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Eliza

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Everything posted by Eliza

  1. Hi there. My psych dr from the VA made a comment about how this depressed emotional me is my norm and to accept it and maybe try for 100% disability since I lost another job. I go through 3 to 5 a year and don't hold them long because of the ptsd and anxiety and depression. My ptsd was rated. Not anything else. Should I try for 100? Or will they drop my 70? I'm too nervous to even try.
  2. Someone whom I know is 100 percent and still worked. He doesn't anymore but he did while he was receiving the 100 percent. He said you can still work. I wouldn't want to work unless it was part time or something. My anxiety gets ridiculous.
  3. I don't expect to get 100. I will let u know how it turns out. Like I said any rating would be fine. But the report definitely says 70 percent. We will see what the rater does with it.
  4. Thank you very much for responding. It helps me feel a little better because I couldn't understand the wording quite right. Hopefully it is 70 percent. I would take anything though. I have a tough time keeping jobs.
  5. 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: F43.10; F60.3 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD ICD code: F43.10 Comments, if any:he veteran presents for an initial PTSD C&P assessment based on MST. She has a h/o premilitary trauma, and post military trauma. SMRs show a diagnosis of PTSD following her military psych admission. Her PTSD therefore predates her postmilitary trauma. Despite documented awareness of her pre-military trauma, numerous records and providers have documented her PTSD as being d/t her MST. Although she continues to have some occasional reexperiencing symptoms related to her premilitary trauma, the major and intensity of her reexperiencing symptoms is related to her MST, rather then her other traumas (nonmilitary). MST remains the focus of her treatment. There is no evidence that her post-military trauma caused any permanent worsening of her PTSD beyond its normal course. Her PTSD is therefore felt to be primarily d/t her MST. There are markers of a potential MST in her SMR and Personnell records. Evidence indicates that she reported a MST the next day, had a rape kit performed at a private hospital 1 day later (results were no DNA evidence but some evidence of physical trauma), and that an OSI investigation occured. Her sudden desire to get out of the service (after wanting to make it a career) and ER psych visits within 2 weeks of her MST and psych hospitalization show a change in behavior and psychiatric symptoms following her MST which is consistent with MST and which previously was not present. Her enlistment exam is negative for MH symptoms and treatment. A routine psych screening performed on 7-14-08 showed no evidence of psychiatric symptomatology prior to her MST. Additionally, she has had difficulty with intimacy and occupational functioning uncharacteristic of her pri-military functioning. There therefore is sufficient evidence that the MST, as likely as not, occured and resulted in a change in behavior and symptoms. Records indicate that command had difficulty believing her account of MST given the veteran's "changing events/timeline/and details" of the initial report and also making additional claim that she was assaulted and held at knifepoint in a vehicle outside her barracks by one of her assailants that was proven to be false. Minor changes in her account are however not atypical of rape victims, as indicated by the psych consultant who saw her on 12/15/08 in the ER. Her false report can be adequately explained by her frustration with not being believed by her command, her desire to hold her assailant accountable and with her desire to "get out of the service" after the MST. Since being d/c'd from theaccount of the MST has been fairly consistent in minor details and completely consistent in the major details. Mental Disorder Diagnosis #2: Borderline Personality Disorder ICD code: F60.3 Comments, if any: There is clear evidence of a personality disorder as evidenced by an active diagnosis of Borderline PD in both her outpt and inpt psych records. Her personality disorder is not felt to be caused by the service or permanently aggravated by the service. Personality disorders tend to be conditions which develop in adolescence or early adulthood and tend to develop in response to severe or prolonged trauma, as is the case with this veteran. She has a pre-military history of extensive emotional and physical abuse by various people and a h/o a sexual assault. She has a h/o self cutting since age 16yo. Personality Disorders are often associated with mood disorders and/or substance abuse which tend to stem from long term behavior problems and psychosocial functioning difficulties which stem from the personality disorder. It is more likely than not that the presence of her preexisting personality disorder is the primary cause of her relationship problems, self- destructive behavior and difficulty adapting to the service and pattern of misconduct which is documented in the SMRs and military Personnell records and was the eventual cause of her Administrative separation after only 8-9 months. Although she did not endorse mental health symptoms at the time of her enlistment exam, this does not mean that she was not symptomatic