I had a c&p exam for my ptsd/mst claim on 1/19/17 at the VA Outpatient center in Fort Worth and just got the results back today. I was quite shocked by the notes. I feel that the c&p psychologist did not review the merits of my case properly and just opined hat I was exaggerating my symptoms based on a 15 question "MENT" test which consisted of me differentiating between happy, angry and sad faces. She also asked me to remember 5 items after 5 minutes (which she gave me the answer after I couldn't remember 2 of them). She asked me nothing about my symptoms or about the events of the trauma. She picked what parts of my VA medical records she included in the report (i.e., sleep disturbance). I feel like I have been shafted. She is basically refuting the diagnosis given by my TWO VA psychiatrists, VA psychologist and my VA social worker.
I waited over 25 years to file my sexual assault claim due to me being extremely embarrassed and unable to bring myself to talk about the events that occurred while I served as a submariner in the Navy. The assault happened in 1988; back before don't ask, don't tell. Needless to say I was traumatized and afraid of being kicked out. Nonetheless, I was medically discharged a year later due to asthma brought on by anxiety and panic attacks while onboard my duty station.
So, now I am at the point where I am finally seeking help and I spend 20 minutes with a c&p psychologist who seems to be indifferent about my condition. I almost feel like I should have just retreat back to my home in silence instead of being treated like a liar!!!
What can I do about this?
Here is my c&p exam:
LOCAL TITLE: COMP & PEN MENTAL HEALTH/PSYCHOLOGY EXAM STANDARD TITLE: PSYCHOLOGY C & P EXAMINATION CONSULT DATE OF NOTE: JAN 19, 2017@09:30 ENTRY DATE: JAN 19, 2017@11:27:37 AUTHOR:
EXP COSIGNER: URGENCY: STATUS: COMPLETED
Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only *
Name of patient/Veteran:
1. Diagnostic Summary
Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation?
[ ] Yes [X] No
2. Current Diagnoses
a. Mental Disorder Diagnosis #1: No Diagnosis
Comments, if any: Psychological Testing
A test of response bias specifically related to PTSD symptoms was administered to the veteran during this examination to assess the credibility of his self-report. The name of this measure is withheld in this report in order to protect the integrity of the test. This test was specifically standardized on a sample of veterans applying for financial remuneration for a claim of disability resulting from PTSD. The veteran's score on this test was significantly above the established cutoff, indicating that his performance was not consistent with persons diagnosed with PTSD but was consistent with the test performances of disability claimants simulating symptoms of PTSD. As such, there is reason to suspect symptom exaggeration and a response style indicative of attempts to portray himself as worse off than he actually may be with regard to PTSD symptoms. Based on the Veteran's scores, additional testing was performed to further evaluate the possibility of overreporting or exaggeration of mental health symptoms.
A second test of response bias was given that was specifically designed to assess the credibility of reported psychopathology symptoms of response bias related to mental illness. Each item on this test was designed to evaluate constructs and behaviors useful in identifying overreporting. This test was developed and validated using both simulation and known-groups designs to identify individuals attempting to overreport symptoms of mental illness. In addition, the validity of this exam has been generalized across various racial/ethnic groups, genders and settings. The Veteran's total score on this measure was above the cutoff, indicating that his responses were not consistent with persons diagnosed with any mental illness. In addition, the Veteran's scores on this interview indicate that his behavior was inconsistent with his reported symptoms and he endorsed very extreme and uncommon symptoms, symptom combinations that are both unlikely and inconsistent with common mood and psychotic disorders, and he had a tendency to endorse severe and unusual psychotic symptoms. He also endorsed an unusual course of illness that is inconsistent with the course of most psychiatric disorders recognized in clinical practice.
It is possible that the veteran suffers from a mental illness. However, I am ethically unable to provide a diagnosis at this time given the veteran's response pattern of overreporting on three objective, reliable and valid psychological tests. Providing a diagnosis would require this examiner to resort to mere speculation and would violate the American Psychological Association's (APA) Ethical Principles of Psychologists and Code of Conduct.
b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI):
Deferred to a physician
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] No mental disorder diagnosis
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
1. Evidence Review
Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS
a. Relevant Social/Marital/Family history (pre-military, military, and post-military):
Family - Veteran was raised in a "normal" environment by his mother. "I wasn't that close to my father." Veteran has two brothers and two sisters. Veteran's mother was a kindergarten teacher and his father was a "mobile home constructor". Veteran denied any childhood medical/mental health problems. Veteran denied a family history of mental illness.
Marital - Veteran has never been married. His last relationship ended around October of 2016 due to his "agitation." "She wanted to talk about stuff and I didn't want to discuss issues with her." Veteran has three sons (ages 16, 20 and 22). "My oldest two sons I don't really talk to since they're gone-one is overseas and the other I think moved up North. I call them every now and then and try to reach them but I hardly get in contact with them. I have a close relationship with my youngest son. He keeps me going."
