Jessamine

Thanks all. I will call the VA hospital and the 800 #. It's so weird, the one guy (DAV) said the it was LHI exams or something like that, and then the other rep called back and said "nah, you're good". It's so confusing because a lot of times it will say processing or awaiting review. I haven't actually had "no longer needed" before lol. Looks like I have some calls to make. Thanks all!

Hey all. I have 2 claims, a RAMP appeal and a new one for conditions the RAMP appeal evolved into. There wasn't a whole lot of movement. On my RAMP I had a C&P on 1/31 that basically proved my new claim moreso than what it was actually for, and then yesterday on my new one a "Request 3, exam request processing" popped up and then an hour later went to "Request 3 closed. No longer needed. Date: Not available" Err.. so do I have pending appointments or did they review my other evidence? I only ask because I am supposed to be moving from PA to WV and I have been trying to hold off until exams, if needed, are done. If they don't need them anymore, I know I have extensive records provided and would be wanting to move ASAP. I didn't want to jump off of my sinking ship until they had everything they needed, if that makes sense. So what does the no longer needed thing mean? Is it as obvious as it sounds and they don't need another exam? DAV guy 1 said I had pending exams, DAV guy 2 said nope, you're good on exams. Errr... anyone have this happen? And if it matters, there are DBQ's on file as well. Thanks

I was very lucky with Dr. R, he did use that phrasing in 3 of the 4 (he did them for Fibro & RA), and on the 3rd one he said it was "unquestionably caused by medical negligence and a misdiagnosis of a fracture, thus delayed critical treatment while in service". I don't know how his will hold up against this guy's, since he is their chief c&p examiner, but I am hoping well. I will reach out and see if he can amend his 4th one for consistency. Thank you so much! Hopefully there is a light at the end of the tunnel somewhere. LOL my meds are more than my mortgage at this point

Right? What is so disheartening is I know they were given surgical reports and xrays repeatedly, so the wording he uses makes me feel a bit less good about it. I mean, technically it wasn't for the RA, it was ankle increase, feet and a knee, but I got hopeful lol. My regular doc is a gem, his DBQ's (he's done one annually for the past 2 years, with xrays too) are very strong and he even flat out stated the misdianosis of a fracture as a sprain would be malpractice in any other scenario. I was emailing DAV first thing this morning asking them to resubmit everything again. I am nervous now as to whether this C&P is adequate for it's intended purpose. I am also nervous to return the 5103 response saying "no additional evidence" for the separate claim that actually is for RA, if their c&p dude can't see it. Thank you so much for your help in navigating all of this messiness.

Drat, I was hoping to kill to birds with one stone. This C&P wasn't for RA at all, it was for the ankles, feet and knees, but since he kept going back to the RA repeatedly, I was hopeful since the DAV ended up putting one in for me. Hopefully this one is still good for what it was intended for? Eeek, I am so glad that I have additional IMO's and DBQ's just in case this isn't enough to at least increase the ankle, and connect the feet and knee. Thank you for your help!

I can't tell if this was a good c&p or a bad one, to be honest. He did ignore the flat feet and apparently missed the knee xrays. That's okay though because I have a few IMO's and DBQ's there that are crazy strong since I've been being treated for years. It is concerning that he doesn't mention the over 300 pages of records, including surgical records, that DAV sent in. What surprised me was that it just kept referring to RA and how in the end of both it seems like he linked it to my various pains in service, which kind of make it look like a service connection to me. Any insight? My meds are insanely expensive and VA does not cover 3 of them so if it does in fact end up SC, I can hopefully opt in to choice and get the right medications. The thing that concerns me is every answer seems secondary to the RA so if his statements do not indicate service connection, I will continue being out on my butt paying $1192,16 for my rxs

Sorry for the delay, dude wrote my name and my doctors name like everywhere. Hopefully I didn't miss anything with anonymizing it. Foot Conditions, including Flatfoot (Pes Planus) Disability Benefits Questionnaire 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 ------------ a. List the claimed condition(s) that pertain to this DBQ: Arthropathy of foot b. Select diagnoses associated with the claimed condition(s): [X] Arthritic conditions [X] Arthritis, rheumatoid Side affected: Both Date of diagnosis: Right 2018 Date of diagnosis: Left 2018 c. Comments (if any): No response provided d. Was an opinion requested about this condition (internal VA only)? [ ] Yes [X] No [ ] N/A 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's foot condition (brief summary): Medical History extracted from last Foot DBQ dated 9/13/2016: "STR's are silent for a left foot metatarsal fractures." Veteran claims on 9-24-2004 she was diagnosis with closed metatarsal fracture of the left 2nd and 3rd metatarsals. VBMS was silent for a left foot metatarsal condition. Veteran claims she has submitted the evidence to PhilRO for consideration for her claim on 9-1-2016." INTERVAL HISTORY: Veteran has been diagnosed with Rheumatoid Arthritis (RA) (DOCTOR , DO of ANYTOWN, PA) and is currently undergoing treatment. Of note, veteran has musculoskeletal complaints consistent with pain in multiple bilateral joints including her feet, ankles, knees, hips, back and TMJ joints. 