 8 of 26 d. Relevant Legal and Behavioral history: Denied e. Relevant Substance abuse history: Denied using illegal substances. Veteran stated he uses smokeless tobacco every two days. Veteran stated he drinks beer, usually three to four 24 ounce cans an evening, two to three times per week, but has not had any in about a month. f. Other, if any: No response provided. 3. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threatening situations (non-combat related stressors.) 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 #6 - "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) [X] Witnessing, in person, the traumatic event(s) as they occurred to others Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). CONFIDENTIAL Page 9 of 26 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 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, 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. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Exaggerated startle response. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause 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 CONFIDENTIAL Page 10 of 26 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: [X] Depressed mood [X] Anxiety [X] Panic attacks more than once a week [X] Chronic sleep impairment [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Impaired impulse control, such as unprovoked irritability with periods of violence 5. Behavioral Observations: --------------------------- Upon interview today, the veteran was observed to be in adequate hygiene, and seasonally and casually dressed. The veteran reported that he drove himself to the appointment. During the interview, the veteran was alert and well oriented to person, place time and circumstance. The veteran made good eye contact and was cooperative. The veteran was ambulatory without devices and there was no atypical psychomotor movement observed. Speech pace, intensity and amplitude were WNL. There was no evidence of expressive or receptive articulation dysfluencies noted. Stream of thought was linear and persistent. Content of thought was logical and goal directed. The veteran denied acute suicidal and homicidal ideation in active or passive forms. This individual understands the consequences of their own behavior. The veteran can interpret simple proverbs adequately. The veteran denied experiencing acute mania, hypomanic, hallucinations (visual, auditory, tactile, olfactory, and gustatory). Affect was mildly dysphoric today. Attention-concentration and general memory appeared grossly intact. 6. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes[X] No 7. Competency CONFIDENTIAL Page 11 of 26 ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes[ ] No 8. Remarks, (including any testing results) if any: --------------------------------------------------- Discussed purpose of the evaluation with the Veteran and limits of confidentiality and veteran was given the opportunity to ask questions and indicated understanding of these limits prior to beginning this exam today.

Good afternoon, I have just received my medical from my C&P, and looking over I am worried that I am going to drop my 50% rate that I am currently at. From other posts, I seem to have gathered that most of the decision of the rating party rely on the Occupational ability of the Veteran. Do they look into other parts of this as well (Personal life, sleep, depression). Or do they solely base judgment on that small paragraph by the psych? I will post my results later when I get home if I can figure it out.

Hello Everyone, I just came back from two C&P exams today. One was the PTSD review and the other was for IBS. Both of these seemed to be a little bit strange. The first was for IBS and took no more than 9 minutes from the time they called my name until I was leaving. The evaluator did ask me about my stomach, when it started all of this and then he told me that it would be service connected... I thought that was a bit strange because they are not the ones that make that decision are they? The PTSD review was rather quick as well. I think that I was in there for 25 minutes. This guy did not seem to care what I was saying except to answer his questions. The first thing that he asked me was about my drinking, and I told him that yes I do drink. However I drink because of the problems that I am having. He just told me to hold on and we would get back to that, and proceeds to ask me how much I drink and how often... Never again bringing up the why do I drink bit. I was trying to explain to him that I do not drink all the time only when I get really aggravated or pissed off with things, or after I have been up for days at a time to get some time away from my mind. The he goes into triggers, and all of that and we get around to what I am doing every day which I tell him I work and I go home. The question following this was "Do you have a job?" I thought from the previous statement that I had told him that I do indeed have a job because that's what I do, go to work and go home? Everything that he asked seemed from a script which Im sure it was but he had no care for my answers or was he paying any attention to what I was saying. At one point I was talking about how I feel bad that I am not doing enough for my kids, because I cant take them out to the things they want. The next question he asked is "Do you have children?" I thought I just told him about my kids? Is this normal, or is this guy just tired of what he is doing and doesn't care what you are saying as long as it is the answer to what he is asking. Just pushing forward for the next question.

