sauerkraut1977

Thank you for the info. Knowing the VA I figured it could not be rated again since i already have a rating for my feet.

Hi all. Just found out today that i have osteoarthritus in both of my feet. I am currently SC for bilateral plantar fascitis at 30% which i've had an appeal for 18 months and waiting on the hearing to be rescheduled. About to get stem cell Injections so sure i will get 50% one of these years. My question is this... can i get SC also for the arthritis? Thanks in advance for amy help!!

Sure wish I kept my mouth shut. The VA wants to blame everything on stuff that happened before the military instead of focusing on the combat and how it changed my life forever. Hope the system gets it shit together one of these days and stops putting us though hell to just get the benefits we deserve and are entitled to. Take care.

Thank you all for the feedback. I am SC 30% for Anxiety order and went ro the VA and they diagnosed me with cronic PTSD so thatvis why i filed a new claim and asked for an increase. Also because they rated the anxiety as PTSD i wanted my disability diagnosis changed to PTSD. I went to a benefits fair today and talked personally with someone from the regional office and she said all the shit he put in his notes with what he thinks the percenages should be not only was wrong but should have no affect on the rating. Section 3 for rating purposes he checked every box and and admitted the social imparment so in her option i should get a raise to 50 or 70. But as we all know with the VA also need to be prepared for another appeal if they tey to lower it. He conceded to the current diagnosis and i should hopefully stay at 30. We will see. Claim is in the preparation for decision. Update: no increase for MH and 10% for Gerds. Reconsideration filed for Gerds since got the Barretts esophagus disease diagnosis after claim was decided. New claim for PTSD filed along with Gulf War syndrome and rhe Barretts. Stay tuned for more VA fun to come. Thank you all and best wishes in your fight.

Thank you all for the feedback. I am SC 30% for Anxiety order and went ro the VA and they diagnosed me with cronic PTSD so thatvis why i filed a new claim and asked for an increase. Also because they rated the anxiety as PTSD i wanted my disability diagnosis changed to PTSD. I went to a benefits fair today and talked personally with someone from the regional office and she said all the shit he put in his notes with what he thinks the percenages should be not only was wrong but should have no affect on the rating. Section 3 for rating purposes he checked every box and and admitted the social imparment so in her option i should get a raise to 50 or 70. But as we all know with the VA also need to be prepared for another appeal if they tey to lower it. He conceded to the current diagnosis and i should hopefully stay at 30. We will see. Claim is in the preparstion for decision phase with June 30th date.

