IMEF-Gunny

Rating came in, 70% anxiety. I do attend therapy and take medication for Depression and anxiety. I am diagnosed with PTSD, major depressive disorder and anxiety secondary to IBS. I am rated only on the anxiety. Total rating is IBS 30%, Fibromyalgia 40%, Hearing 0%, Tinnitus 10%, Anxiety 70% - Total 90%

Thanks for the reply!

I was awarded 40% SC for Fibromyalgia.

Here is my recent C&P results for anxiety secondary to SC IBS and Fibromyalgia. Thoughts or opinions on SC rating? LOCAL TITLE: PSYCH C&P EXAM MA STANDARD TITLE: C & P EXAMINATION NOTE Mental Disorders (other than PTSD and Eating Disorders) 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. Diagnosis ------------ a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)? [X] Yes [ ] No If the Veteran currently has one or more mental disorders that conform to DSM-5 criteria, provide all diagnoses: Mental Disorder Diagnosis #1: Anxiety Disorder due to another medical condition (IBS, fibromyalgia) b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided. 2. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [X] No c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [X] Not shown in records reviewed 3. 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? [ ] 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? No response provided. SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): PRE-MILITARY SOCIAL/MARITAL/FAMILY HISTORY: Please see previous C&P exams POST - MILITARY SOCIAL/MARITAL/FAMILY HISTORY: E. Social Functioning: The veteran is currently married to second wife since 1999 Current relationship description: "my wife is a great support. We get along okay, I pretend to give a shit about a lot of things. I don't have emotional connections with others. My wife can leave tomorrow and take the kids and I won't give a shit. I mean I love them but I don't I don't have the emotional connection. We have not slept in same bed in 7/8 years because she says I shake so my in bed. I sweat a lot in bed." Children: 7 children (23 through 1.5). 5 still live in the home. Oldest daughter thinks her father is distant from her. He Believes relationship with others children is good. He is supportive of them. Older son is autistic and lives in a home. He has one grandson (1 year old) Friends and Hobbies: no friends. talks to two military Buddies occasionally. Structure of day: work structures his day. When he is not working "I tries to stay busy but winter time is boring and gives me more time to think" b. Relevant Occupational and Educational history (pre-military, military, and post-military): PRE-MILITARY OCCUPATIONAL and EDUCATIONAL HISTORY: See previous C&P POST-MILITARY OCCUPATIONAL and EDUCATIONAL HISTORY: Education: none Occupation: refinery- maintenance coordinator; 11 years Has the veteran lost time from work due to mental health issues? He missed about 5 or 6 days a year due to anxiety. However, when at work he is missing time from work because of anxiety- for the days he must put on SCBA (similar to the MACH 4) this is highly anxiety provoking. He noted about 20 hours a week he is anxious, about 10 of those hours he is not as efficient, reliability due to the anxiety. Difficulties at work? Anxiety. Dangerous work, needing to don SCBA (similar to MACH 4) Causes difficulties? See above Are these difficulties mild/moderate/severe: ranges mild to Severe Efficiency/reliability/productivity at work: usually good except for those 10 hours a week Quality of interactions with supervisor/coworkers: poorly. 