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HankChinaski

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Posts posted by HankChinaski

  1. Thanks for your feedback. I am a Combat Vet with a Combat Action Badge, so we didn't get into much detail.

     

     

    Sec 9 Part A:

    A. CLAIM TYPE - ORIGINAL, DBQ PSYCH PTSD Initial, the following

           contentions need to be examined - PTSD, The VARO has verified the

           veteran's combat service and the veteran has the following combat medals

           Combat Action Badge,

     

  2. Hello all. I would like to thank all of you for your work on this site. I am a long time lurker, first time poster. I received my C&P Results back and would appreciate any feedback. I understand that there is no way to be fully accurate when trying to guess a rating based off of this information. I am just under immense stress lately as I have watched my life fall apart piece by piece over the last few years. I had good rapport with the interviewer but don't know what to make of some of the things he wrote. Thanks in advance for your insights you all do great work here.

    SECTION I:

                                       ----------

        1. Diagnostic Summary

        ---------------------

        Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria

        based on today's evaluation?

        [X] Yes   [ ] No

       

           ICD code:  309.81

          

        2. Current Diagnoses

        --------------------

        a. Mental Disorder Diagnosis #1: PTSD

               ICD code: 309.81

     

           Mental Disorder Diagnosis #2: Alcohol Abuse, in Remission

               ICD code: 305.03

     

           Mental Disorder Diagnosis #3: No response provided.

     

        b. Medical diagnoses relevant to the understanding or management of the

           Mental Health Disorder (to include TBI): No response provided.

     

        3. Differentiation of symptoms

        ------------------------------

        a. Does the Veteran have more than one mental disorder diagnosed?

           [X] Yes   [ ] No

          

        b. Is it possible to differentiate what symptom(s) is/are attributable to

           each diagnosis?

           [X] Yes   [ ] No   [ ] Not applicable (N/A)

          

               If yes, list which symptoms are attributable to each diagnosis and

               discuss whether there is any clinical association between these

               diagnoses:

                  Currently, no symptoms are attributed to alcohol abuse, because

                  alcohol abuse is in remission. All symptoms are attributable to

                  PTSD.

                 

        c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?

           [ ] Yes   [X] No   [ ] 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 reduced reliability and

               productivity

     

        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?

           [X] Yes   [ ] No   [ ] No other mental disorder has been diagnosed

          

               If yes, list which portion of the indicated level of occupational and

               social impairment is attributable to each diagnosis:

                  Currently, no occupational or social impairment is attributed to

                  alcohol abuse, because alcohol abuse is in remission. All

                  occupational and social impairment is attributable to PTSD.

                 

        c. If a diagnosis of TBI exists, is it possible to differentiate what

    portion

           of the occupational and social impairment indicated above is caused by

    the

           TBI?

           [ ] Yes   [ ] No   [X] No diagnosis of TBI

           

                                       SECTION II:

                                       -----------

                                   Clinical Findings:

                                   ------------------

        1. Evidence review

        ------------------

        In order to provide an accurate medical opinion, the Veteran's claims folder

        must be reviewed.

       

        a. Medical record review:

        -------------------------

        Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed?

        [X] Yes   [ ] No

       

        Was the Veteran's VA claims file (hard copy paper C-file) reviewed?

        [ ] Yes   [X] No

       

          If yes, list any records that were reviewed but were not included in the

          Veteran's VA claims file:

           

          If no, check all records reviewed:

         

            [X] Military service treatment records

            [ ] Military service personnel records

            [ ] Military enlistment examination

            [ ] Military separation examination

            [ ] Military post-deployment questionnaire

            [X] Department of Defense Form 214 Separation Documents

            [X] Veterans Health Administration medical records (VA treatment

    records)

            [ ] Civilian medical records

            [ ] Interviews with collateral witnesses (family and others who have

                known the Veteran before and after military service)

            [ ] No records were reviewed

            [X] Other:

                  MTR - govt and nongovt, VA documents and forms,

                 

        b. Was pertinent information from collateral sources reviewed?