Hi all. Just got my exam result for Hugh Blood pressure and Gastero GI. Need help interperating these results as I have never know how SC Works for these. Thank you all on advance and I apperciate your Assistance. LOCAL TITLE: COMP & PEN GENERAL MEDICAL EXAM STANDARD TITLE: C & P EXAMINATION NOTE DATE OF NOTE: MAY 09, 2017@08:30 ENTRY DATE: MAY 15, 2017@10:33:59 AUTHOR: AZMABALANI,GITI E EXP COSIGNER: URGENCY: STATUS: COMPLETED Hypertension Disability Benefits Questionnaire Name of patient/Veteran: Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with hypertension or isolated systolic hypertension based on the following criteria: [X] Yes [ ] No [X] Hypertension Date of diagnosis: 03/2017 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's hypertension condition (brief summary): Veteran reports diagnosis of high BP since March and taking medication. He denies stroke, hypertensive emergency. b. Does the Veteran's treatment plan include taking continuous medication for hypertension or isolated systolic hypertension? [X] Yes [ ] No If yes, list only those medications used for the diagnosed conditions: Lisinopril 10mg Daily c. Was the Veteran's initial diagnosis of hypertension or isolated systolic hypertension confirmed by blood pressure (BP) readings taken 2 or more times on at least 3 different days? [ ] Yes [X] No [ ] Unknown Reading 1: 148 / 100 Date: 03/08/2017 Reading 1: 119 / 68 Date: 3/28/2017 Reading 1: 133 / 94 Date: 05/08/2017 d. Does the Veteran have a history of a diastolic BP elevation to predominantly 100 or more? No response provided. 3. Current blood pressure readings ---------------------------------- Systolic Diastolic Blood pressure reading 1: 133 / 94 Date: 5/8/2017 Average Blood Pressure Reading: Calculating / Calculating 4. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to the conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No c. Comments, if any: No response provided 5. Functional impact -------------------- Does the Veteran's hypertension or isolated systolic hypertension impact his or her ability to work? [ ] Yes [X] No 6. Remarks, if any ------------------ No remarks provided. **************************************************************************** Esophageal Conditions (Including gastroesophageal reflux disease (GERD), hiatal hernia and other esophageal disorders) Disability Benefits Questionnaire Name of patient/Veteran: Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS Diagnosis --------- Does the Veteran now have or has he/she ever been diagnosed with an esophageal condition? Yes Gastroesophageal reflux disease (GERD) ICD code: Date of diagnosis: 2017 Medical history --------------- Description of the history (including onset and course) of the Veteran's esophageal conditions: Veteran was prescribed PPI for report of acid reflux and chest discomfort in 2017. Review of STRs shows several occasion of nausea nd gastroenteritis. No H-Pylori test in records. History of alcohol dependency Does the Veteran's treatment plan include taking continuous medication for the diagnosed condition? Yes Medications used for the diagnosed condition: Prilosec 40mg daily Signs and symptoms ------------------ Does the Veteran have any of the following signs or symptoms due to any esophageal conditions (including GERD)? Yes Sign and Symptoms: Reflux Pain Substernal Shoulder Sleep disturbance caused by esophageal reflux Frequency of symptom recurrence per year: 4 or more Average duration of episodes of symptoms: Less than 1 day Nausea Frequency of episodes of nausea per year: 4 or more Average duration of episodes of nausea: Less than 1 day Esophageal stricture, spasm and diverticula ------------------------------------------- Does the Veteran have an esophageal stricture, spasm of esophagus (cardiospasm or achalasia), or an acquired diverticulum of the esophagus? No Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------------- Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? No Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? No Diagnostic Testing ------------------ Have diagnostic imaging studies or other diagnostic procedures been performed? Yes Diagnostic Testing Preformed: Esophagram (barium swallow) Date: Results: ordered Has laboratory testing been performed? Yes CBC Date of test: 03/28/2017 Hemoglobin: 14.3 Hematocrit: 41.9 White blood cell count: 9.2 Platelets: 375,000 Helicobacter pylori Date of test: 5/9/2017 Results: NEGATIVE Are there any other significant diagnostic test findings and/or results? No Functional impact ----------------- Do any of the Veteran's esophageal conditions i mpact on his or her ability to work? No Remarks, if any: No response provided ----------------- NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. **************************************************************************** Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS MEDICAL OPINION SUMMARY ----------------------- MEDICAL OPINION REQUEST TYPE OF MEDICAL OPINION REQUESTED: Secondary Service connection. OPINION REQUESTED: Secondary Service Connection. Is the Veteran's Gastrointestinal problems at least as likely as not (50 percent or greater probability) proximately due to or the result of Unspecified anxiety disorder with features of obsessive compulsive disorder and other trauma related disorder (also claimed as posttraumatic stress disorder)? Rationale must be provided in the appropriate section. **OPINION: It is at least as likley as not that the veteran's Acid reflux is related to Unspecified anxiety disorder with features of obsessive compulsive disorder and other trauma related disorder (also claimed as posttraumatic stress disorder). -Review of medical literature supports a close correlation between anxiety and symptoms of acid reflux. " Anxiety and depression increase GERD-related symptoms reported in population-based studies . Thus, it has been proposed that patients who did not respond to PPI therapy are more likely to have psychosocial comorbidity than those who were successfully treated with a PPI" /es/ GITI E AZMABALANI, D.O. Staff Physician, Compensation & Pension Signed: 05/15/2017 10:34 Date/Time: 09 May 2017 @ 0830 Note Title: COMP & PEN GENERAL MEDICAL EXAM LOCAL TITLE: COMP & PEN GENERAL MEDICAL EXAM STANDARD TITLE: C & P EXAMINATION NOTE DATE OF NOTE: MAY 09, 2017@08:30 ENTRY DATE: MAY 15, 2017@10:30:14 AUTHOR: AZMABALANI,GITI E EXP COSIGNER: URGENCY: STATUS: COMPLETED Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS MEDICAL OPINION SUMMARY ----------------------- EDICAL OPINION REQUEST TYPE OF MEDICAL OPINION REQUESTED: Secondary Service connection. OPINION REQUESTED: Secondary Service Connection. Is the Veteran's Hypertension at least as likely as not (50 percent or greater probability) proximately due to or the result of Unspecified anxiety disorder with features of obsessive compulsive disorder and other trauma related disorder (also claimed as posttraumatic stress disorder)? OPINION: It is less likley as not that the veteran's HTN diagnosed at age 39 is related to or the result of Unspecified anxiety disorder with features of obsessive compulsive disorder and other trauma related disorder (also claimed as posttraumatic stress disorder). * Veteran has stage one HTN based on VA PCP findings of two occasions of diastolic BP elevation of 90-100 from 3/2017 to 5/2017. Anxiety could cause secondary HTN but the HTN is paroxysmal, abrupt elevation of blood pressure (which can be greater than 200/110 mmHg). This veteran does not have any report of paroxysmal elevation of BP. Secondary causes of HTN should be performed only in patients with an unusual presentation of hypertension (new onset at an especially young or especially old age, presentation with stage 2 hypertension, abrupt onset of hypertension in a patient with previously normal blood pressure, resistant hypertension) or in those with a clinical clue for a specific cause of hypertension, such as an abdominal bruit (suggestive of renovascular hypertension) or low serum potassium (suggestive of primary aldosteronism). This veteran does not have any of the above indications. /es/ GITI E AZMABALANI, D.O. Staff Physician, Compensation & Pension

