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 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Panic Disorder Mental Disorder Diagnosis #2: PTSD Mental Disorder Diagnosis #3: Unspecified Depressive Disorder b. Medical diagnoses relevant to the understanding or management of the mental health disorder (to include TBI): Per the veteran: None. He reported some physical symptoms related to his anxiety and psychotropic medications. Specifically, he reported that he takes muscle relaxers a couple of times per week for the stomach cramps that he experiences when he has a panic attack. He also takes Zantac on occasion. He reported that he was prescribed Viagra to counter the effects of Lexapro, but has not really been taking it. He denied ever experiencing a head injury, seizures, LOCs, or having been diagnosed with TBI. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? Page 17 of 116 [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: Panic Disorder: Panic attacks (up to 2-3 times per day); fear of having another panic attack; fear of consequences of panic attack; avoidance of situations that may cause a panic attack. PTSD: Please see PTSD Symptom Checklist below. Also accounts for compulsive checking behaviors related to concerns about safety. Unspecified Depressive Disorder: Mood symptoms including feelings of depression; problems with appetite; changes in weight. Symptoms common to Panic Disorder and PTSD: Anxiety; Concerns about safety; checking behaviors. Symptoms common to PTSD and Unspecified Depressive Disorder: Anhedonia; Sleep difficulties. Symptoms common to all 3: Persistent negative emotional state; Memory/Concentration problems; Rumination; Social Withdrawal. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] 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) 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] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). 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, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. [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 I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 [X] Stressor #2 OPINION: The examination of this 36-year-old Army OIF veteran, which included a clinical interview, psychometric testing and review of his C-File (through VBMS/VVA)/CPRS/JLV records, indicates that he meets DSM-5 criteria for diagnoses of Panic Disorder, PTSD, and Unspecified Depressive Disorder (secondary to his anxiety disorders and their significant impact on his functioning), all of which are at least as likely as not (50% or greater probability) caused by or a result of his military experiences and a fear of hostile military or terrorist activity (i.e., fear of mortar rounds during service and his specified trauma events.) It is recommended that .....continue to engage in individual psychotherapy and psychiatric medication management in order to reduce his symptomatology.