tylerb333

July 21, 2018

PTSD)
                        Disability Benefits Questionnaire

    Name of patient/Veteran:   
    
    Is this DBQ being completed in conjunction with a VA 21-2507, 
    C&P Examination
    Request?
    [X] Yes  [ ] No
    

                                   SECTION I:
                                   ----------
    1. Diagnostic Summary
    ---------------------
    Does the Veteran now have or has he/she ever been diagnosed with 
    PTSD?
    [X] Yes  [ ] No
       ICD Code: F43.10

    2. Current Diagnoses
    --------------------
    a. Mental Disorder Diagnosis #1: Antisocial personality disorder
         ICD Code: F60.2

       Mental Disorder Diagnosis #2: Opioid use disorder
         ICD Code: F11.20

       Mental Disorder Diagnosis #3: PTSD
         ICD Code: F43.10

    b. Medical diagnoses relevant to the understanding or management 
    of the
       Mental Health Disorder (to include TBI): Deferred to medical

    3. Differentiation of symptoms
    ------------------------------
    a. Does the Veteran have more than one mental disorder 
    diagnosed?
       [X] Yes  [ ] No
       
    b. Is it possible to differentiate what symptom(s) is/are 
    attributable to
       each diagnosis?
       [X] Yes  [ ] No  [ ] Not applicable (N/A)
       
           If yes, list which symptoms are attributable to each 
           diagnosis and
           discuss whether there is any clinical association between 
           these
           diagnoses: Antisocial personality disorder is responsible 
           for
           contentious interpersonal relationships including 
           threats, aggression,
           assault; failure to accept responsibility; violation of 
           social norms
           and law; impulsive decisions and behaviors; and affective 
           instability.
           In the symptom list below antisocial personality disorder 
           is
           responsible for impaired judgment, disturbance of 
           motivation and mood,
           difficulty establishing and maintaining effective 
           social/work
           relationships, difficulty adapting to stressful 
           circumstances, and
           impaired impulse control.

           Opioid use disorder has been in institutional remission 
           June 2018, and
           is not at this time contributing to the symptom picture.  
           Substance
           use is well known to have deleterious effects on mood, 
           cognition, and
           behavior.  When active, however, these symptoms likely 
           take a
           predominant role.

           PTSD is responsible for the remaining symptoms below, 
           which include
           depressed mood, chronic sleep impairment, and flat 
           affect.
           
           
    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 occupational and social impairment, is it 
    possible to
       differentiate which impairment is caused by each mental 
       disorder?
       [X] Yes  [ ] No  [ ] Not Applicable (N/A)
       
           If yes, list which occupational and social impairment is 
           attributable
           to each diagnosis: As noted above regarding symptoms, 
           Antisocial
           personality disorder is primary and PTSD is secondary.
           
           
    c. If a diagnosis of TBI exists, is it possible to differentiate 
    which
       occupational and social impairment indicated above is caused 
       by the TBI?
       [ ] Yes  [ ] No  [X] Not Applicable (N/A)
       
                                   SECTION II:
                                   -----------
                               Clinical Findings:
                               ------------------
    1. Evidence Review
    ------------------
    Evidence reviewed (check all that apply):
    
    [X] VA e-folder
    [X] CPRS


    2. Recent History (since prior exam)
    ------------------------------------
    a. Relevant social/marital/family history:
          The veteran last completed a PTSD review DBQ 06/20/17, and 
          he reported
          that since that exam he has moved from Columbus to 
          Marysville.  The
          veteran currently is in residential programming at 
          Chillicothe VA,
          hoping for placement in the DOM.

          The veteran denied his family situation since last exam.

          Socially, the veteran said he is getting along well with 
          other
          residents here.  His girlfriend and mother visited him 
          here.  He said
          he is made some acquaintances in the programming as well 
          as a couple
          friends.
          
          
    b. Relevant occupational and educational history:
          The veteran denied changes in education since last exam.  
          He has
          completed a GED and some college, and has a license to 
          work with fuel
          and chemicals for shipping.

          The veteran denied employment since May 2017.  He worked 
          in landscaping
          prior and occasionally for his mother after that.  His 
          mother's
          business is sales of retail and bank machines.  He said 
          his mother
          arranged his hours to suit him.
          
    c. Relevant mental health history, to include prescribed 
    medications and
       family mental health:
          The veteran denied pre-military and military mental health 
          treatment.
          Specifically, he denied a history of hospitalization, 
          suicide attempt,
          outpatient therapy, and prescription of psychotropic 
          medications prior
          to about 2001. CPRS and VBMS were reviewed with the 
          following relevant
          mental health entries.



          06/20/17: PTSD review DBQ.  MSE: Mood and affect 
          depressed, otherwise
          normal.  Examiner opined significant impairment.

          06/14/18: Medical certificate.  The veteran requested 
          admission due to
          depression, suicidal ideation, overdose attempt on 
          Seroquel and alcohol
          last evening, and hearing voices telling him to kill 
          himself every day.
          UDS was positive for oxycodone, Suboxone, and 
          cannabinoids.  DX:
          Cocaine dependence; alcohol abuse; cannabis dependence; 
          opioid
          dependence; PTSD.

          06/19/18: Medical certificate.  Veteran seen for change in 
          programming.
          MSE: Normal except for dysphoric affect.
          
    d. Relevant legal and behavioral histor
y:
          The veteran denied arrest since last exam, however, he has 
          3 years and
          3 months left on parole.  As a juvenile, the veteran was 
          arrested for
          trespassing, DUI, domestic dispute.  He denied being 
          remanded to
          juvenile detention.  During military, the veteran was 
          arrested for
          underage consumption.  He also received NJPs for being 
          late to work (up
          to 10 hours), possession of pornography, disrespect to a 
          commanding
          officer, and drinking while on duty.  After service, the 
          veteran has
          been arrested for domestic violence 2, aggravated robbery 
          3, and
          theft.  He served 10 years in ODRC.  While in prison, the 
          veteran
          reported that he ran the inmate "store" providing drugs, 
          contraband
          items, and running gambling schemes.  He received over 50 
          tickets for
          institutional rules violations while in prison.  He was 
          released in
          September 2016.
          
    e. Relevant substance abuse history:
          The veteran reported that historically he has rarely used 
          alcohol,
          perhaps 1-2 times per month and none since June 2018.  The 
          veteran
          denied use of illicit drugs since June 2018.  In the 
          period immediately
          prior he primarily used narcotics and heroin.
          
    f. Other, if any:
          Nothing further.
          
