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Mark D Worthen PsyD

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

Mark D Worthen PsyD had the most liked content!

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About Mark D Worthen PsyD

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    E-4 Petty Officer 3rd Class

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  • Location
    Park City, Utah
  • Interests
    Improving the reliability and validity of C&P exams for PTSD and other mental disorders.

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  1. Complex PTSD usually results from sustained, awful childhood abuse - sexual, physical, or mental/emotional - often all three. I've diagnosed Complex PTSD several times, usually with female MST survivors. A crucial point for C&P psychologists: Either opine that military sexual trauma aggravated the pre-existing mental disorder beyond its normal course and progression; or explain how adult trauma can, in a sense, "reawaken" dormant or subthreshold trauma-related symptomatology. It's rare these days for VBA to claim a disorder pre-dated military service, but the last thing I want is someone with horrible PTSD to receive a denial.
  2. I tried to connect my social media accounts--Twitter, Google+, and LinkedIn--but for each of them I received an error message, like this: You need to pass the "client_id" parameter Missing required parameter: client_id Is there something I need to do on my end that I'm too dense to figure out? Thanks! P.S. Teresa - Thank you for regularly publishing your newsletter. I haven't worked the past two years while I received medical treatment, and I wasn't keeping up with veterans disability news as much as in the past. But as my recovery progressed (all better now thank goodness!), I started to get back up to date and your newsletters (which I did read regularly) reminded me to get back on the forum so that I can share info when it might help and so I can continue to learn from you all.
  3. The odds are exceptionally low that it would change anything. A few facts to know: * If VA used ICD-11, a vet could theoretically be diagnosed with Complex PTSD due to childhood trauma and due to combat trauma. * Complex PTSD is an ICD-11 diagnosis, but the VA uses DSM-5/ICD-10-CM, which does not have Complex PTSD as a diagnosis. * I'm neither a veterans law attorney, nor an expert on the regulations, but I think you fall under 38 C.F.R. § 3.951(b), which states in part: "A disability which has been continuously rated at or above any evaluation of disability for 20 or more years for compensation purposes under laws administered by the Department of Veterans Affairs will not be reduced to less than such evaluation except upon a showing that such rating was based on fraud." See also M21-1 III.iv.8.C.1.a. Protected Evaluations for Compensation Purposes Under 38 CFR 3.951(b). And see M21-1 IV.ii.2.F.5.b. Discontinuance of Monitoring for Changes in Employability Status. Here's a quote: "Monitoring changes in employability status is not required when the Veteran ... as an IU rating that has been in effect for 20 or more continuous years ..." All the best, Mark
  4. That should get you a C&P exam for sure. I wish you all the best! Mark
  5. 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.)
  6. 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.
  7. Great intel @Buck52 ! Nothing like having a personal contact within the bureaucracy.
  8. 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.
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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.
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