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sanktuary

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About sanktuary

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    E-3 Seaman
  1. sanktuary

    Esophagus C&P thoughts.

    Well I agree. I waited maybe to long to start looking into any of this, but i was under the impression if I took benefits it would have taken it from the older vets, so I just kept declining to put in a claim every time the VA told me I should. I did not know the system was already funded whether i claimed or not. The knee has a service connected event but the Physicians Assistant did not even do a proper exam on that. I claimed for Serrobheric Dermatitis which is caused by extreme cold and my back which they have sent me to Spinal Specialists outside the VA.. but they did not even give me and exam for those claims. On the back issue I was told that it was extreme wear and tear and that at 40 I have the lower back of a 90 yr old. So they will probably kick that claim telling me it was not service related. Even though within 5 yrs after getting out I told the VA on my initial visit i had back and knee issues. So 26 with an arthritic back. I guess we will have to ride this out. Now my esophagus issue which was done by the same PA-C that did my knee seems riddled with issues. I had a service connected event, and recently was diagnosed with a stricture but this PA-C did not answer any of the questions that the VA was looking for answers to. To me it just seems open to denial as he provided nothing relevant to what the VA was needing to confirm a SC issue. Basically i will be on these pills for life and possibly more stricture stretching, which i would only assume will get worse as I age.
  2. sanktuary

    Mental Health C&P

    Do you have any SC ratings now? I have just started this process. As of now I have no listed SC's and have completed exams ( if you call some of them exams ) for the knee, tinnitus, ptsd, panic /agoraphobia Ratings are based on how the disability affects/impacts your ability to work- (I thought the examiner would make a statement to that affect but I dont see it there in the C & P exam.) Hey Berta, the only thing this apparently says is Criterion G ( along with all of the other Criterion in the A-I list) and the part in the beginning where she stated " [X] Total occupational and social impairment " and at the end where she stated " In my opinion, the Veteran's Panic Disorder and Agoraphobia were incurred while he was serving in the Army. I guess you have seen a lot more of these than myself. She basically shifted the PTSD to Panic and Agoraphbia, even though the criterion for PTSD was met. She stated she felt the Panic and Agoraphobia were more present, i guess. But nothing really more on the work front outside of her saying that I do not have a job and haven't in years. Thanks Again
  3. sanktuary