    3. PTSD Diagnostic Criteria
    ---------------------------

    Please check criteria used for establishing the current PTSD 
    diagnosis. The
    diagnostic criteria for PTSD, are from the Diagnostic and 
    Statistical Manual
    of Mental Disorders, 5th edition (DSM-5).  The stressful event 
    can be due to
    combat, personal trauma, other life threatening situations (non-
    combat
    related stressors).  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 #6 - 
    "Other
    symptoms".
    
       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).

       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).

       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] Markedly diminished interest or participation 
                   in
                       significant activities.

       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] Hypervigilance.
                   [X] Exaggerated startle response.
                   [X] Sleep disturbance (e.g., difficulty falling or 
                   staying
                       asleep or restless sleep).

       Criterion F:
                   [X] The duration of the symptoms described above 
                   in Criteria
                       B, C, and D are more than 1 month.

       Criterion G:
                   [X] The PTSD symptoms described above cause 
                   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.

    4. Symptoms
    -----------
    For VA rating purposes, check all symptoms that actively apply 
    to the
    Veteran's diagnoses:
    
       [X] Depressed mood
       [X] Chronic sleep impairment
       [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 in adapting to stressful circumstances, 
       including work or a
           worklike setting
       [X] Impaired impulse control, such as unprovoked irritability 
       with periods
           of violence

    5. Behavioral observations
    --------------------------
       The veteran presented as guarded.  We were able to establish 
       adequate
       rapport through time.  He initiated conversation and 
       elaborated on topics,
       often to highlight the frequency and severity of symptoms.  
       He was easily
       re-directed, however.  He was cooperative in that he answered 
       all
       questions asked.  The veteran's mood was neutral and stable.  
       His affect
       was mildly flat and mildly irritable, with limited mobility 
       in range and
       intensity.  The veteran seldom smiled and laughed, and seldom 
       responded to
       humor.  He was not tearful.  There was no hopelessness and 
       helplessness
       evident in his comments.  There was no objective evidence of 
       facial
       flushing, vigilance, arousal, tremor, perspiration, or muscle 
       tension.
       Speech, thought processes, orientation, attention, and memory 
       all were
       within expectations.  Psychomotor was remarkable for bouncing 
       a leg.
       Given vocabulary, and educational, employment, and military 
       history, I
       estimate his IQ in the average range.  The veteran denied 
       recent changes


       in sleep, noting he experiences nightmares about 70% of the 
       time.  He
       appeared alert and rested and did not report functional loss 
       due to sleep
       problems.  He said his appetite is unchanged with some weight 
       increase
       with abstinence from drugs.  Thought content was negative for 
       objective
       signs of psychosis and the veteran denied same.  He also 
       denied suicidal
       and homicidal ideation, but added "They call it passive SI.  
       I'm getting
       better at telling people about it."

       Given several opportunities, the veteran reported current 
       symptoms of:
       Nightmares; not liking to think about the military event; 
       staying away
       from crowds; inability to interact with people; increased 
       stress with
       work; blaming himself for the event happening; being aware of 
       his
       surroundings; isolating from others; not sleeping well; drug 
       use.  


       The veteran reported abilities indicating that he retains 
       considerable
       cognitive capacity (physical capacity is not assessed here).  
       When home,
       he enjoys gardening, growing roses, and mowing his sisters 
       grass.  He told
       that he can drive independently.  The veteran said he can 
       perform personal
       care independently.  The veteran told that he can use a 
       calendar, clock,
       calculator, telephone, and computer.  He reported that he can 
       manage
       money, appointments, and medications, as well as shop and pay 
       bills.  For
       enjoyment he watches TV on his laptop, works out, watches OSU 
       football,
       and does some light reading.  He had good social skills on 
       exam. Socially,
       the veteran said he is getting along well with other 
       residents here.  His
       girlfriend and mother visited him here.  He said he is made 
       some
       acquaintances in the programming as well as a couple friends.
       
    6. Other symptoms
    -----------------
    Does the Veteran have any other symptoms attributable to PTSD 
    (and other
    mental disorders) that are not listed above?
    [ ] Yes  [X] No
    
    7. Competency
    -------------
    Is the Veteran capable of managing his or her financial affairs?
    [X] Yes  [ ] No
    
    8. Remarks, (including any testing results) if any:
    ---------------------------------------------------
       ****This forensic report is a legal document intended for the 
       sole use of
       VBA in determining the veteran's eligibility for compensation 
       and pension.
       This examination is very different from other psychological 
       examinations,
       such as for treatment, with considerably different criteria 
       and, thus,
       often with considerably different diagnoses and outcomes.  As 
       such, great
       caution is needed in interpreting this information and use of 
       this report
       outside its intended purpose by VHA personnel, VSO, and/or 
       the veteran is
       STRONGLY discouraged.  This examination does not constitute a 
       rating
       decision.  Rating decisions are made solely by the Regional 
       Office after
       all available data have been reviewed and verified.  Note 
       that "The
       examiner should not express an opinion regarding the merits 
       of any claim
       or the percentage evaluation that should be assigned for a 
       disability.
       Determination of service connection and disability ratings 
       for VA benefits
       is exclusively a function of VBA" (VHA Directive 1046).  
       Thus, any
       questions or concerns regarding rating decisions should be 
       directed to the
       Regional Office or an Appeals Board.****



       The veteran was seen today for this PTSD Review exam.  I 
       verbally provided
       the usual informed consent regarding:  this being a VBA 
       assessment, not
       treatment; the report becomes a legal document; the forensic 
       role of VBA;
       the potential outcomes of a review exam; and limits to 
       confidentiality.
       A written copy of Informed Consent was offered.

       Throughout the interview the veteran inserted nearly every 
       symptom of PTSD
       listed in the DSM 5.  He noted often that these symptoms are 
       severe and
       prevent him from interacting with people and working with 
       others.  This
       was not particularly consistent with mental status and 
       functional data.

