Usaf9498

I sat down and typed this out and tried to put down everything that is bothering me. Would you guys mind taking a look at it and giving me some feedback. I tried not to ramble and make it all jumbled but I just have so much going through my head right now. Thank you for any feedback and criticism Personal Statement PTSD.pdf

As of right now, I have the session notes from myhealthevet where the doc gave me a 1.5 hour question and answer exam. I had not filed a claim at the time yet so while I think it was essentially a C&P exam, it was not officially one. I also have the notes from myhealthevet from the therapist I am seeing at the VA about my weekly Monday sessions in my CPT therapy. For the Sleep Apnea all I have is the 2012 home sleep study results. Unfortunately I am self employed and don't make enough money to pay the $2800 health insurance premium monthly so we have been without for about a year. I would have to come out of pocket for an overnight sleep study in a facility so that is why I am hopeful I can get it done by the VA. If not, I will figure out how to come up with the money on my own. From what I understand, at the study, you don't get diagnosed per say. They send those to a doctor who then (after being paid) makes a diagnosis. I might be wrong on this point however. For Tinnitus, I don't think there is any way to prove that but it is noted by my PCP in my VA records that I told her I had it. As for hearing loss, I requested an Audiology exam at the VA and took it. I was diagnosed with hearing loss in both ears, but worse in right ear. She also notes that I told her about tinnitus, with worse ringing in my right ear. I prescribed a hearing aid in my right ear and get fitted for it and take possession of it on September 11th. I am on a antidepressant SSRI who a civilian doctor prescribed me for panic attacks a couple of months before I was finally accepted into the VA for benefits because I served in the Gulf war timeframe and deployed to 3 operations. My VA PCP has now taken over that prescription and I am getting it filled through the VA. It helps take the edge off and has helped a lot with my panic attacks but it makes my tinnitus much worse. Laying awake in bed at night, which I do nightly at around 3am, it sounds like a hot summer night full of really, really loud cicadas in my head now.

if there is a prescribed form from the VA USE IT... ALWAYS USE IT. not using it has become a reason to immediately deny, which is part of the attempt to look like they are really cutting the backlog or blame it on vets not doing what they are supposed to do. I got some potentially great news yesterday. I was talking to my old AF buddy who was my roommate. I told him about my claim and we hat I was trying to connect. He told me he remembers hearing me gasping for air and choking in my sleep so we did a VA-4138 and he signed it and he emailed it back. Hopefully that will help service connect my SA. He also put in there that he obviously knew I was in Khobar Towers when it was bombed since we were buddies and were both attached to the 20th CRS at Shaw AFB. I'm going to upload that to my claim today. So I'll have a statement from me, my wife, my mom, and a buddy I served with. I think I'll stop there so my c-file remains neat and clean.

I kinda like mine too so I don't think I will take that bet! I sent a message to my PCP through myhealthevet this morning asking her the procedure. Thank you for that advice. I had seen mention of Peggy before and looked it up this morning. Here in another 10 days, my claim will be ablut 30 days old. I will reach out at that point and see what is happening. My mom works with a gal whose husband is not 100% pandt. She told me in an email it took her 5 years to get a C&P for OSA and 3 years for PTSD. Ha! He is a beer drinking buddy of mine. Honestly the only buddy I have anymore. He always razzes me about it. That is exactly what I plan to do.

Statement in support of claim. Should I do the VA 21-4138 or just type the doc and sign it? ? I have a buddy statement from someone I served with and my mom, with her account of the bombing and calling the red cross and my first shirt asking on information on me because she knew I was stationed at Khobar. Should I ask them to redo them and put them on the 21-4138 as well? As far as the c-file goes, I will call and request a viewing today. So now that it says no longer needed I assume that they already verified it? Do your STRs show that concussion? I might have mis-communicated this. I did not get a concussion, rather I meant that the concussion of the bomb, gave me tinnitus, and quite possibly the hearing loss. Should I request an MRI? I am overweight and find it extremely hard to lose weight. For whatever reason, I can diet and work out like crazy but for whatever reason, I hold on to my weight. I do get headaches but I can't say that they are really frequent. The are different from a typical headache however in that they are stabbing pains in my scalp. I can feel them coming on and they just have to run their course. Nothing that I have ever taken has seemed to help them. Vision problems. So 3 years ago, I had to go to an opthamologist because in my right eye, I had severe pain and redness, light sensitivity, extreme shooting headache etc. He diagnosed me with Rheumatoid Arthritis in my eye. However, he did no bloodwork or anything to confirm that. I just had this flare up again a month ago and he sounded less convinced that it is RA. I do not have trouble walking a straight line. I do have dizzineess but it is reallly really infrequent. I managed to somehow remember who did my sleep study yesterday and they agreed to send me the results so I should have them in 3 weeks give or take. That was a home sleep study done in 2012. So far, the VA has not asked me for a C&P for SA. My PC said that I could start getting my SA equipment from the VA but did not tell me how to go about it. I assume they will not just give me CPAP stuff without seeing a prescription which I no longer have. Should I ask for a sleep study? I have frequent and very fast urination. My buddy is always commenting on how quickly i pee. He always says i must have a bladder the size of a walnut. Until I got my sleep under control with my CPAP, I used to have accidents at night. I do not have ED per say but I will say that since I got on Escitalopram for anxiety, I have a hugely diminished sex drive. I can still do it, I just have lost a lot of my desire to. Holy cow, I had no idea any of this could be tied together if it indeed can be, or if any of it is related. I have a lot more homework to do for sure. GeekySquid thank you so much, and I mean that, for taking time out of your day to answer all of this.

I was at Khobar Towers in 1996 when it was bombed. I opened my claim August 8th. I checked today and the status is in evidence gathering. I claimed : PTSD (post traumatic stress disorder) (related to: PTSD - Combat) (New) Hearing Loss (related to: PTSD - Combat) (New) tinnitus (related to: PTSD - Combat) (New) sleep apnea (related to: PTSD - Combat) (New) There is an open request for medical records backing up any claims. I am cpt therapy now for my PTSD. Do I need to upload all of that or will they already have access to that since it is being done at the VA? I had a hearing test done at the VA a month ago and I have severe hearing loss in my right ear as well as bilateral tinnitus. They ordered a hearing aid for my right ear. I didn't connect the dots at the time that she asked why I might have loss in only one ear. I realize now that it is likely from the concussion from the bomb detonation. My tinnitus started then, but I never saw a doctor for it. As far as sleap apnea goes, I was diagnosed with obstructive sleep apnea about 7 years ago and have used a CPAP every since. The doctors office that I was diagnosed at is no longer in business and I was a self pay patient and have always bought my own equipment. I had a second sleep study done 2 years ago for a new device and lo and behold, that doctor office is also out of business. I don't know what I can send in for records of that besides a statement from my wife stating she slept with me and noticed my breathing stop and choking. As of now the only C&P that they have scheduled for me is a hearing C and P. Seems odd that they have not ordered a sleep study nor a PTSD C&P. I did notice that there was something called a JSSR Coordinator Review that says now is no longer needed. Any advice on what to upload for the requests?

You are not wrong and I am starting down the path of cutting way back and if that does not work, stopping altogether

Vetquest, I'm pretty well terrified to be honest. My startle response is ridiculous, I'm snappy at my wife and kids, I get way too worked up over menial stuff, I have no friends anymore, I have sleep apnea, hearing loss, wake up at 3am almost every night with my tinnitus sounding like a cicada swarm inside my head, I drink like a fish, I own my business but have hired people because I can no longer deal with people, I avoid anything bright and noisy like fireworks, avoid public places and places with crowds. I am scared to death to do the exam. I just want to be better

Do you have some preparation suggestions?

This c&p for hearing is at the va here in Kansas City. As for PTSD diagnosis. I have already been diagnosed and am being treated at the va for PTSD.

Hello, I applied for disability on Aug 8th. Yesterday, 20th I got a call to schedule my c&p for hearing loss. I assumed they would schedule everything at once. Is that normal? Here is what I claimed if that helps.