Thanks ArNG11, I have been dealing with this since 2005, and nothing seems to work. I use to be a big gym rat, always in the gym working out it was what I did. Now that does not work, I will go to the gym and belong to a 24hr gym. I will go when there are no people and the first sign of someone coming too close to me there I am usually out the door. I have talked with a few people about this but in the end it kind of makes my situation worse. Especially when I see that these individuals have been dealing with these same problems since 1970s... It has almost been 10 years since I was deployed and in my thinking as to where I should be I shouldn't still be driving like I'm driving down a road filled with IEDs, Sleepless nights, and so on... I understand why I am doing these things, I went through the PTSD program with the VA, they explained it all to me. The only source of relief that I have is to avoid every possible situation that may pop up which leaves me alone. Finding others that have the feelings that I have does help. Makes me feel less crazy knowing that I am not the only one that is going through this. For a long time that is how I felt, and did not bring it up with anyone because of this. The VA does nothing to help me, I had a good social worker before but they retired from the VA. Now its all drugs and quit drinking... I go long periods without drinking and I do take the medications that they prescribe for a long while until I realize that I am feeling and doing the exact same as I was when I first started on the medications. A few years back they had me on some anxiety medications that did help me, however they were prescribing that I take way too much of it so I started only taking them as needed. When I told the psych about this, they told me that I was abusing the drug and took me off of it saying that I have abusive tendencies... I am unsure how that is abusive when I was only taking them when I had a situation where I could feel myself getting too worked up rather than 2 every 6 hours as they had wanted. Also, I would only take 1 of them rather than 2. It worked, I brought that up during my last session with the psych and she again stated that it is an abusive pattern because the brain begins to make me feel anxious or angry so that I will take the meds and my brain would continue to increase the frequency on these "attacks" so that I would take more and more of the drug. She says the same with alcohol, I can take it or leave it when I drink its because I have been up for 3 days in a row and I just want to be out for a while. So my track record with mental health at the VA is not the best.... I can not continue to go when I am seen for only 15 minutes and that is all that I am told is to not drink or that I'm a drug abuser when that IS NOT THE CASE!!!.. Sorry for going on and on, just a venting session I guess. Thanks again to everyone for the responses.

Berta, No, I have not tried to increase anything. When I go to the VA for help, they just try to put me on more medications when I told them that I do not want to take them anymore. The ones that they want me to try are the same that may be linked to killing veterans in the past. My degree is in the medical field, and I really did not learn anything to obtain this degree. I just used the knowledge that I learned during my time in the military and somehow pulled through. I have no records of any kind from the post office, I was taken to the office on more than one occasion with the supervisor and my union rep however it was never filed upon because I did not argue with them unless I was right. My current position is with US DOL, I work in a office and enter codes into a computer system and check that certain papers come in on time. So easy a monkey could do it.

Hello again, ARNG11, My exam was done at a VAMC. I do not think that I have any of those records left. I tried getting onto the "Blue Button" site and there are no records for me prior to June of 13. As far as treatment goes, all they seem to care about is if I drink and how much then want to pump me full of meds. I don't want the medication, it isn't helping me with any of my problems. The ones that do (ambien) they do not want me to take that anymore.

Hello again, Thank you for replying to me. Yes, I do have a job now.. I sit alone and I bring up a report of tasks that need to be accomplished each day. The job that I had previous was with the postal service, but I gave that up when I went back to school. I have been wondering if they would accept an article from me, it is some of what has been bothering me. I think that the article was in the New York Times or maybe the NewYorker. I will have to research it, but it seems that the title was "Kill Company" or something of that sort. I was part of this mission as well as many others. PTSD definatly is troublesome for me on a daily basis, other than going to work I do not go out of the house. I still only go places late at night when I do not have to worry about a crowd... The few circumstances where I have been out in a crowded environment have not went well and usually end with me ensuring that I still have my sidearm and moving towards the nearest exit. I am guessing that these are things that I need to bring up at the review. Could it have been that them questioning no CMB or CAB was trying to establish whether I was in a "stressful" situation? Because I do remember that I was asked to write down stressful situations after my C&P exam. Thanks again.

Hello, I have just recently stumbled on this site while searching for answers... About 5-6 years ago, I applied for PTSD compensation. I was awarded something like 10% at that time. During my C&P, two things I was told affected the low ball on this. The first being that I was never awarded my CMB, although I should have been more than once. The second was that I was getting good grades in school while working a full time job. The examiner had questioned why I did not even receive a CAB, I am guessing that he did not know that as a medic this was not something I could have earned. After the time of the Award, I was sent to Walter Reed for a mental health eval, and soon came back to find that I was being booted from the National Guard. My Social worker at the VA gave me a choice of either checking into a mental health clinic or being forced into one. I chose to go on my own... While there I had asked that my rating be increased, and it was soon increased to 50%. NOW, I have another appointment dated for 29th of June. In the last few years, I went back to school using the VocRehab, and finished my degree in 2014. I am worried that they are going to use that same thinking that there is no way that there is any mental impairment in this individual because he was able to finish school with a GPA of 3.4 while being a father of 2 young kids. Please if anyone would have any information for me it would be greatly appreciated.