Hello, I am having my first kid in July so im sorta freaked out about finances right now. Had my C&P last week, here are the results. Also, below that are results from a private psychologist who did a DBQ for me in June of 2016. I am currently rated at 30% for Anxiety condition and 10% for tinitus. Thoughts? Electronic copy finally showed up on Myhealthevet. I'm pretty sure I'm over stressing the issue, but I have a kid coming in July/August. First child, so im sorta scared Sh*tless about finances right now. Getting atleast a picture of what I have to work with might reduce my stress. Additionally, below this last C&P result are DBQ's from May 2016 filled out by a private Psychologist. Deployed OIF 2008-2009.please help: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 ICD code: F43.12 2.Current Diagnoses--------------------a. Mental Disorder Diagnosis #1: PTSD ICD code: F43.12 Comments, if any: associated with depressive and anxiety symptoms 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [X] No b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): as in other evaluations c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [X] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- 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 reduced reliability and productivity 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 TBISECTION II:----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply):[X] VA e-folder (VBMS or Virtual VA) Evidence Comments: all are contained in the veteran's claims folder reviewed electroncially through VBMS 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): Veteran was last evaluated April 2, 2016. No history of emotional or psychiatric disorders/ predisposition during childhood years. Brother has been discharged from the military due to Schizophrenia. Veteran has been living in the country since July 2016. He met a gf last August and decided to move in together in October. Vet said his gf is generally good for her. She provides the care he is wants and uses it as rationalization why he is staying with her. He admits that he has some doubts why she is putting up with him and suspects that she might have some ulterior motives (e.g. getting a better life in the US). "I don’t mind, our relationship is neutral, she gets benefits and so do I." -Vet endorsed trust issues. Vet has a tendency to check her phones, he made her quit her job because of fear that if his gf is not by his side, she may be doing some other business that will put their relationship at risk. Vet admits that he doesn't trust her fully yet he is considering marrying her. Vet is expecting a child with her. Vet denied any close heterosexual relationship with anyone in the past. He had commercial sex to satisfy his need. He had one "relationship" back in 2014 but did not turned out well. He felt "used" for investing on her and it was not reciprocated. Veteran said he has problems with relating to others. "other people don’t listen... i don’t know how to talk to them." Vet said he cannot connect with servicemen's sense of humor, overall demeanor. He said he can act very aggressively, imposing and threatening. He has a high expectation of how things are supposed to be done and expected this on other people. When he does not get the things he expected, it frustrates him and can become very aggressive. Vet said this change of character around 2007-2009 when he was on his 2nd duty station. This kind of short temperedness was also endorsed outside of the military. b. Relevant Occupational and Educational history (pre-military, military, and post-military): Noted Veteran's educational and occupational background as contained in VAE done April 2016. Veteran said he had a job after he was fired from his job in Qatar in April 2015. Doing sandwich delivery but did not last long because he had an accident that prevented him from continuing with that work. NO other kind of productive employment since that time. Vet is into using his GI bill (a benefit he started using back in 2012). Vet is pursuing a course in Culinary since Oct 2016. Vet said he likes cooking and knows how to cook, hence his desire to pursue a course in culinary. He however said the class is alienating because of the language barrier that made him cuss inside. He finds the teachers egotistical. He is pursuing this course as a possible opportunity that he can pursue in the future like a cake online business where he just bakes and take orders online without interacting with people. He anticipates the next school year in June. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Index event: combat deployment in 2008. There was an explosion that hit about 100meter from him when he felt terrified. Vet is aware of his how their hostile enemies are capable off and thought his life was really in danger. Vet froze up for about a minute but then realized that they have a job to do and powered up to prepare for retaliation. He related that it was only after about a day that they were told that it was not a missile that exploded rather an airplane accident that carried missiles that happened. Index event 2: veteran wrote a statement about his experience in public showers where he received being slapped at, touched in sensitive places that he did not like. Veteran endorsed that he had to deal with it at that time since it was a common thing to happen and didn’t really want to report the incident for fear of being alienated in the unit or get somebody in trouble. Vet endorsed feeling helpless that he cannot do anything to escape/ or address the situation that he was in at that time. He endorsed feeling embarrassed and some guilt for not having the courage to do anything at that time. Veteran endorsed overly accommodated thinking about taking future assignments/duty stations seriously and got easily pissed off with other members of his unit who just tend to jerk around and not take their duties seriously. He became short tempered. Vet endorsed developing startle reactions when he sees people with their hand on their side that has the potential of accidentally hitting his crotch area. People don’t care anyone but themselves. People are selfish, everything do things for a gain. This has led him to avoid them as far as possible. Social interaction has suffered and became more reclusive. Vet said that his motivation to go out and engage in social activities is no longer there. He identifies his best friend *FRIENDS NAME* as the person he can trust. He is trying his best to make his current relationship to work for him. He has a tendency to think that his life now has somewhat been "oriented" but cannot really say if he is already focused or goal oriented. He is considering a married life and being a responsible father. He admits having some anxieties with it at this time. Vet endorsed having dreams/ nightmares about the explosion and things that happened in the military that can happen 2-3 times per week, resulting to early morning waking up and feeling relieved that he was not there. Sleep impairment is endorsed having episodes of recollections of his index event usually triggered by stresses and events and cues that reminds him of it. It used to occur about 1x/week and more current only when reminded of it. Alcohol effect can trigger it, hence he tries to avoid it. Vet said he would feel sad about it and would want to isolate himself to deal with the memory. Vet self-esteem affected because he felt he didn’t have to freeze up at that time; Made him think that he had to be very diligent in his subsequent work ever since then because of the history of freezing up in his job when it happened. Vet endorsed some doubts about his abilities.... "I’m not good enough for a lot of things;" "maybe I’m not as good enough as i thought i am". Veteran said he easily gets nervous when feeling intimidated and verbally aggressive when having a hard time convincing other people of his stand especially when knows he is right. Vet said he can get easily wound up and anxious when meeting a deadline. Vet endorsed recurrent preoccupation about what is going to happen, what is his next move. etc. Panic attacks can happen sporadically as triggered by unexpected sounds or noise, or negative news on tv. Social situations that he is unfamiliar with also triggers it. Noted treatment records from *Florida VA facility* where he is maintained on Duloxetine, Trazodone and Prazosin. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): Vet used to live close to his grandfather. He reported a volatile relationship with him due to difference in opinion. Vet endorsed that police has been called multiple times to settles down his temper that has a tendency to become really aggressive. NO charges has been filed against him. Vet had a intense altercation with a girl he met when he first moved in the country around August of 2016. The altercation came to the point of his antagonist pulling out a knife to threaten him. He said he was being aggressive and loud at that time. This was no police involved. e. Relevant Substance abuse history (pre-military, military, and post-military): no problematic use of alcohol; no history of using illicit drugs except using marijuana to calm him down when he is feeling edgy and panicky. said he self-medicated. he has not smoked marijuana ever since he got into the Philippines.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: experiencing an explosion while on combat duty station in 2008 that turned out to be an airplane accident 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? [X] Yes [ ] NoIs the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No b. Stressor #2: unwanted sexual touching in the context of traditional military humor. Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] NoIs the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] NoIs the stressor related to personal assault, e.g. military sexual trauma? [X] Yes [ ] Nof yes, please describe the markers that may substantiate the stressor. Veteran developed trust issues with people and became more reclusive in dealing with social situations. Veteran developed assimilated and overly accommodated thinking as a result of his index event. He also developed inability to relate to people after the event that had occupational and social negative impact. Self-esteem and self-worth has been questioned. 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] 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. 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] 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[X] Stressor #2 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks more than once a week [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] Impaired impulse control, such as unprovoked irritability with periods of violence 6. Behavioral Observations -------------------------- Veteran came in alone, appropriately dressed for the interview. Generally cooperative with spontaneous and goal directed speech. Generally calm disposition. Mood was euthymic with a wide and appropriate range of affect Logical thoughts process (+) overly accommodated thinking as well as assimilated thinking as related to experience of the two index event disturbed motivation, arousal symptoms of irritability poor to fair impulse control, some insight to symptoms influenced judgement no suicidal ideations .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 -------------------------------------------------- The current diagnosis is the better description of the etiology of the vet's symptoms rather then broader and non-specific implication of his previous diagnosis of unspecified depressive disorder. This is a progression of the previous diagnosis as more symptoms about the current diagnosis became evident. Veteran exhibited cognitive symptoms consistent to a person who has suffered a trauma in his life and developed symptoms that fulfills the criteria for PTSD based on DSM V. All evidences on record considered and was built on. Veteran's current symptoms will likely affect successful social interaction that would make a typical employment environment challenging. Other forms of productive pursuits can be considered that does not place too much emphasis on social interaction to deliver its "products," NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application___________________________________________________________________________________________________________________________________Here are the additional DBQ's from a private Psychologist I went to for a few sessions before leaving the country.As far as I know, he was objective, I didn't know him like a PCP or anything.Here are the items checked on one for mid-2016 from my private Psychologist I was seeing for an extended time for treatment:X OCCUPATIONAL AND SOCIAL IMPAIRMENT WITH DEFICIENCIES IN MOST AREAS, SUCH AS WORK, SCHOOL, FAMILY RELATIONS, JUDGMENT, THINKING AND/OR MOOD
X The Veteran experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
X The Veteran's response involved intense fear, helplessness or horror.
X Recurrent and distressing recollections of the event, including images, thoughts or perceptions.
X Recurrent distressing dreams of the event.
X Acting or feeling as if the traumatic event were recurring; this includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur on awakening or when X intoxicated.
X Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
X The traumatic event is not persistently re-experienced.
X Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
X Efforts to avoid thoughts, feelings or conversations associated with the trauma.
X Efforts to avoid activities, places or people that arouse recollections of the trauma.
X Inability to recall an important aspect of the trauma.
X Markedly diminished interest or participation in significant activities.
X Feeling of detachment or estrangement from others.
X Restricted range of affection (e.g., unable to have loving feelings).
X Difficulty falling or staying asleep.
X Irritability or outbursts of anger.
X Difficulty concentrating.
X Exaggerated startle response.
X The duration of the symptoms described in Criteria B, C and D is more than 1 month.
X The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
X Depressed mood
X Panic attacks that occur weekly or less often
X Panic attacks more than once a week
X Chronic sleep impairment
X Mild memory loss, such as forgetting names, directions or recent events
X Flattened affect
X Impaired judgment
X Disturbances of motivation and mood
X Difficulty in establishing and maintaining effective work and social relationships
X Difficulty adapting to stressful circumstances, including work or a work like setting
X Inability to establish and maintain effective relationships
X Impaired impulse control, such as unprovoked irritability with periods of violence
X Neglect of personal appearance and hygiene