        [X] Yes   [ ] No

       

          If yes, describe:

            Buddy or lay statement from who was Veteran's

            ex-girlfriend,

           

        2. History

        ----------

        a. Relevant Social/Marital/Family history (pre-military, military, and

           post-military):

              Relevant social history,

               birthplace,

              (mostly) happy childhood memories,

              (-) homeless currently,

              (-) rent currently,

              (+) own currently,

              (#0) of household occupants in addition to Veteran,

              (-) close friends, Veteran states that he feels estangement from

              others, he reached out to one of his military friends two weeks ago,

              this was the first tome to do that for one year, Veteran used to be

              active on Facebook, but he is no longer active on facebook, he began

              experiencing the idea that his thoughts were being communicated in a

              certain way by others,

              (-) attend social activities,

              (+) hobbies or interests, Video games, all kinds, grand theft auto,

    mad

              and football, wrestling, Veteran used to be an avid sports fan, he

    used

              to know the lines of college and professional football teams, he does

              not do that anymore,

     

              Relevant marital history,

              (S) civil status, he used to have a girlfriend, they were together for

              3 years, he used to yell and scream at her, he states that it took

              everything within him to keep from hitting her, but he never hit her,

              she left and she did not come back; Veteran states he never assaulted

              his ex-girlfriend prior to their breakup; alternatively, he states

    that

              he choked his girlfriend in the heat of the moment 2 times, but she

    did

              not pass out,

              (#0) number of marriages,

              (#0) number of divorces,

              (#1) number of childrren  y/o son, Veteran's son's mother does not

              allow Veteran's son to have unsupervised visits with Veteran,

     

              Relevant family history,   

              (-) emotional or mental problems,

              (+) heart disease, PGF has CAD and h/o CABG,

              (+) both parents living,

              (-) close to them, he rarely talks with them,

              (#1) siblings living, 1 sister,

              (-) close to her, they have not spoken for 2 years 

     

              Pre-military, Veteran states he killed his first animal at 10 y/o,

              which was a deer, and he gutted and cleaned it at that age.

              Post-military, Veteran states that he carries a gun wherever he goes.

              He was closer to his family and other people pre-military and

    military.

              Post-military, he has become distant with family and friends. His

              parents live inand have a home there

    .

              Post-military, after finishing his contract work in which he mostly

              worked on military instillations for the federal government, he lived

              with his parents for 2 months in  He moved f

              to  to go to College in 2012. He did not start having problems

              from symptoms of PTSD until after he finished his contract work, which

              was more like being in, rather than out of, the military, and began

              living more as a civilian.

             

             

        b. Relevant Occupational and Educational history (pre-military, military,

    and

           post-military):

              Relevant occupational history,

               

              (-) currently working outside the home,

              (2012) year last worked outside the home,

              (F) P = part time, F = fulltime,

              (security) type of work,

              (nothing) current source of income, Veteran indicates that he has used

              up his savings and now he is behind on many of his bills,

              (+) emotional or mental symptoms associated with occupational

    problems,

              Veteran was fired from his last two jobs,

     

              Relevant educational history,

              (+) learning difficulties,

              (-) learning disabilities,

              (he has two years of college) level of education,

              (+) emotional or mental symptoms associated with educational problems,

              difficulty concentrating,

     

              Veteran graduated from HS at 18 y/o. He went to college for one year.

              He worked seasonal work, restaurant work, cabinet factory, met a

    woman,

              had a son, was in and out of legal troubles, and entered the USA at 23

              y/o. He was discharged from the USA at 27 y/o. He worked for

    as

              a regional supervisor for 5 years.

    . ;

    Veteran

              states he was a distinguished soldier during basic training. He became

              the best mechanic while in stationed in Germanny. He was a

    leader

              and NCO in the Ranger battalion. He did not get DUIs and he did not

    get

              into fights. Veteran states that he laughed at the PTSD symptoms

              checklist when he first came back from his deployment to Iraq. but now

              he cannot get a job due to such symptoms. He has not been able to hold

              down a job for the past 3 years.

             

             

        c. Relevant Mental Health history, to include prescribed medications and

           family mental health (pre-military, military, and post-military):