2016 almost lost job because a woman at work stated she was So intimidated by him she could not bring herself to come to work. "I have to be very careful the way I act, what I say. I walk on eggshells. I am very blunt, very honest and other people don't like it. I don't relate to them. I think differently than them" Does your problems only occur during times of significant stress? usually c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post- PRE-MILITARY MENTAL HEALTH HISTORY: See prior C&P General Health: Active Outpatient Medications (including Supplies): Active Outpatient Medications Status =========================================================== ============= = 1) ARIPIPRAZOLE 20MG TAB TAKE ONE-HALF TABLET BY MOUTH ACTIVE ONCE A DAY 2) HCTZ 12.5/LISINOPRIL 20MG TAB TAKE 1 TABLET BY MOUTH ACTIVE EVERY MORNING FOR HEART OR BLOOD PRESSURE 3) PRAVASTATIN NA 20MG TAB TAKE ONE-HALF TABLET BY MOUTH ACTIVE EVERY EVENING TO LOWER CHOLESTEROL (REPORT ANY MUSCLE PAIN OR WEAKNESS) 4) SERTRALINE HCL 100MG TAB TAKE ONE AND ONE-HALF ACTIVE TABLETS BY MOUTH EVERY MORNING FOR MOOD 1) Essential hypertension 2) Hyperlipidemia 3) Testicular hypofunction 4) Smoker 5) Bloating 6) Sleep disorder 7) Smoker 8) History of noncompliance with medication regimen 9) Posttraumatic stress disorder 10) Erectile dysfunction 11) Irritable bowel syndrome POST-MILITARY MENTAL HEALTH HISTORY: History of Psychiatric care: His history of psychiatric care has included: PSYCHOTROPIC MEDICATIONS: sertraline a. Side effects of medication: none noted PSYCHIATRIC INPATIENT TREATMENTS: none PSYCHIATRIC OUTPATIENT CARE: symptoms and medication monitoring: Ronda Bray, nurse practitioner since 1.6.2017 Suicidal Thoughts, intentions, plans or intent Presence of SI: rarely (once every three or four months) SUICIDE RISK ASSESSMENT COMPLETED Veteran aware of 1-800 number yes Card handed to veteran no Homicidal thoughts, intentions, plans, intent Presence of HI: No Subjective Complaints: Describe fully. How do you see your symptoms affecting your daily living? "I can't go anywhere, I can't relax, I am always worried about the bathroom, if I am going to have an accident. I stay away from everyone. I am embarrassed" Any remission from symptoms? Veteran says no Stressors: Health, Family, Significant other, MH problems causing more MH problems Impairment in thought: none Spontaneous Reporting of Symptoms: "I never know when I have to go to the bathroom. I must carry close with me. You can't go anywhere or do anything. I have had incidents in public, work, home. I never have a good time. I don't like to go out. Its horrifying. It effects intimacy with my wife." End of Spontaneous Report: Anxiety: jittery, worry, jumpy, mind races, unable to shut Down thoughts. Inter turmoil. He paces and fidgets. Used to drink but no longer. Does not like crowds, noise, being out, being around people. Sometimes heart races, hands sweat other times it is feeling of uneasy. He noted when he is home he "gets a break" from the anxiety. He likes to grill and that helps him relax. He noted the IBS accidents : "its anywhere, anytime, there is no method, it can be morning, noon or night. I can go (to the bathroom) several times a day, I can go once a day" He noted incontinence of bowel at least once every two weeks. He noted IBS can "go away" for a week and he then obtains a false sense of security that he is better. Unfortunately then IBS returns. Mild anxiety: fidgety, overly watchful Moderate anxiety; somewhere in the middle of the two Severe anxiety: pacing "like crazy" he cannot sit still. Hands sweating, increased heart rate. His body aches. More anxiety he has the more he is eating, more sleep Problems He feels on most days he is moderately anxious. He notes he spends equal amount of time in mild and severe anxiety He does not endorse symptoms of Generalized Anxiety Disorder. Consequence of anxiety: he cannot relax, he cannot enjoy being around family, Big public stuff is worse. Fibromyalgia: body aches all the time, interrupts sleep. "I don't think it increases my anxiety but fibro effects everything. You know every day is going to be a shitty day" He has 7 children. 