6/10 for pain. DOCTOR has provided an opinion that states that the Veteran's ankle trauma was more than likely the inital preciptating factor in the onset of her Rheumatoid Arthritis. b. Does the Veteran report pain of the foot being evaluated on this DBQ? [X] Yes [ ] No If yes, document the Veteran's description of pain in his or her own words: Pain as an "achiness" in the left and right foot (as well as in the ankles, knees, hips, back and TMJ joints). c. Does the Veteran report that flare-ups impact the function of the foot? [X] Yes [ ] No If yes, document the Veteran's description of flare-ups in his or her own words: Foot pain is like a throbbing ache. d. Does the Veteran report having any functional loss or functional impairment of the foot being evaluated on this DBQ (regardless of repetitive use)? [ ] Yes [X] No 3. Flatfoot (pes planus) ------------------------ No response provided 4. Morton's neuroma (Morton's disease) and metatarsalgia -------------------------------------------------------- No response provided 5. Hammer toe ------------- No response provided 6. Hallux valgus ---------------- No response provided 7. Hallux rigidus ----------------- No response provided 8. Acquired pes cavus (clawfoot) -------------------------------- No response provided 9. Malunion or nonunion of tarsal or metatarsal bones ----------------------------------------------------- No response provided 10. Foot injuries and other conditions -------------------------------------- a. Does the Veteran have any foot injuries or other foot conditions not already described? [X] Yes [ ] No If yes, describe the foot injury or other conditions (including frequency and physical exam findings) and complete question b. (severity and side affected). Pain in the feet consistent with arthropathy with has been confirmed to be secondary to RA. b. Indicate severity and side affected: [X] Moderately severe [ ] Right [ ] Left [X] Both c. Does the foot condition chronically compromise weight bearing? [ ] Yes [X] No d. Does the foot condition require arch supports, custom orthotic inserts or shoe modifications? [ ] Yes [X] No e. Comments: No comments provided 11. Surgical procedures ----------------------- a. Has the Veteran had foot surgery (arthroscopic or open)? [ ] Yes [X] No b. Does the Veteran have any residual signs or symptoms due to arthroscopic or other foot surgery? No response provided 12. Pain -------- RIGHT FOOT: Is there pain on physical exam? [X] Yes [ ] No If yes, (there is pain on physical exam), does the pain contribute to functional loss? [X] Yes [ ] No (Further description of limitations requested in Section XIII below.) LEFT FOOT: Is there pain on physical exam? [X] Yes [ ] No If yes, (there is pain on physical exam), does the pain contribute to functional loss? [X] Yes [ ] No (Further description of limitations requested in Section XIII below.) 13. Functional loss and limitation of motion -------------------------------------------- a. Contributing factors of disability (check all that apply and indicate side affected): [X] Pain on movement Side affected: [ ] Right [ ] Left [X] Both [X] Pain on weight-bearing Side affected: [ ] Right [ ] Left [X] Both [X] Pain on non weight-bearing Side affected: [ ] Right [ ] Left [X] Both [X] Interference with standing Side affected: [ ] Right [ ] Left [X] Both Contributing factors of disability associated with limitation of motion: b. Is there pain, weakness, fatigability, or incoordination that significantly limits functional ability during flare-ups or when the foot is used repeatedly over a period of time? RIGHT FOOT: [X] Yes [ ] No If yes, (there is a functional loss due to pain, during flare-ups and/or when the joint is used repeatedly over a period of time) please describe the functional loss: Pain from RA is severe and limits ability to stand and hence work LEFT FOOT: [X] Yes [ ] No If yes, (there is a functional loss due to pain, during flare-ups and/or when the joint is used repeatedly over a period of time) please describe the functional loss: Pain from RA is severe and limits ability to stand and hence work c. Is there any other functional loss during flare-ups or when the foot is used repeatedly over a period of time? RIGHT FOOT: [ ] Yes [X] No LEFT FOOT: [ ] Yes [X] No 14. 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 any conditions listed in the Diagnosis section above? [X] Yes [ ] No If yes, describe (brief summary): RA diagnosed and treatment started in 2018. Multiple other joints also affected. Veteran also diagnosed with comorbid fibromyalgia. Right ankle ORIF surgery in October 2004 (not SC'd), PTSD and depression. 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: No comments provided 15. Assistive devices --------------------- a. Does the Veteran use any assistive devices as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [ ] Yes [X] No b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided. 16. Remaining effective function of the extremities --------------------------------------------------- Due to the Veteran's foot condition, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc., while functions for the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 17. Diagnostic testing ---------------------- a. Have imaging studies of the foot been performed and are the results available? [X] Yes [ ] No If yes, is degenerative or traumatic arthritis documented? [X] Yes [ ] No If yes, indicate foot: [ ] Right [ ] Left [X] Both b. Are there any other significant diagnostic test findings or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): Positive imaging for RA and lab results positive for RA performed by Dr. DOCTOR , RO of DOCTOR OFFICe Medical Center in ANYTOWN, PA from 3/2018. c. If any test results are other than normal, indicate relationship of abnormal findings to diagnosed condition: No response provided 18. Functional impact --------------------- Regardless of the Veteran's current employment status, do the condition(s) listed in the Diagnosis section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)? [X] Yes [ ] No If yes, describe the functional impact of each condition, providing one or more examples: RA is severe in multiple joints including feet, ankles, knees, hips, back and jaw. Veteran remains limited in her daily activities and is unable to work on a sustained basis. Work recommended would be of a sedentary nature. 