              Relevant mental health history,

              (-) mental health care before military service,

              (-) mental health care during military service,

              (+) mental health care after military service,

              (#0) previous suicide attempt(s),

              (#0) previous hospitalization on psychiatric ward(s),

              (#0) previous court orders for involuntary treatment,

              (+) currently seeing a provider for the purpose of medication

              management,

              (-) currently attending individual psychotherapy and/or group therapy,

              he used to go to groups, he lost his driver's license, therefore he

    has

              not been going, because it is difficult getting there,

              (+) h/o severe emotional trauma,

              (-) h/o head trauma,

              (-) h/o evaluation for TBI,

              (+) current emotional or mental problems,

              (+) mood often blue or sad,

              (+) anger,

              (+) h/o ever experiencing seven or more days of manic excitement

    (i.e.,

              abnormally, discretely, and persistently elevated, expansive, or

              irritable mood), decreased need for sleep, racing thoughts, or

              pressured speech, Veteran states that he has gone for many days

    without

              sleeping, he would keep busy because he was unable to sleep, he used

    to

              self-medicate insomnia by drinking alcohol to the point of blacking

              out, he has h/o anxiety and paranoia, racing thoughts, increased goal

              directed behavior (in terms of playing a video game), agitation (in

              terms of pacing around the apartment), he was not talking faster or

              more than usual, no significant change in self-esteem or grandiosity,

              no significant distractability, (+) behavior for the purpose of

              pleasure with potentially painful consequences (alcohol problem),

              (+) h/o of hallucinations, he used to have these when he was drinking

              alcohol, he used to have alcohol hallucinosis, he has been sober since

              June 2015,

              (+) h/o delusions, he has h/o delusions of reference,

                 

              Prescribed medications,

              List, propranolol, sertraline, and trazodone; he was remotely taking

              aripiprazole and valproate, he was taking quetiapine when going

    through

              inpatient treatment for alcohol abuse, he has h/o risperidone and

              risperidone-associated akathisia, 

              (+) adverse events with one or more of these, his sleep is too deep

              with trazodone, then he has disturbing dreams, then he cannot wake up

              out of these disturbing dreams, because his sleep is too deep,

              (-) beneficial effects with each of these, propranolol was previously

              helpful while he was on risperidone to decrease the akathisia

              associated with risperidone, sertraline is not yet producing a

              beneficial effect,

     

              Family mental health,

              Please see above under "relevant family history."

             

             

        d. Relevant Legal and Behavioral history (pre-military, military, and

           post-military):

              Relevant legal history,

              (+) symptoms associated with legal problems,

              (+) h/o arrests for assault, battery, or violence,   

              (+) h/o arrests, convictions, or sentencing (to jail or prison),

              (-) currently on parole or probation,

              (-) current conservator or guardian,

              (+) h/o DUI, #1,

     

              Relevant behavioral history,

              (+) symptoms associated with behavioral problems, Veteran states that

              he does not talk with anyone, he does not do anything, he enrolled in

              school, he cannot deal with that anymore, he dropped out of College, he

              cannot deal with the people there, he believes he is viewed by others

              as a time bomb, after he was arrested for eluding an officer.       

              (yesterday) last time to be in a heated argument with another person,

              (June, 2015) last time that to be in a physical altercation with

              another person,   

              (poor) quality of sleep generally,     

     

              Pre-military: Veteran had reckless driving charges and assault with a

              deadly weapon charges prior to USA service. He was charged with

              reckless driving. He ended up doi of house arrest for

              reckless driving. He took assault with a deadly weapon to a jury who

              did not find him guilty as charged. It was determined that he was

              defending himself, and he was absolved of any wrong doing. Military:

              Veteran has one negative counseling statement for missing formation

    one

              morning due to oversleeping when they had a power outage, when his

              roommate was on leave, but other than that he did not have any other

              LOCs, no LORs, no Article 15s, and no other non-judicial or judicial

              punishments.

     

              Postmilitary: Veteran was arrested in 2013, and he was placed in a

     

     

              mental health safe cell while in jail, because he drove off from a

              traffic stop away from an officer. He was initially written up for

              felony eluding, but the charges were plea bargained down to a

              misdemeanor. Veteran  has pending charges. He has a warrant out for

    his

              arrest. This is for criminal speeding (99 mph in a 45 mph zone).

             

        e. Relevant Substance abuse history (pre-military, military, and

           post-military):

              (+) tobacco during past 30 days,

              (today) when last used,

              (-) alcohol during past 30 days,

              (July 2015) when last used, he got out of treatment June 8th, he

              relapsed in July, for 2 days,

              (+) h/o alcohol problem or alcohol abuse,

              (-) illicit drugs during past 30 days,

              (prior to March, 2014) when last used, he has not used spice

    (synthetic

              MJ since prior to his first inpatient treatment program,

              (+) h/o inpatient or outpatient treatment for alcohol or illicit

              substances, 2 times,

              (+) currently attending AA, NA, or other support groups, Veteran does

              not believe that he suffers from alcoholism,

     

              Veteran smoked a joint of MJ when he graduated from HS, he did not

              smoke MJ during the military, and he smoked MJ less than 6 times after

              the military. He drank alcohol 2 times during HS, he was a social

              drinker during college and the military, while in Germany, and he became

              an alcoholic after the military. He was drinking a lot with his

              friends, at the time of his deployment to Gerrmany, from dusk until dawn.

