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Found 159 results

  1. Hi everyone! Hope all is well! My boyfriend has his C/P on Saturday for his increase request that he put in back in November. Can you give your opinions on the results of the C/P? VA Notes Source: VA Last Updated: 18 Mar 2015 @ 0431 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: 14 Mar 2015 @ 0930 Note Title: COMP & PEN GENERAL MEDICAL EXAM NORTH TEXAS HEALTH CARE SYSTEM - DALLAS DIVISION KOKEL,JIM S KOKEL,JIM S Location: Signed By: Co-signed By: Date/Time Signed: 14 Mar 2015 @ 0940 LOCAL TITLE: COMP & PEN GENERAL MEDICAL EXAM STANDARD TITLE: C & P EXAMINATION NOTE DATE OF NOTE: MAR 14, 2015@09:30 ENTRY DATE: MAR 14, 2015@09:40:43 AUTHOR: EXP COSIGNER: URGENCY: STATUS: COMPLETED Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire Name of patient/Veteran: Indicate method used to obtain medical information to complete this document: [ ] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. [ ] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional CONFIDENTIAL Page 5 of 134 relevant evidence. [ ] Examination via approved video telehealth [X] In-person examination Evidence review --------------- Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: vbms 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a thoracolumbar spine (back) condition? [X] Yes [ ] No Thoracolumbar Common Diagnoses: [ ] Ankylosing spondylitis [ ] Lumbosacral strain [X] Degenerative arthritis of the spine [ ] Intervertebral disc syndrome [ ] Sacroiliac injury [ ] Sacroiliac weakness [ ] Segmental instability [ ] Spinal fusion [ ] Spinal stenosis [ ] Spondylolisthesis [ ] Vertebral dislocation [ ] Vertebral fracture Diagnosis #1: lDDD and facet DJD Date of diagnosis: increase sc 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's thoracolumbar spine (back) condition (brief summary): initiall hurt l-s on patrol in afganistan in a fire fight. he has had 2 facet injections and helped x 2 weeks only. sch for ablation 3-27-15. chiropractic therapy did not help. b. Does the Veteran report flare-ups of the thoracolumbar spine (back)? [X] Yes [ ] No If yes, document the Veteran's description of the flare-ups in his or her own words: lbp every day and constant. pains are usually sharp, averages 7, can CONFIDENTIAL Page 6 of 134 go higher earlier in am and cant put on socks. agggrevated by sitting long periods, walking, standing, sex. no pains in legs, no numbnes in legs. wears a back brace. no surgery. compared to military to now it is now about 60 % worse. pains are alot more freq/worse, cant do things like he used to do. affects his sleep. c. Does the Veteran report having any functional loss or functional impairment of the thoracolumbar spine (back) (regardless of repetitive use)? [ ] Yes [X] No 3. Range of motion (ROM) and functional limitation -------------------------------------------------- a. Initial range of motion [ ] All normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Forward Flexion (0 to 90): 0 to 40 degrees Extension (0 to 30): 0 to 5 degrees Right Lateral Flexion (0 to 30): 0 to 15 degrees Left Lateral Flexion (0 to 30): 0 to 15 degrees Right Lateral Rotation (0 to 30): 0 to 20 degrees Left Lateral Rotation (0 to 30): 0 to 20 degrees If abnormal, does the range of motion itself contribute to a functional loss? [X] Yes (please explain) [ ] No If yes, please explain: pains with rom Is there evidence of pain with weight bearing? [ ] Yes [X] No Is there objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine (back)? [ ] Yes [X] No b. Observed repetitive use Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional loss of function or range of motion after three repetitions? [ ] Yes [X] No c. Repeated use over time Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No CONFIDENTIAL Page 7 of 134 Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [X] No [ ] Unable to say w/o mere speculation d. Flare-ups Is the exam being conducted during a flare-up? [ ] Yes [X] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups? [ ] Yes [X] No [ ] Unable to say w/o mere speculation e. Guarding and muscle spasm Does the Veteran have guarding or muscle spasm of the thoracolumbar spine (back)? [ ] Yes [X] No f. Additional factors contributing to disability No response provided 4. Muscle strength testing -------------------------- a. Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Hip flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Knee extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle plantar flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle dorsiflexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Great toe extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 CONFIDENTIAL Page 8 of 134 b. Does the Veteran have muscle atrophy? [ ] Yes [X] No 5. Reflex exam -------------- Rate deep tendon reflexes (DTRs) according to the following scale: 0 Absent 1+ Hypoactive 2+ Normal 3+ Hyperactive without clonus 4+ Hyperactive with clonus Knee: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Ankle: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam --------------- Provide results for sensation to light touch (dermatome) testing: Upper anterior thigh (L2): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Thigh/knee (L3/4): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Lower leg/ankle (L4/L5/S1): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Foot/toes (L5): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent 7. Straight leg raising test ---------------------------- Provide straight leg raising test results: Right: [ ] Negative [X] Positive [ ] Unable to perform Left: [ ] Negative [X] Positive [ ] Unable to perform 8. Radiculopathy ---------------- Does the Veteran have radicular pain or any other signs or symptoms due to radiculopathy? CONFIDENTIAL Page 9 of 134 [ ] Yes [X] No 9. Ankylosis ------------ Is there ankylosis of the spine? [ ] Yes [X] No 10. Other neurologic abnormalities ---------------------------------- Does the Veteran have any other neurologic abnormalities or findings related to a thoracolumbar spine (back) condition (such as bowel or bladder problems/pathologic reflexes)? [ ] Yes [X] No 11. Intervertebral disc syndrome (IVDS) and episodes requiring bed rest ----------------------------------------------------------------------- a. Does the Veteran have IVDS of the thoracolumbar spine? [ ] Yes [X] No 12. Assistive devices --------------------- a. Does the Veteran use any assistive device(s) as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [X] Yes [ ] No If yes, identify assistive device(s) used (check all that apply and indicate frequency): Assistive Device: Frequency of use: ----------------- ----------------- [X] Brace(s) [ ] Occasional [X] Regular [ ] Constant b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided. 13. Remaining effective function of the extremities --------------------------------------------------- Due to a thoracolumbar spine (back) condition, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc.; functions of the lower extremity include balance and propulsion, etc.) [X] No 14. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, CONFIDENTIAL Page 10 of 134 complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No c.Comments, if any: No response provided 15. Diagnostic testing ---------------------- a. Have imaging studies of the thoracolumbar spine been performed and are the results available? [ ] Yes [X] No b. Does the Veteran have a thoracic vertebral fracture with loss of 50 percent or more of height? [ ] Yes [X] No c.Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No 16. Functional impact --------------------- Does the Veteran's thoracolumbar spine (back) condition impact on his or her ability to work? [X] Yes [ ] No If yes describe the impact of each of the Veteran's thoracolumbar spine (back) conditions providing one or more examples: manual 17. Remarks, if any: -------------------- No remarks provided. Thanks!