19. Remarks, if any: -------------------- Not an ACE Exam. Foot Correia Questions: #1. Is there evidence of pain on passive range of motion testing? Yes #2. Is there evidence of pain when the joint is used in non-weight bearing? Yes #3. Is the opposing joint undamaged? No Arthropathy of foot: Level of Severity: Moderate Veteran is currently pregnant and is due to deliver her 5th child in July 2019. Upon review for this case, it becomes apparent that the multiple joint complaints while AD are consistent with Rheumatoid Arthritis even though it was not diagnosed while active duty. This is confirmed by records reviewed by Dr. DOCTOR , DO dated 3/16/2018. Veteran has been seen and evalauted by an outside Rheumatolgist and has been diagnosed and treatment started for Rheumatoid Arthritis in 2018. **************************************************************************** Knee and Lower Leg Conditions Disability Benefits 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 ------------ a. List the claimed condition(s) that pertain to this DBQ: Recurrent fracture right medial maleous tibia; right lateral collateral ligament sprain, left knee lateral collateral ligament sprain b. Select diagnoses associated with the claimed condition(s) (Check all that apply): [X] Knee strain Side affected: [ ] Right [X] Left [ ] Both Date of diagnosis: Left 2004 [X] Knee meniscal tear [X] Tibia and/or Fibula fracture Side affected: [X] Right [ ] Left [ ] Both c. Comments (if any): No response provided d. Was an opinion requested about this condition (internal VA only)? [ ] Yes [X] No [ ] N/A 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's knee and/or lower leg condition (brief summary): Knee Medical History extracted from last Knee DBQ dated 9/13/2016. "STR's evident for a left knee contusion on 25Aug04 that was self limiting." "Veteran claims left knee gives out intermittently (once a week). Veteran denies any medication for her knee condition. Veteran claims her knee is sore daily. Veteran clains on 9-24-2004 she did have a left knee sprain and was seen by a DOCTOR, but there is no supporting documentation. Veteran reports since military discharge that she had a left knee meniscus disorder dated 6/15/2007 and was diagnosis with DJD left knee on 2/11/2010. No evidence noted for a recurrent medial mallelous fracture noted. Veteran claims documentation to support her left knee complaints were previously submitted on 9-1-2016." KNEE INTERVAL HISTORY: Left knee is painful daily. Pain 6/10. Veteran has been diagnosed with Rheumatoid Arthritis (RA) (DOCTOR , DO of ANYTOWN, PA) and is currently undergoing treatment. Of note, veteran has musculoskeletal complaints consistent with pain in multiple bilateral joints including her feet, ankles, knees, hips, back and TMJ joints. Ankle Medical History extracted from last Knee DBQ dated 9/13/2016. "STR's evident for right ankle sprain which was later diagnosis as a right ankle fracture. STR' radiograms for a right ankle fracture evident and Veteran was medically boarded out of the military for this condition." "Veteran claims right ankle always hurts and she is unable to wear flat shoes. Veteran claims it hurts when it rains. She notes it will intermittently lock up and sometimes she will fall. Veteran denies any medication use for her right ankle condition. Veteran claims shortly after military discharge she had an ORIF right ankle for Trimal ANYTOWNr repair on 13Dec04. Please note, VBMS is silent for this documentatin and she reports it was submitted on 9-1-2016 to support the claim." RIGHT ANKLE INTERVAL HISTORY: Veteran has been diagnosed with Rheumatoid Arthritis (RA) (DOCTOR , DO of ANYTOWN, PA) and is currently undergoing treatment. Of note, veteran has musculoskeletal complaints consistent with pain in multiple bilateral joints including her feet, ankles, knees, hips, back and TMJ joints. 6/10 for pain. DOCTOR has provided an opinion that states that the Veteran's ankle trauma was more than likely the inital preciptating factor in the onset of her Rheumatoid Arthritis. b. Does the Veteran report flare-ups of the knee and/or lower leg? [X] Yes [ ] No If yes, document the Veteran's description of the flare-ups in his or her own words: Pain in right and left ankles (as well as in the ankles, knees, hips, back and TMJ joints). Also, Veteran claims intermittent sharp pain and when it locks it feels like it is being pinched/squeezed. c. Does the Veteran report having any functional loss or functional impairment of the joint or extremity being evaluated on this DBQ, including but not limited to repeated use over time? [X] Yes [ ] No If yes, document the Veteran's description of functional loss or functional impairment in his or her own words: Ankle pain is like a throbbing ache and it limits her ability to fully flexes her feet. 3. Range of motion (ROM) and functional limitation -------------------------------------------------- a. Initial range of motion Right Knee ---------- [X] All normal [ ] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0 to 140): 0 to 140 degrees Extension (140 to 0): 140 to 0 degrees Description of pain (select best response): No pain noted on exam Is there evidence of pain with weight bearing? [ ] Yes [X] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [ ] Yes [X] No Is there objective evidence of crepitus? [ ] Yes [X] No Left Knee --------- [X] All normal [ ] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0 to 140): 0 to 140 degrees Extension (140 to 0): 140 to 0 degrees Description of pain (select best response): Pain noted on exam on rest/non-movement If noted on exam, which ROM exhibited pain (select all that apply)? Flexion, Extension Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): On the medial and lateral joint line. Is there objective evidence of crepitus? [ ] Yes [X] No b. Observed repetitive use Right Knee ---------- Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional functional loss or range of motion after three repetitions? [ ] Yes [X] No Left Knee --------- Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional functional loss or range of motion after three repetitions? [ ] Yes [X] No c. Repeated use over time Right Knee ---------- Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: May vary with activity Left Knee --------- Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: May vary with activity d. Flare-ups Right Knee ---------- Is the exam being conducted during a flare-up? [ ] Yes [X] No If the examination is not being conducted during a flare-up: [ ] The examination is medically consistent with the Veteran's statements describing functional loss during flare-ups. [ ] The examination is medically inconsistent with the Veteran's statements describing functional loss during flare-ups. Please explain. [X] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups. Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: May vary with activity Left Knee --------- Is the exam being conducted during a flare-up? [ ] Yes [X] No If the examination is not being conducted during a flare-up: [ ] The examination is medically consistent with the Veteran's statements describing functional loss during flare-ups. [ ] The examination is medically inconsistent with the Veteran's statements describing functional loss during flare-ups. Please explain. [X] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups. Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: May vary with activity e. Additional factors contributing to disability Right Knee ---------- In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: Interference with standing Please describe additional contributing factors of disability: Joint pain secondary to RA limit ability to stand for prolonged periods of time Left Knee --------- In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: Interference with standing Please describe additional contributing factors of disability: Joint pain secondary to RA limit ability to stand for prolonged periods of time 4. Muscle strength testing -------------------------- a. Muscle strength - Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Right Knee: Rate Strength: Flexion: 5/5 Extension: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No Left Knee: Rate Strength: Flexion: 5/5 Extension: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No b. Does the Veteran have muscle atrophy? [ ] Yes [X] No c. Comments, if any: No response provided 5. Ankylosis ------------ Complete this section if the Veteran has ankylosis of the knee and/or lower leg. a. Indicate severity of ankylosis and side affected (check all that apply): Right Side: [ ] Favorable angle in full extension or in slight flexion between 0 and 10 degrees [ ] In flexion between 10 and 20 degrees [ ] In flexion between 20 and 45 degrees [ ] Extremely unfavorable, in flexion at an angle of 45 degrees or more [X] No ankylosis Left Side: [ ] Favorable angle in full extension or in slight flexion between 0 and 10 degrees [ ] In flexion between 10 and 20 degrees [ ] In flexion between 20 and 45 degrees [ ] Extremely unfavorable, in flexion at an angle of 45 degrees or more [X] No ankylosis b. Indicate angle of ankylosis in degrees: No response provided c. Comments, if any: No response provided 6. Joint stability tests ------------------------ a. Is there a history of recurrent subluxation? Right: [X] None [ ] Slight [ ] Moderate [ ] Severe Left: [X] None [ ] Slight [ ] Moderate [ ] Severe b. Is there a history of lateral instability? Right: [X] None [ ] Slight [ ] Moderate [ ] Severe Left: [X] None [ ] Slight [ ] Moderate [ ] Severe c. Is there a history of recurrent effusion? [ ] Yes [X] No d. Performance of joint stability testing Right Knee: Was joint stability testing performed? [ ] Yes [ ] No [ ] Not indicated [X] Indicated, but not able to perform If joint stability is indicated, but unable to test, provide reason: Guarding prevented testing Left Knee: Was joint stability testing performed? [ ] Yes [ ] No [ ] Not indicated [X] Indicated, but not able to perform If joint stability is indicated, but unable to test, provide reason: Guarding prevented testing e. Comments, if any: No response provided 7. Additional conditions ------------------------ a. Does the Veteran now have or has he or she ever had recurrent patellar dislocation, "shin splints" (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibular impairment? No response provided b. Comments, if any: Ankle(s) Information a. Initial range of motion Right ankle ----------- [ ] All Normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Dorsiflexion (0-20): 0 to 10 degrees Plantar Flexion (0-45): 0 to 45 degrees If ROM is outside of normal range, but is normal for the Veteran (for reasons other than an ankle condition, such as age, body habitus, neurologic disease), please describe: Normal for body habitus. If abnormal, does the range of motion itself contribute to a functional loss? [ ] Yes, (please explain) [X] No Description of pain (select best response): Pain noted on exam but does not result in/cause functional loss If noted on examination, which ROM exhibited pain (select all that apply)? Dorsiflexion, Plantar Flexion Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): Veteran expressed tenderness on palpation of right ankle. Is there objective evidence of crepitus? [ ] Yes [X] No Left ankle ---------- [ ] All Normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Dorsiflexion (0-20): 0 to 10 degrees Plantar Flexion (0-45): 0 to 45 degrees If ROM is outside of normal range, but is normal for the Veteran (for reasons other than an ankle condition, such as age, body habitus, neurologic disease), please describe: Normal for body habitus. If abnormal, does the range of motion itself contribute to a functional loss? [ ] Yes, (please explain) [X] No Description of pain (select best response): Pain noted on exam but does not result in/cause functional loss Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): Veteran expressed tenderness on palpation of left ankle. Is there objective evidence of crepitus? [X] Yes [ ] No b. Observed