Here is some more info now that Benefits decided to work. Disabilities Claimed: PTSD (post traumatic stress disorder) (related to: PTSD - Combat) (New), Major depression (related to: PTSD - Combat) (New), Sleep disturbances (related to: PTSD - Combat) (New), Hypertension (related to: PTSD - Non-Combat) (New), Gastrointestinal problems (related to: PTSD - Non-Combat) (New), Hyperlipidemia (related to: PTSD - Non-Combat) (New), Adjustment reaction (New), Unemployability (New), Unspecified anxiety disorder with features of obsessive compulsive disorder and other trauma related disorder ( claimed as posttraumatic stress disorder (Increase)

Thanks Berta. I received a chronic ptsd diagnosis from the va in houston and thats why i had to drop my Appeal and File a new claim. I was a C&P and from a nom MH doc and she Believer he was Off case due to putting oercentage values in the exam. My whole Argument on this is i am at 30% and File an increase due to further va diagnosis and Erlasse back on alcohol and the fact i can no longer work and have not for a Year. Urs starting to look like i am going to have to find a ins die to go to to get this right. I have been battlibg this for 2 years now and it is stating to get Every oid. Thanks for the responces so far and please Keep thw replies comming.

Need some hell understanding this egal for increase and na Diagnose Ptsd. Thank you! LOCAL TITLE: COMP & PEN MENTAL HEALTH/PSYCHOLOGY EXAM STANDARD TITLE: PSYCHOLOGY C & P EXAMINATION CONSULT DATE OF NOTE: MAY 03, 2017@09:30 ENTRY DATE: MAY 05, 2017@17:31:30 AUTHOR: DAYTON,GREGORY D EXP COSIGNER: URGENCY: STATUS: COMPLETED Mental Disorders (other than PTSD and Eating Disorders) Disability Benefits Questionnaire Name of patient/Veteran: Xxxxx, XXXX Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No SECTION I: ---------- 1. Diagnosis ------------ a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)? [X] Yes [ ] No If the Veteran currently has one or more mental disorders that conform to DSM-5 criteria, provide all diagnoses: Mental Disorder Diagnosis #1: Other Unspecified Anxiety Disorder Mental Disorder Diagnosis #2: Alcohol Use Disorder Mental Disorder Diagnosis #3: Adjustment Disorder with Mixed Disturbance of Emotions and Conduct b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): None 2. 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: Other unspecified anxiety disorder: anxiety. Alcohol use disorder: impaired judgment, depressed mood, difficulty establishing and maintaining effective work and social relationships, suspiciousness, chronic sleep impairment. Adjusmtent disorder with mixed disturbance of emotions and conduct: depressed mood, difficulty establishing and maintaining effective work and social relationships, suspiciousness, chronic sleep impairment. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 3. 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: This writer is of the opinion that, in total, his service-connected Other Unspecified Anxiety Disorder accounts for no more than 20% of his current occupational and social impairment. Non- service connected Alcohol Use Disorder and Adjustment Disorder with Mixed Disturbance of Emotions and Conduct, account for the remaining 80% (40% each). 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 ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS [X] Other (please identify other evidence reviewed): Virtual VA and VBMS. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military military, and post-military): See the 11/2/15 Contract MH C&P report for background information. He is currently living in Patriot House, the "homeless program." He has never married and is not dating. b. Relevant Occupational and Educational history (pre-military, military, and post-military): See the 11/2/15 Contract MH C&P report for background information. The veteran has not been employed since working as a forklift operator for Coca Cola between January and May 2016. He told this writer he was fired for difficulty getting along with others; but has previously testified he was terminated when his legal history was uncovered. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post- military): See the 11/2/15 Contract MH C&P report for background information. During this review period, the veteran was seen at the Houston VA until October 2016, before coming to Dallas. Notes indicate "drinking to self medicate his anxiety"; "being fearful that he will have to go back to prison"; "expresses frustration at the many challenges he has faced since release from prison"; and "tendency to return to drinking when stressed." He was prescribed sertraline in Houston. He admitted to providers in Houston his stepmother "made him" go to a mental health professional several times during childhood; and that he was prescribed ritalin as a child. "He reported a two week period during his deployment to Kuwait when his until was constantly relocating and he feared being attacked." He said he'd twice attempted suicide: when he was told by the Army they were going to court martial him; and when he was sentenced to prison in 2007. When he was first seen in Dallas, he was homeless and unemployed, had run out of his mediation from Houston VA providers, and was experiencing anxiety and panic as well as some nightmares. He was also drinking hard liquor 3-4 times a week. He reported being diagnosed with PTSD in Houston, but apparently related to his history of sexual abuse for years as a child. He also reported MST, and that his little s ister's death of SIDS when he was 5 "significantly affected his mother (committed), which in turn affected him." He was started on sertraline, doxipin, and disulfiram, and referred for therapy. As of April 2017, the veteran was enrolled in the Dallas VA Community Based Employment Program. Today, the veteran described functioning better- and enjoying a better quality of life- prior to his 2007 arrest. He'd completed an associates degree and was working toward a pilots license. He was working and was not homeless. "It all went to shit because of me drinking and chasing xxxxx all the time", he told this writer. See "Remarks", end of this report. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): See the 11/2/15 Contract MH C&P report for background information. During this review period, the veteran has twice been in trouble with the authorities, and was jailed for 22 days in Dallas, apparently for failing to report to his agreed upon housing. In Houston, prior to moving to this area, he was arrested for "soliciting" and this was later changed to "transporting for immoral purposes." The veteran is still on probation following his 2007-2015 incarceration for sexual abuse of a child. e. Relevant Substance abuse history (pre-military, military, and post-military): See the 11/2/15 Contract MH C&P report for background information. The veteran said "I don't get DRUNK drink anymore"; but admitted he is still drinking regularly and sometimes heavily, which is a violation of his parole. He last drank "last night"; and said, "I got a gallon of vodka in my car!" f. Other, if any: No response provided. 