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QuietNow last won the day on September 9 2017

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About QuietNow

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  • Service Connected Disability
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    Arguing with the VA

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  1. I'm seeing a LOT of veterans recently having their PTSD ratings re-evaluated and moved into another mental issue such as Major Depressive Disorder, Adjustment Disorder, etc. The ramifications of this to the veteran is not clear, but it looks like it is a bid to remove them from a service-connected rating. PTSD is the only mental rating that I know that can be diagnosed more than a year out of service. There are many PTSD claims that are getting denied because they fail to get Criterion F - "symptoms more than one month in duration." That seems like utter horse hockey because it takes more than one month to get into the system for a C&P exam. It's a 2-3 yr wait for most of us to get to the diagnostic exam phase. If you don't have something in every Criterion in the VA's PTSD and DSM-5 guidelines, it's not PTSD it's something else. I've talked to one woman who requested a female examiner and got a male examiner that got negative marks on Criterion C - Avoidance. So, she's coming in for PTSD due to MST and the VA rattles her with a male examiner instead of the female she requested. And somehow that very fact does not get marked as Avoidance? It's the very definition of Avoidance!! I'm putting the text from the VA web page on PTSD Criterion here, because they may make that page unavailable if the VA thinks veterans are actually reading it. ------ PTSD and DSM-5 In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 1). PTSD is included in a new category in DSM-5, Trauma- and Stressor-Related Disorders. All of the conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion. For a review of the DSM-5 changes to the criteria for PTSD, see the American Psychiatric Association website on Posttraumatic Stress Disorder. DSM-5 Criteria for PTSD Full copyrighted criteria are available from the American Psychiatric Association (1). All of the criteria are required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria: Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): Direct exposure Witnessing the trauma Learning that a relative or close friend was exposed to a trauma Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics) Criterion B (one required): The traumatic event is persistently re-experienced, in the following way(s): Intrusive thoughts Nightmares Flashbacks Emotional distress after exposure to traumatic reminders Physical reactivity after exposure to traumatic reminders Criterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the following way(s): Trauma-related thoughts or feelings Trauma-related reminders Criterion D (two required): Negative thoughts or feelings that began or worsened after the trauma, in the following way(s): Inability to recall key features of the trauma Overly negative thoughts and assumptions about oneself or the world Exaggerated blame of self or others for causing the trauma Negative affect Decreased interest in activities Feeling isolated Difficulty experiencing positive affect Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s): Irritability or aggression Risky or destructive behavior Hypervigilance Heightened startle reaction Difficulty concentrating Difficulty sleeping Criterion F (required): Symptoms last for more than 1 month. Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational). Criterion H (required): Symptoms are not due to medication, substance use, or other illness. Two specifications: Dissociative Specification. In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli: Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream). Derealization. Experience of unreality, distance, or distortion (e.g., "things are not real"). Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately. Note: DSM-5 introduced a preschool subtype of PTSD for children ages six years and younger. How Do the DSM-5 PTSD Symptoms Compare to DSM-IV Symptoms? Overall, the symptoms of PTSD are generally comparable between DSM-5 and DSM-IV. A few key alterations include: The revision of Criterion A1 in DSM-5 narrowed qualifying traumatic events such that the unexpected death of family or a close friend due to natural causes is no longer included. Criterion A2, requiring that the response to a traumatic event involved intense fear, hopelessness, or horror, was removed from DSM-5. Research suggests that Criterion A2 did not improve diagnostic accuracy (2). The avoidance and numbing cluster (Criterion C) in DSM-IV was separated into two criteria in DSM-5: Criterion C (avoidance) and Criterion D (negative alterations in cognitions and mood). This results in a requirement that a PTSD diagnosis includes at least one avoidance symptom. Three new symptoms were added: Criterion D (Negative thoughts or feelings that began or worsened after the trauma): Overly negative thoughts and assumptions about oneself or the world; and, negative affect Criterion E (Trauma-related arousal and reactivity that began or worsened after the trauma): Reckless or destructive behavior What Are the Implications of the DSM-5 Revisions on PTSD Prevalence? Changes in the diagnostic criteria have minimal impact on prevalence. National estimates of PTSD prevalence suggest that DSM-5 rates were only slightly lower (typically about 1%) than DSM-IV for both lifetime and past-12 month (3). When cases met criteria for DSM-IV, but not DSM-5, this was primarily due the revision excluding sudden unexpected death of a loved one from Criterion A in the DSM-5. The other reason was a failure to have one avoidance symptom. When cases met criteria for DSM-5, but not DSM-IV, this was primarily due to not meeting DSM-IV avoidance/numbing and/or arousal criteria (3). Research also suggests that similarly to DSM-IV, prevalence of PTSD for DSM-5 was higher among women than men, and increased with multiple traumatic event exposure (3).