              Other times, he could drink until 2 AM, go to sleep, wake up at 5 AM,

              go to PT, and be fine, while in the regular Army battalion, but he was

              not able to keep that lifestyle while in the Ranger battalion, because

              they put him through too much. Veteran does not like talking with

              anyone about anything, even the weather. Veteran feels uncomfortable

              when in large groups of people. This triggers intense urges for

              drinking alcohol. Living with his emotions and feelings is more

              difficult without alcohol than with alcohol.

             

             

        f. Other, if any:

              No response provided.

             

        3. Stressors

        ------------

        Describe one or more specific stressor event(s) the Veteran considers

        traumatic (may be pre-military, military, or post-military):

       

        a. Stressor #1: 1. Military Combat Trauma (Veteran observed traumatic events

              as experienced by others, including seeing a person get his face shot

              off, seeing people with their heads cut off, and seeing a dead body,

    he

              claims he saw a US missile hit a minivan carrying an entire family,)

             

              Does this stressor meet Criterion A (i.e., is it adequate to support

              the diagnosis of PTSD)?

              [X] Yes  [ ] No

             

              Is the stressor related to the Veteran's fear of hostile military or

              terrorist activity?

              [X] Yes  [ ] No

             

              Is the stressor related to personal assault, e.g. military sexual

              trauma?

              [ ] Yes  [X] No

             

        b. Stressor #2: No response provided.

       

        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] Witnessing, in person, the traumatic event(s) as they occurred to

                  others

     

           Criterion B: Presence of (one or more) of the following intrusion

    symptoms

                        associated with the traumatic event(s), beginning after the

                        traumatic event(s) occurred:

              [X] Recurrent, involuntary, and intrusive distressing memories of the

                  traumatic event(s).

              [X] Recurrent distressing dreams in which the content and/or affect of

                  the dream are related to the traumatic event(s).

              [X] 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).

              [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 external reminders (people,

                  places, conversations, activities, objects, situations) that

    arouse

                  distressing memories, thoughts, or feelings about or closely

                  associated with the traumatic event(s).

     

           Criterion D: Negative alterations in cognitions and mood associated with

                        the traumatic event(s), beginning or worsening after the

                        traumatic event(s) occurred, as evidenced by two (or more)

    of

                        the following:

              [X] Persistent and exaggerated negative beliefs or expectations about

                  oneself, others, or the world (e.g., "I am bad,: "No one can be

                  trusted,: "The world is completely dangerous,: "My whole nervous

                  system is permanently ruined").

              [X] Persistent, distorted cognitions about the cause or consequences

    of

                  the traumatic event(s) that lead to the individual to blame

                  himself/herself or others.

              [X] Persistent negative emotional state (e.g., fear, horror, anger,

                  guilt, or shame).

              [X] Markedly diminished interest or participation in significant

                  activities.

              [X] Feelings of detachment or estrangement from others.

              [X] Persistent inability to experience positive emotions (e.g.,

                  inability to experience happiness, satisfaction, or loving

                  feelings.)

     

           Criterion E: Marked alterations in arousal and reactivity associated with

                        the traumatic event(s), beginning or worsening after the

                        traumatic event(s) occurred, as evidenced by two (or more)

    of

                        the following:

              [X] Irritable behavior and angry outbursts (with little or no

                  provocation) typically expressed as verbal or physical aggression

                  toward people or objects.

              [X] Reckless or self-destructive behavior.

              [X] Hypervigilance.

              [X] Exaggerated startle response.

              [X] Problems with concentration.

              [X] Sleep disturbance (e.g., difficulty falling or staying asleep or

                  restless sleep).

     

           Criterion F:

     

     

              [X] Duration of the disturbance (Criteria B, C, D, and E) is more

    than

                  1 month.

                 

           Criterion G:

              [X] The disturbance causes clinically significant distress or

                  impairment in social, occupational, or other important areas of

                  functioning.