       Some patterns of thought developed throughout the interview, 
       such as when
       the veteran noted that when people try to enforce rules or 
       consequences
       for his behavior he makes threats and blames them for causing 
       him to use
       substances.  He noted that all his criminal behavior and drug 
       use is due
       to the military assault, even though he also reported that 
       alcohol and
       drug use began at an early age, as did arrest.  For example, 
       the veteran
       said that the traumatic event in service caused and or 
       heightened his drug
       use in response, but he also commented that "I figured out 
       when I was
       younger that using drugs and alcohol makes problems like that 
       go away."
       The veteran noted that he was found to have steroids in his 
       jacket while
       at Bay Pines.  He subsequently was discharged from the 
       program.  He then
       interpreted that as "people make me fail.  That (being 
       discharged from Bay
       Pines) put me in a bad place and made me attempt suicide.  
       They deny my
       individual unemployability because they say I'll get better 
       with
       treatment, then the treatment kicks me out and I'm worse 
       now."  This
       behavior and thinking is quite consistent with personality 
       disorder.

       The veteran was diagnosed with PTSD in prior C&P exams, the 
       diagnosis has
       been carried forward by treatment providers, and by his 
       report continues
       with sufficient symptoms for the diagnosis.  Thus the 
       diagnosis of PTSD
       continues, as likely as not due to events in military 
       service.  Antisocial
       personality disorder was present well before military 
       service, so it is
       less likely as not caused by military events, and there is no 
       evidence
       that this disorder was exaggerated by military events.  Also, 
       alcohol and
       illicit drug use clearly was  present prior to enrollment in 
       military, so
       it is less likely as not caused by military service.  There 
       is no evidence
       that the veteran's substance use was due to events in 
       military service nor
       has it progressed beyond the normal course for this disorder.  
       Put another
       way, even if the military event had not occurred it is likely 
       that the
       resulting pattern of substance use would have been present.  
       Moreover,
       while there is some equivalence in the literature about the 
       direction of
       causality when both mental disorder and substance use are 
       present, DSM 5
       does not acknowledge any substance use disorder as "due to 
       mental
       illness," yet there are numerous "substance-induced" mental 
       disorders.



       INDIVIDUAL UNEMPLOYABILITY
       The veteran retains considerable residual mental function 
       (physical
       limitations, if any, are not assessed nor considered here).  
       The veteran
       can perform personal care independently.  He has a driver's 
       license and


       drives independently.  The veteran can use a calendar, clock, 
       calculator,
       telephone, and computer.  He can manage money, appointments, 
       and
       medications, as well as pay bills.  There is no mental 
       disorder that
       prevents him from attending to, learning, and persisting to 
       complete
       simple and complex tasks.  There is no cognitive dysfunction 
       that would
       prevent same.  His performance on mental status in attention,
       concentration, memory, abstraction, and thought processes 
       were within
       expectations for age.  The veteran reported limited 
       socialization.  Yet,
       he dated, married, and maintains a current relationship 
       (after divorcing).
       He maintains some contact with family.  Moreover, the veteran 
       was a quite
       bright, capable, pleasant, cooperative gentleman on exam, and 
       his social
       skills here were excellent.  He reported isolating at home, 
       not liking to
       be around people, and having difficult relationships through 
       time.  The
       veteran is not a member of any clubs/organizations.  Indeed, 
       personality
       disorder is predictive of contentious interpersonal 
       relationships and the
       affective instability and impulsive decisionmaking/behavior 
       of the
       personality disorder may interfere with motivation and 
       concentration.

July 21, 2018

Can I site law in a letter submitted as evidence?

The veteran was diagnosed with PTSD in prior C&P exams, the 
       diagnosis has
       been carried forward by treatment providers, and by his 
       report continues
       with sufficient symptoms for the diagnosis.  Thus the 
       diagnosis of PTSD
       continues, as likely as not due to events in military 
       service.  Antisocial
       personality disorder was present well before military 
       service, so it is
       less likely as not caused by military events, and there is no 
       evidence
       that this disorder was exaggerated by military events.  Also, 
       alcohol and
       illicit drug use clearly was  present prior to enrollment in 
       military, so
       it is less likely as not caused by military service.  There 
       is no evidence
       that the veteran's substance use was due to events in 
       military service nor
       has it progressed beyond the normal course for this disorder.  
       Put another
       way, even if the military event had not occurred it is likely 
       that the
       resulting pattern of substance use would have been present.  
       Moreover,
       while there is some equivalence in the literature about the 
       direction of
       causality when both mental disorder and substance use are 
       present, DSM 5
       does not acknowledge any substance use disorder as "due to 
       mental
       illness," yet there are numerous "substance-induced" mental 
       disorders.

LAW: pay attention to examples not to use....and c an p doc uses likely, less likely as not....

June 30, 2018

Yes I'm 70 percent with secondary substance use disorder. I have a total rating of 80 percent. The soc said I was able to follow direction, etc. And I would likely get better with treatment.

June 30, 2018

this was the clarfacation the BVA asked for, and the subsequent opinion:

The veteran's use of opiates, cannabis, and alcohol began prior to service, thus current/recent use/abuse is not caused by an in-service related event. Given the veteran's consistent diagnosis and treatment of PTSD, and the frequency of relapse of substance use, it is as least as likely as not that his substance use (to include opioid use disorder) is aggravated beyond its natural progression by his PTSD symptoms. (this is in my favor)

Per 3/15/2017 initial PTSD exam the veteran was diagnosed with PTSD, alcohol use disorder, cannabis use disorder, and opioid use disorder, all of which were in early remission. The 3/15/2017 medical opinion, the examiner opined that the veteran's opioid use disorder, and substance use in general, was made worse by his MST. The 6/20/2017 review PTSD examination indicates that symptoms present at that time were due to PTSD and not substance use as he had been abstinent from drug use with the exception of his opioid maintenance therapy. The veteran is service connected for the combination of PTSD and substance use disorders however per 11/20/2017 medical opinion regarding unemployability, the examiner noted that the veteran was service-connected only for PTSD and not substance use which is incorrect. Per rating decisions 3/27/2017 and 10/11/2017, the veteran was service connected for "PTSD with secondary alcohol use disorder, cannabis use disorder, and opioid use disorder." They are separate disorders, and not all symptoms are present all of the time. The examiner commented specifically on the veteran's PTSD symptoms and separated the veteran's substance abuse disorder symptoms. The veteran's substance use predated his military service;(sic) thus it was not caused by his reported assault. It was, however, likely aggravated by the residuals of his assault as described in treatment notes which indicate that with worsening PTSD symptoms, the veteran has reported relapsing on substances, particularly heroin. (again, in my favor)

June 30, 2018

except, I was denied. You think I'd win in ramp? Ive got additional evidence...I've been hospitalized three times,. Once, in a lockdown ward/

June 30, 2018

Denial...really?