3. 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 [X] Impaired judgment [X] Difficulty in establishing and maintaining effective work and social relationships 4. Behavioral observations -------------------------- Appropriately dressed and groomed. Psychomotor behavior anxious. Mood and affect irritable. Speech was rapid and pressured, and he peppered his speech with vulgarities thoughout the examination, describing other people's behavior or situations in which he'd felt mistreated. No gross deficits in short- or long-term memory evidenced. Thought processes coherent and goal-directed. No delusions, hallucinations, obsessions. 5. Other symptom Does the Veteran have any other symptoms attributable to mental disorders that are not listed above? [ ] Yes [X] No 6. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 7. Remarks (including any testing results), if any: --------------------------------------------------- DSM-5 diagnoses: Other Unspecified Anxiety Disorder, at least as likely as not incurred in or caused by service; Alcohol Use Disorder, not incurred in or caused by service; and Adjustment Disorder with Mixed Disturbance of Emotions and Conduct, not incurred in or caused by service. The previous examiner diagnosed unspecified anxiety disorder, and this is continued by this writer. However, the previous examiner noted his polysubstance abuse disorder was in full remission; this is not the case today. The veteran's alcohol use disorder is not in remission, but is active (see body of report, "Relevant Substance Abuse History"). This writer's diagnosis of Adjusment Disorder with Mixed Disturbance of Emotions and Conduct accounts for the mood and conduct symptoms exhibited by this veteran that are NOT related to service. This diagnosis- together with his Alcohol Use Disorder- accounts for the majority of his occupational and social impairment. The veteran has already been diagnosed with a service-connected anxiety condition, and this writer is willing to conceed that a small portion of his current impairment is related to mood symptoms precipitated by stressful events in service many years ago (see below). However, even that situation- which led to his General discharge- occured within the context of his abusing multiple substances, which he's previously admitted impaired his judgment in service. This writer is of the opinion that, in total, his service-connected Other Unspecified Anxiety Disorder accounts for no more than 20% of his current occupational and social impairment. Non-service connected Alcohol Use Disorder and Adjustment Disorder with Mixed Disturbance of Emotions and Conduct, account for the remaining 80% (40% each). The veteran has told others- and implied today- that military service, and specifically deployment to Kuwait, is responsibe for all his mental health issues. "What happened over there is the reason I'm like this", he told his social worker last July. This writer does not agree with that assessment of the etiology and course of his mental illness. It doesn't take into account five years of sexual molestation as a child by his stepbrother; his mother's mental disintegration (including hospitalization) after the death of the veteran's little sister when he was 5; his history of psychiatric treatment in childhood; alcohol, benzodiazapine, and opioid abuse in service, which started before he went to Kuwait and then continued after service (he still drinks excessively); conviction of sexual assault of a child years after service, leading to attempted suicide and a 7-year prison term, during which he was witness to traumatic events; and since release from prison, difficulty finding work or housing due to his legal history, resulting in homelessness and unemployment. He neglected to tell the previous MH C&P examiner about the years of sexual abuse as a child, or about having been treated by mental health professionals in childhood. And he didn't even mention Kuwait as a potential stressor during that previous examination. None of these stressful events and circumstances have to do with service, started during service, or are related to service (except the substance abuse, which is not a service-connectible condition). Despite telling this writer his substance abuse and treatment started after Kuwait, he has previously clearly testified these occured while deployed to Korea, before Kuwait. He has repeatedly told providers (and the previous C&P examiner) the events that precipitated his General Discharge (destruction of government property) were finding out his girlfriend cheated on him while he was TDY; and the Army changing it's mind about allowing him to reclassify as a recruiter. He admitted today that he "self-destructed" after learning that his reclassification was withdrawn by the Army after their review revealed his Article 15 in Korea. Neither of these events is a PTSD Criterion A stressor. And neither of them have anything to do with Kuwait. The veteran's description of his experiences in Kuwait are not supportive of a PTSD Criterion A stressor, either. What he described to others as being "fired upon", he clarified today as: "They just came and got us in the middle of the night, told us to pack our shit up." The only reason he reported they were being fired upon was because they were forced to quickly evacuate their position. Over the next two weeks, he said, they were told to move several more times, which he said was very stressful, and made him fearful of attack. Nevertheless, he was not actually exposed to any incoming fire and did not experience any life-threatening events, based on his description today. As already noted above, he did not mention his Kuwait deployment during his 2015 C&P examination for PTSD. In this writer's opinion, it is not clinically reasonable to attribute a lifetime of emotional, behavioral, relationship, substance, authority, legal, and financial problems to the events in Kuwait he described; a girlfriend cheating on him; or disappontment over his failed bid for reclassification. As described above, he has a long history of much more severe stressors that not related to service, that are more likely responsible for his mental and emotional problems today- and for most of his history. Results of the MMPI-2-RF administered as part of today's C&P exam, were invalid- the veteran responding in an inconsistent and exaggerated fashion. This, too, is not supportive of his claim for increased service- connection. /es/ GREGORY D DAYTON, Ph.D. Staff Psychologist Signed: 05/05/2017 17:31