    Mental Health C&P

    Hello Berta, Yes I actually was awarded an AAM for this. It is all in the military records. I guess I am not worried what they actually classify my issues as! I was diagnosed with multiple mental health issues over the past 20 yrs ( Major Depressive Disorder, Generalized Anxiety Disorder, Panic attacks with Agoraphobia as well as PTSD) The Agoraphobia to me is the most debilitating. I just wanted any thoughts on how this looks as far as rating may go. I understand also that all of the MH issues are rated as one, and the most severe is the rating they use. I do appreciate everyone's help on this new journey for me through this whole new level of bureaucracy and red tape.
  4. Hey all! I just downloaded the mental health dbq from the appt i had the other day. As a precursor the VA for my whole time using the VA has me listed as having GAD, MDD, Panic Attacks w/ Agorophobia and PTSD. Below is the eval that was just done. Appreciate your thoughts as this was done by someone in the same field as my condition. They had scheduled me for 2 exams 1 for PTSD and One for GAD, Panic and Agorophobia.. only did this 1. Mental Disorders (other than PTSD and Eating Disorders) Disability Benefits Questionnaire Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)? [X] Yes [ ] No ICD code: F41.0 If the Veteran currently has one or more mental disorders that conform to DSM-5 criteria, provide all diagnoses: Mental Disorder Diagnosis #1: Panic Disorder ICD code: F41.0 Mental Disorder Diagnosis #2: Agoraphobia ICD code: F40.0 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): n/a 2. Differentiation of symptoms ----------------------------- No response provided. 3. Occupational and social impairment ------------------------------------ No response provided. SECTION II: ---------- Clinical Findings: ----------------- 1. Evidence Review ----------------- Evidence reviewed (check all that apply): [X] VA e-folder [X] CPRS 2. History --------- No response provided. 3. Symptoms ---------- No response provided. 4. Behavioral observations ------------------------- Duplicate request: Please see the PTSD DBQ completed today. Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire SECTION I: 1. Diagnostic Summary -------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [ ] Yes [X] No If no diagnosis of PTSD, check all that apply: [X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [X] Veteran has another mental disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire: 2. Current Diagnoses ------------------- a. Mental Disorder Diagnosis #1: Panic Disorder ICD code: F41.0 Mental Disorder Diagnosis #2: Agoraphobia ICD code: F40.0 b. Medical diagnoses relevant to the understanding or management of the mental health disorder (to include TBI): n/a 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? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason: The Panic Disorder and Agoraphobia are part of the same problem. Each feeds the other. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [X] 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] Total occupational and social impairment b. For the indicated occupational and social impairment, is it possible to differentiate which impairment is caused by each mental disorder? [ ] Yes [X] No [ ] Not Applicable (N/A) If no, provide reason: Panic Disorder and Agoraphobia exacerbate each other 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 Evidence Comments: They are records from the VA clinic. 2. History --------- a. Relevant social/marital/family history (pre-military, military, and post-military): Says he is "always at home." He does not go out because of panic attacks. Says he has to prepare himself for weeks to go out. If he does leave the house, it is with his wife. They started home schooling the children because his wife couldn't leave him at home. Says he has intrusive thoughts of what if he had the thought of hurting the kids. He is unable to be apart from his wife for over 10 minutes. Being home by himself scares him. His wife and younger children are always in the home now because Veteran won't be alone. Social impairment is extreme and is affecting his family. b. Relevant occupational and educational history (pre-military, military, and post-military): Graduated from high school, worked at a pizza restaurant and joined the Army a year later. He was in the infantry. After the Army, he has mostly tried to work from home using the Internet. He would build websites and had a marketing company. He quit when he was expected to leave the house and go to conferences to promote the marketing company. He says panic attacks became so debilitating, he couldn't even work from home. He is not currently employed. He has credit card debt and no income. c. Relevant mental health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Veteran states that he was "fearless" before he went to Korea. Says he "changed completely" after the death of his friend, Hicks, in 1996. In the STR, there is a note about his having a Mental Status Exam in 1996 at a Mental Health Clinic. No details are available. Veteran says he did not return for treatment because "everybody picks on you" if you get treatment. Veteran had many incidents which caused him to feel anxious in the Army. In basic training, a recruit had a heart attack and was berated. In the Korea DMZ, he was fired upon. Also, the camp was threatened that North Korea was making inroads into the DMZ. The soldiers were told that they had 15 second lifespan. Veteran states that his first "big panic attack" occurred in 1997, shortly after he left the Army. Says he went to a VA in Atlanta, no record is available. He was fearful of having cancer or a heart attack. Veteran was admitted to inpatient psychiatry at the VA in 2004. He was fearful that he had mouth cancer. He declined medication, fearing that medications would cause problems. Because he refused meds, he was in psycyhotherapy at the VA from 2005 to 2011. Veteran's symptoms only worsened. He avoids situations that cause panic attacks so his world has become very restricted. He is not currently in treatment. He went to exposure therapy in 2017 at UNC which helped a very small amount. He is now able to be alone for 10-20 minutes. He says he gets panic attacks when he takes medication, fears addiction, fears being suicidal. e. Relevant substance abuse history (pre-military, military, and post-military): Says he does not drink alcohol. "Alcohol about killed me in the military." f. Other, if any: No response provided. 3. Stressors ----------- Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: In Basic Training, a soldier had a heart attack. Says anxiety started that day. Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [ ] Yes [X] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [ ] Yes [X] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No b. Stressor #2: In Korea, a soldier stepped on a mine and lost his foot. Veteran was told that he was lucky because that mine had been there for decades. Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [ ] Yes [X] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No c. Stressor #3: He was on bridge duty in Korea, He came under gunfire one night. He started to run to get ammunition but was called back. . Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No d. Additional stressors: If additional stressors, describe (list using the above sequential format): North Korea threatened to attack the DMZ. They were shown satellite photos of the enemy digging into the DMZ. They were put on lockdown. 4. PTSD Diagnostic Criteria -------------------------- Note: Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criterion A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] Witnessing, in person, the traumatic event(s) as they occurred to others 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). Criterion C . Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent 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] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #3 5. Symptoms ---------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Anxiety [X] Suspiciousness [X] Panic attacks more than once a week [X] Chronic sleep impairment [X] Disturbances of motivation and mood 6. Behavioral Observations ------------------------- Veteran is alert, fully oriented, dressed in clean, casual clothing. Mood is anxious. Affect is constricted. He becomes tearful when talking about the loss of his friend and the effect his anxiey has on his family. He denied suciidal thinking. He avoids eye contact. Speaks in a tremulous voice. 7. Other symptoms ---------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 8. Competency ------------ Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any ------------------------------------------------- Active duty service dates: Branch: Army DBQ PSYCH Mental disorders: The Veteran is claiming service connection for agoraphobia, anxiety and insomnia. Please examine the Veteran for a chronic disability related to his or her claimed condition and indicate the current level of severity. If more than one mental disorder is diagnosed please comment on their relationship to one another and, if possible, please state which symptoms are attributed to each disorder. ************************************************************************** ** DBQ PSYCH PTSD Initial: The Veteran is claiming service connection for PTSD due to the claimed stressor of Inicident at Korean DMZ. Please examine the Veteran for a chronic disability related to his or her claimed condition and indicate the current level of severity. If more than one mental disorder is diagnosed please comment on their relationship to one another and, if possible, please state which symptoms are attributed to each disorder. If your examination determines that the Veteran does not have diagnosis of PTSD and you diagnose another mental disorder, please provide an opinion as to whether it is at least as likely as not that the Veteran's diagnosed mental disorder is a result of an in-service stressor related event. Response: The Veteran has many symptoms of PTSD and has had events that could cause PTSD. However, the more appropriate diagnosis for this Veteran is Panic Disorder along with Agoraphobia. Panic Disorder and PTSD have many overlapping symptoms. This Veteran happens to have incurred a trauma but his presentation more closely resembles Panic Disorder. There is scant evidence to demonstrate that the anxiety started in the Army, namely the note that a Mental Status Examination took place at a Mental Health Clinic with no details provided. This corresponds to the Veteran's report that he was evaluated after his close friend died. His first panic attack occurred within a year of his departure from the Army. In my opinion, the Veteran's Panic Disorder and Agoraphobia were incurred while he was serving in the Army.
  5. sanktuary