The veteran's use of opiates, cannabis, and alcohol began prior to service, thus current/recent use/abuse is not caused by an in-service related event. Given
the veteran's consistent diagnosis and treatment of PTSD, and the frequency of relapse of substance use, it is as least as likely as not that his substance use
(to include opioid use disorder) is aggravated beyond its natural progression by his PTSD symptoms.

Per 3/15/2017 initial PTSD exam the veteran was diagnosed with PTSD, alcohol use disorder, cannabis use disorder, and opioid use disorder, all of
which were in early remission. The 3/15/2017 medical opinion, the examiner opined that the veteran's opioid use disorder, and substance use in general,
was made worse by his MST. The 6/20/2017 review PTSD examination indicates that symptoms present at that time were due to PTSD and not
substance use as he had been abstinent from drug use with the exception of his opioid maintenance therapy. The veteran is service connected for the
combination of PTSD and substance use disorders however per 11/20/2017 medical opinion regarding unemployability, the examiner noted that the
veteran was service-connected only for PTSD and not substance use which is incorrect. Per rating decisions 3/27/2017 and 10/11/2017, the veteran was
service connected for "PTSD with secondary alcohol use disorder, cannabis use disorder, and opioid use disorder." They are separate disorders, and not
all symptoms are present all of the time. The examiner commented specifically on the veteran's PTSD symptoms and separated the veteran's substance
abuse disorder symptoms. The veteran's substance use predated his military service, thus it was not caused by his reported assault. It was, however,
likely aggravated by the residuals of his assault as described in treatment notes which indicate that with worsening PTSD symptoms, the veteran has
reported relapsing on substances, particularly heroin.

June 30, 2018

is this in my favor? The veteran's use of opiates, cannabis, and alcohol began prior to service, thus current/recent use/abuse is not caused by an in-service related event. Given
the veteran's consistent diagnosis and treatment of PTSD, and the frequency of relapse of substance use, it is as least as likely as not that his substance use
(to include opioid use disorder) is aggravated beyond its natural progression by his PTSD symptoms.

June 30, 2018

If a c and p examiner checked the box stating it was an in-person exam, and it was not. Is this good enough for appeal for remand or reversal?

June 30, 2018

The last C and P examiner said this:

The veteran's use of opiates, cannabis, and alcohol began prior to service, thus current/recent use/abuse is not caused by an in-service related event. Given the veteran's consistent diagnosis and treatment of PTSD, and the frequency of relapse of substance use, it is as least as likely as not that his substance use (to include opioid use disorder) is aggravated beyond its natural progression by his PTSD symptoms.

The examiner was mistaken when they said I had used opiates prior to service. That is factually untrue. I had tried marijuana and alcohol, what teenager hasn't. Additionally, I had gotten waivers prior to enlisting for marijuana.

Also, the examiner checked the box stating it was an in-person exam. It was not.

June 30, 2018

Note Title: SUICIDE BEHAVIOR REPORT

Location: Chillicothe OH VAMC

Signed By: HINES,JEENEE M

Co-signed By: HINES,JEENEE M

Date/Time Signed: 18 Jun 2018 @ 1007

-------------------------------------------------------------------------

LOCAL TITLE: SUICIDE BEHAVIOR REPORT

STANDARD TITLE: SUICIDE RISK ASSESSMENT NOTE

DATE OF NOTE: JUN 18, 2018@10:03 ENTRY DATE: JUN 18, 2018@10:04:06

AUTHOR: HINES,JEENEE M EXP COSIGNER:

URGENCY: STATUS: COMPLETED

DOB: JUL 22,1980 (37)

-- Date/Time of event:

Jun 13,2018@22:00 (Time is approximate)

Location of event: Off station

Patient status at time of event: Outpatient

Outcome of event: remained outpt, hospitalized: indicate where in

the box below

voluntarily came to UC day after

-- Source of information: Written, Patient self-report

Name & Phone # of source: veteran

-- Patient's stated: Level of INTENT of this event was: High

Staff assessment: Level of INTENT of this event was: High

Staff assessment: Level of LETHALITY of this event was: Low

Last Pain Score Before Event: 6

Did the patient have access to firearms? Unknown

Description of event: struggling with depression and positive for

suicidal ideation, made an attempt at overdose on quetiapine and alcohol

Past 10 Clinic Visits:

06/17/2018 12:40 CHI MH INPT PSY 21-45MIN UNSCHEDULED

06/16/2018 14:31 CHI MH INPT PSY 21-45MIN UNSCHEDULED

06/15/2018 13:00 CHI RECREATION GROUP 2 UNSCHEDULED

06/15/2018 12:46 CHI PHARM INPT MH UNSCHEDULED

06/15/2018 09:03 CHI MH INPT PSY 21-45MIN UNSCHEDULED

06/15/2018 09:00 CHI TCM CARE MANAGEMENT R UNSCHEDULED

06/14/2018 12:37 CHI MH URGENT CARE 8-4 1

01/03/2018 15:30 CHI TELE MHRRTP UNSCHEDULED

12/20/2017 15:55 CHI PRRTP NP UNSCHEDULED

12/20/2017 13:30 CHI PM&RS PHYSICIAN INPAT CANCELLED BY

CLINIC

-- Patient is currently receiving treatment in the following areas:

Ambulatory Care

Primary Care Provider: COPC

Case Manager/Therapist: COPC

Name of Provider prescribing psychiatric medications:COPC

Active problems - Computerized Problem List is the source for the

following:

1. Cocaine dependence (SNOMED CT 31956009)

2. AA - Alcohol abuse (SNOMED CT 15167005)

3. Cannabis dependence (SNOMED CT 85005007)

4. Low back pain (SNOMED CT 279039007)

5. Chronic post-traumatic stress disorder

6. Opioid dependence

-- BRIEF PLAN/DISPOSITION:

Developed crisis management plan, Medication management, Refer for

Mental Health treatment, Assure followup appointment is made

/es/ JEENEE M HINES, LISW-S

CLINICAL SOCIAL WORKER

Signed: 06/18/2018 10:07

From the service...even then I had work, social, and legal problems.

