Bluebonnie

@vync Ty for replying but the reason I ask is because they received my c and p exam the next day. Thats way to fast don't you think? I just never heard anyone say that their results have ever been received that fast and had success. Have you?

@kuwaitin08, How soon was your final exam sent over to the RO?

@Vync @Kuwaitin08 Hello, so it's been a month since I had my second c and p exam with my hlr. Called Peggy just to check on everything and she tells me that they received my results the 28th of January which was the day after my exam. So I ask well what's the hold up and she tells me they are sending me another letter out on Monday asking do I have any additional information like treatment records etc. Like wth . I sent that in before they scheduled the exam and sent in the form stating I have nothing else to give them. I mean come on with a yes or no damn it. Seems like they are delaying and denying. Has the happen to anyone else before? I thought after your exam was completed they make a decision. Did I miss something?

@Vync 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 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Other Specified Trauma- and Stressor-Related Disorder ICD code: F43.8 Comments, if any: Veteran does NOT meet full DSM 5 diagnostic criteria for PTSD. While the veteran did experience a Criterion A trauma event (physical assault by significant other), her other significant stressor in the service does NOT meet Criterion A (sexual harassment), though the latter appears to have had a more long-term impact on her functioning. She does NOT endorse, exhibit, and there is no record of her experiencing core symptoms (arousal) that are essential to a PTSD diagnosis based on the Criterion A stressor (her arousal is far more closely related to her reported sexual harassment). However, the veteran DOES meet DSM 5 diagnostic criteria for Other Specified Trauma- and Stressor-Related Disorder. It is AT LEAST AS LIKELY AS NOT that the Other Specified Traumaand Stressor-Related Disorder is the result of an in-service stressor related event. Mental Disorder Diagnosis #2: Panic Disorder w/Agorophobia ICD code: F41.0 Comments, if any: Veteran also meets full DSM 5 diagnostic criteria for Panic Disorder, with agorophobia. It is AT LEAST AS LIKELY AS NOT that the veteran's Panic Disorder is SECONDARY TO her Other Specified Trauma- and Stressor-Related Disorder. Mental Disorder Diagnosis #3: Unspecified Depressive Disorder ICD code: F32.9 Comments, if any: Veteran also meets full DSM 5 diagnostic criteria for Unspecified Depressive Disorder. It is AT LEAST AS LIKELY AS NOT that the veteran's Unspecified Depressive Disorder is SECONDARY TO her Other Specified Trauma- and Stressor-Related Disorder. b. Medical diagnoses relevant to the understanding or management of the mental health disorder (to include TBI): No response provided. 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? [X] Yes [ ] No [ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: PTSD Symptoms: * Sleep disturbance due to nightmares * Recurring/intrusive thoughts about his/her trauma(s). * Arousal symptoms, including hypervigilance, exaggerated startle response; irritability/angry outbursts; difficulty remembering specifics related to the trauma event(s); * Avoidance symptoms of avoiding reminders of the trauma(s); having strong reactions when aspects of the trauma(s) are encountered/experienced. * Negative alterations in cognitions and mood associated with the traumatic event(s) Symptoms associated with veteran's depressive disorder include: * depressed mood most of the day, nearly every day * markedly diminished interest in or pleasure in all, or almost all, activities most of the day, nearly every day * significant weight loss when not dieting or weight gain (not related to physiological condition) or decrease or increase in appetite nearly every day * insomnia or hypersomnia nearly every day * psychomotor agitation or retardation nearly every day (observable to others) * fatigue or loss of energy nearly every day * feelings of worthlessness or excessive or inappropriate guilt nearly every day * diminished ability to think or concentrate, or indecisiveness, nearly every day * recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation or suicidality OVERLAPPING SYMPTOMS OF PTSD/MDD, include, but is not limited to: sleep problems (related to onset and maintenance); fatigue; concentration difficulties; difficulties experiencing positive emotions; feeling isolated or disconnected from others; loss of interest in previously enjoyable activities; having strong negative beliefs about oneself, the world, others. As well as feelings of worthlessness or excessive or inappropriate guilt nearly every day. Symptoms associated with veteran's panic disorder include: * palpitations, pounding heart, or accelerated heart rate * excessive perspiration/sweating * trembling or shaking * sensation of shortness of breath or smothering * feelings of choking * chest pain or discomfort * nausea or abdominal distress * feeling dizzy, unsteady, light-headed, or faint chills or heat sensations * derealization (feelings of unreality) or depersonalization (being detached from one-self) * fear of losing control or "going crazy" * fear of dying * persistent fear or worry about additional panic attacks or their consequences * significant maladaptive change in behavior related to the attacks 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 deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood 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: It is not feasible to parse out the veteran's level of occupational/social impairment (a global assessment of impairment) into diagnostic categories as the conditions have a significant, bidirectional impact on one another with significant overlap in symptoms. NOTE: The overall functional impairment of this veteran is best conceptualized via the chosen statement above in Section 1, Item 4a ("occupational and social impairment...") and NOT the symptoms checklist at the conclusion of this report (see section 2, Item 3 - "Symptoms") as symptom endorsement alone do not capture the frequency or severity of their presence. 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 [X] Other (please identify other evidence reviewed): Veteran's electronic C-File (through VBMS) and CPRS medical records were reviewed. Particular attention was directed to previous C&P examination dated: n/a prior mental health notes: CPRS VBMS documents including, but not limited to: buddy/lay statement DD-214; STRs (negative for psych, depression, anxiety) VA Form 21-0781 VA Form 21-526EZ No collateral information was available in C-file and no collaterals joined veteran to C&P evaluation. Evidence Comments: 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: Direct service connection OPINION: Direct service connection Does the Veteran have a diagnosis of (a) post traumatic Stressor disorder that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) personal trauma during service? Rationale must be provided in the appropriate section. 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. Additional remarks for the examiner: Tab B (Stressor Statement in VBMS) Stessor Statement VAF 21-0781 Tab C (Stressor Statement in VBMS) Stessor Statement VAF 21-0781 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: sexual harrasment (mainly verbal with some physical posturing) 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 If no, explain: sexual harrassment 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. MST event b. Stressor #2: physical assault while pregnant by significant other (which prompted her military discharge) 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: personal assault 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. see above 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] No criterion in this section met. Criterion 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 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 and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined"). [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [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] Reckless or self-destructive behavior. [X] Hypervigilance. [X] Exaggerated startle response. [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 #2 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks more than once a week [X] Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively [X] Chronic sleep impairment [X] Disturbances of motivation and mood [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Inability to establish and maintain effective relationships [X] Suicidal ideation [X] Neglect of personal appearance and hygiene [X] Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. 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 -------------------------------------------------- As part of this C&P evaluation, veteran was administered the PTSD Checklist - DSM 5 (PCL-5) & Beck Depression Inventory - Second Edition (BDI-II). The PTSD Checklist - DSM 5 is a 20-item self-report instrument for measuring the severity of criteria for posttraumatic stress disorder. Ms.(......) PCL score of 68 is above the recommended score that is typically indicative of PTSD symptomatology (31-33 based on Bovin et al., 2015, Psych Assessment; maximum score of 80). No previous administration(s) of this instrument were located in the veteran's records. The PCL is considered a screening measure and does NOT include validity scales. As such, it is susceptible to positive and negative impression management. The Beck Depression Inventory - Second Edition (BDI-II) is a 21-item self-report instrument for measuring the severity of depression in adults and adolescents aged 13 years and older. Ms. (........) BDI-II score of 46 is indicative of severe depressive symptoms being endorsed at the present time. No previous administration(s) of this instrument were located in the veteran's records. The BDI-2 is considered a screening measure and does NOT include validity scales. As such, it is susceptible to positive and negative impressions.

@Vync thanks for replying.....but yes my last c and p was Dec 30 last year and also my last exam seem favorable except he didn't check anything in criteria b section of my exam and diagnosed me with something else. Hopefully this time all goes well. Here is a copy of my last one.

Thanks @Kuwaitin08.....guess it's time to get my paperwork together although I'm not exactly sure of what I should bring. Your new exams were performed by va or outside specialist? How soon did they schedule your exams and once completed when did you receive a decision?