  2. Folks: It's a long story and I'll spare you most of the details. Anyway, when I first filed my FDC claim, I did 13 DBQ's and the subsequent exams that go along with them to speed along the FDC. So, little happened at first for over 6 months as my claim was stuck in "Review". The original estimted completion dates for my claim went from 15 months to 31 months as of 12/10/2014? So, I filed a FOIA to enusre that all of my files were present and were digitised into the VBMS System.? But..this action appeared to birng my case to a screeching halt? After several FOIA status letters, I got a letter from the RO that I could come down and review my C-File? Well, when I got there...they were surpised that I showed up and said "no" at first to reviewing the file and then after I spoke up said, "not then" but a very nice VBA Rep helped me before I left and later on another call a few days later. I was told that VBA had to go out and find "all" of my records and that's the reason for the extra time? I argued that they already had "all" of my records beause I filed an FDC and further certifited earlier that all of my records were in their possession already as part of my FDC package. Also, I argued that with all of the extensive prep work that I did that it made no sense to double my claim completion dates and it should have actually cut them in half...and the VBA Rep agreed. Also, he notified me yesterday that I was being scheduled for at least four new ACE Exams for Tinnitus, Obstructive Sleep Apena, Gulf War Issues and one I could not remember? I already have SMRS' confirming all of this including a lot of audiology tests in the military. I was involved in a surprise explosion as a Tank Commander without hearing protection being on me. I would not have been wearing protection at that time anyway based upon the mission. But, it's interesting that they would do something like this Tinnitus Test over the phone anyway? Because, I'm not familiar with these (ACE Exams) I am doing my research now to prepare, I'm not sure if it's either, good, bad or nuetral that we are doing ACE instrad of more C&P Exams? I know that the Hadit.com Forum has some information on the ACE Exams and I'm doing my reserach now. Consequently, my file does have very extensive SMR evidence (about 1500 pages) and the OSA was diagnosed in the Military and again by a very prominent Sleep Doctor in the civilian Sector who confirmed it. Frankly, I have not sleapt in the same room with my wife for many years because she says that my night time breathing really scares her? Frankly, that's my biggest motivator to get this claim done so I can get some help on the OSA...otherwise some OSA patients stroke out and have many other issues that I'm really worried about now. Anyway, if anypone can shed some light on the ACE's and how they work, I would appreciate it..
  3. I have been reading on this forum and am really nervous about the C&P exam that I have coming up this Thursday. It seems there are so many horror stories. I was triggered with PTSD summer of 2013 and had to call VA crisis line Nov 2013 when I was thinking of killing myself because I was becoming so unraveled and didn't understand why...hadn't been in the service since 1996 and didn't even know that MST existed...it wasn't until i talked to the crisis DR follow up the next day that he said it sounded like I had PTSD. I thought PtSD was just for people who saw war. I was out of on short term disability at work in Nov 2013, Dec 2013, March 2014, and haven't been able to work since June 2014. Since June 2014 I have been hospitalized 3 times for PTSD and Bipolar. The first hospitalization was at a VA facility and I was there only for the PTSD-MST. It wasn't until then that I found out that I could even get compensation for what happened to me in the military where I was gang raped. It took me until the end of Aug before I could even write a statement to file my claim. I have been suicidal since then a handful of times, disassociate, blah, blah, blah. I use to work full time, working on a Grad degree, second bachelors, and have two kids. I couldn't even keep my kids at home over christmas break and had to pay for daycare because I can't handle having them at home even though I dont' work. I even applied for the VA CWT program where they help you find a job and have a disability. They dropped me from the program saying I was "occupational maladjustment disorder". I'm concerned about the whole proof thing like many others who have posted here. I'm also afraid that they will think I am exagerating my symptoms, although my VA counselor has stated that I can't do CBT for the MST until I have sufficient coping skills which right now I do not. OK...proof...when the rape happened I was on shore duty and the perps where stationed on a submarine. When word got out they started an investigation on the submarine but nothing ever came from it. Shortly after I was asked to move off base and couple months later had to get tested for STD and turned out they left me with a parting gift. Is this enough? What I went through was so traumatic I don't know if I can take someone telling me it didn't happen. Second question. My VSO said that my statement should be enough since they should be able to pull records to cooberate my story. They have my VA hospitalization and treatment records since Nov 2013. Should I upload my hospital documents from the other two hospitalizations? My VSO thinks it will delay my claim and understands what a financial strain I am under now with not being able to work. What do you think? What can I expect? We are falling so far behind bills, I'm pulling my hair because I have gone from a someone to a nobody in a matter of a year. Anyhow any advice would help....thanks
  4. Folks: At this point it looks like I finished all of my C &P exams last week and I'd like to know what happens next from you seasoned, Hadit.com veterans? Although I'm not satisfied with all of the exams, I did get to retake the one that I was most concerned about and suspect I'll be appealing some contentions? Also, originally, I submitted 13 DBQ's with exams as part of my claims submission package, so that part of my claim is very robust. I'm not sure I would have done the DBQ's again because I retook most of the same exams again anyway and it just cost me more time in the process? That said, I was never able to confirm that all of my hard copy files ever got fully digitized into the VBMS System? I did get a "verbal" from a senior VBA official that they were in fact there? But, like many vets, about half of my service medical records (SMR's) are handwritten by military doctors and I believe they don't get the same attention as the newer chrisp typed records that come out of DOD and the VA Systems today? For me, some of my most important SMR evidence is on these handwritten SMR's. So, I was advised by some seasoned, claims veterans that have turned in claims over the years to provide statements of support and buddy statements to bridge that gap for the VBA claims raters? It's supposed to "tell the full story" so the raters can peice it all together? One note is that I'm more convinced now then ever after my interactions with examiners that the final outcome of a claim is due in large part to the "luck of the draw" and who works your claim? In one case, I came across someone, whom had their mind already made up before I ever walked thru the door and I suspect that this is more of a "personality type" than the way business is usually done. Just like "global warming", some may have a bias that the whole "Gulf War Syndrome" an in their opinion, it just - does not jibe? However, although there are examination rules, policies, regulations, etc. in place ...many professionals also have a lot of subjective leeway in filling out the forms and personal biases and if you "draw" someone like that, it's like a spawning salmon,( you or me) are swimming against the current to get where you need to go..to get your just due?
  5. Here are the results of my c&p exam...would like opinion on rating and whether they might give me tdiu that I applied for...thanks ahead of time for your input,,, I tried to narrow down the exam to only the important info... 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [X] Yes [ ] No ICD code: F43.10 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD, chronic ICD code: F43.10 Mental Disorder Diagnosis #2: Bipolar I Disorder, mixed ICD code: F31.13 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Hypertension, Obesity 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: hx of trauma, nightmares, flashbacks, traumatic memories, hypervigilance, avoidance of reminders of trauma, persistent guilt Bipolar I: mood swings, manic episodes and depressed mood, low self esteem, increased appetite and weight gain 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 level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [X] Yes [ ] No [ ] No other mental disorder has been diagnosed If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: PTSD: 60% Bipolar: 40% 2. History ---------- Veteran reports she has not been able to work since June 2014. Worked 4 out of the last 14 months. Worked at the Verizon call center doing tech support. "Had a good job and made good money. Having issues maintaining my composure. I was dissociating especially on breaks. Jumpy and emotional. Ususally very laid back person. Customer service don't always get nice customers. Started getting written up for poor performance. She reports she was on a leave of absence for 6 mos and then was let go because she was unable to perform her job. Too many triggers". She was told by her Dr Putatunda, psychiatrist, that she could not work. CWT: voc rehab at VA. 4. PTSD Diagnostic Criteria --------------------------- Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, 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 symptomsith 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] Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent 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, distorted cognitions about the cause or consequences of the traumatic event(s) that lead to 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 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] 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 I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Panic attacks more than once a week [X] Chronic sleep impairment [X] Flattened affect [X] Impaired judgment [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Suicidal ideation 8. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any -------------------------------------------------- Medical Opinion: "Does the Veteran have a diagnosis of (a) posttruamtic stress disorder that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) miitary sexual trauma during service? Yes, the Veteran symptoms of posttraumatic stress disorder do meet DSM-5 criteria and are as least as likely as not (50 percent or greater probability) incurred in or caused by (the) miitary sexual trauma during service. Veteran has been working, studying and trying to function in her marriage, family and work settings. She has legitimately sought professional help for her sx and continues to do so. She has beenhospitalized three times for sx related to PTSD and bipolar disorder. The Veteran was consistent in her presentation and facts. She is compliant with treatment. In your opinion, is it at least as likely as not, that the Veteran's documented history of STD on exit exam dated 5/28/1996 supports the occurrence of the described military sexual assault in November 1992? In my clinical opinion, the documented history of STD on exit exam dated 5/28/1996 does support and add validity to the Veteran's claim of military sexual assault.
