JWMN89

I filed for an increase on my 70% PTSD rating in early March as I'm no longer able to work. My personal psychiatrist completed a DBQ, wrote a letter, and included a GAF report. I included three years of her medical records with the increase application. Last week I had a C&P with VES. It was a sub-15 minute affair via telehealth and the doctor hadn't even reviewed my records yet. I would certainly hope the VA reviewer who will set the rate would give more credence to the DBQ from the psychiatrist than that "quickee" interview. JW

I am 70% for PTSD alone. It's a static rating now and I'm in my mid 50's. The VSO cited some state benefits like property tax and license plates as his reasoning.

I saw a VSO yesterday who recommended I file for an increase without also for IU. He said my records and DBQ meet 100% and that this is preferable to IU. I was under the impression it was best to apply for both and that the rater would place me in 100% over IU if I meet 100. Should i go along with the VSO or ask him to file for IU at the same time anyway? Thanks!

Thank you for all the replies. I am currently working but "not well". I hide in my office a lot, have breakdowns, can't deal with people (tough when you manage 70 people), and have frequent absences either due to FMLA and leaving early or missing days outright. Plus all the appointments I have to go too. To be honest I'm just going thru the motions and it's only a matter of time before I'm "counseled" or "written up" for performance issues. I'm amazed I've been able to keep it up as long as I have. I'm working on preparing to file for TDIU. I'm thinking 2-3 months then I'll have to leave my job. I'm in the process of refinancing my house to pull out extra cash to help with the "war chest". I'm paying down debt like crazy and have a plan which I think will carry me through. I'm not sure how long the initial TDIU claim will take? Any ideas? I have long term disability available at work so that is an option. Do you think I'd be able to go out on LTD (while still employed) and file for TDIU? My LTD is thru work so I would still be technically "employed" while getting it. JWMN89