June 29, 2018

Here is a fascinating one as well. I always heard this was the golden ticket...

June 29, 2018

The aforementioned C and P examiner was a nightmare! There are horror stories about this woman. She acted like the benefits were coming out of her pocket.
My initial C and P examiner's opinion was closer to the truth.

June 29, 2018

Note Title: SUICIDE BEHAVIOR REPORT

Location: Chillicothe OH VAMC

Signed By: HINES,JEENEE M

Co-signed By: HINES,JEENEE M

Date/Time Signed: 18 Jun 2018 @ 1007

-------------------------------------------------------------------------

LOCAL TITLE: SUICIDE BEHAVIOR REPORT

STANDARD TITLE: SUICIDE RISK ASSESSMENT NOTE

DATE OF NOTE: JUN 18, 2018@10:03 ENTRY DATE: JUN 18, 2018@10:04:06

AUTHOR: HINES,JEENEE M EXP COSIGNER:

URGENCY: STATUS: COMPLETED

DOB: JUL 22,1980 (37)

-- Date/Time of event:

Jun 13,2018@22:00 (Time is approximate)

Location of event: Off station

Patient status at time of event: Outpatient

Outcome of event: remained outpt, hospitalized: indicate where in

the box below

voluntarily came to UC day after

-- Source of information: Written, Patient self-report

Name & Phone # of source: veteran

-- Patient's stated: Level of INTENT of this event was: High

Staff assessment: Level of INTENT of this event was: High

Staff assessment: Level of LETHALITY of this event was: Low

Last Pain Score Before Event: 6

Did the patient have access to firearms? Unknown

Description of event: struggling with depression and positive for

suicidal ideation, made an attempt at overdose on quetiapine and alcohol

Past 10 Clinic Visits:

06/17/2018 12:40 CHI MH INPT PSY 21-45MIN UNSCHEDULED

06/16/2018 14:31 CHI MH INPT PSY 21-45MIN UNSCHEDULED

06/15/2018 13:00 CHI RECREATION GROUP 2 UNSCHEDULED

06/15/2018 12:46 CHI PHARM INPT MH UNSCHEDULED

06/15/2018 09:03 CHI MH INPT PSY 21-45MIN UNSCHEDULED

06/15/2018 09:00 CHI TCM CARE MANAGEMENT R UNSCHEDULED

06/14/2018 12:37 CHI MH URGENT CARE 8-4 1

01/03/2018 15:30 CHI TELE MHRRTP UNSCHEDULED

12/20/2017 15:55 CHI PRRTP NP UNSCHEDULED

12/20/2017 13:30 CHI PM&RS PHYSICIAN INPAT CANCELLED BY

CLINIC

-- Patient is currently receiving treatment in the following areas:

Ambulatory Care

Primary Care Provider: COPC

Case Manager/Therapist: COPC

Name of Provider prescribing psychiatric medications:COPC

Active problems - Computerized Problem List is the source for the

following:

1. Cocaine dependence (SNOMED CT 31956009)

2. AA - Alcohol abuse (SNOMED CT 15167005)

3. Cannabis dependence (SNOMED CT 85005007)

4. Low back pain (SNOMED CT 279039007)

5. Chronic post-traumatic stress disorder

6. Opioid dependence

-- BRIEF PLAN/DISPOSITION:

Developed crisis management plan, Medication management, Refer for

Mental Health treatment, Assure followup appointment is made

/es/ JEENEE M HINES, LISW-S

CLINICAL SOCIAL WORKER

Signed: 06/18/2018 10:07

From the service...even then I had work, social, and legal problems.

June 29, 2018

Note Title: SUICIDE BEHAVIOR REPORT

Location: Chillicothe OH VAMC

Signed By: HINES,JEENEE M

Co-signed By: HINES,JEENEE M

Date/Time Signed: 18 Jun 2018 @ 1007

-------------------------------------------------------------------------

LOCAL TITLE: SUICIDE BEHAVIOR REPORT

STANDARD TITLE: SUICIDE RISK ASSESSMENT NOTE

DATE OF NOTE: JUN 18, 2018@10:03 ENTRY DATE: JUN 18, 2018@10:04:06

AUTHOR: HINES,JEENEE M EXP COSIGNER:

URGENCY: STATUS: COMPLETED

DOB: JUL 22,1980 (37)

-- Date/Time of event:

Jun 13,2018@22:00 (Time is approximate)

Location of event: Off station

Patient status at time of event: Outpatient

Outcome of event: remained outpt, hospitalized: indicate where in

the box below

voluntarily came to UC day after

-- Source of information: Written, Patient self-report

Name & Phone # of source: veteran

-- Patient's stated: Level of INTENT of this event was: High

Staff assessment: Level of INTENT of this event was: High

Staff assessment: Level of LETHALITY of this event was: Low

Last Pain Score Before Event: 6

Did the patient have access to firearms? Unknown

Description of event: struggling with depression and positive for

suicidal ideation, made an attempt at overdose on quetiapine and alcohol

Past 10 Clinic Visits:

06/17/2018 12:40 CHI MH INPT PSY 21-45MIN UNSCHEDULED

06/16/2018 14:31 CHI MH INPT PSY 21-45MIN UNSCHEDULED

06/15/2018 13:00 CHI RECREATION GROUP 2 UNSCHEDULED

06/15/2018 12:46 CHI PHARM INPT MH UNSCHEDULED

06/15/2018 09:03 CHI MH INPT PSY 21-45MIN UNSCHEDULED

06/15/2018 09:00 CHI TCM CARE MANAGEMENT R UNSCHEDULED

06/14/2018 12:37 CHI MH URGENT CARE 8-4 1

01/03/2018 15:30 CHI TELE MHRRTP UNSCHEDULED

12/20/2017 15:55 CHI PRRTP NP UNSCHEDULED

12/20/2017 13:30 CHI PM&RS PHYSICIAN INPAT CANCELLED BY

CLINIC

-- Patient is currently receiving treatment in the following areas:

Ambulatory Care

Primary Care Provider: COPC

Case Manager/Therapist: COPC

Name of Provider prescribing psychiatric medications:COPC

Active problems - Computerized Problem List is the source for the

following:

1. Cocaine dependence (SNOMED CT 31956009)

2. AA - Alcohol abuse (SNOMED CT 15167005)

3. Cannabis dependence (SNOMED CT 85005007)

4. Low back pain (SNOMED CT 279039007)

5. Chronic post-traumatic stress disorder

6. Opioid dependence

-- BRIEF PLAN/DISPOSITION:

Developed crisis management plan, Medication management, Refer for

Mental Health treatment, Assure followup appointment is made

/es/ JEENEE M HINES, LISW-S

CLINICAL SOCIAL WORKER

Signed: 06/18/2018 10:07

-------------------------------------------------------------------------

June 29, 2018

The Psychologists opinion is correct: I am able to follow directions and complete simple tasks. But she errs in her judgement in three regards: 1) I am only able to keep and hold a job for a brief period before my PTSD symptoms present as is evidenced in my medical records with respect to my attending groups and hospitalizations. When my symptoms present I am unable to sleep. I become erratic, and hear voices, become paranoid, sometimes attempting suicide. This in and of itself lends itself more times than not to my being dismissed or fired. I eventually relapse to get relief from my symptoms. This leads to sustained use and dependence. 2) I can respond appropriately to coworkers as Dr. Houle suggests, but as I previously mentioned, the PTSD symptoms present, and I am unable to sleep, I become erratic, and I hear voices, I become paranoid, and to suggest I can maintain relationships at work while exhibiting these behaviors is asinine. 3) Dr. Houle suggests that drugs are my problem and that I am not service connected for drug use is just false. I am service connected for drug abuse disorder, a secondary condition to my PTSD (Military Sexual Trauma). Additionally, she states my inability to hold a job is due to that very thing, opioid use disorder.

Additionally, I attended said treatment and was dx'd for behavior. That VA left me 1000 miles away without shelter or a plane ride home. I ended up in their VA hospital as a result of a suicide attempt... Since that time I've attempted suicide one other time, that is, twice in 3 mos, and I am currently hospitalized. Do you think in light of these circumstances I would have a shot at IU in the ramp program?

June 29, 2018

Does this sound or look right to anyone? Denied TDIU...

=========================================================================

Date/Time: 20 Jun 2017 @ 0800

Note Title: C&P MENTAL DISORDER

Location: Chalmers P Wylie VA Outpatnt

Signed By: HOULE,ALLISON C

Co-signed By: HOULE,ALLISON C

Date/Time Signed: 20 Jun 2017 @ 1641

-------------------------------------------------------------------------

LOCAL TITLE: C&P MENTAL DISORDER

STANDARD TITLE: MENTAL HEALTH C & P EXAMINATION CONSULT

DATE OF NOTE: JUN 20, 2017@08:00 ENTRY DATE: JUN 20, 2017@16:41:06

AUTHOR: HOULE,ALLISON C EXP COSIGNER:

URGENCY: STATUS: COMPLETED

*** C&P MENTAL DISORDER Has ADDENDA ***

Review Post Traumatic Stress Disorder (PTSD)

Disability Benefits Questionnaire

Name of patient/Veteran: xxxxxxx

Is this DBQ being completed in conjunction with a VA 21-2507, C&P

Examination

Request?

[X] Yes [ ] No

SECTION I:

----------

1. Diagnostic Summary

---------------------

Does the Veteran now have or has he/she ever been diagnosed with PTSD?

[X] Yes [ ] No

2. Current Diagnoses

--------------------

a. Mental Disorder Diagnosis #1: Posttraumatic Stress Disorder

ICD Code: F43.10

Mental Disorder Diagnosis #2: Opioid Use Disorder, Severe, In early

remission, on maintenance therapy

ICD Code: F11.20

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?

[X] Yes [ ] No

b. Is it possible to differentiate what symptom(s) is/are attributable to

each diagnosis?

[X] Yes [ ] No [ ] Not applicable (N/A)

If yes, list which symptoms are attributable to each diagnosis and

discuss whether there is any clinical association between these

diagnoses: The veteran's symptoms are primarily related to his PTSD

since he has not used substances in more than six months.

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 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?

[X] Yes [ ] No [ ] No other mental disorder has been diagnosed

If yes, list which portion of the indicated level of occupational and

social impairment is attributable to each diagnosis: The veteran's

impairment is related to his PTSD.

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

Evidence Comments:

The veteran's electronic medical records (CPRS & VistAWeb) and military

records (VBMS) were reviewed.

The veteran was referred for a compensation and pension examination. The

veteran was informed verbally of the nature and purpose of the examination

and confidentiality limits. He appeared to have a basic understanding of

the purpose of the examination and confidentiality limits. He was provided

with a chance to ask questions about the evaluation procedures. All

questions were answered to reasonable satisfaction or referred to other

resources. He was informed that this examiner is not his treating

clinician

or the legal determiner of compensation or pension benefits. Instead, he

was informed that this examiner is an independent provider of clinical

information and expertise to assist those who review and make legal

compensation and pension claim decisions and would not be participating in

her healthcare. He was given information about the Veteran's 24-hour

Crisis

Line. The veteran indicated understanding of these terms and explicitly

and

freely consented to the evaluation. The judgments of symptoms and opinions

in this evaluation report are offered to a reasonable degree of

psychological certainty and are only based upon the information available

at the time of the evaluation.

This report was dictated using Dragon Naturally Speaking dictation

software. The report has been proofread; however, there still may be some

typographical errors due to the nature of the dictation software.

The veteran began participating in recovery services at the VA in May

2017.

His last group note was dated 5/31/17.

A note dated 2/26/17, by Dr. Laurie Berger, indicates that the veteran

began therapy at the Vet Center in October 2016. He attends therapy on a

weekly basis. He attended six sessions with Dr. Berger when this note was

written.

