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Mark D Worthen PsyD

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Mark D Worthen PsyD last won the day on June 20 2016

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About Mark D Worthen PsyD

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    E-4 Petty Officer 3rd Class

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  • Location
    Asheville, North Carolina
  • Interests
    Improving the reliability and validity of C&P exams for PTSD and other mental disorders.

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  1. Denied PTSD, Chronic

    That should get you a C&P exam for sure. I wish you all the best! Mark
  2. PTSD Denied NSC - Schizophrenia NSC

    If he hasn't had an Agent Orange Registry Health Exam for Veterans, it's a good thing to do for medical (treatment) reasons. It is completely separate from the disability compensation process, but the doctor can alert the veteran to conditions that might be related to Agent Orange exposure, for which he could then receive treatment. (If he does not have an earned income, and for other reasons, he is probably eligible for free medical treatment at the VA.)
  3. IMHO Secretary Bob is the real deal - he really gives a f**k. He is trying to drastically change the entrenched, fear-based, authoritarian management style that emanates from 810 Varmint Ave. (Can you tell whose blog I read?) Of course the Entrenched are resisting tooth and nail. I hope whomever is Prez come next January will reappoint him, although that doesn't happen often.
  4. Great intel @Buck52 ! Nothing like having a personal contact within the bureaucracy.
  5. Is your request for VBA-specific records that exist only in your claims file? Assuming that is the case, it might work a lot better if VBA set up a system where vets could request VBA-specific records only, e.g., Rating Decisions, Statement of the Case, etc. Might save a bunch of time and money.
  6. From what you wrote, it sounds like the PharmD is the problem...
  7. Licensed pharmacists (PharmD degree) employed by the VA often treat psychiatric patients, although a psychiatrist is supposed to review their work, and see the patient regularly or every once in awhile - I don't know what the standard is. But your situation does not sound right. I suggest calling the MH clinic and requesting an appt with a psychiatrist. Also try talking with the Patient Advocate (some are really effective, others not so much from what I hear.) If you still do not have an appointment with an MD soon, then call and write the Chief, Mental Health Services at your VAMC, with copies to the Chief of Staff and Medical Center Director. Btw, it's not unusual for people with Panic Disorder to become less agoraphobic with treatment over time, but it is much less common for a patient to stop having frequent panic attacks but still have the agoraphobia. Also, note the name of the diagnosis: Agoraphobia Without History of Panic Disorder. Also note that Agoraphobia Without History of Panic Disorder was a DSM-IV diagnosis that is not in DSM-5. All the Best, Mark
  8. I apologize @Berta, I somehow missed your post. You're right, Global Assessment of Functioning (GAF) scores are no longer part of the DSM, although I still saw them mentioned by RSVRs (raters) and ALJs (BVA judges) through 2016. The GAF is a unreliable and only modestly valid measure of functional impairment. (I'm using these terms in the scientific, not legal, sense. See: Reliability and validity.) We discussed the problems with the GAF in this journal article, on page 205: Worthen, M. D. & Moering, R. G. (2011). A practical guide to conducting VA compensation and pension exams for PTSD and other mental disorders. Psychological Injury and Law, 4(3-4), 187-216. doi:10.1007/s12207-011- 9115-2 | http://bit.ly/ptsd-exams
  9. I agree with all the great advice you received in this thread. There is a lot of debate about the changes made to the diagnostic criteria for PTSD with the publication of DSM-5 in 2013. I personally think it's a mixed bag, but one big positive I see is this addition to Criterion A A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: ... 4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). I see this addition as a very positive change because under DSM-IV, guys like you would have a very hard time receiving a PTSD diagnosis. It can still be a challenge, but it's better. I evaluated some of your fellow Airmen, and guys from other branches, with very similar experiences as you have had, and sure enough, the majority had PTSD or subsyndromal posttraumatic stress syndrome. I had the advantage of working at a C&P Clinic that gave us enough time to conduct thorough, evidence-based psychological evaluations, which is always important, but especially important with a new diagnostic criteria set. My hat's off to you @AirForce99. All the Best, Mark
  10. What your VSO told you is correct. I almost always found that a combat veteran's stressor statement(s) were very helpful. In other words, particularly since I am not a veteran, it helped me more fully understand how horrible and traumatic the event(s) were. Be sure to use VA Form 21-0781 - STATEMENT IN SUPPORT OF CLAIM FOR SERVICE CONNECTION FOR POST-TRAUMATIC STRESS DISORDER (PTSD) - for your stressor statement(s). You can type or handwrite them. As long as your handwriting is legible, it's perfectly fine to do it that way. What you're writing is something exceptionally personal and painful, and what's more personal, in terms of written communication, than handwriting? There are some guides to writing to VA, such as: StateSide Legal - VA Disability - Step 3: Gather and submit evidence (general advice on writing a letter to VA - it's down near the bottom of the page). Swords to Plowshares - WRITING YOUR PTSD STRESSOR STATEMENT Nolo - How to Write a Stressor Statement for a PTSD Claim for Veterans Disability Compensation I thought I had read some good advice about a stressor letter on veterans law attorney Chris Attig's blog (http://www.veteranslawblog.org/), but I searched on his site and couldn't find it. His site is a little hard to search, so I could have missed it. Btw, the content on his site is excellent IMHO. @fiasco2g - I hope this helps. I very much admire, respect, and appreciate your service, and sacrifice, to our nation. All the Best, Mark
  11. I need help understanding my C&P exam!