Hi everyone, So I have an update on my higher level review claim. Previous info. first Hlr received aug.22 Va found error oct.4 which was a DTA error Received letter about error. Sent in additional info upon request because I assumed it had been moved to supplemental lane for additional development. Call Peggy and yes it's in the development phase. Dec. 20 spoke to Peggy and it seems another letter has been sent out today in regards to another c and p exam when an appointment becomes available. According to Peggy Est completion date changed from mar 2020 to September 2020. Has anyone had this happen in their review? or can someone give be me a little insight as to what they are doing? Also why do I have to take another c and p exam. Has anyone else taken another one before and if so how did it go?

@Kuwaitin08 I ask because when I called to find out my appeal status after it updated to error the representative mentioned it over the phone. She said they mailed me out a packet/letter and went on to say something about a 5103 and a restricted report and if I don't receive it this week to call back. I don't know I'm assuming they are switching me to the supplemental lane and a 5103 from what I read seems like more development to me. My initial claim was denied because they said I didn't have a diagnosis of PTSD on my c and p exam. My diagnosis were panic disorder with agorphobia and severe depression both were at least as likey according to my c and p exam. However the vba stated without a diagnosis of PTSD they can't grant it. So when my claims agent sent in my appeal paperwork basically telling to them look in my va medical records they will see that I have been diagnosed my va psychiatrist initially for PTSD along with other diagnosis of depression and panic disorder. It's like they do what to acknowledge my initial diagnosis of PTSD from my psych doctor at the va or purposely trying to overlooked it.

Okay ty I will update as soon as I receive it.

Hello again everyone. I am wondering if someone can help me understand what's going with my claim for PTSD/mst personal assault. So I am currently in a high level review appeal. My status on my appeal says va is correcting and error. Appeal received on 08/22/2019 Va appeal closed(temporarily) on 10/04/2019 Check back on 10/07/2019 Va made a new decision 10/04/2019 Va is correcting an error 10/04/2019 When I called Peggy they say to wait on a letter but did give me a little detail in regards to what the letter stated. It states something about a 5103 form and mst restricted report DOD. Can someone tell me what to think of it.

Also does anyone know what a 5103 form/letter is????

@kuwaitin08 what does your issue say under the issues tab when you click on it. Mines is blank.

Okay thank you, I feel a little bit better knowing I'm not the only one. I wait on the letter and update you guys when I get it. If anything changes or you get more info please let me know.

Hello everyone my status is the same as well except the dates, but they are not to far apart as well. I am wondering if someone can help me understand what's going with my claim for PTSD/mst personal assault. So I am currently in a high level review appeal. My status on my appeal says va is correcting and error. Appeal received on 08/22/2019 Va appeal closed(temporarily) on 10/04/2019 Check back on 10/07/2019 Va made a new decision 10/04/2019 Va is correcting an error 10/04/2019 When I called Peggy they say to wait on a letter but did give me a little detail in regards to what the letter stated. It states something about a 5103 form and mst restricted report DOD. Can someone tell me what to think of it.

Hello again everyone. I am wondering if someone can help me understand what's going with my claim for PTSD/mst personal assault. So I am currently in a high level review appeal. My status on my appeal says va is correcting and error. Appeal received on 08/22/2019 Va appeal closed(temporarily) on 10/04/2019 Check back on 10/07/2019 Va made a new decision 10/04/2019 Va is correcting an error 10/04/2019 When I called Peggy they say to wait on a letter but did give me a little detail in regards to what the letter stated. It states something about a 5103 form and mst restricted report DOD. Can someone tell me what to think of it.

Hello Unique11128, Who is Dr Brett valette and do you think he will be able to do something about this? Also can you explain to me what they are saying in layman's term please?

Can someone please explain to me what exactly are they saying as to why they denied my claim for PTSD and what is needed to Grant it? Also what should I do next because I have no idea, I'm so confused!

Update So my claim was deferred for additional development, which I don't understand what they mean. If I had all the required caluza elements, what can I possible do now to get it moving along? Does anyone know what I should do at this point?