It's been about two years since I've posted here. I received a 70% rating for PTSD in 2017. These forums were very helpful to me. Recently I've had another inpatient stay in the psych ward at the VAMC (my third in 15 months) and I'm having more and more difficulty coping with everything. My symptoms are kind of out of control, despite multiple medication changes, and work is becoming more and more difficult every day. I tend to hide in my office, don't talk to people, have breakdowns crying during the day, and generally "exist" and not much else. My work quality has suffered and I'm at the point now where I'm thinking I'm not going to make it to retirement in seven years. I'm burning thru my FMLA hours this year with leaving early, taking days off for being "sick", and the two weeks from this last hospitalization, plus all the appointments I have to attend. My 70% is "static" so there are no future exams scheduled. I turn 55 this year. My PTSD claim was a bit complicated in that it involved something that happened to me in childhood (abuse) that was brought to the surface while in the service (a traumatic flashback) that led to an extended hospital stay and a medical discharge. I remember Berta mentioning my C&P exam was very unusual in that the examiner did an exceptional job writing a favorable opinion. I have a VA psychiatrist along with a private psychiatrist and private therapist and am generally happy with my care (although I'm still waiting on that cure). I'm considering filing for an increase to my PTSD rating (and also filing for IU at the same time). I know if I meet the schedular they'll go that route over IU so 100% is the way I hope it goes. I'm planning to obtain a vocational expert report on myself as part of the increase application process. My private psychiatrist completed a new DBQ for me (she did one in 2017 too). With these DBQ items I'd like to get some feedback on where you think I'll end up? I'm still working (although not well) so I'm thinking I wouldn't get IU. But what about 100%? Thank you. SECTION IV - OCCPUATIONAL AND SOCIAL IMPAIREMENT Occpuational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking and/or mood. SECTION VII - SYMPTOMS - Depressed mood - Anxiety - Suspiciousness - Panic attacks more than once a week - Near continuous panic or depression affecting the ability to function independently, appropriately and effectively - Chronic sleep impairment - Impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete tasks - Flattend affect - Difficulty in understanding complex commands - Gross impairment in thought processes or communication - Difficulty in establishing and maintaining effective work and social relationships - Difficulty in adapting to stressful circumstances, including work or a work like setting - Inability to establish effective relationships - Suicidal ideation - Persistent delusions or hallucinations - Persistent danger of hurting self or others - Neglect of personal appearance and hygiene - Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene SECTION VIII - OTHER SYMPTOMS PATIENT SUFFERS A MULTITUDE OF SYMPTOMS RESULTING FROM MAJOR DEPRESSION WITH PSYCHOTIC FEATURES AND PTSD. PATIENT SUFFERS FROM AUDITORY HALLUCINATIONS WHICH ARE AT TIMES COMMANDING TO SELF-HARM. HALLUCINATION FREQUENCY HAS INCREASED SINCE LAST EXAMINATION IN 2017. PATIENT HAS SUFFERED FROM AUDITORY HALLUCINATIONS SINCE 2008 WHEN FIRST DOCUMENTED BY DR. XXXXXXX. PATIENT TENDS TO AVOID SOCIAL INTERACTION AND ENGAGES IN ISOLATION ORIENTED ACTIVITIES. PATIENT HAS BEEN WORKING WITH THERAPIST XXXXX ON EFFORTS TO EXPAND SOCIAL ACTIVITIES. PATIENT EXPERIENCES GREAT CHALLENGES IN THIS REGARD AND STATES HE IS MORE COMFORTABLE "BEING ALONE" AND "BEING AWAY FROM PEOPLE". PATIENT CURRENTLY WORKS FULL-TIME BUT IS MISSING WORK ON A REGULAR BASIS DUE TO HIS CONDITION. PATIENT OFTEN WILL LEAVE WORK EARLY DUE TO NOT FEELING WELL (NOT TOLERATING STRESS AT WORK). HE HAS HAD SEVERAL RECENT OCCASIONS OF MISSING MULTIPLE DAYS OF WORK ON FMLA FOR SYMPTOM EXACERBATION. PATIENTS ABILITY TO WORK IS GREATLY IMPAIRED BY HIS ILLNESS AND HE IS UNABLE TO TOLERATE STRESSORS AT WORK. PATIENT REPORTS AN INABILITY TO "TOLERATE" OTHERS AT WORK, AN INABILITY TO REMAIN CALM AT WORK, AND REPORTS DAILY DIFFICULTIES CONCENTRATING AT WORK. HE HAS FREQUENT EPISODES AT WORK OF TEARFULNESS AND "LOSING IT" AND WILL HIDE IN HIS OFFICE WITH THE DOOR CLOSED. PATIENT SUFFERS FROM BOUTS OF SELF-HARM DIRECTED THINKING, SUICIDAL IDEATION, AND RUMMINATIONS OF DYING. PATIENT HAS HAD A RECENT EXACERBATION OF THESE SYMPTOMS RESULTING IN HOSPITALIZATION AT THE VA IN XXXXXX. SECTION X - REMARKS THE PATIENT HAS EXPERIENCED SEVERAL UPS AND DOWNS WITH HIS TREATMENT SINCE THE LAST DBQ FILLED OUT IN 2017. OVERALL THE PATIENTS CONDITION HAS NOT IMPROVED. SYMPTOMS INCLUDING AUDITORY HALLUCINATIONS, SUICIDIAL IDEATION, NIGHTMARES, FLASHBACKS, AND ANXIETY HAVE INCREASED ON OCCASION. THESE SYMPTOMS ARE GREATLY AFFECTING THE PATIENTS ABILITY TO FUNCTION ON A DAY TO DAY BASIS. HIS ABILITY TO WORK IS HINDERED WITH THESE DAILY SYMPTOMS AND HE HAS MISSED WORK ON MULTIPLE OCCASIONS DUE TO HIS DIAGNOSES. HE REPORTS AN INCREASED DIFFICULTY BEING ABLE TO FUNCTION AT HIS JOB DUE TO THESE ISSUES. THE PATIENTS MOOD FLUCTUATES FROM CALM TO SAD ON A DAILY BASIS. PATIENT HAS MADE USE OF THE VETERANS CRISIS LINE ON SEVERAL OCCASIONS WHEN FEELING THE NEED TO REACH OUT FOR HELP. OVERALL IT IS MY OPINION THAT THE PATIENTS CONDITION IS DEBILITATING FOR HIM IN THE AREAS OF LIVING INCLUDING WORK, SOCIAL, AND PERSONAL. PATIENT CONTINUES TO STRUGGLE IN ALL AREAS OF LIVING. PATIENT ATTENDS BIWEEKLY THERAPY VISITS WITH LPC UTILIZING TALK THERAPY AND EMDR. PATIENT ALSO HAS FREQUENT MEDICATION MANAGEMENT ENCOUNTERS WITH PSYCHIATRIST. PATIENT FOLLOWS UP WITH GROUPS AT THE VA HOSPITAL IN XXXXX. PATIENT UNDERSTANDS THE IMPORTANCE OF CONTINUING THERAPY VISITS AND PSYCHIATRIC MEDICATION MANAGEMENT VISITS AND PLANS TO CONTINUE THEM. PATIENT HAS BEEN VERY PROACTIVE IN SEEKING TREATMENT.