                 

           Criterion H:

              [X] The disturbance is not attributable to the physiological effects

    of

                  a substance (e.g., medication, alcohol) or another medical

                  condition.

                 

           Criterion I: Which stressor(s) contributed to the Veteran's PTSD

                        diagnosis?:

              [X] Stressor #1

     

        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] Panic attacks that occur weekly or less often

           [X] Chronic sleep impairment

           [X] Difficulty in establishing and maintaining effective work and social

               relationships

           [X] Inability to establish and maintain effective relationships

     

        6. Behavioral Observations

        --------------------------

        Appearance - attire is summertime casual, grooming is average, and

    presently,

        the veteran does not appear to intermittently be in distress as he

        intermittently discusses his taaumas.

        Behavior - eye contact is intermittent, and speech is of unremarkable rate,

        rhythm, volume, prosody, and articulation. Speech contains profanity in many

        sentences.

        Comportment suggests that the veteran gets along adequately with this writer.

     

        Affect is neutral.

        Thought processes are logical, linear, and goal-oriented. Presently, the

        veteran does not have a formal thought disorder.

        Thought content is without homicidal ideation or suicidal ideation.

        Perceptions - the veteran presently does not appear to be responding to

        internal stimuli.

        Insight is fair. Judgment is fair.

        Psychomotor activity - Veteran becomes agitated when talking about his

        experiences in Iraq.

        Muscular observation shows absence of focal motor deficits.

        Cognitions are grossly intact.

        Abstractions demonstrate at least average capacity for logical reasoning and

        systematic thought.

     

        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

        --------------------------------------------------

           REQUESTS AND FINDINGS

     

           A. CLAIM TYPE - ORIGINAL, DBQ PSYCH PTSD Initial, the following

           contentions need to be examined - PTSD, The VARO has verified the

           veteran's combat service and the veteran has the following combat medals

           Combat Action Badge,

     

           Veteran is a y/o divorced, unemployed EA who served in a Ranger

           battalion while serving in the USA and experienced military combat while

           serving in Iraq. Veteran served in the USA from 2003 to 2007.

           He was in the motor pool division of the Ranger battalion. He observed

           traumatic events as experienced by others, including seeing a person get

           his face shot off, seeing people with their heads cut off, and seeing a

           dead body. He claims he saw a US missile hit a minivan carrying an entire

           family, because the US forces wanted to kill one enemy combatant inside

           the minivan. Veteran saw a VAMC on

           10/01/2014, who diagnosed him with and treated him for PTSD. Veteran

           experienced military combat stressors. Currently, at night he has dreams,

           in which he cannot get his gun to shoot, because it will not fire. During

           the day, he has uncontrollable thoughts. He visions someone getting shot.

           Either he is shooting at the person getting shot or groups of people are

           shooting at the person getting shot. He hears someone getting shot. He

           states that it makes a very distinct sound. Thunderstorms, trigger he to

           "lose it," whereby he becomes diaphoretic, comes to, and finds himself on

           the floor in the prone position, after he has pulled his ex-girlfriend to

           the floor with him. He has trouble sleeping for one week following such

           events. Firecrackers on the 4th of July trigger he to "lose it," whereby

           he finds he has pulled his son to the ground with him, causing abrasions

           to his son's B/L knees. Veteran states that he avoids people, because

    when

           they find out that he is an Iraq War veteran, then they have a tendency

    to

           talk with him and ask him questions about his experiences. He states that

           he hates it when they state that they understand, and he states that they

           do not understand, because they were not there. Veteran voices his

           suspiciousness and states that as soon as groups of people at AZU, where

           he was in school, and groups of people where he has been employed find

    out

           that he has issues, then people talk about him and he is talked about.

           Veteran states that people make jokes as to when would he be going postal

           and start shooting up the office. He states that he knows that others are

           talking about him, because when he goes into a room, then everyone stops

           talking.  Veteran states that once people become uncomfortable with

           someone, then they plot and scheme. Veteran used to be a baseball player,

           where he learned that being calm and controlled worked to his advantage,

           but he states that he has lost the ability of being calm and controlled

    in

           order to work to his advantage.  He recognizes that he has a "short fuse"

           and can suddenly go from neutral to angry, agitated, and combative with

           the right cue, as in someone older bossing him around and telling him

    what

           to do. He states "[he] wants to punch out a window over nothing." Veteran

           states that if he applies for a supervisor position, then he is offered

    an

           entry level position instead. He states in the past he was able to deal

           with supervisors, but now he cannot deal with supervisors.  One of his

           supervisors was talking to him as though he was a child, then Veteran

    took

           his left hand, placed it across his supervisors neck, and pushed him

           against the wall. His supervisor "flipped out," talked about suing him,

           and talked about pressing charges. Then Veteran was immediately let go.