So they don't have enough to deny it but they don't have enough to grant/rate? What more could they want? Are they going to tell me? I mean they could have just flat out denied me right? Do they usually do after a deferred, I mean I heard they like to delay and deny.

Update My claim status changed to deferred with a new completion date. Can someone tell exactly what that is and why would they deferre it? Do you think maybe it was because of my c and p exam wasn't clear enough? I thought overall it was a thorough report other than the box left uncheck in criterion B and the pyramid diagnosis situation.

Thank all of you for the responses. I am really wishing for the best, even though I feel like they sometimes try to find any reason to just deny us. I will update as soon as I know something.

I thought it says I don't meet the criteria rating PTSD? I'm confused. If the rater reads?

Thank you...I sure hope everything is alright. Now that I have posted it more clearly I was wondering if you could look at criterion B and tell me why he stated (no criterion met)? Will this affect my claim even though I was diagnosed with Other Specified Trauma- and Stressor-Related Disorder and not PTSD? Also, why did my status change so quickly after my c and p exam. It was at gathering evidence and changed to pending decision approval all in a matter of four days after my exam. Do you have any idea why?

--------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [ ] Yes [X] No 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Other Specified Trauma- and Stressor-Related Disorder ICD code: F43.8 Comments, if any: Veteran does NOT meet full DSM 5 diagnostic criteria for PTSD. While the veteran did experience a Criterion A trauma event (physical assault by significant other), her other significant stressor in the service does NOT meet Criterion A (sexual harassment), though the latter appears to have had a more long-term impact on her functioning. She does NOT endorse, exhibit, and there is no record of her experiencing core symptoms (arousal) that are essential to a PTSD diagnosis based on the Criterion A stressor (her arousal is far more closely related to her reported sexual harassment). However, the veteran DOES meet DSM 5 diagnostic criteria for Other Specified Trauma- and Stressor-Related Disorder. It is AT LEAST AS LIKELY AS NOT that the Other Specified Trauma and Stressor-Related Disorder is the result of an in-service stressor related event. Mental Disorder Diagnosis #2: Panic Disorder w/Agorophobia ICD code: F41.0 Comments, if any: Veteran also meets full DSM 5 diagnostic criteria for Panic Disorder, with agorophobia. It is AT LEAST AS LIKELY AS NOT that the veteran's Panic Disorder is SECONDARY TO her Other Specified Trauma- and Stressor-Related Disorder. Mental Disorder Diagnosis #3: Unspecified Depressive Disorder ICD code: F32.9 Comments, if any: Veteran also meets full DSM 5 diagnostic criteria for Unspecified Depressive Disorder. It is AT LEAST AS LIKELY AS NOT that the veteran's Unspecified Depressive Disorder is SECONDARY TO her Other Specified Trauma- and Stressor-Related Disorder. b. Medical diagnoses relevant to the understanding or management of the mental health disorder (to include TBI): No response provided. 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? [X] Yes [ ] No [ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: PTSD Symptoms: * Sleep disturbance due to nightmares * Recurring/intrusive thoughts about his/her trauma(s). * Arousal symptoms, including hypervigilance, exaggerated startle response; irritability/angry outbursts; difficulty remembering specifics related to the trauma event(s); * Avoidance symptoms of avoiding reminders of the trauma(s); having strong reactions when aspects of the trauma(s) are encountered/experienced. * Negative alterations in cognitions and mood associated with the traumatic event(s) Symptoms associated with veteran's depressive disorder include: * depressed mood most of the day, nearly every day * markedly diminished interest in or pleasure in all, or almost all, activities most of the day, nearly every day * significant weight loss when not dieting or weight gain (not related to physiological condition) or decrease or increase in appetite nearly every day * insomnia or hypersomnia nearly every day * psychomotor agitation or retardation nearly every day (observable to others) * fatigue or loss of energy nearly every day * feelings of worthlessness or excessive or inappropriate guilt nearly every day * diminished ability to think or concentrate, or indecisiveness, nearly every day * recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation or suicidality OVERLAPPING SYMPTOMS OF PTSD/MDD, include, but is not limited to: sleep problems (related to onset and maintenance); fatigue; concentration difficulties; difficulties experiencing positive emotions; feeling isolated or disconnected from others; loss of interest in previously enjoyable activities; having strong negative beliefs about oneself, the world, others. As well as feelings of worthlessness or excessive or inappropriate guilt nearly every day. Symptoms associated with veteran's panic disorder include: * palpitations, pounding heart, or accelerated heart rate * excessive perspiration/sweating * trembling or shaking * sensation of shortness of breath or smothering * feelings