Mkah gives good advice. You will feel different as going thru experiences shapes us but it's important to have something else to grab onto. A hobby, family, daily routine, something you can embrace. Work hard to resist the urge to isolate as solitude isn't conducive to healing. You can do it and please continue posting. You have people here who care and understand. JW

Your mother passing in 2012 and you seeking treatment shortly after for fire PTSD seems to be a definite timeline. In your 2012 treatment did you talk about only your fire related issues or did you bring up the molestation as a child and the choking incident also? Being involved in a fire "incident" with your mothers passing and then flashing back to your own near death fire experience and having PTSD seems very obvious. JW

Blackcloud, Thank you for your service. How long ago was your mothers death in the fire and did you seek treatment soon after that? Depending on that could help you I would think. If in your treatment records soon after your mothers death you are mentioning also the ship fire that would seem to provide a link between the two events I would think. I am fairly new here but it seems to me that link between triggering your memories of the shipboard fire and thus bringing out PTSD might be important. How that is documented may play a part in how your case was decided. Again I'm new here and inexperienced in the VA ways so hopefully some of the more seasoned posters can provide more information. JW

Thank you for the replies. My PTSD rating is 70%. I will need to continue therapy to manage and will hopefully be able to continue as I have. Decades of therapy haven't supplied a cure and I really haven't gotten better but I've been able to at least work somewhat steadily. I just want to make sure I do everything right. JW

Now that I have my rating I have some new questions about it. If anyone can answer these or provide input I'd be grateful. I plan to continue treatment with the VA and my private doctors and based on the last thirty years would expect it will last the rest of my life. If anything I've noticed over the last few years my symptoms have gotten worse and the ability to leave the house and work day to day has become more difficult with each year. While therapy and medication have kept me going they haven't provided the "cure" I've so long sought. 1. Now that I'm rated is it "permanent" or will I have followup C&Ps with the VA? Do they normally reevaluate and if so how often? How will they let me know? 2. If I continue to deteriorate and my illness finally makes it impossible for me to work what do I do? How long does a rating increase application/claim take to process? I plan to work as long as I can but reality being what it is there will probably come a day when I can't. 3. Other than continuing therapy what things should I do to maintain my rating status with the VA? 4. What kind of things should I "not do" so I don't jeopardize my rating in any way? Thank you, JW

I'm so happy for you after reading about your story you deserve it! JW

I did obtain an IMO from Dr. David Anaise for my claim although I'm not sure now it was necessary with the other letter I had from my doctor and the C&P results. I will say though it was well written, eight pages reviewing existing records (with heavy quotations) and an opinion of "more likely than not". While Dr. Anaise is not a psychiatrist I took a chance on him as he's close to where I lived and I've read good results from his clients. I will hang onto the letter and they offered to update it at a later date if needed. The only thing I'd add is more rationale although he did reference and quote the C&P rationale in his opine comments. The letter format was an introduction with my statement, a review of certain parts of my other reports with opinions and references, some legal rationale and the opinion. The letter did mention some case law which I think is representative of the fact Dr. Anaise is also an attorney. Speaking of him being an attorney in fact when I spoke to him and another doctor in his practice they mentioned to me they would hurry my letter to me because he was going to Washington to testify at the court of veterans affairs this week. The cost was $1500 (flat fee) and delivery of the letter took about eight days total. They sent me a draft to approve and a day later sent the final eight page letter with attachment exhibits and a cv for my use. The total "package" sent to me for the IMO was 44 pages mostly made up of exhibits (my other reports). Overall I would give the letter a solid "A" grade. JW

Good luck to you BroncoVet we're rooting for you! JW

This brief partial exam is one of the most unusual C & P exams I have ever read for PTSD. It also reveals that a VA C & P MH doctor took considerable time to develop their opinion. Berta, To clarify this was part of the 18 page report (the ending) it's not a separate report itself. JW

Berta, Yes the original report was 18 pages. I thought the doctor did an excellent job and the report was very accurate. I didn't post the whole thing because it's full of very personal information and I'm a bit paranoid. The doctor was exactly correct though in her assumptions. There were two stressors that occurred in service leading to a flashback and memories emerging so there was enough for them I guess. I was pleased it went well as it took nearly three hours for the appointment. JW

Buck, EBenefits showed 70% for PTSD. I'm going to have to wait until the letter arrives to see if that's final. JW