    Esophagus C&P thoughts.

    Yea I agree 63Sierra.. They told me in the service it was a hole in my stomach, then this examiner said it was this weiss tear that caused stricture. The worst was i have been told for the last 20 yrs it was due to my mental health issues. Then one night we were eating dinner, and as I swallowed it felt like it got stuck ( has happened before), but this time it did not go down after a few minutes. After 3 hours of throwing up, i told my wife it was time to go to the ER. Sure enough food was stuck in my chest. An endoscopy, 2 biopsies later. The doctors were the ones that told me I should be filing a claim. As it will never go away and could possibly get worse. I have been there where you wake up in the middle of night unable to breathe. I have proof the issue was caused in the service as I spent 7 days in the ICU in Seoul, SK for it. It just seems like I am getting the run around on this. The guy did not even really ask me any questions regarding the issue. Took a few minutes regarding my knee, but no tools were used to check my ROM , did not even ask a bout my back or the dermatitis. Just feels like my case is going to be one of those that drag out for years in appeals since the initial examiner was so lax and did not even answer the questions the VA had asked to be answered.
  6. sanktuary

    Esophagus C&P thoughts.

    Thanks for the help. I just do not think this is right. I mean why would they allow someone unqualified to do an exam? Why would the person doing the exam evade the main question that the VA looks for in these cases " Is the injury related to a service connection with More So Likely Than Not" evidence? All this is going to do now is drag me from the initial claim to now dealing with appeals for months if not years due to these examiners being unqualified or not caring if they answer the questions laid out beforehand. This system needs overhauled. The directions in the heading of the C&P explicitly asks to do the following, and yet it was not done! MEDICAL OPINION REQUEST TYPE OF MEDICAL OPINION REQUESTED: Direct service connection OPINION: Direct service connection Does the Veteran have a diagnosis of (a) stomach condition that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) stomach issues in service during service? Rationale must be provided in the appropriate section. DBQ GI Esophagus (including GERD & hiatal hernia) MEDICAL OPINION REQUEST TYPE OF MEDICAL OPINION REQUESTED: Direct service connection OPINION: Direct service connection Does the Veteran have a diagnosis of (a) stomach issues/vomiting blood that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) stomach issues in service during service? Rationale must be provided in the appropriate section.
  7. sanktuary

    Esophagus C&P thoughts.