  2. It is not possible to record the C&P exam with an audio recorder. While state law does allow for recordings in some states with one-party consent, there are many states that require consent of all parties to the recording. In Maryland law, as long as both parties are aware of the recording and consent to it, it is legal. If one is unaware it is illegal in most cases. DC is completely different. In Washington, DC, you can record whatever because it's one-party consent. But this is Federal law, not state. There's a statute that forbids recordings or attorneys present because the exam is investigative in nature, not judicial. One thing, though, can you have someone present in your exam? To give morale support and take notes of the proceeding? Or at least bear witness? I've seen several cases now of women with PTSD from MST where they have requested a female examiner, been promised a female examiner, and on the day of the exam it's a male ready to review them. In one case, the female examiner that she was scheduled with was free that hour and when the veteran put up a fuss, they brought the female examiner into the room to sit by her while the male examiner conducted the exam. Then, after asking the questions in the C&P, the male examiner asked her to take a series of exams to uncover other mental issues and malingering: MMPI-2, MENT, TOMM. The TOMM exam is inexplicable because it is used to uncover malingering for Alzheimer's or other memory diseases. Why would that be used in a PTSD exam? MMPI-2 appears to be used to declare her PTSD as another personality disorder to deny the claim.
  3. Hi Andyman73, Dissociation is that hiding of things from yourself. The classic dissociation event is driving somewhere and finding out that you drove home on autopilot. PTSD has dissociative characteristics where most of us have blocked out parts of the trauma. It's a bit like looking at a photograph that just doesn't make sense to you --you can't figure out what it is. You stare at it for a long time, and eventually you realize it's a pretty horrible picture of a car accident. Your brain couldn't accept it, so it wouldn't cognitively acknowledge what the picture was. Depersonalization in PTSD refers to the feeling that events are happening "out of body." That you can view them from a distance while your body endures whatever is going on. There's a slowing of time feeling. Derealization is when the world around you does not seem real. You'll notice things like colors flattening out, feeling like you're behind a pane of glass while interacting with the world. Or trudging through a desert. You're detaching from everyone and everything and numbing yourself. Many trauma patients describe that they feel this shutting down process before they finally decide to commit suicide. Many others can go most of their lives with the derealization. HyperboleAndAHalf had a blog post that nailed derealization. That post is an inspiration and an illumination for many of us. I myself have been lying on the couch while the syrupy yoga instructor therapist goes on about knowing how I feel and stay strong it gets better. And I've glared at her and wished her to Jericho. http://hyperboleandahalf.blogspot.com/2013/05/depression-part-two.html It can get better. But it takes a lot of time, distance, decent therapy, and willpower. Willpower is really hard to muster. I knew I was sliding into something really bad when my running wasn't keeping the endorphins up for a full day anymore. I had been running in the morning before work. But then, it was morning and evening just to stay feeling good. And the time where I felt ok emotionally after a run got shorter and shorter until I couldn't muster the will to go running anymore.
  4. Hi All, Is there a specific forum for the VA's eBenefits site? Several issues with that site, but today I found one that takes the cake. I checked my personal information under the Manage tab at the top of the page Manage -> Compensation -> Update your direct deposit and contact information In the personal information, some person or program had filled in my secondary contact phone number with MY SOCIAL SECURITY NUMBER!!!!! I changed that immediately. But others should check that out. I suspect that it's an automatic form fill-in program that ran wild, but I am likely not the only one affected. If you see your SSN where a phone number should be, change it immediately and put in the primary contact number again if you don't have a secondary phone number. --QuietNow
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