in regard to her personality disorder and (from premilitary trauma), especially in light of her self admission (per her own statements in the records) of a pattern of lying and h/o self mutilation. Although it is as likely as not that her Personality Disorder and PTSD mutually affect each other, there is no clear evidence that her personality disorder was permanently worsened by her PTSD/MST beyond it's normal course. Mental Disorder Diagnosis #3: Major Depression, moderate recurrent ICD code: F32.1 Comments, if any: Her depression is felt to be d/t a combination of her PTSD and Personality Disorder. Both conditions are frequently associated with depression. Since there is an overlap in symptoms and she has significant psychosocial functioning difficulties related to each condition, it would be speculative to try to determine which condition is the cause of her depression (without resorting to mere speculation). b. Medical diagnoses relevant to the understanding or management oftheeMental Health Disorder (to include TBI): noncontributory ICD code: see medical notes 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: There is such an overlap in symptoms that it would be speculative to try to differentiate which symptoms and which psychosocial functioning difficulties are due to any one condition with the following exception: Due to PTSD exclusively: Hypervigilance, mistrust, re-experiencing symptoms, increased startle reaction, avoidance of crowds Due to Borderline PD exclusively: deceitfulness/lying; pattern of unstable interpersonal relationships self image and affects; impulsivity; abandonment issues; pattern of parasuicidal behavior/self harm; unstable self image; chronic feelings of emptiness; victim mentality; transient stress related paranoia c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [X] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [X] No [ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: There is such an overlap in symptoms that it would be speculative to try to differentiate which psychosocial functioningdifficulties specifically are due to any one condition. Each condition appears to cause moderate to serious psychosocial functioning difficulty (based on the severity of each condition). 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 [X] Military service personnel records [X] 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) [X] 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: statement of claim b. Was pertinent information from collateral sources reviewed? ] Yes [X] No 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): PREMILITARY HISTORY: The veteran was born and raised in Ohio. She lived with her mother after her parents divorced when she was very young. She has one brother and 7 1/2 brothers. They moved almost every year; she indicates that it was difficult to always have to make new friends. She indicates that her father was barely involved in her life. She was repeatedly emotionally abused by her mother and her mother's boyfriends. Her brother's friend once tried unsuccessfully to rape her. Her mother is described as an alchoholic. Eventually her father took her brother to live with him (when she was 13yo); she went to live with her grandmother when she was 13yo. When her grandmother died, she returned to her mother's home; she indicates that it was more stable after she married when the veteran was 11yo. She had stayed with her grandmother off and on in the summers previously. She graduated high school with average grades with certification as a nursing assistant. She was active in the drama club, track and cross country. She worked at a local restaurant for 1.5 years before graduating and joining the service. She wanted to make it a career. Abuse or neglect: as per above Discipline problems: none reported Juvenile offenses: none ETOH problems in adolescence: none MILITARY HISTORY: Branch: Air Force Duration: 9 months (7/08-4/09) Location/MOS/: noncombat; MOS: services helper Discharge: General under Honorable-E1 (pattern of misconduct) Active combat exposure: no Military Sexual Trauma: Yes Disciplinary Actions: 2 article XV for altering public records and making a false statement or attack General comments: POSTMILITARY HISTORY: The veteran is single and has never married. She moved in with her HS sweetheart after leaving the service. He was emotionally abusive and physically abusive on one occasion. The relationship resulted in 2 children (5yo and 1yo) but lasted only 6 years. For the last 8 months she has been in a new relationship with her best friend's son (her age). She lives with her friend Emily,Emily's 2 children and her 2 children. She endorses almost impulsively marrying someone that she hardly knew after her MST. She indicates that both of her relationships were negative affected by her difficulty with intimacy which started after her MST. Her relationship currently is also negatively affected by irritability, emotional detachment and social withdrawal. She keeps to herself and does not interact with neighbors or coworkers. She has 2-3 friends. She endorses mistrust of most people. She has little contact with family. Neglect of ADLs: none Neglect of hygiene/appearance: none Involvement in organizations: none Activities/hobbies: horseback riding; service dog; kids; reading b. Relevant Occupational and Educational history (pre-military, military, and post-military): Educational