    Great advice re: filing for IU! Of course, if @Osccore9 receives a 100% rating it will be a moot point, but if it's 70% and working is not a reality at this time, then an IU claim would for sure be the thing to do. I also agree with @Gastone that, while it certainly might have been true in the past (I've heard so many very credible horror stories from countless veterans), in the 5+ years I worked for VA as a C&P examiner, I saw the vast majority of RSVRs (Raters) make conscientious decisions, even going out of there way (while under a lot of pressure to increase production) to make sure they had explored every avenue for service-connection. VBA has the highest percentage of veteran-employees (other than DoD, of course) of any agency in the federal government (50%). Although the majority of non-veterans like myself really give a s**t about you guys too, I think it does say something that they hire so many vets. By the way, going back to Osccore9's C&P exam report, the examiner did a much more thorough job researching, describing, and explaining several pertinent behavioral markers than usual. She (I think it was a she) also has clearly educated herself extensively regarding the long-term sequelae (effects) of sexual trauma. That's really nice to see, especially given how many mediocre (at best) exam reports that contractors and VA staff produce.
  12. This is one reason why veterans should be granted electronic (Internet) access to their claims file on VBMS. VSOs have access. Contract examiners have access. The IME companies (QTC, VES, etc.) have access. C&P clinics have access. Why not the vet? Is this need on the agenda of any of the influential veterans service organizations?
  13. That is an excellent point. Many, many vets do not know that they need to request Vet Center records separately from any other VA medical records. I recently wrote a long detailed page on how to request veterans military records and medical records, and I put the Vet Center info in red with arrows pointing at it because it is so often overlooked! http://ptsdexams.com/veterans-military-records/#vet-center-records All the best, Mark
  14. My understanding is that de novo reviews by a Decision Review Officer (DRO) take place much faster than an appeal to the Board of Veterans Appeals. Is that correct?
  15. I need help understanding my C&P exam!

    That might have been true in the past, but since the advent of the DBQs, the Raters focus on the items checked off on the 'Symptoms' list (Section II, Number 5 of the Initial PTSD DBQ). The reason for this focus is that those symptoms come directly, verbatim, from the General Rating Formula for Mental Disorders. I cannot remember the last time I saw a rating consistent with the summary statement of social and occupational impairment (Section I, Number 4a) when the symptoms endorsed corresponded with a significantly higher rating. Plus, Raters now use an automated Evaluation Builder, which uses the items in the Symptoms List to determine the rating. I attached a copy of the General Rating Formula for Mental Disorders. Mark General Rating Formula for Mental Disorders.docx