repetitive use Right ankle ----------- Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional loss of function or range of motion after three repetitions? [ ] Yes [X] No Left ankle ---------- Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional loss of function or range of motion after three repetitions? [ ] Yes [X] No c. Repeated use over time Right ankle ----------- Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No If the examination is not being conducted immediately after repetitive use over time: [ ] The examination is medically consistent with the Veterans statements describing functional loss with repetitive use over time. [ ] The examination is medically inconsistent with the Veterans statements describing functional loss with repetitive use over time. Please explain. [X] The examination is neither medically consistent or inconsistent with the Veterans statements describing functional loss with repetitive use over time. Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: May vary with activity. Left ankle ---------- Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No If the examination is not being conducted immediately after repetitive use over time: [ ] The examination is medically consistent with the Veterans statements describing functional loss with repetitive use over time. [ ] The examination is medically inconsistent with the Veterans statements describing functional loss with repetitive use over time. Please explain. [X] The examination is neither medically consistent or inconsistent with the Veterans statements describing functional loss with repetitive use over time. Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: May vary with activity. d. Flare-ups Right ankle ----------- Is the examination being conducted during a flare-up? [ ] Yes [X] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-up? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: May vary with activity. Left ankle ---------- Is the examination being conducted during a flare-up? [ ] Yes [X] No If the examination is not being conducted during a flare-up: [ ] The examination is medically consistent with the Veterans statements describing functional loss during flare-ups. [ ] The examination is medically inconsistent with the Veterans statements describing functional loss during flare-ups. Please explain. [X] The examination is neither medically consistent or inconsistent with the Veterans statements describing functional loss during flare-ups. Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-up? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: May vary with activity. e. Additional factors contributing to disability Right ankle ----------- In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: Yes, newly diagnosed RA which has MD has opined may have been the preciptating factor for her other multiple musculoskeletal complaints Left ankle ---------- In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: Yes, newly diagnosed RA which has MD has opined may have been the preciptating factor for her other multiple musculoskeletal complaints 4. Muscle strength testing -------------------------- a. Muscle strength - rate strength according to the following scale 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Right ankle: Rate Strength: Plantar Flexion: 4/5 Dorsiflexion: 4/5 Is there a reduction in muscle strength? [X] Yes [ ] No Left ankle: Rate Strength: Plantar Flexion: 4/5 Dorsiflexion: 4/5 Is there a reduction in muscle strength? [X] Yes [ ] No b. Does the Veteran have muscle atrophy? [ ] Yes [X] No c. Comments, if any: Newly diagnosed RA which has MD has opined may have been the preciptating factor for right and left ankle condition(s) as well as her other multiple musculoskeletal complaints 5. Ankylosis ------------ Complete this section if Veteran has ankylosis of the ankle a. Indicate severity of ankylosis and side affected (check all that apply): Right side: Left side: [ ] In plantar flexion [ ] In plantar flexion [ ] In dorsiflexion [ ] In dorsiflexion [ ] With an abduction deformity [ ] With an abduction deformity [ ] With an inversion deformity [ ] With an inversion deformity [ ] With an eversion deformity [ ] With an eversion deformity [ ] In good weight-bearing position [ ] In good weight-bearing position [ ] In poor weight-bearing position [ ] In poor weight-bearing position [X] No ankylosis [X] No ankylosis b. Comments, if any: No response provided 6. Joint stability ------------------ Right ankle Is ankle instability or dislocation suspected? [X] Yes [ ] No If yes, complete the following: Anterior Drawer Test Is there laxity compared with opposite side? [ ] Yes [ ] No [X] Unable to test due to pain and guarding Talar Tilt Test Is there laxity compared with opposite side? [ ] Yes [ ] No [X] Unable to test due to pain and guarding Left ankle Is ankle instability or dislocation suspected? [X] Yes [ ] No If yes, complete the following: Anterior Drawer Test Is there laxity compared with opposite side? [ ] Yes [ ] No [X] Unable to test due to pain and guarding Talar Tilt Test Is there laxity compared with opposite side? [ ] Yes [X] No [X] Unable to test due to pain and guarding 7. Additional comments ---------------------- Does the Veteran now have or has he or she ever had "shin splints", stress fractures, achilles tendonitis, achilles tendon rupture, malunion of calcaneus (os calcis) or talus (astragalus), or has the Veteran had a talectomy (astragalectomy)? [ ] Yes [X] No 8. Surgical procedures ---------------------- Indicate any surgical procedures that the Veteran has had performed and provide the additional information as requested (check all that apply): Right side: [X] Arthroscopic or other ankle surgery Type of surgery: ORIF Date of surgery: 2004 [X] Residuals of arthroscopic or other ankle surgery Describe residuals: pressure with unable to wear flat shoes due to positional pressure. Left side: [X] Arthroscopic or other ankle surgery Type of surgery: Date of surgery: 2004 [X] Residuals of arthroscopic or other ankle surgery Describe residuals: pressure with unable to wear flat shoes due to positional pressure. 