Social - "I had a lot of friends growing up but over the years they sort of fell to the wayside. I had friends going into the military and in boot camp but after sub school I stayed to myself. I had some associates but I didn't want to make any friends after sub school. Currently I have a few associates but I wouldn't call them friends." Prior to the military, the veteran enjoyed running track, playing football, singing in the choir and being in the art club ("I was the cartoonist for the school paper."), science and chess club. "During the military I didn't have any activities other than working on my rating. After I got out I got into oil painting, swimming, cycling and home renovation. I can no longer cycle or swim because of my back and respiratory issues. I haven't attended church in three years and my mother is now a pastor."
b. Relevant Occupational and Educational history (pre-military, military, and post-military):
Educational - Veteran earned a Bachelor's Degree in Electrical Engineering in 1995 and a Master's Degree in Biomed Engineering in 2009. Veteran informed that he was a good student and denied a history of suspensions, expulsions or learning problems.
Occupational - Veteran's job history prior to the military includes custodian and lawn care (self-employed). Veteran serve in the Navy from July 13, 1987- May 16,1989. Veteran was a college student from 1990-1997 and 2004-2009. Since being discharged from the military the veteran has worked as an RF engineer/consultant (1997-2004: "I got into an argument with my supervisor because he always wanted to include me on projects he was working on and I thought that was inappropriate. I thought he had an interest in me even though he didn't say it outright. He wanted to go out and do stuff outside of work hours."); and bioengineer/prosthetic designer for the Department of Commerce (2010-March of 2016: "I got in several arguments because of space and eventually withdrew and stopped producing. I had to share a small space with a coworker and he was constantly rolling back in his chair asking me questions and tapping me on the shoulder so it finally came to a head.").
Occupational problems reported include poor social interaction ("Shouting at people and avoiding contact with guys in the office. I worked better with females."), difficulty concentrating ("Because I was focused on not being in a vulnerable position. I missed deadlines or didn't finish tasks because I couldn't focus. I asked to have my own office but you can't have one as a junior engineer."), difficulty following instructions ("If men tried to get close to me because it reminded me of sub school and the threat of not being advanced or promoted."), forgetfulness, and increased absenteeism ("In 2015 I couldn't deal with the office so I started working from home but my supervisor didn't want me to sever myself from the office totally. I had anxiety about going back and sharing an office with another male. I felt better working by myself because I was more productive.").
In regards to reprimands, the veteran informed that he was written up for poor work performance, absenteeism, being AWOL and conflicts with his officemate. "The conflicts with my officemate led to me being fired." Veteran informed that he has applied for one job since being fired. When asked if he was a productive and reliable employee he stated, "As long as I was alone and no one was being touchy with me."
Veteran denied the following occupational problems: assignment of different duties and tardiness
An October 5, 2016 MH OUTPT NOTE states, "He is unemployed and uses income from renting rooms to pay living expenses."
An October 5, 2016 MH Attending note states, "Lost his last job as a biomedical engineer in March 2016 after "tussling" with an older man in his office who would repeatedly come up behind him and touch/pat his shoulders which reminded him of his Navy experience...Owns home and rents out rooms for income."
c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Mental Health Veteran began mental health treatment at the North Texas VA in August of 2016 and is compliant with his medication regimen of risperidone, prazosin and sertraline despite feeling "groggy and spaced-out." Veteran denied a history of psychiatric hospitalizations.
An October 12, 2016 SLEEP TELEPHONE NOTE states, "I called the patient and explained their sleep test results in detail. I explained him that the study did not show significant sleep apnea despite his sleeping on his back. He is unable to sleep on his side due to his shoulder problems...Encouraged the patient to lose weight."
A November 2, 2016 MH PTSD INDIVIDUAL NOTE states, "Veteran believes that gay men are going to hurt him. He also informed worker that he has experienced a lot of fear and worry this Halloween with people who are transgender, to the point that he is not sleeping for fear they will break into his home. Veteran is worried that he may have to "barricade" his home with bars on the windows."
A November 3, 2016 MH Attending Note states, "Updates that since last appt, his GF ended their relationship, "she said I was over agitated." Last week, he describes an incident at a restaurant when a transgendered person was standing by him, he turned and saw the person,
got so upset that he ran out of the restaurant and vomited. Since last week has felt progressively worse. "It's harder to tell which people to stay aware from.. it's a whole new ballgame with transgendered [people]...I don't know who my enemy is." He states he needs to set a perimeter on his house, put bars on his windows/doors, and update his security alarm. Reports poor sleep, gets out of bed 3-4x/night to check doors/windows and frequency of NMs has increased. Appetite is low. Feels that he cannot focus, "I'm constantly thinking how to avoid these people." Reports hearing male voices talking outside of his windows so he fears they will break in (reason for "setting perimeter"). When he is in public he has thoughts of "I need to get them before they get me" when he passes male strangers. Has not had any violence but does say he has had verbal arguments (told someone in the Wal-Mart line to back up and they argued with him, for example)...+ MST in Navy- unwanted taunts, suggestive remarks and genital contact and kissing from supervisor."