I just re-read what I said when I was questioned during my first eval. I said that occassionally I drink 5 or more drinks when with family or friends. I said I'll have 3-4 drinks 4x a week. I know it wasnt honest, and I know that it's always my standard answer when speaking to docs. I have a problem and know it, but I seem to never be honest about it. If asked I am going to honest. I'm sure the c and p examiner will read my file so maybe they won't bring it up. I hope I didnt bite myself in the ass by not being completely honest. If I did, well than I'll deal with that. First things first and one step at a time. And I know it's time to do something about the drinking. I thank you all for you time and help. Here is my exam docs If you are so inclined to view them. VA Problem List Source: VA Last Updated: 25 Jul 2019 @ 1152 Sorted By: Date/Time Entered (Descending) then alphabetically by Problem Your VA Problem List contains active health problems your VA providers are helping you to manage. This information is available 3 calendar days after it has been entered. It may not contain active problems managed by non-VA health care providers. If you have any questions about your information, visit the FAQs or contact your VA health care team. Problem: Anxiety (SCT 48694002) Date/Time Entered: 08 Jul 2019 @ 1200 Provider: ANYANIKE,TISHA DLocation: VA Heartland-West VISN 15 Status: ACTIVE Comments: -- Problem: Bilateral tinnitus (SCT 4831000119102)Date/Time Entered: 08 Jul 2019 @ 1200 Provider: ANYANIKE,TISHA DLocation: VA Heartland-West VISN 15 Status: ACTIVE Comments: -- Problem: Hearing loss (SCT 15188001)Date/Time Entered: 08 Jul 2019 @ 1200 Provider: ANYANIKE,TISHA DLocation: VA Heartland-West VISN 15 Status: ACTIVE Comments: -- Problem: Major depression (SCT 370143000)Date/Time Entered: 08 Jul 2019 @ 1200 Provider: ANYANIKE,TISHA DLocation: VA Heartland-West VISN 15 Status: ACTIVE Comments: -- Problem: Obesity (SCT 414916001) Date/Time Entered: 08 Jul 2019 @ 1200 Provider: ANYANIKE,TISHA DLocation: VA Heartland-West VISN 15 Status: ACTIVE , JEREMYPARRATT L CONFIDENTIAL Page 19 of 85 Comments: -- Problem: Sleep apnea (SCT 73430006)Date/Time Entered: 08 Jul 2019 @ 1200 Provider: ANYANIKE,TISHA DLocation: VA Heartland-West VISN 15 Status: ACTIVE Comments: -- PARRATT, JEREMY L CONFIDENTIAL Page 20 of 85 VA Admissions and Discharges Source: VA Last Updated: 25 Jul 2019 @ 1152 No information was available that matched your selection. However if you were recently discharged, your summary may be available 3 calendar days after it is completed. PARRATT, JEREMY L CONFIDENTIAL Page 21 of 85 VA Notes Source: VA Last Updated: 25 Jul 2019 @ 1152 Sorted By: Date/Time (Descending) VA Notes from January 1, 2013 forward are available 3 calendar days after they have been completed and signed by all required members of your VA health care team. If you have any questions about your information please visit the FAQs or contact your VA health care team. Date/Time: 22 Jul 2019 @ 1417 Note Title: KC-MH PTSD STATUS FORM Location:VA Heartland-West VISN 15 Signed By:REDD,MICHAEL JOHN Co-signed By:REDD,MICHAEL JOHN Date/Time Signed: 22 Jul 2019 @ 1423 Note LOCAL TITLE: KC-MH PTSD STATUS FORMSTANDARD TITLE: MENTAL HEALTH INITIAL EVALUATION NOTE DATE OF NOTE: JUL 22, 2019@14:17 ENTRY DATE: JUL 22, 2019@14:17:41 AUTHOR: REDD,MICHAEL JOHN EXP COSIGNER: URGENCY: STATUS: COMPLETED PTSD STATUS FORM Mr.PARRATT is a 43 year old Veteran presenting to PTSD specialty care for treatment. The Veterane provided the following background information: ETHNICITY: NOT HISPANIC OR LATINO RACE White not Latino(a) HOUSING Residence CURRENTLY WORKING FOR PAY Yes IF NOT WORKING, PRIMARY REASON IS CURRENTLY APPLYING FOR VA DISABILITY BENEFITS No PERIOD(S) OF SERVICE PARRATT, JEREMY L CONFIDENTIAL Page 22 of 85 Persian Gulf War SOCIAL SUPPORT The Veteran rated their perception of social support as: Someone who understand my problems: Never Someone I trust to talk with about my problems: Never Someone is around to help me if I need it: Usually CURRENT BARRIERS TO TREATMENT None TRAUMA EXPERIENCES TREATED IN PCT Military related trauma: Yes Non-military related trauma: No PROBLEM WITH PAIN FOR MORE THAN THREE MONTHS No PAIN RATING-PAST WEEK Score: 0 PAIN INTERFERENCE-PAST WEEK Score: 0 CURRENTLY RECEIVING VET CENTER SERVICES No CURRENTLY RECEIVING MENTAL HEALTH CARE FROM NON-VA Yes VETERAN WILLING TO HAVE FAMILY INVOLVED IN TREATMENT No ASSESSMENT PCL-5 (PTSD Symptom Checklist for DSM 5) was administered at this encounter. A PCL-5 was performed and was positive. The score was 75. The event you experienced was: Bombing of Kobar Towers in 1996 The event happened: more than 10 years ago 1. Repeated, disturbing, and unwanted memories of the stressful PARRATT, JEREMY L CONFIDENTIAL Page 23 of 85 experience? Extremely 2. Repeated, disturbing dreams of the stressful experience? Moderately 3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)? Extremely 4. Feeling very upset when something reminded you of the stressful experience? Extremely 5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)? Extremely 6. Avoiding memories, thoughts, or feelings related to the stressful experience? Extremely 7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)? Extremely 8. Trouble remembering important parts of the stressful experience? Extremely 9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)? Extremely 10. Blaming yourself or someone else for the stressful experience or what happened after it? Extremely 11. Having strong negative feelings such as fear, horror, anger, guilt, or shame? Extremely 12. Loss of interest in activities that you used to enjoy? Extremely 13. Feeling distant or cut off from other people? Extremely 14. Trouble experiencing positive feelings (for example, being unable to PARRATT, JEREMY L CONFIDENTIAL Page 24 of 85 feel happiness or have loving feelings for people close to you)? Quite a bit 15. Irritable behavior, angry outbursts, or acting aggressively? Extremely 16. Taking too many risks or doing things that could cause you harm? Moderately 17. Being "superalert" or watchful or on guard? Extremely 18. Feeling jumpy or easily startled? Extremely 19. Having difficulty concentrating? Extremely 20. Trouble falling or staying asleep? Extremely PHQ-9 was adminstered at this encounter. A PHQ-9 screen was performed. The score was 22 which is suggestive of severe depression. 1. Little interest or pleasure in doing things More than half the days 2. Feeling down, depressed, or hopeless More than half the days 3. Trouble falling or staying asleep, or sleeping too much Nearly every day 4. Feeling tired or having little energy Nearly every day 5. Poor appetite or overeating Nearly every day 6. Feeling bad about yourself or that you are a failure or have let yourself or your family down More than half the days 7. Trouble concentrating on things, such as reading the newspaper or watching television Nearly every day 8. Moving or speaking so slowly that other people could have noticed. Or the opposite being so fidgety or restless that you have been moving around a lot more than usual Nearly every day PARRATT, JEREMY L CONFIDENTIAL Page 25 of 85 9. Thoughts that you would be better off dead or of hurting yourself in some way Several days 10. If you checked off any problems, how DIFFICULT have these problems made it for you to do your work, take care of things at home or get along with other people? Very difficult Based on initial assessment and/or detailed chart review the following are relevant presenting problems for the Veteran: Need for PTSD specialty tx /es/ MICHAEL REDD, PH.D. Licensed Marriage and Family Therapist Signed: 07/22/2019 14:23 Date/Time: 22 Jul 2019 @ 0830 Note Title: KC-MH BIOPSYCHOSOCIAL ASSESSMENT CONSULT Location: VA Heartland-West VISN 15 Signed By:REDD,MICHAEL JOHN Co-signed By:REDD,MICHAEL JOHN Date/Time Signed: 22 Jul 2019 @ 1441 Note LOCAL TITLE: KC-MH BIOPSYCHOSOCIAL ASSESSMENT CONSULT STANDARD TITLE: MENTAL HEALTH CONSULT DATE OF NOTE: JUL 22, 2019@08:30 ENTRY DATE: JUL 22, 2019@08:30:17 AUTHOR: REDD,MICHAEL JOHN EXP COSIGNER: URGENCY: STATUS: COMPLETED *** KC-MH BIOPSYCHOSOCIAL ASSESSMENT CONSULT Has ADDENDA *** Date of Visit: 7/22/19 @ 0840 Veteran was seen for a 120 minute PTSD consult to assess trauma related symptoms following referral from PCHMI. Veteran's identity was confirmed with name and last 4. He was educated regarding the purpose of the consult and limits to confidentiality. Veteran provided verbal consent to continue. S: The majority of the session was spent reviewing the Veteran's history and current symptoms. Veteran reported that the index traumatic event was the bombing of the Kobar towers that occurred during his deployment to Saudi Arabia in 1996. PARRATT, JEREMY L CONFIDENTIAL Page 26 of 85 FULL REPORT TO FOLLOW O: Veteran presented to his consult appointment on time. He was casually dressed and appropriately groomed. Mood appeared moderately depressed and affect was mood congruent. Veteran became tearful during questions about PTSD symptoms and in recounting the index trauma. Veteran was cooperative throughout the evaluation procedures. Eye contact was okay. Thought processes were logical, linear, and goal-directed. Thought content was relevant to topic. Speech was normal as to rate, tone, and prosody. Memory and concentration were adequate for the current session. Judgment and insight were fair. CURRENT SUICIDALITY/HOMICIDALITY: Upon direct questioning, Veteran denied current suicidal and homicidal ideation, plan and intent. Veteran acknowledged that he has occasional thoughts of dying but denied any thoughts about killing himself, or any plan or intent to carry out any thoughts. See suicide screening results below (C-SSRS) CLINICAL REMINDER ACTIVITY: Depression Screening: PHQ-2+I9 Depression Screening Score: 5 The score on this administration is 5, which indicates a POSITIVE screen on the Depression Scale over the past two weeks. Suicide Screening Score: 1 The results of this administration revealed suicidal ideation over the last 2 weeks, which indicates a POSITIVE primary screen for Risk of Suicide. Over the past two weeks, how often have you been bothered by the following problems? 