    I just looked the examiner up online, it gives his name and then states " MPH, PhD, PA-C " He is listed as a Physicians Assistant on the VA website. But told me he was in family practice .
  8. sanktuary

    Esophagus C&P thoughts.

    I agree that is why it is so confusing to me. I do take medications for the condition, due to an ER visit where food had gotten stuck in my esophagus. Then they finally referred me to the VA GI Clinic and seen that they have been wrong all of these years. The Weiss tear ( which I did not know i had, they told me in Seoul that I had a hole in my stomach and it would affect me for life) as it healed would cause scarring in the esophagus, which causes stricture. He stated that I have not seen anyone for this issue but then the next sentence states that the doctors have always told me the swallowing issue was related to my panic and anxiety. That in itself is contradictory. The examiner states I have not had continuity of care, but everytime I had brought this up to the PCP they blew me off and just stated it was due to my MH issues.
  9. Hey everyone love the site. I was just looking over the C&P exams that came back in through the blue button. While my knee C&P exam was terrible ( Doctor laid me on my back and pushed all of his weight down on my knee, pushing it into my chest) hurt like hell, i even told him it was hurting. But that one looks like he just did not care. No tool used to measure anything, said I had no complaints since the service, even though my VA records shows imaging, offering of knee replacements and braces... but I digress. The tinnitus one they gave me ( MOS 11B ) said Does the Veteran report recurrent tinnitus: Yes Date and circumstances of onset of tinnitus: He reported constant ringing since 1996-97. Circumstances of onset related to weapon training without hearing protection. The tinnitus is described as a loud whine or buzz sound. It is more noticeable in a quiet area, at night in bed. 2. Etiology of tinnitus ---------------------- At least as likely as not (50% probability or greater) caused by or a result of military noise exposure. My bigger issue is I can not make this out regarding the stomach disorder and espohagus issue i am having. They have diagnosed me with Eosonophil Esophagitis. They told me it was caused from silent reflux due from stomach issues. But where as the exam for tinnutis stated At Least as Likely As NOT. This one doesn't say that. Can you guys give me your thoughts on what this looks like? ########################### Esophageal Conditions (Including gastroesophageal reflux disease (GERD), hiatal hernia and other esophageal disorders) Disability Benefits Questionnaire Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ---------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review -------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS Diagnosis -------- Does the Veteran now have or has he/she ever been diagnosed with an esophageal condition? Yes Other esophageal condition (such as eosinophilic esophagitis, Barrett's esophagus, etc.) Other diagnosis #1: mallory weiss tear (esophogus)/healed 1995 ICD code: 000 Date of diagnosis: 1995/during military service Medical history -------------- Description of the history (including onset and course) of the Veteran's esophageal conditions: 42-year-old male here with a history of a Mallory Weiss tear* of the esophagus during military service (1995) here in C&P to be considered for residual GI problems. Since military service, he never sought medical care, always being told his dysphasia (difficulty in swallowing) is due to anxiety. Vet states he has PTSD, VA records stat he has panic attacks with anxiety. Had a gastroscopy (considering the stomach with a camera) 5/2/2018 at Wake Forest/NCBH that VA records state he had an esophageal dilatation. " * "Severe and prolonged vomiting can result in tears in the lining of the esophagus. The esophagus is the tube that connects your throat to your stomach. Mallory-Weiss syndrome (MWS) is a condition marked by a tear in the mucous membrane, or inner lining, where the esophagus meets the stomach. Most tears heal within 7 to 10 days without treatment, but Mallory-Weiss tears can cause significant bleeding. Depending on the severity of the tear, surgery may be necessary to repair the damage." ********************************************************* Does the Veteran's treatment plan include taking continuous medication for the diagnosed condition? Yes Medications used for the diagnosed condition: pantoprazole 40 mg bid Does the Veteran have an esophageal stricture, spasm of esophagus (cardiospasm or achalasia), or an acquired diverticulum of the esophagus? Yes Severity of condition: Amenable to dilation Moderate Permitting liquids only Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? No Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? No Have diagnostic imaging studies or other diagnostic procedures been performed? Yes Diagnostic Testing Preformed: Upper endoscopy Date: 5/02/2018 Results: esophogeal stricture/ esophogitis Are there any other significant diagnostic test findings and/or results? No Do any of the Veteran's esophageal conditions impact on his or her ability to work? No Remarks, if any: ------------------ Esophogeal problems (esophogitis and esophogeal stricture documented in 5/02/2018 study).
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