Single Status Update
I just had my C&P, What do you think for my rating? I appreciate all you time. This was the worse thing to ever go through and glad it's finally done.
Does the Veteran have a diagnosis of PTSD DSM-5 criteria on today's eval?
[X] Yes [ ] No
2. Current Diagnoses,1PTSD 2Panic Disorder 3Agorophobia 4Major Depressive Disorder
b. Medical diagnoses relevant. obstructive sleep apnea, fibromyalgia, hypothyroidism.
a. Does the Veteran have more than one mental disorder diagnosed?
[X] Yes [ ] No
4. Occupational and social impairment
[X] Occupational and social impairment with reduced reliability and productivity
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)
Vet has multiple co-morbid psych dx and therefore cannot differentiate level of impairment due to each mental disorder due to overlap in symptoms.
Does stressor meet Criterion diagnosis of PTSD)?
[X] Yes [ ] No
Is the stressor related to the Veteran's fear of hostile military terrorist activity?
[X] Yes [ ] No
Is the stressor related to personal assault, e.g. military sexual trauma?
[X] Yes [ ] No
Criterion A: Exposure to
[X] Directly experiencing the traumatic event(s)
Criterion B: Presence of
[X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
[X] Recurrent distressing dreams
[X] Dissociative reactions
[X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic
[X] Marked physiological reactions to internal or externalcues that symbolize or resemble an aspect of the traumatic
Criterion Persistent avoidance of
[X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated
[X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects,
Criterion Negative alterations
[X] Persistent and exaggerated negative beliefs or expectations about oneself, others
[X] Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the
individual to blameherself others.
[X] Persistent negative emotional state
[X] Markedly diminished interest or participation in significant activities.
[X] Persistent inability positive emotions
Criterion E: Marked alterations arousal
[X] Irritable behavior angry outbursts
[X] Exaggerated startle response.
[X] Problems with concentration.
[X] Sleep disturbance
[X] Duration disturbis more than month.
[X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important
[X] The disturbance is not attributable to the physiologicaleffects of a substance
Criterion I: Which stressor contributed to the Veteran's PTSD diagnosis?:
X] Stressor #1
[X] Depressed mood
[X] Panic attacks more than once aweek
[X] Chronic sleep impairment
[X] Mild memory loss, such as forgetting names, directions or recentevents
[X] Flattened affect
[X] Impaired judgment
[X] Disturbances of motivation a
[X] Difficulty in establishing and maintaining effective work and social
[X] Difficulty in adapting to stressful circumstances,including worklike setting
[X] Obsessional ritualsInterfereActivities
[X] Neglect personalAppearance hygiene
DSM 5 Diagnosis:PTSD-Panic d/o with agoraphobia-Generalized Anxiety D/o
Vet meets the DSM-5 diagnostic criteria for PTSD as level of severity - severe. Relationship of mental disorders to each other Vet's MDD, recurrent,moderate is secondary to her PTSD.HerPanicDisorder, Agorophobia and FSAD are also secondary to her PTSD. It is my medical opinion that vet's MST stressor is as least as likely as not suppported by and consistent with the in service marker evidence. Her agorophobia preclude her from functioning satisfactorily in work environments.
As a preface, I am not a doctor nor am I a rater. I am just a veteran whose DBQ results make you look sane and healthy. I am not joking.
I don't see anything about your status or other info so I am not sure exactly where you are in the process.
Is this your first rating you are going for? or are you already rated for PTSD and or other things, possibly physical issues?
How long have you been out of the service? if filed within 1 year of your discharge date and these items are in your Service records, then they are considered presumptive and that makes them easier for you to get rated.
Is your nexus clear and well documented in your service record? I am not asking details, that would be intrusive and from the info you posted I would not want to pick at any "scabs". That is for you and your therapist, and I highly recommend you work with them two or three times a week, at a minimum.