  6. Hi all, I was wondering about a letter I received from the VA. It says for IU that "The Veteran must periodically cerify continued unemployability, but if there is no scheduled future reduction or medical examination required, he/she may be considered by some states to be permanently and totally disabled." Does anyone happen to know what states those are? I have TDIU and was wondering if I should expect a C&P in the future, even though its been 4 years without one. Thanks!
  7. I wasn't sure what to title this and where to put it. timeline: November 2011, rated 70 % SC for MH. Including PTSD, Bipolar, yadda yadda. 2011-Present time, Lots of counselings and changing of Meds. About a month ago, I went to my regular physical doctor at VA. I told her that I still have suicidal thoughts. She made me see the counselor. I talked to counselor in October, and she made an appointment for me on Nov 10, 2014. She said I can bring my wife if I wanted to, and I did. We shot the bull and talked about how things were getting better for us, etc. I am trying to get back in shape and started walking/jogging a while back. Also, I need to add, that my VA psychiatrist changed my drugs from one thing to Lithium. I told the counselor that I believe the drugs were a good thing, so far. I noticed on my BlueButton MyHealtheVet, that she marked that I was doing better, etc, etc, etc.. Well, for one, I don't want to talk about all the bad stuff when my wife is sitting next to me. Because everything I say will be used against me (trust me). I get a call this Monday, (17 November) from the C&P people. They said I need to come in for a C&P re-evaluation or a yearly evaluation for my MH claim. 19 November, I showed up at this C&P reevaluation, and the Dr. asked, Do you know why you are here? I said no ma'am. And she explained that the VA was making sure that I was being properly taken care of, and that my benefits didn't need to be bumped up. When I was in the office with this Dr., my body felt like it was on fire. My chest started beating fast. My hands were shaking. I was crying, etc. She asked me to tell her what the following meant, "Don't Count your chickens before they hatch". I just repeated it like a fool like 5 or so times. I honestly believe that the new drug that they gave me started to kick in. She wanted to put me in the Mental Jail, But she kept asking me if I wanted to go there, but I told her, I prefer not. She said, what if I make you? I said, you got to do what you go to do, but I Prefer not. Those people in the mental ward are literally crazy people. I'm depressed and act all weird, but I'm not "crazy" like some of those. In the mental ward, there was this one guy that kept shitting on everything. I'm not like that. I'm glad that she seen me in my bad times, since it was a C&P exam. But, I am so Scared that they are going to re-evaluate me and say that I don't deserve the 70% that I get. I already feel as though I am using the system, and it makes me feel really bad for having to "prove" my insanity. I wish I could go back in time and not ever go to the VA. I want life to be like it was before I went to Afghanistan in 2011. Anyway, if these post are supposed to be in the form of a question, What is the chances of them downgrading my % ?
  8. I served from '68 to '72. I filed for severe hearing loss, tinnitus, and PTSD in 2007. I received 30% on the hearing and tinnitus. They denied the PTSD for lack of proving stressor incident. At that time I had no idea where to get copies of my ships logs as I had assumed they would get them. I did not file a NOD. I continued to be treated for PTSD by the VA for the next few years. As my condition seemed to be worsening, my Dr. asked why I was not receiving compensation so I could retire and alleviate some stress? In June 2012, I found the official logs of the incidents and re-filed. After a C&P exam they awarded 50% PTSD for a combined rating of 60% in September 2012. I filed a NOD immediately and had another C&P in June 2013. In July they raised the percentage to 70% PTSD and a total of 80%.I then filed for IU and also another NOD on the original claim. In Jan 2014 they denied the IU. They also showed I had withdrawn my NOD to the original claim. (I contested this and in August they put the NOD back as active) I also have a rare cancer that was stage 4 when found in 2010 by the VA (not Service connected) Unlike most cancers, this is very slow growing but has no FDA approved treatment here in the US. (When found the VA told me to go home and get my affairs in order as they had no treatment for it) I went to Germany for 3 treatments in 2012 which halted the progression of the cancer. It did not cure it, but bought me some time. When I filed with SS for disability retirement, I filed for PTSD and when asked did I have any other conditions, I told them about the cancer. They looked it up and told me this cancer was on their automatic list and they could grant it immediately. The VA in their IU denial stated that I was IU, however since SS granted disability on the cancer, it was not service connected so they had to deny. I filed a NOD explaining I did not file with them or SS for disability on the cancer, but for PTSD. Along with the NOD I submitted a letter from the chief VA psychologist who was treating me who explained the severity of my PTSD and the added depression from the cancer diagnosis aggravated my PTSD symptoms and according to his treatment notes he advised retiring to alleviate stress for the last year before I actually retired. October 8th, I received a phone call from the DRO. She asked if I would take another C&P exam and then a hearing. I agreed. I had the C&P exam on Monday October 27th and the DRO hearing was scheduled for the following Thursday October 30. The C&P examiner volunteered at the end of my exam "you have taught me something today. I had an earlier exam today claiming depression and I could not see it. Yours is real. I feel it." Her words, I seen no reason the VA to deny you benefits. When I met with the VSO prior to the hearing, he was not even aware the DRO had scheduled another C&P exam. He tried to see if they had received it yet. They had not. We explained what the current exam Doctor had quoted and pointed out on the prior C&P exam June 2013 which raised it to 70% the Dr. had said I had already retired due to the Cancer at the time of the exam. This was incorrect. I did not retire until the month after that exam and retired due to my service connected disability PTSD. He went next door and spoke with the DRO and came back and asked would I settle for an informal hearing. I agreed. The VSO introduced us to the DRO and then went mute. My wife presented the case to the DRO explaining the above info and showing her the letter (which was supposed to have been in my file along with the NOD) to the DRO. She asked who this Dr. was that wrote the letter (It was on official VA letterhead and showed his official capacity with the VA and his credentials) My wife explained who he was. It was obvious she had not reviewed my file prior to the hearing. She said this would depend on what the C&P report said (we did not tell her what the C&P exam doctor had quoted to us) She also stated it was good this hearing was informal as she could move forward with her decision and notification should be forthcoming sooner since she would not have to wait for a transcription of the hearing. Does any of this mean anything?