A December 5, 2016 MH ATTENDING NOTE states, "Updates writer that he has spent ~$3000 since last visit adding bars to the outside of his first floor home window and installing a security system with cameras. Reports he still plans to add more cameras to monitor his roof because "maybe someday deterred by the barricade downstairs might want to get in up there." Reports vague AH of hearing footsteps on his second floor when he is down on the first floor. Denies hearing voices from upstairs or outside his window like he endorsed last visit. Reports nighttime is the hardest for him because "that's when they are outside...the enemy, the transsexuals." Denies actually seeing anyone outside of his house at night. Reports he is comfortable with certain people coming up to his house, like the mailman, but states he is not comfortable when strangers come up. States he is not aggressive but tells them to go away. Does not take his gun with him to the front door. States he now feels better with his house more protected. Is able to watch movies and enjoy them during the day. His security system is on his phone app and he checks it every 3 hours. At night he "secures the perimeter" every 2 hours, has an alarm set."
d. Relevant Legal and Behavioral history (pre-military, military, and post-military):
Behavioral - "In 2005 I grabbed a guy that was dressed like a female. We were meeting for a date but his profile said he was a female. Two months ago a person behind me in line was transgender. I pushed him to the side and ran outside."
Legal - Veteran denied a history of legal problems.
e. Relevant Substance abuse history (pre-military, military, and post-military):
Substance Abuse - Veteran denied a history of substance abuse.
f. Other, if any: No response provided.
Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military):
a. Stressor #1: MST February-April of 1988:
CPRS states, "A male teacher began touching him during class and stepped over lines trying to get too close that made him feel very uncomfortable. Veteran says there was never genital contact because there was touching and kissing on the part of the instructor." Veteran's stressor statement states, "One trainer would come up behind me and massage my shoulders. He also grabbed my waist and pressed himself against me. I could feel his erect penis against my buttocks. He also made sexual innuendos and jokes. He also asked me if my nipples were hard because I was glad to see him. He then said, 'I bet you have a nice sized tool'. He then touched my left nipple and kissed my neck. When I confronted him he stated that if I didn't cooperate, I may not pass through with my classmates. He then grabbed my crotch and said, 'Pass or no pass. You make the determination.' My relationship with my long time high school sweetheart ended that summer (June of 1988) because I withdrew fro the relationship and was too ashamed to confide in her." Please note that this last statement is in contrast to the statement provided by his former girlfriend who stated that the veteran "mentioned that a sexual assault happened to him during training that changed him and that he needed time to work through it."
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. Veteran's treatment records, buddy statement and stressor statement were reviewed. However, there are no markers in the veteran's STRs or personnel records which the VBA has confirmed.
4. PTSD Diagnostic Criteria
No response provided.
No response provided.
6. Behavioral Observations
MENTAL STATUS EXAM - Appearance, Behavior, and Speech Veteran's appearance and dress were appropriate for the exam. His speech was normal in rate and tone. Veteran's response to the evaluation was guarded but engaged. Rapport was easily established with the Veteran who put forth a conscientious effort to answer all questions to the best of his ability.
Thought Process - There was no evidence of loose associations, flight of ideas, circumstantial, or tangential thought process. Veteran completed similarities and interpreted proverbs accurately.
Thought Content - Veteran denied having any obsessions or suicidal/homicidal ideations. However, delusions regarding the security of his home and transgenders were reported. "Transgenders are trying to get back at me because I grabbed the transgender that I was supposed to go on a date with. His profile said he was female. I have to hone in and decipher whether someone is male or female because my initial problems came with my sexual assault in training so I've distanced myself from males who are the enemy. The transgender caught me off guard and now they're trying to trick me. It's a whole new ball game."
Perceptual Abnormalities - "I keep hearing my instructors voice in my head. Especially if I get around someone who has to make choices that involve me. I keep hearing 'pass or no pass' which is what he said to me. I hear a human voice outside my windows. When I go look there's nothing there so I don't know if they've run away or what. That's why I put up security cameras."
Mood and Affect - Veteran's mood was "indifferent" and his affect was flat.
Sensorium and Cognition - Sensorium was clear. Veteran was oriented to time, place and person. Immediate memory was good as he was able to repeat five of seven numbers forward and six of seven numbers in backwards sequence. Recent memory was fair as he recalled two of three items after five minutes. Remote memory was fair as he recalled the names of the last three presidents, the name of his high school, his youngest son's birthday, and his first job. Veteran was unable to recall the name of his elementary or junior high school nor his siblings or two oldest sons birthdays. In regards to concentration, Veteran spelled world forward and backwards and completed simple mathematics, serials 3's, and serial 7's. His intelligence appeared to be average.
Judgment and Insight - Veteran's insight is good as he understands the outcome of his behavior and the choices he makes. His judgment is impaired but he informed that he would return a library book to the library if found, pull over for the police, and return a wallet he found to the owner. 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
Is the Veteran capable of managing his or her financial affairs?
[X] Yes [ ] No
9. Remarks, (including any testing results) if any
Financial: "My brother pays any bills that I can't pay online."
NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application.