1. Little interest or pleasure in doing things More than half the days 2. Feeling down, depressed, or hopeless Nearly every day 3. Thoughts that you would be better off dead or of hurting yourself in some way Several days Columbia Suicide Severity Rating Scale (C-SSRS) PARRATT, JEREMY L CONFIDENTIAL Page 27 of 85 Date Given: 07/22/2019 Clinician: Redd,Michael John Location: Kc-Bh-Honor-Pct-Eval/Redd Veteran: Parratt, Jeremy L SSN: xxx-xx-3926 DOB: Dec 9,1975 (43) Gender: Male Suicidal Ideation in Past Month: None endorsed Method/Plan/Intent in Past Month: No method, no specific plan, and no intent Suicidal Behavior: No Past Suicidal Behavior Reported KEY INDICATORS: None Questions and Answers: 1. Over the past month, have you wished you were dead or wished you could go to sleep and not wake up? No 2. Over the past month, have you had any actual thoughts of killing yourself? No 3. Over the past month, have you been thinking about how you might do this? Not asked (due to responses to other questions) 4. Over the past month, have you had these thoughts and had some intention of acting on them? Not asked (due to responses to other questions) 5. Over the past month, have you started to work out or worked out the details of how to kill yourself? Not asked (due to responses to other questions) 6. If yes, at any time in the past month did you intend to carry out this plan? Not asked (due to responses to other questions) 7. In your lifetime, have you ever done anything, started to do anything, or prepared to do anything to end your life (for example, collected pills, obtained a gun, gave away valuables, went to the roof but didn't jump)? No 8. If yes, was this within the past 3 months? Not asked (due to responses to other questions) Columbia-Suicide Severity Rating Scale (C-SSRS) ? 2016 The Columbia Lighthouse PARRATT, JEREMY L CONFIDENTIAL Page 28 of 85 Project. Scale may be reproduced without permission. Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic purposes. Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities. Follow-Up Pos PTSD/Depression/SI: I have reviewed the results of the Mental Health screens and have evaluated the patient. Based on the evaluation, the following disposition plan will be implemented: Other Comment: Patient to be evaluated for further Mental Health options for treatment Additional risk factors: Risk Factors: Male Sex Chronic PTSD symptoms Access to firearms (hunting firearms) Lacks Social Support, lack of people to confide in Protective Factors: Absence of Psychosis Access to Healthcare Advice/Help Seeking Resourcefulness/Survival Skills Guilt About Impact on Loved Ones Children Positive relationship with current partner Sense of responsibility to others Future oriented Any family history of suicide? No Are you currently having thoughts about hurting or killing someone else? No. Current assessed risk of harming self: Low Current assessed risk of harming others: Low Safety Plan (if risk is moderate or high): Current risk assessed as low. A: Post Traumatic Stress Disorder, chronic P: Veteran and provider discussed the diagnsis of PTSD as well as evidenced based treatment options which included individual trauma focused therapy treatments (Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). Also PARRATT, JEREMY L CONFIDENTIAL Page 29 of 85 discussed group options, though Veteran indicated his preference for individual treatments at this time and that he was nervous just thinking about doing group therapy. He also indicated his preference for individual treatment and that he did not think that family involvement was needed at this time. After the discussion of treatment options Veteran indicated that he was most interested in CPT. He indicated his preference for Monday or Tuesday appointments and for morning appointments if possible. Veteran is currently stable and there is no evidence of imminent harm to self or others. /es/ MICHAEL REDD, PH.D. Licensed Marriage and Family Therapist Signed: 07/22/2019 14:41 Receipt Acknowledged By: * AWAITING SIGNATURE * HEINECKE,NICHOLAS B 07/23/2019 ADDENDUM STATUS: COMPLETED BEHAVIORAL HEALTH BIOPSYCHOSOCIAL ASSESSMENT Service-connected: Vet is a NSC, 43-year-old, Caucasian, married, employed, Persian Gulf War Air Force Veteran. Referred by: PCMHI; Dr. Niki Knight The Veteran's identity was confirmed using the following two identifiers: Name and SS#. Veteran was informed of the purpose of the assessment and the limits of confidentiality and agrees to proceed. PRESENTING PROBLEM: Veteran reports that he went to see his private PCP in February for anxiety symptoms, "felt like it was getting out of control". "I kept dwelling on it until couldn't think of anything else". He rep orted anxiety thoughts about work, relationships with friends, "everything was a panic". He reports that in the last year or two, he started to get a lot of anxiety. He reported an index trauma related to the Kobar towers bombing in 1996 where he PARRATT, JEREMY L CONFIDENTIAL Page 30 of 85 was deployed. He notes that especially around July 4th every year, the fireworks trigger him. "Gets tough." Now, he notes that he is irritable "a lot more than should be", and anxiety (within the last couple of years). "Always hyper alert when out with family", aware of surroundings. "Don't like to be in large crowds anymore" (since deployment). "Don't like to be in situations that I can't control so don't like to be around that many people." He reports having some level of hypervigilance and being jumpy (last 10-15 years) consistently since the trauma but denies that it was there before that. He notes it is worse in the past couple of years. He also reports having significant difficulty sleeping at night and trouble with work due to not wanting to be around people for long. Having more trouble in last several years having conversations with people, feeling more and more uncomfortable, one-on- one, carrying on long conversations. Used to be easy to interact with customers, really enjoyed it before. Now feel more comfortable back in the brewery doing his own thing, not having to interact as much. Now avoiding those interactions and related people on almost a daily basis. More anxious about the talking than just being around them (that they might bring up conversations about his military service which might bring up combat experience). He reports taking escitalopram since February of this year and that it "takes the edge off of the anxiety." He notes that his anxiety is a 6 out of 10 on typical day (10 being the worst). He reports that prior to the last several years it used to be 2-3 out of 10, "didn't really remember having anxiety issues". Out of the symptoms described he notes that the anxiety and irritability are bothering him the most. "Would be nice to not jump out of my skin every time I am startled." "Would like to enjoy spending time with family around July 4th. I normally go inside, and spend time by myself." "I used to really enjoy shooting but I don't anymore. Everything kind of reminds me of that now." Not currently pursuing new claim for PTSD SC. May pursue in the future if it makes sense, but "at this point I just want to be better". RELEVANT BACKGROUND & CURRENT PSYCHOSOCIAL ASSESSMENT Early childhood: He describes his childhood as "Awesome". He reports having one PARRATT, JEREMY L CONFIDENTIAL Page 31 of 85 sister growing up and that his Mom and Dad divorced after he became an adult. He reports that there was not a lot of conflict in the home and denied any childhood trauma or abuse. Parents rarely ever drank, no drug/alcohol abuse in the home. Grew up in a small town, played sports, hunted and fished with Dad and grandfather. Current contact with parents/siblings: Sees sister about once every two years, lives in Texas. Father died three years ago. See Mom when he sees his sister. Talks on the phone, or texts usually about once a week. Current relationship/history: Married, 17 years. Relationship is "great". No real issues, get along great. Irritability (snapping) can cause friction, she gets frustrated with that and wants him to control it more. He notes that she also gets frustrated with his triggering around July 4th and her expressed concerns about his anxiety led him to reaching out to his PCP this last Feb. He notes that he has never been a violent person/fighter. Denies escalated arguments/conflict due to it these problems. Current environment and home/family situation: "good". Spend a lot of time in pool together. He notes that he is spending more time at home with them, stepping away from work responsibilities (though later in the interview information the Veteran shared indicated that this may be because he is trending towards more and more isolation and avoidance of interactions with people). Went on vacation to Florida in April. Noticed irritability, but not anxiety so much. Was on medication for several months by that point so was doing okay. Is family involvement assessed to be appropriate in this episode of care? Not at this time. Would like to "figure this out on my own at this time". Current bereavement issues: Not at this time. Financial History (stress): Self-employed, brewery and retail store, no significant financial stressors reported. Social Support: Have wife to talk to, she is very supportive about talking about things. She urged him to go to PCP to talk about his anxiety. Outside of wife, he reports he doesn't have anyone to confide in or talk to. Can't talk to those he works with (his employees), not really any social interactions outside of work. Have had trouble keeping friends (been more recently). Don't have any currently close friends. PARRATT, JEREMY L CONFIDENTIAL Page 32 of 85 Legal Problems (history and current problems): denied Influence of Veteran's legal situation on progress in care, treatment, or services: N/A Relationship between the presenting conditions and legal involvement: N/A Is a referral to VJO or other legal assistance needed? Not at this time Leisure/Recreation: Swim, fish, bow hunt (do as work permits, "I work a lot"). He reports that he needs to keep very busy all of the time, which he notes is a significant difference from before the index trauma. "I don't do well with not having something to do, used to be able to relax more". Sundays try to spend as a family. Religious/Spiritual Orientation: No. Transportation: Veteran has no difficulties arriving to appointments. Cultural considerations: denied HEALTH ASSESSMENT Is the Veteran connected to medical care for relevant medical needs? Yes. Has Veteran seen a Primary Care Physician in the last year and/or does Veteran need referral for relevant medical needs? Had first appointment with VA PCP in the last couple of weeks. He reports that they indicated he had a Vitamin D deficiency, no other medical issues. He notes that he went to see a private doctor in Feb. for anxiety issues after urging from his wife, then came to VA to try to get the anxiety figured out. He indicates that he would rather not have to be on medication for the anxiety if he can help it. Last time before that to see a doctor was over 10 years ago. Does the Veteran have pain that is impacting their day to day life? (if yes, consider referral to medical care) None reported Nutrition screening: *Does the Veteran have food allergies? none *Has the Veteran gained or lost 10 pounds or more in the last three months? Not necessarily in last 3 months. This year has "definitely put on weight". *Has the Veteran experiences a decrease in food intake or appetite? No. Last year or two has had increase in appetite/intake. *Does the Veteran have dental problems? None *Does the Veteran have behaviors that may be indicators of an eating disorder (binging or purging)? None *Need for referral to PCP: No PARRATT, JEREMY