2 from his first marriage (wife adopted his oldest two children). Poor impulse control when feels disrespected, unsafe. Last Physical altercation 3 months ago. Beat the heck out of a man who was threatening him and was trying to get violent with the veteran. He has been in very violent altercations (stabbed three times). Medications help to mellow him out. Themes that will incite violence is when he is threatened, disrespected (but this will incite angry but not necessarily physical violence). He carries a firearm when not working. He noted he has bene carrying a firearm since age 18. Anxiety makes it difficult for him to recall information. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): POST MILITARY LEGAL HISTORY: Veteran denied any legal entanglements since discharge/last exam. e. Relevant Substance abuse history (pre-military, military, and post-military): PRE-MILITARY SUBSTANCE USAGE HISTORY: See past C&P exam POST MILITARY SUBSTANCE USAGE HISTORY: Substance abuse problems/treatment: denied "I might have one glass of wine a week. I just don't drink" Use or abusing illicit drugs: denied Use and abuse of prescription drugs: Denied f. Other, if any: No response provided. 3. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Anxiety [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [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] Suicidal ideation 4. Behavioral observations -------------------------- Confidentiality and lack of discussed and veteran voiced understanding. Veteran's response to interview: "I wish you were my therapist: Cognition- Attention & Concentration: Sufficient Memory- (ST & LT) average for recent events of last few hours or days; average for remote events of past year. Abstraction- able to think abstractly Insight into illness- both intellectual and emotional awareness. Orientation: Time, place and person Judgement: poor when feeling threatened Thought Patterns- Clarity: Coherent Relevance/logic: Logical Flow: slow Content: wnl Is the thought content consistent with reality? yes General Appearance Accessibility- co-operative Clothing Appropriate to age, season, setting and occasion? yes Clean, neat, tidy,? yes Hygiene and grooming: clean Hair: neat Odor: NOne Eye Contact: WNL Psychomotor Behavior Gait: Brisk Handshake: Firm Abnormal movements: none noted Mood and affect Appropriateness of affect: Appropriate to situation. Congruous Range of affect: flat Stability of affect: Stable. Attitude toward examiner during encounter: Frank. Specific mood or feelings observed or reported: anxious Speech Rate of speech: WNL Flow of speech: wnl Intensity of volume: soft. Clarity: Clear. Quantity: offers information Other disorders or symptoms and the extent they interfere with activities particularly: substance abuse disorders: none current somatoform disorders: no personality disorders: no 5. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to mental disorders that are not listed above? [ ] Yes [X] No 6. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 7. Remarks (including any testing results), if any: --------------------------------------------------- Explained to veteran: examiner has no decision making capacity regarding the veteran's rating; the examiner will be asking numerous questions, some of which will provoke emotional response; the veteran was asked to please understand the examiner is not make any personaljudgments regarding the veteran but due to the vast amount of questions some might feel they are being judged and the veteran is encouraged to understand this is not the case it is simply a matter of gathering information for the examination the veteran requested; the veteran was informed the examiner is not native of this geographical area thus mannerisms are different and no offense is meant if the examiner appears to be abrupt or blunt; Veteran was informed of these things at the onset of the interview; the veteran voiced understanding of the above statements: yes Did veteran bring documents to interview: no Interview started: early on time Testing deemed necessary: no OPINION: Anxiety Disorder due to another medical condition (IBS, fibromyalgia) is at least as likely as not due to or caused by IBS and fibromyalgia.