of choking * chest pain or discomfort * nausea or abdominal distress * feeling dizzy, unsteady, light-headed, or faint chills or heat sensations * derealization (feelings of unreality) or depersonalization (being detached from one-self) * fear of losing control or "going crazy" * fear of dying * persistent fear or worry about additional panic attacks or their consequences * significant maladaptive change in behavior related to the attacks 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 deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood 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: It is not feasible to parse out the veteran's level of occupational/social impairment (a global assessment of impairment) into diagnostic categories as the conditions have a significant, bidirectional impact on one another with significant overlap in symptoms. NOTE: The overall functional impairment of this veteran is best conceptualized via the chosen statement above in Section 1, Item 4a ("occupational and social impairment...") and NOT the symptoms checklist at the conclusion of this report (see section 2, Item 3 - "Symptoms") as symptom endorsement alone do not capture the frequency or severity of their presence. 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 [X] Other (please identify other evidence reviewed): Veteran's electronic C-File (through VBMS) and CPRS medical records were reviewed. Particular attention was directed to previous C&P examination ] dated: n/a prior mental health notes: CPRS VBMS documents including, but not limited to: buddy/lay statement DD-214; STRs (negative for psych, depression, anxiety) VA Form 21-0781 VA Form 21-526EZ No collateral information was available in C-file and no collaterals joined veteran to C&P evaluation. Evidence Comments: 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: Direct service connection OPINION: Direct service connection Does the Veteran have a diagnosis of (a) post traumatic Stressor disorder that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) personal trauma during service? Rationale must be provided in the appropriate section. 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. Additional remarks for the examiner: Tab B (Stressor Statement in VBMS) Stessor Statement VAF 21-0781 Tab C (Stressor Statement in VBMS) Stessor Statement VAF 21-0781 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: sexual harrasment (mainly verbal with some physical posturing) 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 If no, explain: sexual harrassment 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. MST event b. Stressor #2: physical assault while pregnant by significant other (which prompted her military discharge) 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: personal assault 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. see above 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] No criterion in this section met. Criterion 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 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 and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined"). [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [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] Reckless or self-destructive behavior. [X] Hypervigilance. [X] Exaggerated startle response. [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 #2 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks more than once a week [X] Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively [X] Chronic sleep impairment [X] Disturbances of motivation and mood [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Inability to establish and maintain effective relationships [X] Suicidal ideation [X] Neglect of personal appearance and hygiene [X] Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. 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 -------------------------------------------------- As part of this C&P evaluation, veteran was administered the PTSD Checklist - DSM 5 (PCL-5) & Beck Depression Inventory - Second Edition (BDI-II). The PTSD Checklist - DSM 5 is a 20-item self-report instrument for measuring the severity of criteria for posttraumatic stress disorder. Ms.(......) PCL score of 68 is above the recommended score that is typically indicative of PTSD symptomatology (31-33 based on Bovin et al., 2015, Psych Assessment; maximum score of 80). No previous administration(s) of this instrument were located in the veteran's records. The PCL is considered a screening measure and does NOT include validity scales. As such, it is susceptible to positive and negative impression management. The Beck Depression Inventory - Second Edition (BDI-II) is a 21-item self-report instrument for measuring the severity of depression in adults and adolescents aged 13 years and older. Ms. (........) BDI-II score of 46 is indicative of severe depressive symptoms being endorsed at the present time. No previous administration(s) of this instrument were located in the veteran's records. The BDI-2 is considered a screening measure and does NOT include validity scales. As such, it is susceptible to positive and negative impressions. Timeline C and p exam done Monday 12/31/2018 Results ready/claim status change to prep for decision on Thursday 01/03/2019 Friday 01/04/2019 pending decision approval