The veteran was initially evaluated for a C&P exam by Dr. Janine Schroeder

on 3/22/17.

2. Recent History (since prior exam)

------------------------------------

a. Relevant Social/Marital/Family history:

The veteran was born and raised in xxxx. He was raised by

his

mother and father until they divorced when he was 7 years old. The

veteran then lived with his mother until he was 14 years old. The

veteran's mother remarried when he was 11 years old and he reported

that he did not get along well with his stepfather. He went to live

with his father at 14 years of age due to being disrespectful towards

his stepfather. The veteran has one older sister and one younger

brother. The veteran's father did not remarry, but he was in a

relationship with the same woman for 20 years. He reported physical

abuse by his father throughout his adolescent years. He recalled one

incident where he got a black eye after his father hit him. He denied

any Child Protective Services involvement. The veteran describes his

father as emotionally absent. His father died in 2007 from a heart

attack.

The veteran is a 36-year-old, divorced male. He was married in 2001

for

five years and divorced in 2006. The veteran reported that they

divorced due to his drug use. They have a 1X-year-old daughter

together. His ex-wife and daughter live in xxxxx. He

maintained some contact with his daughter, but has not seen her in

several years. The veteran reported that he was involved in a

relationship for a few years following his divorce. They are no longer

in a relationship, but are close friends.

The veteran reported that he has spends time with three friends from

high school. The veteran stated that he enjoys gardening.

b. Relevant Occupational and Educational history:

The veteran reported that he did not enjoy school and did not want to

do the work. He frequently skipped school to go skating. He stated that

he would "have a few beers and smoked pot" when he skipped school. He

reported being suspended several times for truancy, fighting, and

disrespect towards teachers. He was never held back a grade. He was

expelled his junior year of high school due to nonattendance. He

earned

his GED in 1997.

The veteran worked for his father from 1997 until 1999 doing ironwork.

The veteran enlisted in the Navy in October 1999. He reported several

disciplinary issues while in the service related to going AWOL, being

late, and underage drinking. He reported that the sexual assault

occurred in the summer of 2001. The veteran received a general under

honorable conditions discharge in September 2001 for misconduct.

The veteran worked in Virginia Beach beginning in September 2001 doing

ironwork. He worked at a company for one year and was fired due to not

showing up for work and using alcohol and drugs. He then worked for

Roofing Services Incorporated from September 2002 until August 2003.

The veteran then earned his tanker men certification, z card, and AB

certification to work on tugboats. He worked on boats from September

2003 until March 2005. At that time his wife left him and he moved

back

to Ohio to be closer to his family. The veteran continued working on

boats in Ohio until the summer of 2005 when he got fired. The veteran

was incarcerated from 2006 until 2016. After his release from prison,

he worked with friends doing landscaping and painting. He began

working

at ABS Money Systems in January 2017, a company that his mother owns.

The veteran reported that he was working 30-40 hours per week for the

first two months. He stated that his hours have declined significantly

since March and he is currently working 5-6 hours per week. He stated

that his work has declined due to his mental health symptoms. However,

according to the initial C & P exam, "he is unable to do a lot for her

because she works serving ATM machines in banks and with his record he

isn't allowed to work in banks." He also reported that his employment

since the military has been "short-lived due to his drug and alcohol

use."

c. Relevant Mental Health history, to include prescribed medications and

family mental health:

The veteran reported that he was diagnosed with ADHD during childhood

and received treatment. The veteran reported a suicide attempt in 2001

after he was discharged from the military. He began attending

treatment

at the Vet Center in October 2016. He reported that he attends

individual therapy twice per week with Dr. Berger. The veteran

described his mood as "anxious, paranoid, and depressed." He stated

that he feels as though he "can't get a break." He reported having

passive thoughts of suicide, but stated that he does not have a plan

or

intention to kill himself. He stated "I couldn't do that to my

family."

He stated that he has had difficulty dealing with his emotions since

he

is no longer using substances and does not have an escape. He stated

"I

don't have the coping skills." He described having difficulty sleeping

and stated that he does not sleep every night. He stated that he is

not

feel safe in his bed.

d. Relevant Legal and Behavioral history:

The veteran reported that he had several misdemeanor offenses as a

juvenile, including truancy, driving without a license, and theft. He

reported that he was arrested for selling drugs at 18 years of age and

was placed on probation for one year. According to the previous exam,

he was arrested numerous times from June 1998 to September 1999. The

veteran was convicted of armed robbery for robbing three pharmacies

with a weapon. He served a 10-year prison sentence beginning in

October

2006 and was released in September 2016. He is currently on parole for

five years.

e. Relevant Substance abuse history:

The veteran reported that he first drank alcohol at 10 years of age.

He

began regularly drinking alcohol during high school. He began smoking

marijuana at 15 years of age on the weekends. He also experimented

with

mushrooms and pain/anxiety medication that he took from his father.

The

veteran's alcohol use increased significantly while in the military.

He

denied using any drugs while in the service. After his discharge from

the service, he continued using alcohol and marijuana. In 2002, he

began using narcotic pain medication. He also began using heroin and

reported that he eventually used heroin intravenously. The veteran

reported using substances throughout his time in prison. He reported

that he has been clean from drugs and alcohol since October 2016. He

has maintained sobriety using Suboxone. He currently attends AA

meetings approximately once per week. He attends substance abuse

groups

at the VA twice per month.

f. Other, if any:

No response provided.

3. PTSD Diagnostic Criteria

---------------------------

Please check criteria used for establishing the current PTSD diagnosis. The

diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual

of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to

combat, personal trauma, other life threatening situations (non-combat

related stressors). 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 #6 - "Other

symptoms".

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 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).

Criterion 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, 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] 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] 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] The duration of the symptoms described above in Criteria

B, C, and D are more than 1 month.

Criterion G:

[X] The PTSD symptoms described above cause 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.

4. Symptoms

-----------

For VA rating purposes, check all symptoms that actively apply to the

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

5. Behavioral observations

--------------------------

The veteran arrived 10 minutes late for his appointment and was pleasant

upon meeting. The veteran was oriented to person, place, situation, and

time. His grooming and hygiene were adequate. He made appropriate eye

contact and presented with a depressed mood with a congruent affect. His

speech was within normal limits for tone, volume, and rate. His thoughts

were logical, linear, and goal-directed. He did not evidence any

psychotic

symptoms, including responding to auditory or visual hallucinations and

delusional beliefs.