Need some hell understanding this egal for increase and na Diagnose Ptsd. Thank you! LOCAL TITLE: COMP & PEN MENTAL HEALTH/PSYCHOLOGY EXAM STANDARD TITLE: PSYCHOLOGY C & P EXAMINATION CONSULT DATE OF NOTE: MAY 03, 2017@09:30 ENTRY DATE: MAY 05, 2017@17:31:30 AUTHOR: DAYTON,GREGORY D EXP COSIGNER: URGENCY: STATUS: COMPLETED Mental Disorders (other than PTSD and Eating Disorders) Disability Benefits Questionnaire Name of patient/Veteran: Preble, Jason Dewayne Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No SECTION I: ---------- 1. Diagnosis ------------ a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)? [X] Yes [ ] No If the Veteran currently has one or more mental disorders that conform to DSM-5 criteria, provide all diagnoses: Mental Disorder Diagnosis #1: Other Unspecified Anxiety Disorder Mental Disorder Diagnosis #2: Alcohol Use Disorder Mental Disorder Diagnosis #3: Adjustment Disorder with Mixed Disturbance of Emotions and Conduct b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): None 2. 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: Other unspecified anxiety disorder: anxiety. Alcohol use disorder: impaired judgment, depressed mood, difficulty establishing and maintaining effective work and social relationships, suspiciousness, chronic sleep impairment. Adjusmtent disorder with mixed disturbance of emotions and conduct: depressed mood, difficulty establishing and maintaining effective work and social relationships, suspiciousness, chronic sleep impairment. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 3. 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: This writer is of the opinion that, in total, his service-connected Other Unspecified Anxiety Disorder accounts for no more than 20% of his current occupational and social impairment. Non- service connected Alcohol Use Disorder and Adjustment Disorder with Mixed Disturbance of Emotions and Conduct, account for the remaining 80% (40% each). 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 ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS [X] Other (please identify other evidence reviewed): Virtual VA and VBMS. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military military, and post-military): See the 11/2/15 Contract MH C&P report for background information. He is currently living in Patriot House, the "homeless program." He has never married and is not dating. b. Relevant Occupational and Educational history (pre-military, military, and post-military): See the 11/2/15 Contract MH C&P report for background information. The veteran has not been employed since working as a forklift operator for Coca Cola between January and May 2016. He told this writer he was fired for difficulty getting along with others; but has previously testified he was terminated when his legal history was uncovered. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post- military): See the 11/2/15 Contract MH C&P report for background information. During this review period, the veteran was seen at the Houston VA until October 2016, before coming to Dallas. Notes indicate "drinking to self medicate his anxiety"; "being fearful that he will have to go back to prison"; "expresses frustration at the many challenges he has faced since release from prison"; and "tendency to return to drinking when stressed." He was prescribed sertraline in Houston. He admitted to providers in Houston his stepmother "made him" go to a mental health professional several times during childhood; and that he was prescribed ritalin as a child. "He reported a two week period during his deployment to Kuwait when his until was constantly relocating and he feared being attacked." He said he'd twice attempted suicide: when he was told by the Army they were going to court martial him; and when he was sentenced to prison in 2007. When he was first seen in Dallas, he was homeless and unemployed, had run out of his mediation from Houston VA providers, and was experiencing anxiety and panic as well as some nightmares. He was also drinking hard liquor 3-4 times a week. He reported being diagnosed with PTSD in Houston, but apparently related to his history of sexual abuse for years as a child. He also reported MST, and that his little s ister's death of SIDS when he was 5 "significantly affected his mother (committed), which in turn affected him." He was started on sertraline, doxipin, and disulfiram, and referred for therapy. As of April 2017, the veteran was enrolled in the Dallas VA Community Based Employment Program. Today, the veteran described functioning better- and enjoying a better quality of life- prior to his 2007 arrest. He'd completed an associates degree and was working toward a pilots license. He was working and was not homeless. "It all went to shit because of me drinking and chasing xxxxx all the time", he told this writer. See "Remarks", end of this report. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): See the 11/2/15 Contract MH C&P report for background information. During this review period, the veteran has twice been in trouble with the authorities, and was jailed for 22 days in Dallas, apparently for failing to report to his agreed upon housing. In Houston, prior to moving to this area, he was arrested for "soliciting" and this was later changed to "transporting for immoral purposes." The veteran is still on probation following his 2007-2015 incarceration for sexual abuse of a child. e. Relevant Substance abuse history (pre-military, military, and post-military): See the 11/2/15 Contract MH C&P report for background information. The veteran said "I don't get DRUNK drink anymore"; but admitted he is still drinking regularly and sometimes heavily, which is a violation of his parole. He last drank "last night"; and said, "I got a gallon of vodka in my car!" f. Other, if any: No response provided. 3. 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 [X] Impaired judgment [X] Difficulty in establishing and maintaining effective work and social relationships 4. Behavioral observations -------------------------- Appropriately dressed and groomed. Psychomotor behavior anxious. Mood and affect irritable. Speech was rapid and pressured, and he peppered his speech with vulgarities thoughout the examination, describing other people's behavior or situations in which he'd felt mistreated. No gross deficits in short- or long-term memory evidenced. Thought processes coherent and goal-directed. No delusions, hallucinations, obsessions. 