L CONFIDENTIAL Page 33 of 85 Medical History/Problems and impact on psychological status or treatment planning: Veteran reports being pretty healthy physically. When in Air Force he reports having had a back problem that can flare up every once in a while rarely. Psychiatric medication evaluation and management provider: According to Veteran he is being prescribed escitalopram, still being prescribed through private PCP, but it will be transferred over to his new VA PCP after the prescription expires (still have a couple of months). Functional status (assessment of patient's ability to live independently and any limitations/needs regarding ADLs/IADLS and other basic living skills): Denies any problems. EDUCATIONAL, VOCATIONAL AND LEARNING ASSESSMENT Highest level of education completed (performance/preferred areas of study/attitude toward education/desire for future education): High School Is further educational assessment needed? Not at this time. History of head injury/trauma? None Employment history: Works at self-owned brewery and retail store for the last 8 years, before that sold insurance (5 years). Before that, construction and welding jobs after he got out of Air Force. Is a referral to vocational rehabilitation or CWT/SEW needed? Not at this time MILITARY SERVICE HISTORY Confirmed via the veteran's copy of the DD214? Branch of service: Air Force Dates of service: 1994-1998 Location and Dates in country: Turkey, Bahrain, Saudi Arabia Enlisted: Yes Highest rank: SrA Rank at discharge: SrA Type of discharge: Honorable Disciplinary actions? No Duties, MOS, specialty: Egress TRAUMA HISTORY AND SYMPTOMS A. Description of Veteran's reported traumatic experiences: a. He reports that he was on deployment in Saudi Arabia in June of 1996 and living in the compound at the Kobar towers. He reports that he normally had worked nights but had switched with someone so he was working at the time. He had just left the parking lot and was on his way to work when a terrorist drove a fertilizer bomb into the tower and exploded it. He reports that 19 people were killed and injured 100s more (all military personnel). He reports that he just missed being there where the truck was by about 5 minutes, and that even though his living quarters were farther away from the detonation spot, the glass blew out of the windows throughout the building and shredded his bed that he would have been in. He reports that there was a lock down but that he saw everything when he came back the next day. B. RE-EXPERIENCING SYMPTOMS (X)INTRUSIVE THOUGHTS: He reports daily. "Not a day goes by without thinking about it." He reports more intrusive thoughts around the anniversary date. He says that he thinks about it everyday, about being helpless and still very much angry. ()NIGHTMARES: He reports that he does not have nightmares at least that he remembers. (X)FLASHBACKS: He reports flashbacks related to fireworks or gunpowder triggers (less so but can still happen with loud noises). (X)EMOTIONAL DISTRESS: He reports significant distress with reminders (10 out of 10). (X)PHYSICAL REACTIONS: breathing heavily, heart pounding, shaking, palms sweaty when reminded of trauma which he reports can last minutes to an hour. C. AVOIDANCE SYMPTOMS (X)AVOID THOUGHTS: Try to avoid thinking about it but can't. Avoids situations where he might have to think about it. (X)AVOID THINGS: Try to avoid talking about it. "Proud" of fact that he served and it is on his business Facebook page. People are curious and they often ask about combat experience. Fear that it will come back to that. He notes that he has started to even avoid employees because they might ask about military experience. Avoiding a military friend who rotated out before the bombing, because of likelihood the conversation would be about the event. Lot of anxiety about talking about the event. Avoid Friday night Royals games because of fireworks. Avoided talking about it even with wife. Avoid stock car racing (used to enjoy going) because of the loud noise and trigger. Avoid pretty much anywhere there is a crowd. Find himself mostly at home or at work now. D. NEGATIVE THOUGHTS & EMOTIONS ()DISSOCIATION: (X)COGNITIVE DISTORTIONS (view of self, others, world): "The world is pretty scary". First time this kind of thing had happened to him, had never been exposed to anything like that. From small town USA before that. (X)EXCESSIVE RESPONSIBIILTY: Denies PARRATT, JEREMY L CONFIDENTIAL Page 35 of 85 (X)PRESISTENT NEGATIVE EMOTIONS: Anger, Sadness for people's families, Fear, (X)LOSS OF INTEREST: yes, especially related to triggers. Strictly bow hunt now instead of shooting firearms like he used to enjoy doing. (X)DETACHED/DISTANT: Confirms ()EMOTIONAL NUMBING: denies E. AROUSAL SYMPTOMS (X)IRRITABILITY/ANGER: 6 out of 10 daily. "It is always right there. Any little thing can set it off." ()RECKLESS BEHAVIOR: No (X)HYPERVIGILANCE: Daily; will have to argue with his wife for "back to wall" position when go out to eat. Will avoid going out because of that. (X)EXAGGERATED STARTLE: Daily. People at work try to scare him (walk up behind him). Have a pretty strong reaction to people walking up behind him. (X)CONCENTRATION: Read a lot in spare time and finds himself re-reading over and over, can't focus. Really bad at work, forgetting to do things at work. (X)SLEEP DISTURBANCE: Can fall asleep very easily. Usually wake up every night at 3pm. After a couple of hours can typically go back to sleep. 5-6 hours a night. Wake up exhausted daily. F. Veteran's duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Veteran reported symptoms following his service and the condition appears to be chronic. Other trauma history? Any traumas during developmental years? History of Neglect/Abuse/Exploitation/ Adult IPV etc): Veteran denies INCIDENCES/RISKS OF DOMESTIC VIOLENCE: Veteran denies any past history. ADDITIONAL PSYCHIATRIC AND SUBSTANCE USE ASSESSMENT REVIEW OF POSSIBLE COMORBID CONDITIONS: DEPRESSION: Current and past depressive symptoms seems to be a sequalae from PTSD rather than a distinct disorder, though more history may be needed to rule this out. MANIA: denied PANIC: None AUDITORY HALLUCINATIONS: denied PARRATT, JEREMY L CONFIDENTIAL Page 36 of 85 VISUAL HALLUCINATIONS: denied History of MH treatment: No prior history of counseling or therapy. No history of inpatient mental health treatment. Substance abuse history: No abuse treatment in the past. Current substance use: Alcohol: Veteran reports that on rare social occasions, such as family get togethers, he might have 5 or more drinks. He notes that right after he got out of the Air Force, he drank more heavily for a couple of years. He reports currently drinking socially and about 4 times a week, 3-4 beers related to his job as a brewer. Drugs: He reports that he has tried marijuana before as an attempt to deal with his anxiety symptoms, but reported that it made him more anxious when under the influence, "didn't agree with me". Synthetic marijuana or other "designer drugs": Denied Prescribed medication abuse: Never really taken prescriptions before until recently. No history of overuse. Tobacco: Not presently. Pack a day smoker for whole adult life until first child (13 years ago). Parents smoked while he was growing up. Smoked more after got out of military. Went from a pack every two to three days to a pack ? pack and a half a day. Caffeine: Drink coffee in the mornings, drink diet coke, a couple a day. Pattern of use: Veteran denies drinking more heavily now than before. Consequences of use: He denies any significant negative consequences from substance use. Family history of substance abuse and MH problems: denied MEDICAL &/OR PSYCHIATRIC ADVANCED DIRECTIVE *Does Veteran have one or both? No *If so, does Veteran need help completing or updating it? (If so, please complete or refer to SW) Veteran does not want advance directive assistance at this time MENTAL STATUS Appearance: casually dressed and groomed Behavior: cooperative Eye contact: established and maintained Mood: Moderately depressed and anxious Affect: congruent with mood Speech: fluent, normal production CONFIDENTIAL Page 37 of 85 Thought process: organized, goal-directed Thought content: appropriate to the topic Delusions: none noted or reported Hallucinations: does not appear to attend to internal stimuli Orientation: intact, x4, all spheres Memory/Concentration: not formally assessed, but grossly intact Fund of knowledge: within normal limits Judgment: fair Insight: fair SNAP Assessment: Strengths: Very motivated, determined when there is something to be done. Needs: None reported Abilities: Sense of humor, pretty easy to talk to. Preferences: Would prefer individual over group treatment at this time. Thinking about group treatment makes him anxious but he would be open to considering it. Mondays and Tuesdays, mornings if possible. PATIENT IDENTIFIED GOALS/PROBLEMS TO BE ADDRESSED IN TREATMENT "Would like to get over it. To get better. Things are escalating as far as the anxiety and avoidance and would like to not have to do that." USE OF COMMUNITY RESOURCES AND NEED FOR ADDITIONAL REFERRALS What resources do you use in your community? (e.g. Vet Center, Community Mental Health, Veteran organizations, etc) None at this time. QUESTIONNAIRES: Vet completed the PTSD symptom Check List (PCL5) and scored 75 out of 80 points. A score above 38 indicates possible PTSD. The Veteran obtained a score of 22 on the PHQ9 which suggests a severely depressed mood. DIAGNOSTIC IMPRESSION (According to the DSM-5): Diagnosis: Post-traumatic Stress Disorder, chronic CPT code 90791 RECOMMENDATIONS/PLAN: It is recommended that Veteran engage in trauma focused therapy to address PTSD and related symptoms. Veteran and provider discussed the diagnosis of PTSD as well as evidenced based treatment options which included individual trauma focused therapy treatments (Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). Also discussed group options, though Veteran indicated his preference for individual treatments at this time and that he was nervous just thinking about doing group therapy. He also indicated his preference for individual treatment and that he did not think that family PARRATT, JEREMY L CONFIDENTIAL Page 38 of 85 involvement was needed at this time. After the discussion of treatment options Veteran indicated that he was most interested in CPT. He indicated his preference for Monday or Tuesday appointments and for morning appointments if possible. -Veteran denies SI/HI. Also discussed how/when to access emergency mental health resources, including the emergency room 24 hours a day. Patient agreed to utilize these services as needed. Patient has written information including phone number to his primary care provider, the phone number to the Kansas City VA mental health clinic, and the 24 hour crisis Suicide Prevention Hotline number at 800-273-8255. /es/ MICHAEL REDD, PH.D. Licensed Marriage and Family Therapist Signed: 07/23/2019 16:45