9. 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 any conditions listed in the Diagnosis Section above? [X] Yes [ ] No If yes, describe (brief summary): Rheumatoid Arthritis, Fibromyalgia, PTSD and depression. 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? [X] Yes [ ] No c. Comments, if any: 9 CM x 0.2 cm on both medial and lateral aspect of left achilles region 10. Assistive devices --------------------- a. Does the Veteran use any assistive devices as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [ ] Yes [X] No b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided 11. Remaining effective function of the extremities --------------------------------------------------- Due to the Veteran's ankle condition, is there functional impairment of an extremity such that no effective functions remain other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc., while functions for the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 12. Diagnostic testing ---------------------- a. Have imaging studies of the ankle been performed and are the results available? [X] Yes [ ] No b. Are there any other significant diagnostic test findings or results? [ ] Yes [X] No c. If any test results are other than normal, indicate relationship of abnormal findings to diagnosed conditions: No response provided 13. Functional impact --------------------- Regardless of the Veteran's current employment status, do the condition(s) listed in the Diagnosis Section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)? [X] Yes [ ] No Unable to stand for long periods of time. Would be best suited for sedentary work. Ankle Correia Questions: #1. Is there evidence of pain on passive range of motion testing? Yes #2. Is there evidence of pain when the joint is used in non-weight bearing? Yes #3. Is the opposing joint undamaged? No Recurrent Tibal Fracture: Level of Severity: Moderate 8. Meniscal conditions ---------------------- No response provided 9. Surgical procedures ---------------------- No response provided 10. 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 any conditions listed in the Diagnosis Section above? [X] Yes [ ] No If yes, describe (brief summary): Recurrent right of right medial tibia addressed with ankle questions as covered in 7.b. Additional Conditions noted above. Rheumatoid Arthritis, Fibromyalgia, PTSD and depression 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 11. Assistive devices --------------------- a. Does the Veteran use any assistive device(s) as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [X] Yes [ ] No If yes, identify assistive device(s) used (check all that apply and indicate frequency): Assistive Device: Frequency of use: ----------------- ----------------- [X] Brace(s) [X] Occasional [ ] Regular [ ] Constant b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided 12. Remaining effective function of the extremities --------------------------------------------------- Due to the Veteran's knee and/or lower leg condition(s), is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc., while functions for the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 13. Diagnostic testing ---------------------- a. Have imaging studies of the knee been performed and are the results available? [ ] Yes [X] No b. Are there any other significant diagnostic test findings and/or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): Positive Rheumatoid Factor as part of work-up by DOCTOR , DO DOCTOR OFFICe Medical Center ANYTOWN, PA in 3/2018. c. If any test results are other than normal, indicate relationship of abnormal findings to diagnosed conditions: DOCTOR opined that the ankle condition(s) diagnosed in 2004 were the initial pressnting arthritic condition that was subsequently diagnsed as Rheumatoid Arthritis in 2018. 14. Functional impact --------------------- Regardless of the Veteran's current employment status, do the condition(s) listed in the Diagnosis Section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)? [X] Yes [ ] No If yes, describe the functional impact of each condition, providing one or more examples: RA is severe in multiple joints including feet, ankles, knees, hips, back and jaw. Veteran remains limited in her daily activities and is unable to work on a sustained basis. Work recommended would be of a sedentary nature. 15. Remarks, if any: -------------------- Not an ACE Exam. Knee Correia Questions: #1. Is there evidence of pain on passive range of motion testing? Yes #2. Is there evidence of pain when the joint is used in non-weight bearing? Yes #3. Is the opposing joint undamaged? No Lateral Collateral Ligament Sprain: Level of Severity: Moderate Upon review for this case, it becomes apparent that the multiple joint complaints while AD are consistent with Rheumatoid Arthritis even though it was not diagnosed while active duty. This is confirmed by records reviewed by Dr. DOCTOR , DO dated 3/16/2018. Veteran has been seen and evalauted by an outside Rheumatolgist and has been diagnosed and treatment started for Rheumatoid Arthritis in 2018.

Yikes, sorry for the spelling errors. my hands are really sore today with the cold

Hey all. You guys were amazing and so helpful when I went through my last C&P exam so I figured I would try my luck again. Short story is I was medboarded out in 2004 for a rather nastu ankle fracture that was misdiagnosed as a sprain for 2 months at Fort Gordon. So i was reading through my most recent c&p expecting it to be tanked again and he closed the report with "Upon review of this case, it becomes apparent that the multiple joint complains while AD are consistent with Rheumatoid arthritis even though it wasn't diagnosed on active duty. This is conformed by records reviewed by DOCTOR DOCTOR dated 3/16/18. Veteran has been seen and evaluated by an outside rheumatologist and hasbeen diagnosed. Treatment started in 2018" He was only doing a knee and ankle c&p and he mentioned both hips, feet, ankles, knees, etc. So I'm shocked. Does this mean what I think it does?