5. Other symptom Does the Veteran have any other symptoms attributable to mental disorders that are not listed above? [ ] Yes [X] No 6. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 7. Remarks (including any testing results), if any: --------------------------------------------------- DSM-5 diagnoses: Other Unspecified Anxiety Disorder, at least as likely as not incurred in or caused by service; Alcohol Use Disorder, not incurred in or caused by service; and Adjustment Disorder with Mixed Disturbance of Emotions and Conduct, not incurred in or caused by service. The previous examiner diagnosed unspecified anxiety disorder, and this is continued by this writer. However, the previous examiner noted his polysubstance abuse disorder was in full remission; this is not the case today. The veteran's alcohol use disorder is not in remission, but is active (see body of report, "Relevant Substance Abuse History"). This writer's diagnosis of Adjusment Disorder with Mixed Disturbance of Emotions and Conduct accounts for the mood and conduct symptoms exhibited by this veteran that are NOT related to service. This diagnosis- together with his Alcohol Use Disorder- accounts for the majority of his occupational and social impairment. The veteran has already been diagnosed with a service-connected anxiety condition, and this writer is willing to conceed that a small portion of his current impairment is related to mood symptoms precipitated by stressful events in service many years ago (see below). However, even that situation- which led to his General discharge- occured within the context of his abusing multiple substances, which he's previously admitted impaired his judgment in service. This writer is of the opinion that, in total, his service-connected Other Unspecified Anxiety Disorder accounts for no more than 20% of his current occupational and social impairment. Non-service connected Alcohol Use Disorder and Adjustment Disorder with Mixed Disturbance of Emotions and Conduct, account for the remaining 80% (40% each). The veteran has told others- and implied today- that military service, and specifically deployment to Kuwait, is responsibe for all his mental health issues. "What happened over there is the reason I'm like this", he told his social worker last July. This writer does not agree with that assessment of the etiology and course of his mental illness. It doesn't take into account five years of sexual molestation as a child by his stepbrother; his mother's mental disintegration (including hospitalization) after the death of the veteran's little sister when he was 5; his history of psychiatric treatment in childhood; alcohol, benzodiazapine, and opioid abuse in service, which started before he went to Kuwait and then continued after service (he still drinks excessively); conviction of sexual assault of a child years after service, leading to attempted suicide and a 7-year prison term, during which he was witness to traumatic events; and since release from prison, difficulty finding work or housing due to his legal history, resulting in homelessness and unemployment. He neglected to tell the previous MH C&P examiner about the years of sexual abuse as a child, or about having been treated by mental health professionals in childhood. And he didn't even mention Kuwait as a potential stressor during that previous examination. None of these stressful events and circumstances have to do with service, started during service, or are related to service (except the substance abuse, which is not a service-connectible condition). Despite telling this writer his substance abuse and treatment started after Kuwait, he has previously clearly testified these occured while deployed to Korea, before Kuwait. He has repeatedly told providers (and the previous C&P examiner) the events that precipitated his General Discharge (destruction of government property) were finding out his girlfriend cheated on him while he was TDY; and the Army changing it's mind about allowing him to reclassify as a recruiter. He admitted today that he "self-destructed" after learning that his reclassification was withdrawn by the Army after their review revealed his Article 15 in Korea. Neither of these events is a PTSD Criterion A stressor. And neither of them have anything to do with Kuwait. The veteran's description of his experiences in Kuwait are not supportive of a PTSD Criterion A stressor, either. What he described to others as being "fired upon", he clarified today as: "They just came and got us in the middle of the night, told us to pack our shit up." The only reason he reported they were being fired upon was because they were forced to quickly evacuate their position. Over the next two weeks, he said, they were told to move several more times, which he said was very stressful, and made him fearful of attack. Nevertheless, he was not actually exposed to any incoming fire and did not experience any life-threatening events, based on his description today. As already noted above, he did not mention his Kuwait deployment during his 2015 C&P examination for PTSD. In this writer's opinion, it is not clinically reasonable to attribute a lifetime of emotional, behavioral, relationship, substance, authority, legal, and financial problems to the events in Kuwait he described; a girlfriend cheating on him; or disappontment over his failed bid for reclassification. As described above, he has a long history of much more severe stressors that not related to service, that are more likely responsible for his mental and emotional problems today- and for most of his history. Results of the MMPI-2-RF administered as part of today's C&P exam, were invalid- the veteran responding in an inconsistent and exaggerated fashion. This, too, is not supportive of his claim for increased service- connection. /es/ GREGORY D DAYTON, Ph.D. Staff Psychologist Signed: 05/05/2017 17:31