I filed my claim for PTSD, and secondaries for PTSD Tinnitus, Hearing Loss, and Sleep Apnea. Thinking ahead to my C&P exam, I was thinking about alcohol usage. I am a beer drinker. I drink every day and I probably drink 10 beers on most days. I drink way too much and I know that. When the VA psych diagnosed me with PTSD before I filed a claim, he asked me about alcohol usage and I told him that I drank a couple of beers a day. I was not honest with him and if I am honest with myself, I am embarrassed about it. I am thinking it will come up again with the C&P exam. I read the what to expect document on this website and it says to tell the examiner that I am not there to talk about alcohol. Is this still the correct or best advice I can follow? I spoke with a vet the other day and he is 100% disabled with ptsd, tinnitus etc. He said that at one time they lowered his rating because he told them he had gotten his drinking under control. I don't want to go in there lying, but, if it is better to not answer that to admit how much I drink...... Thank you for any insight. I did search here before I posted by the way, just didn't find exactly what I was looking for.

Here is the Psychiatrist report from when I went in to get screened. This is not my C and P, which I have not had yet since I am still in the process of filing my claim. My DD 214 does show my Armed Forces Expeditionary Medal with 1 oak leaf cluster as well. PARRATT, JEREMY L CONFIDENTIAL Page 18 of 85 VA Problem List Source: VA Last Updated: 25 Jul 2019 @ 1152 Sorted By: Date/Time Entered (Descending) then alphabetically by Problem Your VA Problem List contains active health problems your VA providers are helping you to manage. This information is available 3 calendar days after it has been entered. It may not contain active problems managed by non-VA health care providers. If you have any questions about your information, visit the FAQs or contact your VA health care team. Problem: Anxiety (SCT 48694002) Date/Time Entered: 08 Jul 2019 @ 1200 Provider: ANYANIKE,TISHA D Location: VA Heartland-West VISN 15 Status: ACTIVE Comments: -- Problem: Bilateral tinnitus (SCT 4831000119102) Date/Time Entered: 08 Jul 2019 @ 1200 Provider: ANYANIKE,TISHA D Location: VA Heartland-West VISN 15 Status: ACTIVE Comments: -- Problem: Hearing loss (SCT 15188001) Date/Time Entered: 08 Jul 2019 @ 1200 Provider: ANYANIKE,TISHA D Location: VA Heartland-West VISN 15 Status: ACTIVE Comments: -- Problem: Major depression (SCT 370143000) Date/Time Entered: 08 Jul 2019 @ 1200 Provider: ANYANIKE,TISHA D Location: VA Heartland-West VISN 15 Status: ACTIVE Comments: -- Problem: Obesity (SCT 414916001) Date/Time Entered: 08 Jul 2019 @ 1200 Provider: ANYANIKE,TISHA D Location: VA Heartland-West VISN 15 Status: ACTIVE , JEREMYPARRATT L CONFIDENTIAL Page 19 of 85 Comments: -- Problem: Sleep apnea (SCT 73430006) Date/Time Entered: 08 Jul 2019 @ 1200 Provider: ANYANIKE,TISHA D Location: VA Heartland-West VISN 15 Status: ACTIVE Comments: -- PARRATT, JEREMY L CONFIDENTIAL Page 20 of 85 VA Admissions and Discharges Source: VA Last Updated: 25 Jul 2019 @ 1152 No information was available that matched your selection. However if you were recently discharged, your summary may be available 3 calendar days after it is completed. PARRATT, JEREMY L CONFIDENTIAL Page 21 of 85 VA Notes Source: VA Last Updated: 25 Jul 2019 @ 1152 Sorted By: Date/Time (Descending) VA Notes from January 1, 2013 forward are available 3 calendar days after they have been completed and signed by all required members of your VA health care team. If you have any questions about your information please visit the FAQs or contact your VA health care team. Date/Time: 22 Jul 2019 @ 1417 Note Title: KC-MH PTSD STATUS FORM Location: VA Heartland-West VISN 15 Signed By: REDD,MICHAEL JOHN Co-signed By: REDD,MICHAEL JOHN Date/Time Signed: 22 Jul 2019 @ 1423 Note LOCAL TITLE: KC-MH PTSD STATUS FORM STANDARD TITLE: MENTAL HEALTH INITIAL EVALUATION NOTE DATE OF NOTE: JUL 22, 2019@14:17 ENTRY DATE: JUL 22, 2019@14:17:41 AUTHOR: REDD,MICHAEL JOHN EXP COSIGNER: URGENCY: STATUS: COMPLETED PTSD STATUS FORM Mr.PARRATT is a 43 year old Veteran presenting to PTSD specialty care for treatment. The Veterane provided the following background information: ETHNICITY: NOT HISPANIC OR LATINO RACE White not Latino(a) HOUSING Residence CURRENTLY WORKING FOR PAY Yes IF NOT WORKING, PRIMARY REASON IS CURRENTLY APPLYING FOR VA DISABILITY BENEFITS No PERIOD(S) OF SERVICE PARRATT, JEREMY L CONFIDENTIAL Page 22 of 85 Persian Gulf War SOCIAL SUPPORT The Veteran rated their perception of social support as: Someone who understand my problems: Never Someone I trust to talk with about my problems: Never Someone is around to help me if I need it: Usually CURRENT BARRIERS TO TREATMENT None TRAUMA EXPERIENCES TREATED IN PCT Military related trauma: Yes Non-military related trauma: No PROBLEM WITH PAIN FOR MORE THAN THREE MONTHS No PAIN RATING-PAST WEEK Score: 0 PAIN INTERFERENCE-PAST WEEK Score: 0 CURRENTLY RECEIVING VET CENTER SERVICES No CURRENTLY RECEIVING MENTAL HEALTH CARE FROM NON-VA Yes VETERAN WILLING TO HAVE FAMILY INVOLVED IN TREATMENT No ASSESSMENT PCL-5 (PTSD Symptom Checklist for DSM 5) was administered at this encounter. A PCL-5 was performed and was positive. The score was 75. The event you experienced was: Bombing of Kobar Towers in 1996 The event happened: more than 10 years ago 1. Repeated, disturbing, and unwanted memories of the stressful PARRATT, JEREMY L CONFIDENTIAL Page 23 of 85 experience? Extremely 2. Repeated, disturbing dreams of the stressful experience? Moderately 3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)? Extremely 4. Feeling very upset when something reminded you of the stressful experience? Extremely 5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)? Extremely 6. Avoiding memories, thoughts, or feelings related to the stressful experience? Extremely 7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)? Extremely 8. Trouble remembering important parts of the stressful experience? Extremely 9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)? Extremely 10. Blaming yourself or someone else for the stressful experience or what happened after it? Extremely 11. Having strong negative feelings such as fear, horror, anger, guilt, or shame? Extremely 12. Loss of interest in activities that you used to enjoy? Extremely 13. Feeling distant or cut off from other people? Extremely 14. Trouble experiencing positive feelings (for example, being unable to PARRATT, JEREMY L CONFIDENTIAL Page 24 of 85 feel happiness or have loving feelings for people close to you)? Quite a bit 15. Irritable behavior, angry outbursts, or acting aggressively? Extremely 16. Taking too many risks or doing things that could cause you harm? Moderately 17. Being "superalert" or watchful or on guard? Extremely 18. Feeling jumpy or easily startled? Extremely 19. Having difficulty concentrating? Extremely 20. Trouble falling or staying asleep? Extremely PHQ-9 was adminstered at this encounter. A PHQ-9 screen was performed. The score was 22 which is suggestive of severe depression. 1. Little interest or pleasure in doing things More than half the days 2. Feeling down, depressed, or hopeless More than half the days 3. Trouble falling or staying asleep, or sleeping too much Nearly every day 4. Feeling tired or having little energy Nearly every day 5. Poor appetite or overeating Nearly every day 6. Feeling bad about yourself or that you are a failure or have let yourself or your family down More than half the days 7. Trouble concentrating on things, such as reading the newspaper or watching television Nearly every day 8. Moving or speaking so slowly that other people could have noticed. Or the opposite being so fidgety or restless that you have been moving around a lot more than usual Nearly every day PARRATT, JEREMY L CONFIDENTIAL Page 25 of 85 9. Thoughts that you would be better off dead or of hurting yourself in some way Several days 10. If you checked off any problems, how DIFFICULT have these problems made it for you to do your work, take care of things at home or get along with other people? Very difficult Based on initial assessment and/or detailed chart review the following are relevant presenting problems for the Veteran: Need for PTSD specialty tx /es/ MICHAEL REDD, PH.D. Licensed Marriage and Family Therapist Signed: 07/22/2019 14:23 Date/Time: 22 Jul 2019 @ 0830 Note Title: KC-MH BIOPSYCHOSOCIAL ASSESSMENT CONSULT Location: VA Heartland-West VISN 15 Signed By: REDD,MICHAEL JOHN Co-signed By: REDD,MICHAEL JOHN Date/Time Signed: 22 Jul 2019 @ 1441 Note LOCAL TITLE: KC-MH BIOPSYCHOSOCIAL ASSESSMENT CONSULT STANDARD TITLE: MENTAL HEALTH CONSULT DATE OF NOTE: JUL 22, 2019@08:30 ENTRY DATE: JUL 22, 2019@08:30:17 AUTHOR: REDD,MICHAEL JOHN EXP COSIGNER: URGENCY: STATUS: COMPLETED *** KC-MH BIOPSYCHOSOCIAL ASSESSMENT CONSULT Has ADDENDA *** Date of Visit: 7/22/19 @ 0840 Veteran was seen for a 120 minute PTSD consult to assess trauma related symptoms following referral from PCHMI. Veteran's identity was confirmed with name and last 4. He was educated regarding the purpose of the consult and limits to confidentiality. Veteran provided verbal consent to continue. S: The majority of the session was spent reviewing the Veteran's history and current symptoms. Veteran reported that the index traumatic event was the bombing of the Kobar towers that occurred during his deployment to Saudi Arabia in 1996. PARRATT, JEREMY L CONFIDENTIAL Page 26 of 85 FULL REPORT TO FOLLOW O: Veteran presented to his consult appointment on time. He was casually dressed and appropriately groomed. Mood appeared moderately depressed and affect was mood congruent. Veteran became tearful during questions about PTSD symptoms and in recounting the index trauma. Veteran was cooperative throughout the evaluation procedures. Eye contact was okay. Thought processes were logical, linear, and goal-directed. Thought content was relevant to topic. Speech was normal as to rate, tone, and prosody. Memory and concentration were adequate for the current session. Judgment and insight were fair. CURRENT SUICIDALITY/HOMICIDALITY: Upon direct questioning, Veteran denied current suicidal and homicidal ideation, plan and intent. Veteran acknowledged that he has occasional thoughts of dying but denied any thoughts about killing himself, or any plan or intent to carry out any thoughts. See suicide screening results below (C-SSRS) CLINICAL REMINDER ACTIVITY: Depression Screening: PHQ-2+I9 Depression Screening Score: 5 The score on this administration is 5, which indicates a POSITIVE screen on the Depression Scale over the past two weeks. Suicide Screening Score: 1 The results of this administration revealed suicidal ideation over the last 2 weeks, which indicates a POSITIVE primary screen for Risk of Suicide. Over the past two weeks, how often have you been bothered by the following problems? 