Hi, Thank you for answering. I knew you had to be 100% P&T to get those benefits, and that I am not, so that was why I was confused. I will chalk that up to spam/informative mail. I was just surprised and lowkey hopeful that they finally had wrapped me up. With the ebenefits, I wish that were the case. I have what is essentially a watered down account. My ex husband was in 7 years after I got out, so when I log in, I can get my letters, I can see my payment history, but I have to jump through some hoops to do it, going to a different screen where I can select myself as the sponsor instead of him. Like, my default status is dependent there. So say I want to find/add a rep, it fills his information and not mine. His stuff defaults now. I did call in, and I am being told that he has to provide a divorce decree to OPM to sever. I have sent it in like 4 times, but it has to be him, apparently. It used to show my disabilities and rating, but now it shows his for some reason. Oddly enough though, it also shows my current husband under dependents so theres that. I will take your advice and see if maybe the VAMC can do it instead of the ID Card offices and DEERS as I was previously directed to. Thanks! Maybe that will fix it. It is so frustrating. I will also check for a new rep as I see everyone getting updates, and all I get are CC's of repeated ramp requests or notice of intents to file with different dates. Thank you for taking the time to answer my silly questions

Hi all, This is probably the dumbest question ever, but has anyone else been receiving letters and pamphlets on Champva and dependent education assistance benefits lately? I'm currently only 70% rated, but do have an active appeal. Unfortunately, I cannot check ebenefits because I was married to another soldier and my ebennies does not update or populate my own information ever since he filed hisown claim. I also cant call my rep because the phone just rings and rings. I don't know if this is essentially spam mail, or if its an administrative thing where my ratings have changed and I haven't been notified yet. I know it's a dumb question, but none of my friends who are vets were receiving this pamphlets, so I thought here would be a good place to see if I should get hopeful or not. My pending deposit is normal, so I'm thinking spam? Thanks

Thanks guys. It's been a really uncomfortable journey getting them all what they need. I just didn't know which part of the assessment the ratings were based off of. The first "pick a box" thing or the symptoms. Thank you for providing some insight there for me. I am a little less worried now, i intended to use what they gave to pay for secondary health insurance since their psych and their physical therapy (LOD injury) are an hour a way from my home and very few of the local docs deal with veteran's choice, that way I can more actively work toward recovery. Thank you all so much for explaining that symptoms are what they rate by. I guess that would explain the difference I was seeing. Cheers!

Hi all! This is so confusing to me. It seems like the box she checked is in direct conflict with the symptoms she chose. I feel like that lowballed me, am I looking at this right? Took almost 2.5 hrs and this is what I got: I removed doctors names and personal information but again, I don't understand what this means. Can someone please take a look and tell me? I am sorry it is long, I am just really confused by the language of it. In a PCL-5, what is a 72 out of 38? This is all jibberish to me. Can someone please help? Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [X] Yes [ ] No 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Post Traumatic Stress Disorder b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided.3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [X] No c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation 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 [ ] No [X] No other mental disorder has been diagnosed 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): The veteran brought civilian records of diagnoses and procedures to session. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): The veteran was referred for a DBQ Initial PTSD evaluation for Post Traumatic Stress Disorder. Information in this assessment is based on the veteran's self-report unless otherwise indicated. The veteran is a 32 year old divorced female. She said that her mother had her when she was 14 years old. She described her childhood as abusive and very difficult. Her mother was "a junkie." Her mother was very abusive emotionally and physically, and two of her stepfathers were also abusive. She said that she tended to take the punishment for her two younger brothers. Her mother was stabbed to death by her brothers' father when the veteran was 9 years old, and she and her brothers witnessed the stabbing. Her own father was declared unfit, so she went into foster care. She has 14 siblings total, but was only raised with the two younger brothers. She is still in contact with some of her siblings. Her brother lives with her. One sister committed suicide recently due to the deaths of her husband and children in a car accident. The veteran has been married 3 times. She stated that she married the first time in order to get her brother out of foster care. He came to live with her and her husband. They had no children. She married a second time and they had 2 sons, now ages 11 and 9. She had one daughter with her third husband, age 4. She stated, "Sometimes I marry people because I'm bored and I don't have friends." She is currently involved in a relationship with her fianc?, FUTURESPOUSE. She stated that this is a good relationship and that he is loving and supportive. He lives in the household with her, her brother, and her 3 children. When asked about friends, she stated that she doesn't have any friends. She considers FUTURE SPOUSE and her little brother to be her friends. She does not associate with anyone else. She stated that she does not like to go out and does not like to interact with people. When asked about an average day, she stated that she works and cares for her children and FUTURESPOUSE. She enjoys reading. b. Relevant Occupational and Educational history (pre-military, military, and post-military): The veteran has a bachelor's degree in Business, and an associate's degree in Criminal Justice. She would like to continue her education to get a master's degree in Emergency and Disaster Management. Although she claims to have ADHD, she denied having any symptoms of it during childhood and denied having any academic difficulties. Her high school transcripts indicate that she had a B average. She stated that her grades have been good throughout her academic career and that