Hi all, When I first filed for disability they sent me to VES a third party VA examiner and they diagnosed me with unspecified anxiety disorder with OCD and gave me a 30% rating. I filed an appeal and did my form 9 in July. On Aug 19th the VA changed my diagnosis to Chronic post-traumatic stress disorder, Insomnia disorder related to another mental disorder, and Major depressive disorder. I received an supplemental statement of case today and referred my VA evidence from July 8 to Aug. 19.I have been building my file with therapy and now I am awaiting starting the PTSD therapy program. I intended to build this evidence and submit it at my hearing, Am I wrong and should I take what I have now and turn it in???. Since they gave me the correct diagnosis finally am I going to get all this included in the appeal or should I file a new claim for all the above diagnosis I have received? Thanks in advance for any information and advice you may have and I look forward to hearing from you all.

Final update:... Well all the battle has been lost. The good old folks at the VA decided nothing on my claim is service connected so that means they pay more attention to the sorry motherfuckers they outsource their exams to against the medical evidence you have in your medical records from VA doctors. I had 3 other issues on this claim and none of them were addressed with an exam just a big FU on all of them. But as I have learned from the numerous people on here and from my own experiences even thought you may lose the battle the war is not over yet. So Wednesday I will go to my VSO and file an appeal on the AS claim appeal # 3 along with filing my form #9 on my first appeal. Also that day I see my rheumatologist and hopefully she will do the back DBQ for me and a Nexxus letter so it will be ready for the good old VA a year or so from now when appeal # 3 gets address. Maybe in a couple of more moths I will get t do my form #9 on appeal # 2 and will now be living in the appeals hell world. SO off to the appeals forum for me and hope others out there have better luck than me.!!! God bless you all!!1

Oh man have I been in that situation before. This is the first time ever I actually want them to slow down with my claim. The last two I wanted them to hurry up and I can not believe I want the opposite. A doctor at the VA told me yesterday on average it takes 2 appeals to get your ratings right and it looks like I am in track for 3. Hang in there Jim!!

Funny you ask, yesterday when I checked the estimated completion date was 7-14 to 7-18 and when I checked just before my post on here I noticed it had now changed to 7-12 to 7-14. the status changed from preparation for decision yesterday and now today it is showing preparing for notification. So you might be right and they are working Saturdays because this has changed since I looked at it yesterday, looks like appeal # 3. On my first appeal I filed it in January and just Thursday I got the statement of case and VA form 9 to fill out so my appeal will move forward, so hope that means even the appeals process is improving.

Update.( Need Help), Just checked e-benefits and status has changed to pending decision approval for 7/12-7/14 up from estimated sept date. Here is the problem I have.. I go to the rheumatologist on 7/13 and I am going to stat my Enbrel or Humeria treatment and I was going to get a Nexxus letter and help on this claim. Is there any way to get this stalled like trying to talk to who has my claim file and talk to them??? As you know it takes 3 days to get access to medical record notes on myhealthvet and I want to get this medical evidence submitted for this claim because I do note want to go through appeal # 3. I just finally got the paperwork on my first appeal and have 60 days to respond so a trip to the VSO is planned for this week. I just have a bad feeling since a 2 month time period just jumped on this claim and as you see the idiot C&P doc did not give me a good exam so I am expecting the worse and a denial decision that would like to avoid. Plus the exam they just looked at the AS and I have other issues on this claim such as: Disabilities Claimed: ankylosing spondylitis (New), inflammatory arthritis secondary to ankylosing spondylitis (Secondary), BL HEARING LOSS (ACOUSTIC TRAUMA) (New), DJD LUMBAR SPINE (New), DJD CERVICAL SPINE (New). in which I have no had an exam for these other issues Hope someone sees this since I posted under my original topic cause I could use some advise. Thank you all again.

It would surprise the hell out of me if they ever called me before hand. I always look on ebenefits and know the answer before the letter arrives since that is the easiest way. If your rating % good decision but probably been low balled, if its the same not good news :-). That lady sure did surprise me now I know according to her the RO will take a VA doctors word over some third party examiner. I guess I will be the guinea pig and soon find out.

I definitely believe they have the "quality control department". I think they probably do not do anything and it might explain why dealings with the government takes as long as it does. You must have made an impression at your VARO for them to call you before issuing an award, wish I was that special. I was at the VA this afternoon and a lady who works there just starting talking to me when she saw I was in a cast and I told here about this issue and she said " just have your doctor write a statement that your condition is service connected and it can be used as your C&P and send it across the street" Here in Houston I am lucky that the RO is here as I can take a van shuttle that runs every 15 minutes from the RO to the hospital so it makes some things easier like getting copies of exams results done outside of VA. o I will just hurry up and wait till the next doctor appointment soon and hope the doctors in a god mood that day. take care!