  9. I figured out how to post my C&P exams to the board. I posted some of this in the MST forum but would like opinions as to what anyone thinks regarding my C&P for PTSD due to MST and my Eating Disorder C&P. I know now that the Eating Disorder (thanks to a nice member here on this forum) will be rated separately but I am more curious about the PTSD C&P exam. The examiner denies PTSD but goes on to say "veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire:" Thank you for any and all input! **************************************************************************************************************************************************************** Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: XXXXX SECTION I: ---------- 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 If no diagnosis of PTSD, check all that apply: [X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [X] Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire: 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Anorexia Nervosa, purging type due to MST Comments, if any: See Eating Disorder DBQ Mental Disorder Diagnosis #2: Other Specified Trauma and Stressor - Related Disorder due to MST Comments, if any: subclinical level of PTSD, which is difficult to determine given the severity of her eating disorder and the overlap in areas regarding the symptom profile presentation b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): ankle pain Comments, if any: fracture of ankle and injury of ankle inservice after syncope episode secondary to excessive compensatory behaviors 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: Symptoms such as purging through the use of laxatives, excessive food restriction and distorted perceptions regarding body image, excessive weight loss and consistent worrying about weight control are directly related to Veteran's diagnosis of Anorexia Nervosa, binging/purging type. Symptoms such as intrusive memories related to the MST and avoidance of conversations, people, and places related in some way to the MST, guilt and shame related to MST and distorted cognitions about the cause of the MST that lead to individual blame are directly related to Veteran's Other Specified Trauma-and Stressor- Related Disorder. Her symptoms and resulting social and occupational impairments related to reported difficulty concentrating, anxiety and sleep disturbances are related to both disorders as Veteran reported experiencing anxiety and subsequent difficulty concentrating and sleeping secondary to persistent thoughts about her body image and some thoughts about the MST. 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 occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [X] Yes [ ] No [ ] No other mental disorder has been diagnosed If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: Symptoms such as purging through the use of laxatives, excessive food restriction and distorted perceptions regarding body image, excessive weight loss and consistent worrying about weight control are directly related to Veteran's diagnosis of Anorexia Nervosa, binging/purging type. Symptoms such as intrusive memories related to the MST and avoidance of conversations, people, and places related in some way to the MST, guilt and shame related to MST and distorted cognitions about the cause of the MST that lead to individual blame are directly related to Veteran's Other Specified Trauma-and Stressor- Related Disorder. Her symptoms and resulting social and occupational impairments related to reported difficulty concentrating, anxiety and sleep disturbances are related to both disorders as Veteran reported experiencing anxiety and subsequent difficulty concentrating and sleeping secondary to persistent thoughts about her body image and some thoughts about the MST. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by theTBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence review ------------------ In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: ------------------------- Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes [ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: C-file reviewed via VBMS/Virtual VA If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [X] Yes [ ] No If yes, describe: 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): Prior Military: Veteran was raised by her mother until she was 11 years old. At that time her mother remarried, resulting in her gaining an older step-sister and a step-father. She described her relationship with her mother, step-sister and step-father as good. "He was the father I never had." Veteran denied any childhood sexual or physical abuse. She further reported having a normal childhood, overall. She reported engaging in normal childhood activities including various sports. Veteran denied getting married or having any children before enlisting in the military. During Military: Veteran reported maintaining contact with her family. She also reported getting along well with other service persons. Initially, during her leisure time she reported spending time with other military personnel and engaging in various social activities. However, shortly after boot camp, she reported a reduction in engaging in social activities secondary to her obsession with focusing on weight loss. Details will be provided in an eating disorder DBQ. Veteran reported getting married to her first husband in September 1990. To this union a child was born in June 1991. Shortly after their child was born, Veteran and her husband divorced. She attributed their divorce to them both being too young. Veteran remarried in December 1993. To this union her second child was born in February of 1996. Post Military: Veteran and her second husband were divorced in 2003 secondary to irreconcilable differences. Despite divorce, she reported maintaining a good relationship with her children. She is currently in a romantic relationship with her partner of 2 years. They have been in a relationship, which she describes as good, since 2012. During her leisure time she reported exercising 3-4 times for about an hour, spending time with friends, watching sports, and taking care of their dog. b. Relevant Occupational and Educational history (pre-military, military, and post-military): Prior Military: Veteran reported graduating from high school on time and receiving and diploma. She reported maintaining a B average and denied being diagnosed with any learning or developmental Veteran denied any behavioral problems resulting in her being suspended or expelled from school. She reported participating in volleyball, track, softball, and the drama club. Veteran reported working at Sea World while in school and denied being terminated or reprimanded. Veteran reported completing one semester of college before enlisting in the military. "I flunked out. My father gave me the option of going to college or joining the military." During Military: Veteran served active duty in the US Navy from May 1990 - April 1996. Her MOS was Intel Specialist. She was honorably discharged as an E3 and denied any reduction in rank or pay. She denied receiving any Article 15s or negative counseling statements. In boot camp Veteran reported being berated for being overweight, which continued throughout her military service. This beratement had a negative impact on her emotional well-being. Veteran reported not being able to perform her job as she should and an increased amount of undocumented sick call visits in 1991-1993 secondary to MST, subsequent eating disorder, syncope and breaking of ankle due to compensatory behaviors utilized to control her weight. Post Military: Veteran attended and completed paralegal school. She reported working multiple jobs as an executive assistant and parlegal secondary to relocations. She denied ever being terminated or reprimanded. Veteran is currently working as a paralegal at Jaderisk, where she has worked for a year since she moved to Texas. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Prior Military: Veteran denied any personal or family history of any mental health disorder to which she is aware. She denied any personal or family history of suicide attempts. Veteran also denied any personal or family history of alcohol or drug addiction to which she is aware. During Military: Service treatment records dated Septebmer 1994, documented that Veteran was referred to the Psychology Clinic in Bethesda secondary to stress and signficant weight loss (approximately 30 pounds since February 1994). Service treatment records also confirm multiple episodes of unexplained syncope, ankle injuries, in addition to episodes of eating disorders and subsequent weight loss beginning in 1990s. During the current evaluation, Veteran reported multiple incidents of sexual harrassment after being transferred to Water Front Operations in San Diego, beginning in September of 1992. She further reported that harrassment eventually progressed to a sexual assault (rape) occuring in November 1992. Service treatment records also document Veteran's pregnancy and subsequent miscarriage in December 1992. During the current evaluation, Veteran reported that the pregnancy was the result of the MST occurring in November 1992. Veteran reported the following symptoms after the MST: difficulty initating and staying asleep secondary to her fear of having nightmares about MST. She additionally reported having a significant amount of difficulty sleeping secondary to taking laxatives excessively resulting in her having to use the restroom throughout the night and thoughts about controlling her body weight. She also reported experiencing anxiety, which she described as being fidgety, restless and unable to stay calm and racing thoughts about loosing weight. "I was constantly thinking about loosing weight. I was so engrossed in it. I constantly weighed myself and had been exercising too much over not eating. I couldn't get myself to throw up. But I could get myself to have loose stools." Post Military: Electronic records confirm that Veteran came to the VA as a walk-in through MH triage secondary to eating disorder issues in June 2014. She reported being depressed a couple of times a week in addition to the MST. The following diagnosis were given during her mental health history in July 2014: Anorexia nervosa with restricting and purging behaviors, mild BMI is 22.81 and Generalized Anxiety Disorder. It was also suggested that the following diagnosis be ruled out: PTSD due to MST, Unspecified depressive disorder with OCPD traits. Veteran was initially prescribed Fluoxetine (Prozac), Hydroxyzine, and Trazadone to manage her symptoms. Hydroxyzine was discontinued, but Veteran continues to take Prozac and Trazadone as prescribed. Veteran experiencing the following symptoms: anxiety about her weight and thoughts about the MST, difficulty initiating and maintaining sleep secondary to racing thoughts about MST and weight, excessive use of laxatives to manage weights, intermittent depressed mood which she describes as crying and withdrawal. She reports that it may last 2-3 days a week. Please note, that with regard to sleep CPRS records document that Veteran is sleeping well with Trazadone. Therefore, nightmares likely occur to a minimal degree at this time. "It just depends on if I am thinking about it. I try to block it out. But I knowthat going through therapy now I am going to have to deal with the issues." She also reported feeling guilty and the MST. "I sometimes feel as if it was my fault." She also reported becoming angry, which she describes as being emotionally angry. "I don't lash out at any other people. But I am angry at myself for having the eating disorder, but I am afraid to get fat. I am just emotional when I think about the sexual trauma. She denied major difficulty concentrating or manic symptoms. Veteran also reported continuing to have a significant amount of sadness because of the miscarriage. "Regardless of how it was conceived. I still have sadness because I lost my baby. Those thoughts will never leave my mind."Veteran denied SI/HI, AVH, psychiatric hospitalizations. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): Veteran denied any legal or behavioral problems, before during or after military. e. Relevant Substance abuse history (pre-military, military, and post-military): Veteran denied use of illegal drugs before during and after military service. She acknowledged occassional use of alcohol but denied abuse. She also denied receiving any DWIs, DUIs public intoxications, or attendance at any substance abuse treatment programs. Veteran also denied anyone ever telling her that she drank too much and needed to cut back. f. Other, if any: No response provided. 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: Veteran reported that in September of 1992, omitted the statement here to graphic and too personal.... 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: non-combat related 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. 1) December 1992, documented pregnancy and miscarriage. 2) Reported attempts and documentation of her going to sick call,for miscarriage. Veteran also reported multiple sick call visits that are undocumented in order to avoid her perpetrator. 3) Reported documentation of significant loss of body weight over short periods of time ---loosing 20 pounds over in boot camp, which lasted 6-8 weeks, loosing 62 pounds over 5 months after birth of her daughter. 4) December 1991 seen in emergency room secondary to syncope, fractured ankle secondary to excessive use of compensatory behaviors to lose weight. 5) Service treatment records dated Septebmer 1994, documented that Veteran was referred to the Psychology Clinic in Bethesda secondary to stress and signficant weight loss (approximately 30 pounds since February 1994). b. Stressor #2: In November 1992, Veteran and her supervisor (1st class petty officer) again omitted the statement here as too graphic and personal but this is where I provided the details of the attack/rape 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: non combat related 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. 1) December 1992, documented pregnancy and miscarriage. 2) Reported attempts and documentation of her going to sick call, for miscarriage. Veteran also reported multiple sick call visits that are undocumented in order to avoid her perpetrator. 3) Reported documentation of significant loss of body weight over short periods of time ---loosing 20 pounds over in boot camp, which lasted 6-8 weeks, loosing 62 pounds over 5 months after birth of her daughter. 4) December 1991 seen in emergency room secondary to syncope, fractured ankle secondary to excessive use of compensatory behaviors to lose weight. 5) Service treatment records dated Septebmer 1994, documented that Veteran was referred to the Psychology Clinic in Bethesda secondary to stress and signficant weight loss (approximately 30 pounds since February 1994). 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criteria 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 Criteria 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 violation, 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). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead to the individual to blame himself/herself or others. [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). 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 [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] Chronic sleep impairment 6. Behavioral Observations -------------------------- Veteran arrived promptly for her scheduled evaluation. She self-identified as a 43 year old Caucasian female who appeared her stated age. Her grooming and hygiene were good. Her posture and gait were unremarkable. She maintained good eye contact. There were no abnormalities noted in psychomotor activity or gross motor activity. She was cooperative with no inappropriate behavior observed. Her rate and flow of communication was clear, logical, and coherent with no indications of irrelevant, illogical, or obscure speech patterns. Thought processes were clear, coherent and goal directed. Thought content was unremarkable and void of any perceptual or delusional disturbances. The veteran's mood was anxious and her affect was of full range. Veteran became tearful when discussing her military experiences including the military sexual trauma and constant beratement related to her weight. She denied current SI/HI. 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 -------------------------------------------------- Given the current predominance of Veteran's eating disorder, she does not currently meet full criteria for PTSD. Therefore, Veteran was diagnosed with Other Specified Trauma and Stressor Related Disorder (subclinical level of PTSD) which is at least as likely as not related to reported military sexual trauma. There is no prior evidence of a mental health disorder. The exacerbation of Veteran's eating disorder, which began in the military in response to beratement related to her weight, was a response to MST, documented pregnancy and miscarriage. STRs document referral to a psychology clinic due to stress and excessive weight loss over a short period of time. It is additionally documented that Veteran was hospitalized due to syncope, ankle fracture resulting from eating disorder. It should be noted that eating disorders often develop as a method of coping with a stressor of which an individual feels he/she has no control over. Veteran continues to engage in behaviors that have resulted in her diagnosis of an eating disorder in service. It is possible that Veteran has continued to engage in these compensatory behaviors to manage her weight because it is an aspect of her life she feels she can control, unlike the MST event. Rationale within in this section and the stressor section of this evaluation confirm that it is at least as likely that the reported MST occurred and restulted in current Other Specified Trauma and Stressor Related Disorder (subclinical level of PTSD)symptoms. It should be noted that once Veteran's eating disorder is treated, resulting in remission, it will be easier to more accurately access for the prescense of other mental health disorders. Please refer to the Eating Disorders DBQ for more specific details and medical opinions regarding Veteran's diagnosis of Anorexia Nervosa. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application ****************************************************************************************** *** COMP & PEN MENTAL HEALTH/PSYCHOLOGY EXAM Has ADDENDA *** Eating Disorders Disability Benefits Questionnaire Name of patient/Veteran: XXXXXXX 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with an eating disorder(s)? [X] Yes [ ] No [X] Anorexia Date of diagnosis: 1992 ICD code: 307.1 Name of diagnosing facility or clinician: U.S. Military diagnosed eating disorder and VANTXHCS diagnosed Anxorexia Nervosa binging/purging type 2. Medical history ------------------ Describe the history (including onset and course) of the Veteran's eating disorder (brief summary): Veteran reported being constantly berated secondary to her weight in boot camp. As a result, in August/September 1990 she began engaging in compensatory behaviors to manage her weight including laxatives, food restriction, and excessive exercising. Veteran was 178 pounds at the beginning of boot camp, which lasts 6-8 weeks. At the end of boot camp she was 158 pounds. Between June 1991 and December 1991 she lost 62 pounds (200 to 138)through the use of diet pills, laxatives, exercise, and food restriction after the birth of her daughter. In December 1991, service treatment records also document an episode of fainting, which resulted in her fracturing her ankle, which was secondary to eating behaviors. She had another episode of syncope in 1993, which resulted in another injury to her ankle due to weakness. In 1992, Veteran was hospitalized for a complete shut down of her gastrointestinal system secondary to excessive use of compensatory behaviors to keep her weight low. In 1994 Veteran was referred to a psychology clinic in Bethesda secondary to stress and eating disorder. Veteran currently takes 8-10 ducolax per day despite restrictive eating behaviors. These behaviors induce approximately 6 loose stools per day. 3. Findings ----------- [X] Resistance to weight gain even when below expected minimum weight [X] Without incapacitating episodes 4. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to an eating disorder? [X] Yes[ ] No If yes, describe: Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health; intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weigh gain, even though at a significantly low weight; distubance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation. Eating small amounts of food and taking 8-10 laxatives (Ducolax) a day to prevent weight gain; history of loosing 62 pounds in 5 months; 20 pounds in 6-8 weeks during boot camp; emergency room visits seconday to syncope and subsequent fractured ankle as a result of extreme weight loss via laxatives, lack of food and energy. 5. Functional impact -------------------- Does the Veteran's eating disorder(s) impact his or her ability to work? [X] Yes[ ] No If yes, describe impact, providing one or more examples: Veteran has approximately 6 loose stools a day secondary to excessive use of laxatives. Though she can continue to work a full time job, her productivity may be negatively impacted by consistent diarrhea. 6. Remarks, if any: ------------------- Veteran's current diagnosis of Anorexia Nervosa, purging type, is most likely incurred in military service and a progression of Veteran's eating disorder diagnosed in service. There is no prior diagnosis or hospitalization for an eating disorder prior to service. Veteran's eating disorder was first documented in service. Additionally, episodes of syncope and excessive weight loss were also documented in the service treatment records. Emotional distress as a result of military sexual trauma and consistent berating because of her weight most likely resulted in Veteran utilizing purging behaviors to cope with stress. Veteran has recently sought treatment. However, she continues to take 8-10 Ducolax a day despite restrictive eating behaviors to control her weight. Despite acceptable weight, she continues to view herself as fat. It should also be noted that Veteran's Anorexia Nervosa is most likely related to military sexual trauma and berating of Veteran due to her weight beginning in boot camp. Rationale: There was an increase in purging behaviors and subsequent hospitalization after military sexual trauma, subsequent pregnancy and miscarriage in 1992. Refer to Initial PTSD DBQ for additional markers.