she was always on the dean's list in college. She currently works in administration and operations. She stated that it is a small company and she does everything - HR, IT, and finance for it. She has held this position for 10 months. She stated that she anticipates that she will be fired soon due to missing a lot of work. Because it is a small company, it does not honor FMLA policies. She said that she misses work because she does not sleep well. When she has a rough night, she knows that she will be irritable so she does not go in the next day. Prior to her current position, she worked at Comcast. She had maintained that position for one year. She said that she had difficulties with attendance at that job too. She served in the U.S. Army. She was released for medical reasons due to a fractured ankle. She cited an incident of MST during her service that occurred in March 2004. She stated that she had gone to a party, had been drinking, and was sleeping it off. She awoke to find one man having sex with her, another putting his pants on, and a third masturbating beside her. She stated that she became pregnant from this encounter and had an abortion. There is do cumentation of mental health treatment in her STR from 7/8/04 to 10/15/04, with diagnoses of Adjustment Disorder, Alcohol Abuse, Cyclothymia, and Depression. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The veteran was psychiatrically hospitalized at the Meadows in 1997 and 1998, then again in 2008. She has had two suicide attempts. There is documentation of mental health treatment in her STR from 7/8/04 to 10/15/04, with diagnoses of Adjustment Disorder, Alcohol Abuse, Cyclothymia, and Depression. She received mental health treatment on an outpatient basis in the community until recently. CPRS records indicate that she attended intake appointments at the VA in June 2016 with a psychiatrist,, and a social worker, but did not make any follow up appointments due to a stated need to refrain from missing work. Her CPRS chart indicates diagnostic impressions of anxiety and chronic depression. She stated that she had been prescribed Adderall and Xanax in the community but Dr would not refill these and she has not taken any psychotropic medication since April 2016. He had offered psychological testing to confirm ADHD but she declined his offer. She said that she had taken several SSRIs in the past but they did not help. She endorsed current symptoms indicative of Post Traumatic Stress Disorder. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): The veteran denied any past or current problems in this area. e. Relevant Substance abuse history (pre-military, military, and post-military): The veteran stated that she had problems with alcohol beginning in the military. She drank more after the rape in 2004. There is documentation in her record that she was drinking a pint of whiskey every two days. She said that she currently drinks once per month, and stated that she drinks 1 or 2 drinks. She was noted to have 2 cups each containing 31 ounce Starbucks coffees with her to this interview. She stated that she needs a lot of caffeine during the day because she cannot sleep at night. She usually drinks 4-6 of these 31 ounce drinks per day, indicating that she is getting 1120 to 1680mg of caffeine per day. She does not consider this to be a problem. Family history is significant in that her mother "was a junkie." f. Other, if any: No response provided. 3. Stressors ------------ Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: Sexual Assault in March 2004 Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [ ] Yes [X] No Is the stressor related to personal assault, e.g. military sexual trauma? [X] Yes [ ] No If yes, please describe the markers that may substantiate the stressor. There is documentation of mental health treatment in her STR from 7/8/04 to 10/15/04, with diagnoses of Adjustment Disorder, Alcohol Abuse, Cyclothymia, and Depression. There is documentation of an elective abortion dated 6/14/04, with the comments, "Conception the result of documented sexual assault. Both post operative instructions and sexual assault support group documentation provided." 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criterion A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).[X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined"). [X] Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.[X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities.[X] Feelings of detachment or estrangement from others. [X] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Reckless or self-destructive behavior.[X] Hypervigilance. [X] Exaggerated startle response.[X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 5. Symptoms ----------- Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships[X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Inability to establish and maintain effective relationships [X] Suicidal ideation 6. Behavioral Observations -------------------------- The veteran was alert and responsive, and oriented to time, person, and place. She was cooperative throughout interview. Eye contact was adequate. Affect was constricted, mood anxious. She was jittery and had difficulty sitting still. Speech was fluent, spontaneous, and goal-directed. Rate, rhythm, and volume were within normal limits. Thought processes were coherent. She denied perceptual disturbances. Memory was adequate for both recent and remote events. Fund of information was adequate. Attention and concentration were adequate. Thinking was abstract. She denied having any current suicidal or homicidal thoughts or plans. Judgment and insight were adequate. 7. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 8. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any -------------------------------------------------- This was not an ACE examination. The veteran was evaluated in person. All available electronic records, including VBMS file were reviewed. The PCL-5 was administered to the veteran during this evaluation. She obtained a score of 72, significantly above the cut off score of 38, suggestive of a PTSD diagnosis.Based on Veteran's self-report, review of all available electronic records, clinical interview, and the scores on the above assessment, she meets DSM-5 criteria for Post Traumatic Stress Disorder. It is believed that her mood and attentional symptoms are manifestations of PTSD and do not represent separate, discrete disorders. Her symptoms are significantly interfering with her daily activities and her social and occupational functioning. It is at least as likely as not (50 percent or greater probability) that this disorder was caused or exacerbated by the military sexual trauma events she experienced during her military service.