    He

           was told that they were going to consider it as though he was never

    hired.

           Veteran admits to being high strung and states that he used to be able to

           filter out supervisors telling him what to do kinds of stressors, but he

           is no longer able to do that. He states that yesterday when he took a

           urine drug test for a job that he would like to get, after waiting for 20

           minutes and watching the receptionist doing one thing or another on the

           computer, he became irate and confrontational. Veteran denies suicidal

           ideation. He states his father's sister's husband killed himself.

          

    Veteran states that he would never do that. He would not do it on

           account of his mother and his son. Work impairments include being up for

    3

           nights at a time without sleeping, then he falls asleep while he is doing

     

     

           something routine, such as tying his shoes. He states that he has missed

    a

           few jobs on account of this problem. Veteran meets the following DSM 5

           criteria for PTSD.

     

           1.) Trauma,

           (+) Directly experiencing the events,

           (+) Witnessing the events as they occurred to others,

           (-) Learning that the traumatic events occurred to someone close,

     

           2.) re-experiencing,

           (+) dreams or nightmares, 

           (+) flashbacks,

           (-) illusions or hallucinations,

           (+) images, perceptions, or thoughts,

           (+) triggers cause emotional and mental distress,

     

           3.) avoidance,

           (-) activities, he enjoyed American Sniper immensely, but he states that

           this stirred up emotions and feelings,

           (+) conversations, he avoids conversations with his Ranger friends,

           (-) feelings,

           (+) people, he avoids seeing his Ranger friends,

           (+) places, he states he does not like the VA, people came back without

           eyes and limbs, he came back with emotional and mental symptoms, 

           (-) thoughts,

     

           4. negative feelings or thoughts, 

           (+) anhedonia,

           (+) decreased interest or participation in activities,

           (+) distorted cognitions about the cause or consequences of the events,

    he

           states that the entire Gulf War was "&$,"

           (+) feeling detached and estranged,

           (-) forgetting details about the events,

           (+) negative beliefs about himself, others, or the world, he states that

           the US federal government is "&$,"

           (+) negative emotions,

     

           5.) Altered arousal and reactivity

           (+) angry outbursts,

           (+) irritable behavior,

           (+) hypervigilance,

           (+) exaggerated startle,

           (+) recklessness,

           (+) self-destructiveness,

           (-) concentration problem, if interested, then he can concentrate really

           well, if not interested, then he cannot concentrate very well,

           (+) sleep disturbance,

     

           6.) (+) long-term duration,

     

           7.) (+) dysfunction,

     

           8.) (+) not due to a medical illness or substance,

     

           Veteran has decreased productivity at work, because he has emotional and

           mental symptoms affecting his ability to work, interpersonal problems

           affecting his ability to get along well with others, and authority and

           submission problems affecting his ability to get along well with

           supervisors. These problems are secondary to symptoms of PTDS. They

           occasionally, but not continuously, affect reliability. Otherwise, his

           ability to adapt to change, maintain a regular work schedule, pay

           attention, concentrate, and reason, show up for the job, maintain himself

           on the job, and complete the job are not impaired. Alcohol abuse is in

           remission. Functional limitations include working under a less than

           supportive supervisor, working around any more than 2 or 3 other people,

           and working indoors.

     

           B. ELECTRONIC CLAIMS FOLDER AVAILABLE, review Veteran's electronic folder

           in VBMS and state that it was reviewed.

           Veteran's electronic folder in VBMS and was reviewed.

     

           C. If more than one mental disorder is diagnosed, comment on their

           relationship to one another.

     

           Alcohol abuse is secondary to insomnia, which is secondary to PTSD.

           Alcohol abuse is in remission.

     

           D. If more than one mental disorder is diagnosed, state which symptoms

    are

           attributed to each disorder.

           Currently, no symptoms are attributed to alcohol abuse, because alcohol

           abuse is in remission.

          

          

        NOTE: VA may request additional medical information, including additional

        examinations if necessary to complete VA's review of the Veteran's

        application.

     

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