  10. NO C-FILE 1. Diagnosis Does teh Veteran now have or has he ever been diagnosed with any conditions of the male reproductive system? YES If yes, indicatate diagnosis: <X> Erectile dysfuncion Date of diagnosis: 2005 2. Medical history a. Describe the history (including onset and course) of the Veteran's male reproductive organ condition(s) (brief summary) DX with ED in West Virginia VA and given Cialis, now on Viagra 3. Voiding dysfunction Does the Veteran have a voiding dysfunction? YES If yes, complete the following section: a. Etiology of voiding dysfunction: UNKNOWN. HE IS OBESE. e. Does the voiding dysfunction cause signs or symptoms of obstructed voiding? YES If yes, check all that apply: <X> Hesitancy <X> Slow or weak stream <X> Decreased force of stream 5. Erectile dysfunction Does the Veteran have erectile dysfunction? YES If yes, complete the following section: a. Etiology of erectile dysfunction: UNKNOWN, DM DX in 2009 so less likely as not related to DM or G/W 13. Remarks, if any: ED
  11. I had two C&P exams for my claim; one was for Tinnitus and the other for PTSD. I completed my Tinnitus exam on 10/03/2014; the doctor stated my hearing was excellent; however I still have ringing in my ears triggered by loud noises. Is it still possible to receive a rating since the DR told me my hearing excellent? My PTSD exam was 10/07/2014, I feel the exam went well, we spoke about my experiences and how they effect me, the DR seemed to hint that I had met all the requirements layer out for PTSD. My questions are how does the VA rate PTSD when the C&P examiner most likely will be more detailed in my PTSD triggers and effects then what I have reviewed on MYHEALTHEVET from what the VA doctor’s have written. From my experience the VA doctors do not put all of the information and make what I say to them better than what it is when they write up their statements after our sessions. Also, does anyone know how long I may have to wait for a rating if my exams are done? I understand that it is different for every claim, I’m just fishing for some different timeframes from people. FYI both my exams were contracted out through VES. I appreciate everyone’s time and assistance, this has been a crappy ordeal and leaves me with the impression the VA sugar coates everything I have said to them about my daily life (Anger, marital issues, nightmares, not sleeping). Again, thank you.
  12. VA Benefits paid on the Friday before and labor day on monday
  13. I was hoping someone that works at the VA could provide me some insight. I was in the Marines from 2001-2005 with two combat tours. I went through the initial process in 2006 and was awarded: PTSD 10%, degenerative joint disease of the right knee 10% and degenerative joint disease of the left knee 10% for a total of 30%. After speaking with friends I decided to have my claim reevaluated. I opened my claim with the VFW January of this year for: PTSD (Increase), degenerative joint disease of the right knee (Increase), degenerative joint disease of the left knee (Increase), residual injury lower back (New), Hypertension, arterial (New), Rhinitis, allergic (New), tinnitus (New), eczema (New), hiatal hernia (New), elbow pain (New). All of the issues marked as “new” are being reviewed as administrative error. They were evaluated by the VA Dr’s and approved as being service connected but were never given a rating, not even 0%. I was only called in to meet with a physician for PTSD (Increase), degenerative joint disease of the right knee (Increase), degenerative joint disease of the left knee (Increase). During my knee exam I had limited range of motion as well as chronic pain that affects my job and personal life. Also, no x-rays were needed because they had x-rays from 8 years ago proving my condition. During my evaluation for PTSD the Dr said my issues have gotten worse and it affects my work/personal life as well. Long story short my question is about increase and my current process. My status in eBenefits is "Preparation for Decision" but I was never seen by a physician for: residual injury lower back (New), Hypertension, arterial (New), Rhinitis, allergic (New), tinnitus (New), eczema (New), hiatal hernia (New), elbow pain (New). Is it a good or bad that I wasn’t seen by a physician for the 7 new issues that were filled as administrative error? They are in my file as being service connected but again never given a rating, not even 0%. I know it’s a tough call without seeing all my documentation but what do you think my outcome will be? I am open to insight.
  14. Last month my husband's reopened/reconsideration went to "pending decision approval" then about two weeks later went back to "review of evidence". Peggy and DAV say that on Aug. 9th C&Ps were ordered. We still have received no notice of appointments. Does this usually take long to get scheduled? My husband's one year date to file a NOD is coming up on Sept. 19th and we wanted to wait as long as possible on filing in hopes the reconsideration would be decided. Thanks, Kate
  15. This is my first post and I wanted input on my sons PTSD exam. The examiner said my son had multiple related diagnosis and his service connection was presumptive because of the conditions of his service and time period of diagnosis. He wanted to know why he waited so long to submit a claim after diagnosis. It's been 6 or 7 years since he was diagnosed right after service. He also said we should arrange to get power of attorney over him. He did not let me in at first and then called for me. He said had looked over his records and would look at some more records and then submit it to the regional office. The exam went quick he did not want to go into detail and said it would be not a stressful exam. My son has several hospitalizations, suicide attempts, near a dozen meds, multiple doctors and the exam lasted about 20 minutes. He has a diagnosis from at least 6 VA doctors. My son has flash backs all the time, becomes homicidal in addition to suicide, has lots of memory issues, wanders, has sleeping issues, nightmares and lots of other issues that make it impossible to take care of himself. When released from hospitalizations they always tell us not to leave him alone or let him live alone. Half of my time there was being given advice about his care and power of attorney. So what are your thoughts?