history: The veteran graduated high school with average grades. She had no difficulties with disciplinary problems. She attended some classes at Stark State while in HS. When she graduated from HS, she had her STNA certification. In 2011, she graduated from Brown Macky College with a LPN. GPA 3.0. She failed anatomy and physiology the first time. Work history: She worked at a restaurant for 1.5 years in HS. Since separating from the service, she has had problems keeping a job. She was a full time student for 2 years. After graduating, she has averaged 3-5 jobs per year, with most jobs (all LPN positions) lasting <3 months until she was fired for calling off and going home early d/t anxiety/PTSD symptoms. She has been at her current position as a LPN charge nurse (supervising STNAs) for the last year. She is on probation and will be terminated if she calls off work one more time (she showed this writer 3 reprimand letters). She has exhausted and gone beyond their call off limitations, but supervisors have worked with her to some degree because she is on FMLA and disclosed her PTSD to them. She keeps to herself and does not interact with coworkers. She is well liked by residents. She works the night shift on a psych ward and feels that she can related to the residents; she feels that she has last longer at her current position becasue "things are quiet on the night shift". However she endorses panic attacks which causes her to go home early 3-4x/mo. She endorses difficulties with productivity,reliability or effectiveness/efficiency d/t anxiety/panic and poor concentration. She has been repeatedly reprimanded for charting errors. She denied difficulty with accepting supervision and/or criticism. She endorses difficulty with flexibility, concentration or impulsivity on the job. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): FAMILY History (mental health, substance abuse, suicide attempts): ETOH: mother autism: 1/2 brother suicide: 1/2 brother PTSD: brother MENTAL HEALTH HISTORY: Pre-military treatment: no treatment or symptoms except for one incident of self cutting at age 16yo Military treatment: SMR show that she presented for a routine psych assessment 7/14/08 and was found to have no psychiatric symptoms or diagnosis. After her MST, records show c/o many neurovegative symptoms of depression, anxiety and PTSD symptoms. She was seen in the ER on several occasions for psych complaints or vague GI symptoms. She was psychatrically hospitalized at Lackland AFB for several days d/t a suicidal gesture (cut on her leg) after her MST. She had some limited outpt treatment including therapy and ambien for sleep problems until she was separated. Records indicate that she was diagnosed with PTSD and Adjustment Disorder with depression. POST-MILITARY TREATMENT: The veteran sought treatment at various civilian psych cewnters over the years, but had trouble trusting providers. Her PCP (Dr. Volpe DO) has been treating her for MD and PTSD since 2010 and continues to give her valium prn. Since 5/15, she has transfer her MH treatment to the VA. She was evaluated by the MST coordinator who confirmed a diagnosis of PTSD based on MST. She is now seen weekly for therapy and q3mo for medication management. She has found treatment to be helpful but remains quite symptomatic. She was psychiatrically admitted in 6/15, where she was diagnosed with PTSD and Borderline PD. She continues to have active diagnoses of PTSD, borderline PD and Major depression. She endorses chronic difficulty with depression, anxiety and panic attacks 3-4x/day. She endorses frequent irritability and anger outburst, but denies assault and violence. She endorses occasional passive thoughts of death, but denies active SI/HI, intent and plan. She also endorses serious difficulty with social withdrawal and emotional detachment. She has frequent difficulty with hopelessness, helplessness, concentration, energy, and impulsivity. She admits that she is impulsive with spending, reckless driving, risk taking behaviors, self cutting and ETOH. She endorses chronic nightmares and re-experiencing symptoms. She endorses hypervigilance and trouble relaxing/high anxiety. She has problemsintimacy, mistrust, fear of abandonment and chronic feelings of emptiness. She denies mania, OCD and psychotic symptoms. Inpatient admissions: one in the military and one at the VA in 6/15 Substance abuse treatment: none Suicide attempts: none, but intermittent suicidal gestures/thoughts and chronic passive thoughts of death Use of psychotropic meds: prozac, hydroxyzine and duloxetine (plus valium prn from her PCP) Side effects: GI upset RELEVANT RECORDS: #1. inpatient VA psych admission discharge summary 6/15: Was gang raped by six active duty military members she knew after being drugged in October 2008. Filed a report, obtained a rape kit, and was not believed by command. Was forced out of service under general conditions after 9 months of service, despite her desire to make the AF a career There's even more to report. But I couldn't get all of it on here. Some of her wording I don't understand. I was fine before the mst happened and she makes it very clear but im concerned they'll blame it on my childhood. And according to the rating thing she rated a 70 percent. Is that right? I know the reviewer is the decide but I know c and p exam can weigh in pretty heavy.
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