My HL test average was 64/65 and word recognition was 84 both ears and that's 0% anyway you cut it......and if you were addressing me Gastone , I know the HL exam, especially the WR cannot be beat.....that's a given, and I have no feelings to speak of.

My hearing is pretty darn bad, my tinnitus is horrible, and I still only met the criteria for 0% HL

The IME report is in.......Thoughts? I warn you, it is lengthy......oddly, as much social issues, no friends, agression,etc as I have....he gave me a GAF score of 65. DrCoyleIMERedacted.docx

Figured out the problem......I used an older version.....new updated Hutsky calculator says 0% for HL. So 0% HL & 10% Tinnitus.

Oddly, if I plug the numbers into the Hutsky calculator, comes up 40%.....If I look at the VA's confusing ass cross reference chart, comes up 0% or maybe 10%?

The results are in......looks like, after running her numbers thru the calculator it would be 40% HL, 10% tinnitus....assuming they don't deny anyway, irregardless of their own audiologists opinion......stranger things have happened! RedactedHearingResults.pdf

Oh, I will....it would be awesome to watch a movie or TV without having to read the words for once!

So, I had my hearing C&P and it went as expected. I haven't seen the results yet, got to check myhealthevet Monday or Tuesday, but I do know that I showed the girl my work exams from the past 10 years, which are bad, and she said her results were about the same. When the testing was over, she was talking to me waaaaay louder and told me I didn't have to wait on the rating to get hearing aids if I am interested. She said as long as I make an appointment to get hearing aids within 6 months, i don't have to re-take the hearing exam. Thoughts?

Ha.......My employer went to what they call "The whisper test" last year. The nurse stands 10-20 feet away, faces away from you and says a word, you have to repeat the word. I fail it misearbly.....mostly I think because my tinnitus rings constant and loud non-stop! I'll post my C&P results around the 20th

Yeah, filed tinitus too....mines constant. I know civi hearing tests are irrelevant to SC ratings.....point being, they show what can be expected on an audiogram by VA.

Well, I'm an 0311 combat veteran, have a MEPS hearing test showed good hearing, boot camp hearing test showed mild hearing loss and post service that shows severe hearing loss in 1000+ Hz ranges. My company does annual hearing tests and last year they started doing a "whisper" test in 2016 , which I also fail miserably. Hopefully I can get some hearing aids!

Hearing exam C&P scheduled for next Friday......you think that means they are conceding hearing loss and doing the C&P to measure the extent of hearing loss?

All of the lab work to rule out Rheumatoid Arthritis came back clean, so I will upload to Ebennies. That will help support the previously undiagnosed Fibromyalgia claim. Also, have an appointment with a Rheumatologist coming up in December.

Is the burden of proof more stringent for a Gulf War veteran to prove, in service event/aggravation when it comes to a FM claim?

My first claim was for sleeplessness, bi-lateral arm pain, bi-lateral shoulder pain, memory loss-short term and stomach issues. The stomach was rated 30% as undiagnosed illness (IBS) w/constipation/diahrea. Since that time, I've been diagnosed with Major depressive disorder, PTSD, sleep disorder NOS. So, my re-open with new & material evidence is in the context that I filed for symptoms of Fibromyalgia, which I have now been diagnosed with. Much like anything, it's a crap shoot......but, I am a tenacious Marine and will never just go away! Thanks for the input!

So, before I knew much about the VA and their love for vets, I submitted my first GWI claim. I filed for symptoms (Stomach issues, sleeplessness, bi lateral arm/shoulder pain, short term memory loss). I had a forgetful C&P doc, I had no idea beforehand what the eam was for, I was nervous as shit and I didn't know enough to press him on examining other issues. I went 26 years without touching the VA and here I was at a C&P exam. I was rated 30% for IBS, all other contentions denied because dr said I denied having any other issues. This week I was diagnosed by a family practice NPC with fibromyalgia, they ordered bloodwork to exclede Rheumatoid Arthritis and scheduled me with a rheumatologist in February. Here is my DBQ. Thoughts? I'm considering a re-open or reconsideration for my initial 6/2016 claim. My NOD is already in for this claim with a request for DRO review. I don't care about back pay money, just principle, so not worried about losing my initial claim date.. DBQ1 001Redacted.bmp DBQ2 001Redacted.bmp DBQ3 001Redacted.bmp

No and here is my hearing test from work.......this will be my first hearing test by VA. I have a Meps hearing test, shows good hearing, boot camp shows mild loss, this....well.......you be the judge.....let's just say I read a lot of closed captioning! MarathonHearingTests.bmp

Just saw where a C&P exam request was posted just a couple hours after this post.........so, I guess that answers that!