  16. I am wondering what is the best option, IME or an IMO, for wading through the VA's appellate process after a NOD has been filed? Would it be wiser to go with a good quality IME examiner first, or just do an IMO with a records review, and then wait for the VA to decide to order any additional C&P's? Part of me thinks that by going through a C&P process with DBQ's in obtaining an IME might be a time saver. Thoughts or advice? Mark
  17. My husband's claim moved from Review of Evidence to Pending Decision Approval today. Usually a good thing, but, there was no C&P exam done. There were four contentions, two new and two reconsiderations, although the new ones also should have been reconsiderations. All were previously denied. Filed for reconsideration on April 15 and they went straight into Review of Evidence on May 31. Now, moved into their current status? What could this mean. Can't believe it's a good thing since no C&P was done. Never had C&Ps on the original claims either. Any thoughts? Thanks, Kate
  18. 8/1/2013 filed for an increase for PTSD on at 30% (overall SC 40%). 10/15/2013 C&P exam for increase - Examiner stated I was unable to be employed due to SC in his report and was very helpful to my case. 1/5/2014 approved increase for 70% PTSD with new diagnosis of MDD secondary (overall SC 80%). IU differed. 6/18/2014 ebenefits changed claim status from review of evidence to awaiting decision approval. Also a dependency claim from 3/13/2013 has changed to decision notification. MY question is, is it likely that them never giving me a C&P for IU is positive or negetive for my claim? Checked AB8 and nothing has changed so I don't believe they have updated anything yet because I dont believe my dependency claim would have been denied. Does anyone have any expericnce with a situation such as this? Does anyone have some insite or even a guess as to what my chances are of approval or denial? I know its case by case but I have never heard of them not scheduling a C&P to make a decision.
  19. I am confused about how things were filed on my husband's claim. He got a denial on several contentions in Sept. 2013. Should have been denied, was filed horribly incomplete. Anyway, my husband filed a reconsideration on two of the claims, PTSD and Tinnitus through DAV in May. The original claim was filed as irritability and anxiety. When the reconsideration with new evidence was done, there was a new diagnosis of PTSD and it was included in the claim for anxiety and irritability. DAV sent everything to Cleveland which is the normal VA for our area but, since his claim was originally heard in Louisville due to part of it being a Camp Lejeune water issue, it apparently should have gone back there. Just last week, it seems to have finally landed in the right place. It is now showing on eBenefits. First went in to "Preparing for Decision", then fell back to "Review of Evidence." There was already a claim in for unemployability which was just recently denied (we were told) but we never received any notification or anything on eBenefits saying so. I understand the denial due to the fact that there were no service connected conditions awarded. Now the current contentions are listed as Unemployability (new) and PTSD (new). So, apparently they threw the unemployability claim back into the mix with the PTSD claim. But, should the PTSD say "new" since it was a reconsideration? They give the date of the original claim as Aug. 1, 2013 which is correct for the unemployability but the PTSD claim was originally filed in 2011, although it was filed as anxiety and irritability which are now symptoms of the PTSD. With the "new" tag, it doesn't sound like reconsideration. BTW, tinnitus is not listed as a contention although it was included in the reconsideration. We are hoping he will at least get an actual C&P this time, since the first time they only looked at the records and decided. I guess what I am asking is does it seem that they should be listed as "new" contentions when it was filed as a reconsideration? Thanks, Kate
  20. Is there a particular time when c&p exams are scheduled? My husband's claim is currently in "review of evidence". That seems like a likely place in the timeline to do a c&p. Thanks, Kate
  21. Went for a second c&p exam last week and I'm afraid it doesn't look good for me. Currently I'm 50% for PTSD and 10% for tinnitus. My first exam was back in '08 when I originally filed so I guess this exam was just a follow up. I'm an OIF 1 veteran if that makes a difference. Below are my exam notes. Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire SECTION I: 1. Diagnostic Summary Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes[ ] No ICD Code: 309.81 2. Current Diagnoses a. Mental Disorder Diagnosis #1: PTSD ICD Code: 309.81 Comments, if any: Based on DSM-5. VBMS and CPRS records reviewed. Based on today's review examination, the veteran continues to meet DSM diagnsotic criteria for PTSD. The veteran has reported a worsening of PTSD symptoms since his 2008 Initial examination, with additional stressors (highlighted in other sections of this examinaiton report). Veteran is currently prescribed psychotropic medications by his former VA-primary care provider, Dr. Shissler, who has since retired-veteran receives medications by mail. Veteran is not currently seen by VA mental health providers. Mental Disorder Diagnosis #2: Alcohol Intoxication ICD Code: 303.00 Comments, if any: Based on DSM-5. VBMS and CPRS records reviewed. Based on today's examination, the veteran currently meets DSM-5 diagnostic criteria for Alcohol Intoxication. The veteran's current substance-related and addictive disorders diagnosis is based on veteran's report of consuming 5-16oz bottles of beer less than 24hrs prior to this examination. In addition, veteran reported history of alcohol addiction and treatment through the VA-Baton Rouge South SATP with Dr. Reidwald. Veteran's current Alcohol Intoxication/Alcohol Dependence diagnosis is at least as likely as not (50/50chance) due to, or result of his PTSD diagnosis. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Dyslipidemia, deviated nasal septum, chronic maxillary sinusis, tinnitus, bilateral sensori hearing loss, hypertension, Comments, if any: Medical diagnoses taken from CPRS records. 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: Alcohol Intoxication- Recent ingestion of alcohol -Clinically significant/problematic behavioral/psychological changes associated with recent consumption of alcohol -One or more of the following sx onset with consumptions of/shortly after consumptions of alcohol: slurred speech, incoordination, unsteady gait, nystagmus, impaired attention/memory, stupor/coma -Sx are not attributable to another medical condition nor explained by another mental disorder PTSD -recurrent and intrusive memories and thoughts of the event -recurrent and disturbing dreams of the event -psychological reactivity -efforts to avoid conversations, thoughts, feelings, related to trauma -loss of interest or participation in activities -feelings of detachment or estrangement from others -emotional numbing -difficulty falling asleep/staying asleep -irritability/anger -difficulty concentrating -hypervigilence -exaggerated startle response -suicidal ideation -memory problems 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 due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes[X] No[ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: Due to overlap of affective and behavioral symptoms. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes[ ] No[X] No diagnosis of TBI SECTION II: Clinical Findings 1. Evidence review In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes[ ] No Was the Veteran's VA claims file reviewed? [X] Yes[ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: CPRS records reviewed. Attention was givent to the Veteran's Initial PTSD examination report, with Dr. Kodur, 8/18/08. Based on his Initial PTSD examination, the veteran met criteria for PTSD, and obtained a GAF score of 49, which suggested serious impairment in the veteran's social and occupational functioning at the time. If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [ ] Yes[X] No If yes, describe: 2. Recent History (since prior exam) a. Relevant Social/Marital/Family history: Veteran reported since his 2008 Initial examination, hw ans his Wife have had two children (ages 5, 2) and their 8yr old dog has died (December 2013). Veteran reported his Wife now works full-time, having weekend and night shift as a Nurse, and veteran provides most of the care and parenting for their children. Veteran reported he enjoys this responsibility, however at times this is stressful. Veteran reported his marriage is currently strained, due to his return to excessive drinking. Veteran reported he has attempted to "quit" several times, and has been successful for short periods of time. Veteran reported when drinking alcohol, he at times becomes argumentive with his Wife, and angry. Veteran reported at times, including within the past 24hrs prior to this appointment, he consumes 5-16oz containers of beer in one sitting, and this irritates his Wife. Veteran reported this is typically how arguments begin. Veteran reported his Wife has stopped communicating with him and gives him the silent treatment