As for what you post from the DBQ. You are crazy as a shit house rat. .... so much for levity. No intention to be rude, just an old saying that applies. Your situation sounds like it was very traumatic and has caused you very serious life challenges that you are not yet able to take control of. You have my utmost empathy and I am so sad to hear yet another service member has had an MST experience.
the C&P doc has linked your MST to a nexus and used the magic words "...is as least as likely as not..." which means that it is at least 50% likely to be service connected.
It is my medical opinion that vet's MST stressor is as least as likely as not suppported by and consistent with the in service marker evidence.
What is missing from what you posted is a similar statement about PTSD and or your other conditions. Those magic words are important. More about this farther down.
The term "severe" is interesting as it does not appear in the DSM 5 for PTSD criteria.
click link below and on that page find the blue heading Chronic and Severe PTSD
what you posted looks like you fit the criteria.
This is where it gets tricky and wonky.
PSTD can be a secondary to MST.
MST is not a secondary to PTSD as a general rule according to the DSM 5 and ICD 10 codes.
However the VA can and has rated MST as a secondary to PTSD but only because the raters don't understand what they are doing in this area.
You can have a nexus for MST and a Nexus for PTSD that are not related and have no overlap. In this case each would need its own rating % and service connection. or you can have PTSD as a secondary to MST and each would still have its own rating and service connection. PTSD ratings get convoluted compared to other conditions and problems.
Again I don't know if you are rated for anything yet so it is hard to list all the possible permutations but what you definitely need will be those magic words for every service connection you are claiming.
Based on your posted info alone, I would think you would be at least 70% on either or both MST and PTSD. Your OSA will likely be 0 or 50, those seem to be their favorite numbers. Your MDD, panic disorder and Agoraphobia may be rated as secondary to PTSD/MST and lumped under that rate, but they will boost it/them. Since PTSD leaps from 70% straight to 100% these "extra" problems will likely boost your rating.
Depending on the severity of your Agoraphobia you may be eligible for the SMC for housebound. They may have to go extra-schedular to reach it. Make sure when you get your decision letter it clearly states that they did or did not look at Housebound. failing to and including the reasoning is a NOD from you and be ready to go to the Board over it.
Your OSA needs to be addressed in the award letter, if not it is a NOD.
You should also look into TD/IU if they don't rate you as 100% Schedular. Based on that write up I doubt you can hold a job unless the company is really protective of you or is a closely held family company. TD/IU pays at the 100% rate and is eligible for SMCs. Again make sure the decision letter says explicitly that they did or did not consider TD/IU. it is another NOD but you will need to fill out your work history, how often you were let go and I highly suggest getting your Social Security pay-in history as it will show any and all employers who you have had and shows any gaps in employment.
If I was a betting man, and I am, I would guess at the topside you will end up being between 100% and 200% when all ratings are tabulated with the VA math calculator. If this is your initial foray into VA ratings you will be listed as either Static or Stable.
All that means is your situation is not getting better but they don't know how it will change with treatment. In 2, 3 or 5 years (odd right?) the VA will do more C&P's on you and you may end up Permanent and Total a.k.a. P&T, or treatment may have helped you become more "normal" (and I use the scare quotes intentionally).
This is probably years in the future but being 100% schedular P&T has advantages over being TD/IU paid at 100% even if the TD/IU is P&T.
One final thing, okay two things.
First keep coming here, reading and posting questions. It will be at least 60 days before your award letter is in your hands. BREATHE. don't let it stress you. use the time to learn more.
Second when your award letter arrives, take it and your FULL DBQ's and redact all your personal information and upload them here.
You want to ask people here to read them and make sure nothing was skipped between them. Those skipped items would be potential NOD's . I know it sounds odd to seek to be beyond 100% but mental health issues and ratings are weird.
MH issues can get better with treatment, but more often than not the service member makes a verbal mistake that the C&P doctor runs with and writes they have gotten better even if they haven't. This means the vet has to fight just to continue to be deemed sick and deserving of compensation. In this context you can think of the additional ratings as "backups" in case that situation occurs. even if they do reduce the one rating, the other ratings would keep you at or above the 100% level.
I wish you luck and better health. Please keep us informed and please work with your therapist.