1. Little interest or pleasure in doing things More than half the days 2. Feeling down, depressed, or hopeless Nearly every day 3. Thoughts that you would be better off dead or of hurting yourself in some way Several days Columbia Suicide Severity Rating Scale (C-SSRS) PARRATT, JEREMY L CONFIDENTIAL Page 27 of 85 Date Given: 07/22/2019 Clinician: Redd,Michael John Location: Kc-Bh-Honor-Pct-Eval/Redd Veteran: Parratt, Jeremy L SSN: xxx-xx-3926 DOB: Dec 9,1975 (43) Gender: Male Suicidal Ideation in Past Month: None endorsed Method/Plan/Intent in Past Month: No method, no specific plan, and no intent Suicidal Behavior: No Past Suicidal Behavior Reported KEY INDICATORS: None Questions and Answers: 1. Over the past month, have you wished you were dead or wished you could go to sleep and not wake up? No 2. Over the past month, have you had any actual thoughts of killing yourself? No 3. Over the past month, have you been thinking about how you might do this? Not asked (due to responses to other questions) 4. Over the past month, have you had these thoughts and had some intention of acting on them? Not asked (due to responses to other questions) 5. Over the past month, have you started to work out or worked out the details of how to kill yourself? Not asked (due to responses to other questions) 6. If yes, at any time in the past month did you intend to carry out this plan? Not asked (due to responses to other questions) 7. In your lifetime, have you ever done anything, started to do anything, or prepared to do anything to end your life (for example, collected pills, obtained a gun, gave away valuables, went to the roof but didn't jump)? No 8. If yes, was this within the past 3 months? Not asked (due to responses to other questions) Columbia-Suicide Severity Rating Scale (C-SSRS) ? 2016 The Columbia Lighthouse PARRATT, JEREMY L CONFIDENTIAL Page 28 of 85 Project. Scale may be reproduced without permission. Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic purposes. Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities. Follow-Up Pos PTSD/Depression/SI: I have reviewed the results of the Mental Health screens and have evaluated the patient. Based on the evaluation, the following disposition plan will be implemented: Other Comment: Patient to be evaluated for further Mental Health options for treatment Additional risk factors: Risk Factors: Male Sex Chronic PTSD symptoms Access to firearms (hunting firearms) Lacks Social Support, lack of people to confide in Protective Factors: Absence of Psychosis Access to Healthcare Advice/Help Seeking Resourcefulness/Survival Skills Guilt About Impact on Loved Ones Children Positive relationship with current partner Sense of responsibility to others Future oriented Any family history of suicide? No Are you currently having thoughts about hurting or killing someone else? No. Current assessed risk of harming self: Low Current assessed risk of harming others: Low Safety Plan (if risk is moderate or high): Current risk assessed as low. A: Post Traumatic Stress Disorder, chronic P: Veteran and provider discussed the diagnsis of PTSD as well as evidenced based treatment options which included individual trauma focused therapy treatments (Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). Also PARRATT, JEREMY L CONFIDENTIAL Page 29 of 85 discussed group options, though Veteran indicated his preference for individual treatments at this time and that he was nervous just thinking about doing group therapy. He also indicated his preference for individual treatment and that he did not think that family involvement was needed at this time. After the discussion of treatment options Veteran indicated that he was most interested in CPT. He indicated his preference for Monday or Tuesday appointments and for morning appointments if possible. Veteran is currently stable and there is no evidence of imminent harm to self or others. /es/ MICHAEL REDD, PH.D. Licensed Marriage and Family Therapist Signed: 07/22/2019 14:41 Receipt Acknowledged By: * AWAITING SIGNATURE * HEINECKE,NICHOLAS B 07/23/2019 ADDENDUM STATUS: COMPLETED BEHAVIORAL HEALTH BIOPSYCHOSOCIAL ASSESSMENT Service-connected: Vet is a NSC, 43-year-old, Caucasian, married, employed, Persian Gulf War Air Force Veteran. Referred by: PCMHI; Dr. Niki Knight The Veteran's identity was confirmed using the following two identifiers: Name and SS#. Veteran was informed of the purpose of the assessment and the limits of confidentiality and agrees to proceed. PRESENTING PROBLEM: Veteran reports that he went to see his private PCP in February for anxiety symptoms, "felt like it was getting out of control". "I kept dwelling on it until couldn't think of anything else". He rep orted anxiety thoughts about work, relationships with friends, "everything was a panic". He reports that in the last year or two, he started to get a lot of anxiety. He reported an index trauma related to the Kobar towers bombing in 1996 where he PARRATT, JEREMY L CONFIDENTIAL Page 30 of 85 was deployed. He notes that especially around July 4th every year, the fireworks trigger him. "Gets tough." Now, he notes that he is irritable "a lot more than should be", and anxiety (within the last couple of years). "Always hyper alert when out with family", aware of surroundings. "Don't like to be in large crowds anymore" (since deployment). "Don't like to be in situations that I can't control so don't like to be around that many people." He reports having some level of hypervigilance and being jumpy (last 10-15 years) consistently since the trauma but denies that it was there before that. He notes it is worse in the past couple of years. He also reports having significant difficulty sleeping at night and trouble with work due to not wanting to be around people for long. Having more trouble in last several years having conversations with people, feeling more and more uncomfortable, one-on- one, carrying on long conversations. Used to be easy to interact with customers, really enjoyed it before. Now feel more comfortable back in the brewery doing his own thing, not having to interact as much. Now avoiding those interactions and related people on almost a daily basis. More anxious about the talking than just being around them (that they might bring up conversations about his military service which might bring up combat experience). He reports taking escitalopram since February of this year and that it "takes the edge off of the anxiety." He notes that his anxiety is a 6 out of 10 on typical day (10 being the worst). He reports that prior to the last several years it used to be 2-3 out of 10, "didn't really remember having anxiety issues". Out of the symptoms described he notes that the anxiety and irritability are bothering him the most. "Would be nice to not jump out of my skin every time I am startled." "Would like to enjoy spending time with family around July 4th. I normally go inside, and spend time by myself." "I used to really enjoy shooting but I don't anymore. Everything kind of reminds me of that now." Not currently pursuing new claim for PTSD SC. May pursue in the future if it makes sense, but "at this point I just want to be better". RELEVANT BACKGROUND & CURRENT PSYCHOSOCIAL ASSESSMENT Early childhood: He describes his childhood as "Awesome". He reports having one PARRATT, JEREMY L CONFIDENTIAL Page 31 of 85 sister growing up and that his Mom and Dad divorced after he became an adult. He reports that there was not a lot of conflict in the home and denied any childhood trauma or abuse. Parents rarely ever drank, no drug/alcohol abuse in the home. Grew up in a small town, played sports, hunted and fished with Dad and grandfather. Current contact with parents/siblings: Sees sister about once every two years, lives in Texas. Father died three years ago. See Mom when he sees his sister. Talks on the phone, or texts usually about once a week. Current relationship/history: Married, 17 years. Relationship is "great". No real issues, get along great. Irritability (snapping) can cause friction, she gets frustrated with that and wants him to control it more. He notes that she also gets frustrated with his triggering around July 4th and her expressed concerns about his anxiety led him to reaching out to his PCP this last Feb. He notes that he has never been a violent person/fighter. Denies escalated arguments/conflict due to it these problems. Current environment and home/family situation: "good". Spend a lot of time in pool together. He notes that he is spending more time at home with them, stepping away from work responsibilities (though later in the interview information the Veteran shared indicated that this may be because he is trending towards more and more isolation and avoidance of interactions with people). Went on vacation to Florida in April. Noticed irritability, but not anxiety so much. Was on medication for several months by that point so was doing okay. Is family involvement assessed to be appropriate in this episode of care? Not at this time. Would like to "figure this out on my own at this time". Current bereavement issues: Not at this time. Financial History (stress): Self-employed, brewery and retail store, no significant financial stressors reported. Social Support: Have wife to talk to, she is very supportive about talking about things. She urged him to go to PCP to talk about his anxiety. Outside of wife, he reports he doesn't have anyone to confide in or talk to. Can't talk to those he works with (his employees), not really any social interactions outside of work. Have had trouble keeping friends (been more recently). Don't have any currently close friends. PARRATT, JEREMY L CONFIDENTIAL Page 32 of 85 Legal Problems (history and current problems): denied Influence of Veteran's legal situation on progress in care, treatment, or services: N/A Relationship between the presenting conditions and legal involvement: N/A Is a referral to VJO or other legal assistance needed? Not at this time Leisure/Recreation: Swim, fish, bow hunt (do as work permits, "I work a lot"). He reports that he needs to keep very busy all of the time, which he notes is a significant difference from before the index trauma. "I don't do well with not having something to do, used to be able to relax more". Sundays try to spend as a family. Religious/Spiritual Orientation: No. Transportation: Veteran has no difficulties arriving to appointments. Cultural considerations: denied HEALTH ASSESSMENT Is the Veteran connected to medical care for relevant medical needs? Yes. Has Veteran seen a Primary Care Physician in the last year and/or does Veteran need referral for relevant medical needs? Had first appointment with VA PCP in the last couple of weeks. He reports that they indicated he had a Vitamin D deficiency, no other medical issues. He notes that he went to see a private doctor in Feb. for anxiety issues after urging from his wife, then came to VA to try to get the anxiety figured out. He indicates that he would rather not have to be on medication for the anxiety if he can help it. Last time before that to see a doctor was over 10 years ago. Does the Veteran have pain that is impacting their day to day life? (if yes, consider referral to medical care) None reported Nutrition screening: *Does the Veteran have food allergies? none *Has the Veteran gained or lost 10 pounds or more in the last three months? Not necessarily in last 3 months. This year has "definitely put on weight". *Has the Veteran experiences a decrease in food intake or appetite? No. Last year or two has had increase in appetite/intake. *Does the Veteran have dental problems? None *Does the Veteran have behaviors that may be indicators of an eating disorder (binging or purging)? None *Need for referral to PCP: No PARRATT, JEREMY L CONFIDENTIAL Page 33 of 85 Medical History/Problems and impact on psychological status or treatment planning: Veteran reports being pretty healthy physically. When in Air Force he reports having had a back problem that can flare up every once in a while rarely. Psychiatric medication evaluation and management provider: According to Veteran he is being prescribed escitalopram, still