On a brief mental status exam he was able to freely recall two of three

words presented after a brief delay. He was able to recall six digits

forward and three digits backward. He was able to complete a serial seven

subtraction task with no errors to seven places. He was able to spell the

word WORLD forwards and backwards. He was able to complete a two-digit

addition and subtraction tasks. He was able to compare an apple and

banana

and was able to reason abstractly when comparing a poem and a statue. His

response to the proverb "don't cry over spilled milk" was good. He was

not

able to provide a response to the proverb "people in glass houses should

not throw stones."

6. Other symptoms

-----------------

Does the Veteran have any other symptoms attributable to PTSD (and other

mental disorders) that are not listed above?

[ ] Yes [X] No

7. Competency

-------------

Is the Veteran capable of managing his or her financial affairs?

[X] Yes [ ] No

8. Remarks, (including any testing results) if any:

---------------------------------------------------

The veteran was administered a psychological measurement that is useful

for interpreting the veracity of other data provided by an examinee

during

a psychological or neuropsychological examination. This assessment can

assist in evaluating and making a clinical opinion regarding the veracity

of an examinee's purported symptoms. Research has determined that this

tool is a useful instrument to administer in order to screen for possible

feigning of PTSD symptoms. The following results should be interpreted in

light of the fact that the measurement that was chosen is a screening

tool

and not designed as a definitive measure of whether or not an individual

is feigning mental illness. The Veteran's total score was not elevated

beyond the cut-off score. Therefore, his PTSD symptoms are considered to

be credible.

The veteran was administered the Minnesota Multiphasic Personality

Instrument-2-Restructred Form (MMPI-2-RF), which is a self-report

psychological assessment used to identify a variety of psychological

syndromes. The veteran was provided a quiet, private room to complete the

testing. It appears the veteran understood the items and responded to the

items in a consistent manner. The veteran over-reported psychological

dysfunction, which is evidenced by a considerably larger than average

number of infrequent responses. The veteran also possibly overreported

symptoms associated with non-credible memory complaints. Although there

is

evidence of over reporting of symptoms, the profile is considered valid

and will be interpreted.

Overall, the veteran endorsed considerable emotional distress that is

likely perceived as a crisis. The veteran reported feeling sad and

dissatisfied with his currently circumstances. He reported a lack of

positive emotional experiences, a lack of energy, and a lack of interest

in activities. He also reported experiencing various negative emotional

experiences including anxiety, anger, and fear. The veteran also reported

a significant history of antisocial behavior. This behavior includes

involvement with the criminal justice system, difficulty with authority

figures, conflictual interpersonal relationships, impulsivity, juvenile

delinquency, and substance abuse. The veteran also endorsed various

unusual thought and perceptual processes.

The veteran endorsed a diffuse pattern of cognitive difficulties

including

memory complaints. He also reported past suicidal ideation and feelings

of

helplessness. The veteran endorsed feelings of anxiety, being anger

prone,

and experiencing multiple fears that restrict his activity inside and

outside of the home. He also reported being unassertive and shy. The

veteran endorsed not enjoying social events and avoiding social

situations. He also reported disliking being around people. On a scale of

personality pathology, the veteran endorsed being self-critical and

guilt-prone. He also endorsed being pessimistic and feeling depressed.

The veteran is currently diagnosed with Posttraumatic Stress Disorder and

Opioid Use Disorder, Severe, In early remission, on maintenance therapy.

The veteran currently lives alone and is not involved in a romantic

relationship. He maintains phone contact with his daughter. He has a

close

relationship with his mother, sister, and two friends. He is currently

working for his mother's company. He reported experiencing symptoms of

PTSD. He is attempting to cope with his emotions without the use of

drugs.

The veteran has been employed numerous times and has been fired for

tardiness or alcohol and drug use. He is currently working 5-6 hours per

week for his mother's company. According to the previous C&P exam, he is

not able to work many hours due to not being permitted to work inside of

a

bank due to his felony record. The veteran reported that he was "working"

during his 10 years in prison selling drugs. He denied having any

difficulties while in prison. The veteran is capable of following

instructions and performing simple tasks. He is able to concentrate on a

simple task and respond appropriately to coworkers and supervisors.

/es/ ALLISON C HOULE, PHD

C&P Psychologist

Signed: 06/20/2017 16:41

06/20/2017 ADDENDUM STATUS: COMPLETED

The veteran presented for his appointment. The report from the C&P Exam was

completed in Capri by Allison Houle, PhD; procedure code 99456 and 96101.

/es/ ALLISON C HOULE, PHD

C&P Psychologist

Signed: 06/20/2017 16:42

June 28, 2018

.

February 9, 2018

How can the RO deny IU when Voc rehab found me unfeasible?

July 21, 2017

one more quick question. About a month ago I saw a request for information from the VA medical facility. Doesn't the BVA have access to that information? And can the BVA see my mental health records?

July 21, 2017

I have all my evidence in, all C and P's completed, submitted all evidence RO asked for. Should I hit the button asking for the BVA to proceed with deciding my claim?

June 26, 2017

will the VA rate a 20% lumbosacral strain higher if the C & P mentions radiculopathy and flare ups occurring at least weekly and often more? is the radiculopathy a secondary condition?

June 24, 2017

I have a letter from my doc stating: i have an application in for bay pines, fl MST/PTSD residential treatment facility and if im selected I'll be gone several months. If i decide still to not go then i need time to address my current problems and improve my mood so i can enter the workforce full time and wirhout reservation. I also have a letter from VOCREHAB stating i am unfeasible.

June 24, 2017

I didnt get comp until 15 years after the assault and 6 mos. after leaving prison.

June 24, 2017

Should i have my boss clarify the fact that my loss of time is due to my symptoms and not the misunderstanding the first c& p examiner had?

June 24, 2017

My boss is going to write a supportung statement claiming that that just isnt true. I have full time work available, 40 hours a week, buy due to my back ailment and ptsd symptom as well as meetings, groups, therapy and physical therapy i am not able to work full time

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