I will be sure to do that. I cannot a rater actually saying that. I have a picture in my head that they get our claim and look at all the documents and they only read a page or two then say well... lets do 10% and call it a day. I uploaded all my medical records from myhealthvet website after I submitted my claim and I was going to do so again since I am still receiving treatment there so it will be current right before the decision date. It makes me scratch my head in wonder at what the raters think when they are handling our claims and at the same time I do not think I would want that job because I am biased and I would SC everyone. Thanks again!

Hey Vync, You are so right about how you have to appeal everything to get things right as they should be. I have 2 appeals right filed because when I went in for PTSD they rated me 30% and called it unspecified anxiety and of course with my symptoms I should be 50% to 70% rated on it and then on my rating for bilateral plantar fasciitis I went through the same on the DBQ from the VA PA who did my C&P where it contradicted itself and I got rated at 30% instead of the 50% that I should have got. I go to the VA for everything and I am in treatment with MH and Podiatry and I have had the doctors use the correct "VA Language" in my medical records so I have the evidence I will need for the appeals. I do consider myself so lucky to have the 50% I have because otherwise I could not afford the Enbrel or Humira I will be on for the rest of my life. But it is important and I am very worried about this claim because if I do not get the SC for the AS then I will probably lose my claim for inflammatory arthritis secondary to AS that I filed to make sure I get rated correctly under code 5002 and 5240. All I can do is take your advise and try to get it SC and the worry about ratings later which I only care about the SC part because from what I seen unless your spine s frozen its hard to get more that 10% to 20% which really does not matter. Thank you again for a your help and I hope all is well on your end.

Vync, My god you are a life saver got and me fired up thank you for the great advice. First thing is I will get my family to write statements for me. Second thing I will do is I will have my rheumatologist at the VA do a statement also for me when I go back on the 13th of July since they are the one's who were finally able to give me a diagnosis and they are really nice and good doctors. On this date I am also to start either Enbrel or Humira shots. Luckily my claim is not to be decided until at least 9/4/16 according to ebenefits and I am sure I will have one or two more exams for everything on the claim. The C&P doctor I do not think he knew what he was doing as you saw on the DBQ where it says one thing then contradicts itself. I was thinking this claim was not going to be as it is turning out to be and I was more worried about it being rated properly as my research has said that the disease should be rated under code 5240 for the AS and code 5002 for the rheumatoid arthritis since it affects a lot of my joints. Thank you again for the great advise and I will get to work on gathering this evidence so hopefully I want have to do a 3rd appeal.

Hi all. Finally went to the regional office today and got my results to share for some good old feed back. of course in my opinion another shitty exam but starting to get use to them now and I will be an appeals expert one of these days. Sorry I had to attach the results but I got them on paper and I had to scan them as a pdf file because I can not use windows 10 worth a shit. The files open up in the Microsoft edge thing and it will not let me copy and paste them or give me the option to save as a word document. Anyways as usual it says onw thing then another and the doctor says its not service connected in his opinion but he was googling the disease because he did not know what it is. also he only wanted to look at my back only but the disease is complicated and has been caught early enough I do not have much x-ray evidence and it effects my joints more than my back and neck. I look forward to some feedback and computer help if someone knows how I can copy and paste the results in the body of this message. Appreciate you all and thanks again! Back DBQ.pdf Back Medical Opinion.pdf

Thank you for your help especially with the cfr rating. I am guessing 60% since i am not totally incapacated. I live in houston and the regional office is here so according to ebenefits the report is due to the va by the 27th so i should be able to go there again and get the report like i did for the VES exams i had. I will be sure to post the results for you all so it might help others.

Hi all. Did not get any feedback on my last post seeing if anyone had any knowledge on Ankylosing Spondylitis. Anyways fed ex jut delivered exam notice through a company named QTC Medical Services. Anyone had any dealings with these people? I filed for the AS with a secondary for arthritis because this condition is in my spine etc. but affects several other joint. I had dealt with VES for exams in the past and they did not go well as I have a pending appeal for A 30% rating that should have been 50 and another appeal for an exam done by the VA at the hospital that also resulted in a 30 that should be a 50. Needless to say I was shocked as hell when the doorbell rang because i submitted this claim just on May 19 and the exam is for June 15. I have not see the VA move this fast. All my treatments and diagnosis has been done at the VA hospital so to me it seems weird they do not trust their own doctors but this is the VA we are talking about. Any advice, questions, comments, or feedback would be greatly appreciated. Thank you all and god bless ya and best results for you fight with the VA!

Hi all. Got a good one for you again. I saw my rheumatologist today and was diagnosed with Ankylosing spondylitis. It affects both my feet, my right hand, left knee, lower back and neck. Apparently this condition is related to rheumatoid arthritis and when i start treatment i will have to take shots for the rest of my life. I just got low balled at 30% for bilateral plantar fascitis which i just found out is related to to ankylosing spondylitis. My question is do you think i should file a claim and will this get services connected??? So internet research i have seen said RA is easier to get service connected but this is another new road i must go down so i would apperciate some Knowledgable feedback. Would this be one of those rare cases i have read about where this disease would be rated and the joints as secondary??? i did have some back issues in my service medical records and my feet so that would help i hope . Thanks all and i look forward to your replies and advice.

Update: they rated me at 30 % so lowballed once again. Good luck to others out there amd hope for better results.