being prescribed through private PCP, but it will be transferred over to his new VA PCP after the prescription expires (still have a couple of months). Functional status (assessment of patient's ability to live independently and any limitations/needs regarding ADLs/IADLS and other basic living skills): Denies any problems. EDUCATIONAL, VOCATIONAL AND LEARNING ASSESSMENT Highest level of education completed (performance/preferred areas of study/attitude toward education/desire for future education): High School Is further educational assessment needed? Not at this time. History of head injury/trauma? None Employment history: Works at self-owned brewery and retail store for the last 8 years, before that sold insurance (5 years). Before that, construction and welding jobs after he got out of Air Force. Is a referral to vocational rehabilitation or CWT/SEW needed? Not at this time MILITARY SERVICE HISTORY Confirmed via the veteran's copy of the DD214? Branch of service: Air Force Dates of service: 1994-1998 Location and Dates in country: Turkey, Bahrain, Saudi Arabia Enlisted: Yes Highest rank: SrA Rank at discharge: SrA Type of discharge: Honorable Disciplinary actions? No Duties, MOS, specialty: Egress TRAUMA HISTORY AND SYMPTOMS A. Description of Veteran's reported traumatic experiences: a. He reports that he was on deployment in Saudi Arabia in June of 1996 and living in the compound at the Kobar towers. He reports that he normally had worked nights but had switched with someone so he was working at the time. He had just left the parking lot and was on his way to work when a terrorist drove a fertilizer bomb into the tower and exploded it. He reports that 19 people were killed and injured 100s more (all military personnel). He reports that he just missed being there where the truck was by about 5 minutes, and that even though his living quarters were farther away from the detonation spot, the glass blew out of the windows throughout the building and shredded his bed that he would have been in. He reports that there was a lock down but that he saw everything when he came back the next day. B. RE-EXPERIENCING SYMPTOMS (X)INTRUSIVE THOUGHTS: He reports daily. "Not a day goes by without thinking about it." He reports more intrusive thoughts around the anniversary date. He says that he thinks about it everyday, about being helpless and still very much angry. ()NIGHTMARES: He reports that he does not have nightmares at least that he remembers. (X)FLASHBACKS: He reports flashbacks related to fireworks or gunpowder triggers (less so but can still happen with loud noises). (X)EMOTIONAL DISTRESS: He reports significant distress with reminders (10 out of 10). (X)PHYSICAL REACTIONS: breathing heavily, heart pounding, shaking, palms sweaty when reminded of trauma which he reports can last minutes to an hour. C. AVOIDANCE SYMPTOMS (X)AVOID THOUGHTS: Try to avoid thinking about it but can't. Avoids situations where he might have to think about it. (X)AVOID THINGS: Try to avoid talking about it. "Proud" of fact that he served and it is on his business Facebook page. People are curious and they often ask about combat experience. Fear that it will come back to that. He notes that he has started to even avoid employees because they might ask about military experience. Avoiding a military friend who rotated out before the bombing, because of likelihood the conversation would be about the event. Lot of anxiety about talking about the event. Avoid Friday night Royals games because of fireworks. Avoided talking about it even with wife. Avoid stock car racing (used to enjoy going) because of the loud noise and trigger. Avoid pretty much anywhere there is a crowd. Find himself mostly at home or at work now. D. NEGATIVE THOUGHTS & EMOTIONS ()DISSOCIATION: (X)COGNITIVE DISTORTIONS (view of self, others, world): "The world is pretty scary". First time this kind of thing had happened to him, had never been exposed to anything like that. From small town USA before that. (X)EXCESSIVE RESPONSIBIILTY: Denies PARRATT, JEREMY L CONFIDENTIAL Page 35 of 85 (X)PRESISTENT NEGATIVE EMOTIONS: Anger, Sadness for people's families, Fear, (X)LOSS OF INTEREST: yes, especially related to triggers. Strictly bow hunt now instead of shooting firearms like he used to enjoy doing. (X)DETACHED/DISTANT: Confirms ()EMOTIONAL NUMBING: denies E. AROUSAL SYMPTOMS (X)IRRITABILITY/ANGER: 6 out of 10 daily. "It is always right there. Any little thing can set it off." ()RECKLESS BEHAVIOR: No (X)HYPERVIGILANCE: Daily; will have to argue with his wife for "back to wall" position when go out to eat. Will avoid going out because of that. (X)EXAGGERATED STARTLE: Daily. People at work try to scare him (walk up behind him). Have a pretty strong reaction to people walking up behind him. (X)CONCENTRATION: Read a lot in spare time and finds himself re-reading over and over, can't focus. Really bad at work, forgetting to do things at work. (X)SLEEP DISTURBANCE: Can fall asleep very easily. Usually wake up every night at 3pm. After a couple of hours can typically go back to sleep. 5-6 hours a night. Wake up exhausted daily. F. Veteran's duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Veteran reported symptoms following his service and the condition appears to be chronic. Other trauma history? Any traumas during developmental years? History of Neglect/Abuse/Exploitation/ Adult IPV etc): Veteran denies INCIDENCES/RISKS OF DOMESTIC VIOLENCE: Veteran denies any past history. ADDITIONAL PSYCHIATRIC AND SUBSTANCE USE ASSESSMENT REVIEW OF POSSIBLE COMORBID CONDITIONS: DEPRESSION: Current and past depressive symptoms seems to be a sequalae from PTSD rather than a distinct disorder, though more history may be needed to rule this out. MANIA: denied PANIC: None AUDITORY HALLUCINATIONS: denied PARRATT, JEREMY L CONFIDENTIAL Page 36 of 85 VISUAL HALLUCINATIONS: denied History of MH treatment: No prior history of counseling or therapy. No history of inpatient mental health treatment. Substance abuse history: No abuse treatment in the past. Current substance use: Alcohol: Veteran reports that on rare social occasions, such as family get togethers, he might have 5 or more drinks. He notes that right after he got out of the Air Force, he drank more heavily for a couple of years. He reports currently drinking socially and about 4 times a week, 3-4 beers related to his job as a brewer. Drugs: He reports that he has tried marijuana before as an attempt to deal with his anxiety symptoms, but reported that it made him more anxious when under the influence, "didn't agree with me". Synthetic marijuana or other "designer drugs": Denied Prescribed medication abuse: Never really taken prescriptions before until recently. No history of overuse. Tobacco: Not presently. Pack a day smoker for whole adult life until first child (13 years ago). Parents smoked while he was growing up. Smoked more after got out of military. Went from a pack every two to three days to a pack ? pack and a half a day. Caffeine: Drink coffee in the mornings, drink diet coke, a couple a day. Pattern of use: Veteran denies drinking more heavily now than before. Consequences of use: He denies any significant negative consequences from substance use. Family history of substance abuse and MH problems: denied MEDICAL &/OR PSYCHIATRIC ADVANCED DIRECTIVE *Does Veteran have one or both? No *If so, does Veteran need help completing or updating it? (If so, please complete or refer to SW) Veteran does not want advance directive assistance at this time MENTAL STATUS Appearance: casually dressed and groomed Behavior: cooperative Eye contact: established and maintained Mood: Moderately depressed and anxious Affect: congruent with mood Speech: fluent, normal production CONFIDENTIAL Page 37 of 85 Thought process: organized, goal-directed Thought content: appropriate to the topic Delusions: none noted or reported Hallucinations: does not appear to attend to internal stimuli Orientation: intact, x4, all spheres Memory/Concentration: not formally assessed, but grossly intact Fund of knowledge: within normal limits Judgment: fair Insight: fair SNAP Assessment: Strengths: Very motivated, determined when there is something to be done. Needs: None reported Abilities: Sense of humor, pretty easy to talk to. Preferences: Would prefer individual over group treatment at this time. Thinking about group treatment makes him anxious but he would be open to considering it. Mondays and Tuesdays, mornings if possible. PATIENT IDENTIFIED GOALS/PROBLEMS TO BE ADDRESSED IN TREATMENT "Would like to get over it. To get better. Things are escalating as far as the anxiety and avoidance and would like to not have to do that." USE OF COMMUNITY RESOURCES AND NEED FOR ADDITIONAL REFERRALS What resources do you use in your community? (e.g. Vet Center, Community Mental Health, Veteran organizations, etc) None at this time. QUESTIONNAIRES: Vet completed the PTSD symptom Check List (PCL5) and scored 75 out of 80 points. A score above 38 indicates possible PTSD. The Veteran obtained a score of 22 on the PHQ9 which suggests a severely depressed mood. DIAGNOSTIC IMPRESSION (According to the DSM-5): Diagnosis: Post-traumatic Stress Disorder, chronic CPT code 90791 RECOMMENDATIONS/PLAN: It is recommended that Veteran engage in trauma focused therapy to address PTSD and related symptoms. Veteran and provider discussed the diagnosis of PTSD as well as evidenced based treatment options which included individual trauma focused therapy treatments (Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). Also discussed group options, though Veteran indicated his preference for individual treatments at this time and that he was nervous just thinking about doing group therapy. He also indicated his preference for individual treatment and that he did not think that family PARRATT, JEREMY L CONFIDENTIAL Page 38 of 85 involvement was needed at this time. After the discussion of treatment options Veteran indicated that he was most interested in CPT. He indicated his preference for Monday or Tuesday appointments and for morning appointments if possible. -Veteran denies SI/HI. Also discussed how/when to access emergency mental health resources, including the emergency room 24 hours a day. Patient agreed to utilize these services as needed. Patient has written information including phone number to his primary care provider, the phone number to the Kansas City VA mental health clinic, and the 24 hour crisis Suicide Prevention Hotline number at 800-273-8255. /es/ MICHAEL REDD, PH.D. Licensed Marriage and Family Therapist Signed: 07/23/2019 16:45 Date/Time: 10 Jul 2019 @ 1456 Note Title: KC-TELEPHONE CONTACT Location: VA Heartland-West VISN 15 Signed By: BATES,TRACEY L Co-signed By: BATES,TRACEY L Date/Time Signed: 10 Jul 2019 @ 1457 Note LOCAL TITLE: KC-TELEPHONE CONTACT STANDARD TITLE: TELEPHONE ENCOUNTER NOTE DATE OF NOTE: JUL 10, 2019@14:56 ENTRY DATE: JUL 10, 2019@14:57:03 AUTHOR: BATES,TRACEY L EXP COSIGNER: URGENCY: STATUS: COMPLETED Contact Number:Cell: (816)510-1846 Contacted Veteran regarding ***************COPIED AND PASTED******************* LOCAL TITLE: Addendum STANDARD TITLE: ADDENDUM DATE OF NOTE: JUL 10, 2019@12:38 ENTRY DATE: JUL 10, 2019@12:38 AUTHOR: ANYANIKE,TISHA D EXP COSIGNER: Please alert pt that his labs are all ok except for a low vitamin D at 16.8 (normal 30-96). I want him to take high dose ergocalciferol 50,000 units weekly for 12 weeks then start taking cholecalciferol 2000 units po daily. I will mail this to him. Recheck with next routine labs.

