I recently had my c&p for mst ptsd. The c&p examiner diagnosed me with ptsd. The stressor was MST. Her opinion on the DQB form was MST.
However, she wrote that she couldn't say without speculation if my stressor contributed to my diagnosis. The rater sent the exam back to her for clarification saying that she said on the DBQ that attributed my ptsd diagnosis with the MST but her written opinion said something different. She responded and stated the same thing that she couldn't say without speculating that the stressor caused the ptsd.
What do I make of this?
1. Diagnostic Summary
Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [X] Yes [ ] No ICD code: F43.10
2. Current Diagnoses a. Mental Disorder Diagnosis #1: PTSD ICD code: F43.10
b. Medical diagnoses relevant to the understanding or management of the mental health disorder (to include TBI): none identified
3. 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
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 occupational and social impairment, is it possible to differentiate which impairment is caused by each mental disorder? [ ] Yes [ ] No [X] Not Applicable (N/A) 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)
1. Evidence Review Evidence reviewed (check all that apply): [X] VA e-folder [X] CPRS
Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military):
a. Stressor #1: Veteran repors verbal harrassment at her unit from 2004-2006 and being sexually assaulted in 2006
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 If no, explain: reported MST
Is the stressor related to personal assault, e.g. military sexual trauma? [X] Yes [ ] No
If yes, please describe the markers that may substantiate the stressor.
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)
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] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect 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 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, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others.
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] 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 #1
5. Symptoms ---------- For VA rating purposes, check all symptoms that actively apply to the
[X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks that occur weekly or less often [X] Chronic sleep impairment [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships
The following contentions need to be examined: post traumatic stress disorder (PTSD) personal trauma - mental disorders (related to: PTSD - personal trauma)
DBQ PSYCH PTSD Initial:
Please review the Veteran's electronic folder in VBMS and state that it was reviewed in your report.
MEDICAL OPINION REQUEST
TYPE OF MEDICAL OPINION REQUESTED: Military Sexual Trauma (MST)
OPINION: Military Sexual Trauma (MST)
What the rater sent back to the examiner:
Please return the exam to the examiner as on the exam she attributed the PTSD diagnosis to the Veterans MST and then in the separate opinion said differently. Please have the examiner provide an opinion as to whether the current PTSD diagnosis is at least as likely as not (50 percent or greater probability) caused by or a result of the in-service MST-related marker(s), and provide a rationale. Please note that only PTSD can be service connected based on circumstantial marker evidence ***************************************************************************** *************
What the examiner wrote back:
Veteran's Service Treatment Records document the presence of events that VBA has identifiend as potential markers for MST prior to the reported incident as well as following the reported incident. Writer is unable to opine without resorting to speculation if Veteran's diagnosis of PTSD is at least as likely as not caused by or a result of the in-service MST-related marker.
Determining if a MST stressor occurred is a legal issue not a clinical issue. Writer is not qualified to opine if a specific marker is sufficient evidence to support a claim of MST or if the absence of a marker is sufficient evidence to dispute the claim of MST.