Buck, yes sir the benefits group is what I was thinking of. I was in group 8 because of income so I had large copays. I actually found it here it looks like I'll be in group 1. JW Priority Group 1 Veterans with VA-rated service-connected disabilities 50% or more disabling Veterans determined by VA to be unemployable due to service-connected conditions Priority Group 2 Veterans with VA-rated service-connected disabilities 30% or 40% disabling Priority Group 3 Veterans who are Former Prisoners of War (POWs) Veterans awarded a Purple Heart medal Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty Veterans with VA-rated service-connected disabilities 10% or 20% disabling Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, "benefits for individuals disabled by treatment or vocational rehabilitation" Veterans awarded the Medal Of Honor (MOH) Priority Group 4 Veterans who are receiving aid and attendance or housebound benefits from VA Veterans who have been determined by VA to be catastrophically disabled Priority Group 5 Nonservice-connected Veterans and noncompensable service-connected Veterans rated 0% disabled by VA with annual income below the VA’s and geographically (based on your resident zip code) adjusted income limits Veterans receiving VA pension benefits Veterans eligible for Medicaid programs Priority Group 6 Compensable 0% service-connected Veterans Veterans exposed to Ionizing Radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki Project 112/SHAD participants Veterans who served in the Republic of Vietnam between January 9,1962 and May 7,1975 Veterans of the Persian Gulf War who served between August 2, 1990 and November 11, 1998 Veterans who served on active duty at Camp Lejeune for at least 30 days between August 1, 1953 and December 31, 1987 Currently enrolled Veterans and new enrollees who served in a theater of combat operations after November 11, 1998 and those who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for five years post discharge. Priority Group 7 Veterans with gross household income below the geographically-adjusted income limits (GMT) for their resident location and who agree to pay copays Priority Group 8 Veterans with gross household income above the VA and the geographically-adjusted income limits for their resident location and who agrees to pay copays Veterans eligible for enrollment: Noncompensable 0% service-connected: Subpriority a: Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this sub priority due to changed eligibility status Subpriority b: Enrolled on or after June 15, 2009 whose income exceeds the current VA or geographic income limits by 10% or less Nonservice-connected and: Subpriority c: Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this sub priority due to changed eligibility status Subpriority d: Enrolled on or after June 15, 2009, whose income exceeds the current VA or geographic income limits by 10% or less

Berta, i don't receive SSDI I was just using SS as an example of date. I work FT so 100% isn't something I was looking for. I will check on the copays though great idea! I really tried hard to supply them with as many relevant records as I could. Combined with a good C&P exam (posted the other day in that forum) I think I was in good shape. I'm amazed it happened so quickly. JW

I went online to EBenefits this morning to see if nothing changed after my C&P last month. It said claim closed and Decision letter sent. After checking around I found a 70% rating for PTSD and MDD and a 3/15/17 effective date which was when I filed my claim. I hadn't set up banking info yet so I did that. Some questions: 1. Will they mail a retro pay check since I didn't have banking set earlier? 2. I know I need to wait for the letter but is EBenefits usually accurate with the rating? 3. Is there a certain day of the month VA sends payments (Like social security is always at the start of the month) or is it the claim date each month? 4. Where can I find information on how my VA class will change? I was class 8 before (big copays). 5. I have a very good private therapist I'm paying for myself. Now that I'll have a rating will the VA pay for him or do they only cover their own therapists? Thanks for the help! JW