Is it possible that hearing loss and tinnitus could be rated and service connected without a C&P ? I fileed the claim, under review 4-5 days, gathering evidence 2 days, review of evidence today, estimated close by 11/17. I submitted FDC, MEPS hearing test showed good hearing at low freq, and normal at high freq, Boot camp audiogram showed some hearing loss, but still normal low freq/mild at high freq, two buddy statements saying they can attest to my audiograms at work in 1992-1996 were bad and that guys used to tease me about being "deaf dumb jarhead" and such, don't have copies of the audiograms from 92-96 as company closed in 1996, sent current audiograms from current employer 2007-2015 showing severe hearing loss in both ears above 1000 hz. Thoughts?

That is him ma'am Robert B Coyle, he performs IME's for many vets represented by Lawyers 4 Vets. I believe he quoted 1/3 of his practice is veterans. He, himself, was denied for hearing loss/tinnitus and fought and won on appeal. I like the fact that he cannot/will not BS, exagerate or pull punches. He will tell you upfront that his assessment will be an honest review. He is not a "hired gun" type.....he's a stand up guy and I'm glad I chose him for my review....irregardless of it's outcome.

As with all veterans suffering from ailments due to service, and especially PTSD, which can only be awarded after a VA employed C&P PHD level Psychologist opines a DSM5 diagnosis, we are often treated as liars, cheats and beggars by the very institution that has sworn an oath to assist us. I recently had to pay for a private, un-biased, 3rd party IME in order to battle against the VA’s railroad job on my PTSD claim. Because they ignore facts, do not follow their own laws/statutes and 99% of the time re-diagnose PTSD as some other issue, it seems we all must travel this road more often than not. I will be honest, I can more easily afford an IME than many in this situation, I have been blessed to work for an outstanding company, so I feel much more for the guys/gals who struggle with mental illness or physical ailments and can barely survive, let alone pay $1,500 for an IME/IMO because the VA refuses to do their duty. This has never been about money for me. This is about honesty, integrity and the VA/Government acknowledging that GWI, PTSD, etc is not imaginary, we are not beggars, liars & thieves and we will not allow the shameful representation that plagued our Vietnam veterans (denial of agent orange) to happen again! Many times, by VA, private docs and Vet Center, I’ve been told “Desert Storm, OIF/OEF vets, etc. don’t come to therapy….mostly Vietnam era vets”……..I can tell you why…..because the reputation the VA, most deservedly, has earned, is one of distrust……BECAUSE of their treatment of our Vietnam Vets (God bless every one of you). I feel compelled to share my experience with the PHD Psychologist who performed my IME. I do not have his results; they may or may not be favorable. That point, to me, is irrelevant to the purpose of this post, because this is simply an honest assessment of my experience. The Dr is Robert Coyle. Dr Coyle is located in Munster Indiana (Outside Gary/Chicago area). Dr Coyle is a Marine and Viet Nam veteran. I found him after searching and contacting around 15 different PHD level psychologists/Psychiatrist around my state, of which I received maybe 5 responses. He was also listed under veteran owned business’. When I searched his name, he had only two reviews, neither was positive. In reading the reviews, to me at least, it seemed pretty obvious that they were from seriously “disgruntled” folks. My interaction with Dr Coyle was outstanding. He was very thorough, professional, straight talker, honest and genuinely caring. I was administered 8 - 10 different tests, interviewed in detail, filled out the PTSD questionnaire along with him and detailed events. All in all, I spent 6 hours with Dr Coyle. I arrived WAY early, he saw me anyway. I was an emotional wreck a couple of times during the process, he made me coffee and suggested a break. I did not sleep the night before, stupid anxiety, and drove 4 hours to see him, he offered to let me take a nap in his recliner before leaving for home, I drove my old work truck (heater went out) he offered me jersey gloves to wear on the drive back so I wouldn’t get cold, after the 6 hour process, he took another 10 minutes and thanked me for my service, explained the exam process and how/when I would get his report. Whether he found in my favor or not, as he explained up front that he cannot guarantee he will not have a different finding than the VA did, which is good as it is honesty, integrity and un-biased truth that I am seeking, he was very professional, courteous and genuinely caring. I would highly suggest Dr Robert Coyle to any veteran seeking an IME/IMO. -Gunny