My DD214 shows I received the Armed Forces Expeditionary medal with 1 oak leaf cluster. That should show them that I was at least in theater during my enlisted dates. I am trying to figure out how to upload a scan of it and of the psychiatrist report but I am not having any luck figuring out how to attach it so that you can read it on here.

I was literally just diagnosed at the VA by the doctor Monday. I keep reading that you should wait for at least a month to 6 months to show that it is a continuous problem. Is that not the case in your opinion? In my med files on myhealthevet, the doctor said I self reported the stressor as the bombing of Khobar Towers so the link is clear as far as being in the report that he filed.

First off thank you for this site and any help I can get. I was USAF and deployed to Saudi and was barracked at Khobar Towers when it was bombed in 96. For the last couple of years, I have started to show a lot of signs of PTSD. I recently went and talked to my Primary Care doc at the VA and she referred me to mental health. I sat and talked to a doctor for over an hour and a half and he diagnosed me with PTSD, depression and anxiety. I also have tinnitus and sleep apnea. I am going to go about starting a PTSD claim and filed my intent to file yesterday. I got on Milconnect and ordered my OMPF files. What I got back in a pdf is my seperation file, my DD214, my enlistment papers etc. No medical records and no copies of orders which I could then use to show I was there. I am sure it would be helpful to have those. What channels do I need to start looking into for my TDY orders? Thank you!