I received my C&P over the weekend. My exam was nearly three hours and I think the report is accurate and fair and represents how things are. I was as honest as I could be with the examiner and despite being nervous to the point of an anxiety attack about it the day before calmed down a bit and was OK during the visit. The doctor did a good job asking questions and made me feel at ease which is saying something. The report ended up being 18 pages which surprised me. I had PMd the results to a handful of people here on HADIT and a couple recommended I post it for more input. I was hesitant to do so but decided my desire for more information is more important than my paranoia of posting it. I'd really like to get the opinions of some senior HADIT posters like Berta and others. I'm thinking this is a good C&P for my claim but would like a more seasoned opinion than my own completely inexperienced one. I've posted the opinion and rationale below. . Thank you. JW. ___________________________________ 5. Symptoms For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Suicidal ideation REQUESTED OPINION: Based on information from the clinical interview, review of records (C-file and VA medical records), and psychological assessment measures, It is my opinion that the veteran meets DSM-5 diagnostic criteria for (1) Post-Traumatic Stress Disorder (PTSD) due to childhood sexual trauma with delayed onset, and (2) Major Depressive Disorder (MDD), Recurrent, with Mood-Congruent Psychotic Features secondary to PTSD. While his PTSD and MDD were less likely than not to have been caused by an in-service stressor, both conditions were more likely than not incurred in service (i.e., delayed onset with clinically significant symptom presentation beginning while on active duty). PSYCHOLOGICAL ASSESSMENT / OBJECTIVE TESTING: Objective psychological assessment measures administered: -- Personality Assessment Inventory (PAI): valid profile without any evidence to suggest inattention, inconsistency, or negative/positive impression management; primary code type - DEP/ARD (97T/85T) * Summary/interpretation of results: Briefly, the veteran's responses on the PAI were suggestive of significant tension, unhappiness, and pessimism, with various stressors (past and/or present) contributing to low mood and self-esteem. Individuals with similar profiles often see themselves as ineffectual and powerless to change the direction of their lives and feel uncertain about goals, priorities, and what the future may hold. In addition to depression, the veteran endorsed significant distress on measures of suicidal thoughts, traumatic stress, and social discomfort or detachment. His profile was most consistent with major depression, and while some traumatic stress concerns were indicated, he did not endorse the full range of concerns typically seen among individuals with PTSD. RATIONALE FOR OPINION: 1. The veteran's symptoms meet DSM-5 diagnostic criteria for PTSD due to childhood sexual trauma. The veteran's history of childhood sexual abuse is well-documented across multiple sources and during the current evaluation, he endorsed the full range of trauma-related symptoms meeting criteria for a diagnosis of PTSD. He was first diagnosed with PTSD while on active duty in xxxx by a DOD psychiatrist and mental health records (private and VA) dating back to xxxx also show that multiple mental Health providers have diagnosed and treated PTSD. Although the veteran experienced some symptoms immediately following the assault (bed wetting, night terrors), these symptoms largely resolved by the time he was in middle school due to reported "traumatic amnesia." His only residual symptoms throughout the remainder of middle school and high school were associated with a chronic mistrust of others and related social detachment. His enlistment exam was silent for any relevant concerns, as were STRs from the time of his enlistment in xxxx until the first disclosure of the assault and associated symptoms in xxxx and xxxx. Thus, there is no evidence to suggest that the veteran was experiencing clinically significant symptoms of PTSD prior to his enlistment and thus the question of aggravation is moot. Records clearly document onset of symptoms while the veteran was on active duty and indicate chronic trauma-related symptoms and impairments since then. 2. The veteran's current mental health symptoms also meet DSM-5 diagnostic criteria for Major Depressive Disorder (MDD), Recurrent, with Mood-Congruent Psychotic Features, secondary to underlying PTSD. His current depressive symptoms are a continuation of those first diagnosed in service as Dysthymic Disorder, and the veteran has been treated for MDD by multiple mental health providers (private and VA) since at least xxxx. As indicated above (Rationale #1), there is no evidence to suggest Clinically significant symptoms of depression prior to military service, and he was first diagnosed with a depressive disorder while psychiatrically hospitalized in service (xxxx). Subsequent records indicate chronic problems with depression since his discharge from active duty. 3. The veteran's history is suggestive of some underlying Personality features which are likely contributing to some of his on-going concerns (e.g., schizoid and avoidant features). Although he was diagnosed with a personality disorder in service, there is insufficient evidence to warrant a personality disorder diagnosis at present, as some of his on-going symptoms can be attributed to underlying PTSD (e.g., mistrust of others, social/interpersonal detachment, avoidance of intimate relationships). 4. The veteran showed no signs of significant exaggeration/feigning or minimization of mental health symptoms on objective testing, during the interview, or when comparing his self-report to the evidence in the record. As such, information from this evaluation is believed to be an accurate reflection of the veteran's current mental health concerns and relevant background.

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I was wondering what people thought of getting an IMO for depression from an MD like Dr Bash or Dr Anaise. Would the VA give weight to a well written mental health IMO that doesn't come from a Psychiatrist? I have an "basic" nexus letter from my board certified psychiatrist but it's thin on rationale and I'm afraid it won't be good enough. I'm considering spending the money on a professional letter from an expert in what the VA wants. Opinions? Thanks. JW in MN

Should just be ST. Typo. No it wasn't mentioned anywhere as it was a repressed memory.

No the memory was repressed in childhood. My entrance exam was very normal and the in service flashback that brought it out was well documented and resulted in hospitalization and discharge. The medical board noted it existed prior to entry but was service aggravated so I don't anticipate a problem there. JW in MN

BroncoVet. Thank you for replying. The examiner was a Phd VA Psychologist. The nexus letter and DBQ I have is from my personal board certified Psychiatrist. I'm hopeful I'm just worried over nothing. If denied I plan to seek out an IMO professional. I have a good job but that's about all I have going good in my life and that's a struggle too. At least I can afford an IMO or two if needed. The MST I experienced was as a child. The memory of it was repressed and didn't come out until the flashback in service. That led to the depression and my constant state of MDD since getting out. The fact service aggravated was noted with the diagnoses by the medical board makes me believe the service connection to be likely versus doubtful. JW in MN