when he drinks now. Veteran reported this usually leads to him becoming angrier. Veteran reported last night, his Wife refused to talk to him. Veteran reported they have sought marital counseling in the past, and the counselor challenged him to not drink for 30 days, which he did. Veteran reported he does not feel his drinking is excessive or problematic, although he has been labeled a "functional alcoholic." Veteran expressed concerns for losing his family due to his excessive drinking at this time. Veteran reported alcohol helps him to cope with sx of PTSD including nightmares and unwanted thoughts, and stated these are issues his Wife does not understand. Veteran reported feeling supported by his family/parents, and they too have encouraged him to seek treatment for his excessive drinking, and to resume marital counseling. b. Relevant Occupational and Educational history: Veteran reported he continues to work as and Industrial Contractor along with his father and brother. Vetran reported doing this work since 2007, and denied having problems on the job. Vetran reported when he is stressed on the job, or experiences panic attacks, his family members are "understanding" and they allow him time to relax in his office. Veteran described having a panic attack some years ago on the job, in which his father drove him to the emergency room. Veteran reported feeling as though he were having a heart attack, and later after tests, he was told he suffered a panic attack. c. Relevant Mental Health history, to include prescribed medications and family mental health: Veteran reported he is not currently receiving mental health services. Veteran reported he is prescribed psychotropic medication, Citalopram, which was origianlly prescribed by his former VA primary care provider, Dr. Shissler. Veteran denied being referred to mental health, and stated his medications continue to come to him via mail. Veteran reported he feels the medication helps him to not feel depressed, however, the medication does not prevent panic attacks, nor does it help him to sleep. Veteran reported he was previously seen at the VA-Baton Rouge South clinic in the SATP program by Dr. Reinwald in 2012. Veteran reported he completed the program, although he did not feel he had problems with alcohol at that time. Veteran denied history of inpatient hospitalization since his last examination. Veteran endorsed current sx to include increased tearfulness, sad/depressed mood, chronic sleep impairment, restlessness, increased nervousness, difficulty managing stress, increased memory problems, distractibility, increased panic attacks, difficulty in crowds and amongst people unknown to him, racing heart/pounding heartbeat, and increased use of alcohol and nicotine. Vetran denied thoughts of harming himself or others, however, reported at times he has become verbally aggressive when stressed or after drinking. Veteran reported increased nightmares, and described a mixture of real events along with events that had not occured in his nightmares. Veteran reported current fear of "being sent back to Iraq," at times. CPRS records indicate veteran was last seen at the VA Baton Rouge South Clinic in the SATP program in February 2012. Records indicate veteran was last seen in psychiatry by Ms. Joseph in March 2012 for medication management. Veteran has a diagnostic history to include Alcohol Dependence, PTSD, and Panic Disorder, NOS. d. Relevant Legal and Behavioral history: Veteran denied e. Relevant Substance abuse history: Veteran reported he was previously seen at the VA-Baton Rouge South clinic in the SATP program by Dr. Reinwald in 2012. Veteran reported he completed the program, although he did not feel he had problems with alcohol at that time. Veteran reported his marriage is currently strained, due to his return to excessive drinking. Veteran reported he has attempted to "quit" several times, and has been successful for short periods of time. Veteran reported when drinking alcohol, he at times becomes argumentive with his Wife, and angry. Veteran reported at times, including within the past 24hrs prior to this appointment, he consumes 5-16oz containers of beer in one sitting, and this irritates his Wife. Veteran reported this is typically how arguments begin. Veteran reported his Wife has stopped communicating with him and gives him the silent treatment when he drinks now. Veteran reported this usually leads to him becoming angrier. Veteran reported last night, his Wife refused to talk to him. Veteran reported they have sought marital counseling in the past, and the counselor challenged him to not drink for 30 days, which he did. Veteran reported he does not feel his drinking is excessive or problematic, although he has been labeled a "functional alcoholic." Veteran expressed concerns for losing his family due to his excessive drinking at this time. Veteran has history of Alcohol Dependence diagnosis. Veteran was last seen in the SATP program 2/6/12. f. Other, if any: No response provided. 3. PTSD Diagnostic Criteria Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threatening situations (non-combat related stressors.) Do NOT mark symptoms below that are clearly not attributable to the criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #5 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in on or more of the following ways: [X] Directly experiencing the tramuatic event(s) Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid 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 D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). [X] Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead to 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] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) 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] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause 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. 4. Symptoms For VA rating purposes, check all symptoms that apply to the Veterans diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks that occur weekly or less often [X] Chronic sleep impairment [X] Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks [X] Impaired judgment [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Impaired impulse control, such as unprovoked irritability with periods of violence 5. Behavioral Observations: MSE: Veteran presented as a neatly and casually dressed 33yr old male with good hygiene and flat affect. Veteran stared at the Examiner, and noted to sit on the edge of the seat in the examination room. Veteran reported consuming 5-16-oz beers last night, and stated this led to problems and silent treatment at home. Vetran then became tearful, and reported fear of losing his family, due to difficulties related to alcohol dependence. Veteran reported consuming alcohol at this time on a daily basis. Veteran reported being able to participate in today's examination, however, and denied problems with comprehension of questions/interview at this time. Veteran denied thoughts of harming himself or others at this time. 6. Other symptoms Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes[X] N 7. Competency Is the Veteran capable of managing his or her financial affairs? [X] Yes[ ] No 8. Remarks, (including any testing results) if any: Based on DSM-5. VBMS and CPRS records reviewed. Based on today's review examination, the veteran continues to meet DSM diagnostic criteria for PTSD. The veteran has reported a worsening of PTSD symptoms since his 2008 Initial examination, with additional stressors (highlighted in other sections of this examination report). Based on today's examination, the veteran also currently meets DSM-5 diagnostic criteria for Alcohol Intoxication. The veteran's current substance-related and addictive disorders diagnosis is based on veteran's report of consuming 5-16oz bottles of beer less than 24hrs prior to this examination. In addition, veteran reported history of alcohol addiction and treatment through the VA-Baton Rouge South SATP with Dr. Reidwald. Veteran's current Alcohol Intoxication/Alcohol Dependence diagnosis is at least as likely as not (50/50chance) due to, or result of his PTSD diagnosis. Veteran is currently prescribed psychotropic medications by his former VA-primary care provider, Dr. Shissler, who has since retired-veteran receives medications by mail. Veteran was seen by NP Ms. Joseph, for medication management (3/2012), however no other appointments with MH since that time. Veteran is not currently seen by VA mental health providers. Sorry if that makes peoples head hurt. It just seems like the examiner wrote more about my drinking problem than a review of my symptoms. 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 due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication This is what worries me, in my initial exam it was stated as severe, not mild. Im really worried about my rating being dropped, can someone help me decipher all this? If you need more info. from me about anything just let me know. thanks
  22. I am at a crossroads in my battle with the VA. I was service connected at 10% for degenerative disk disease in 2011. My claim was pretty cut and dry and i made it through with little to no assistance. My symptoms became a lot worse after my claim was closed. I was treated on multiple occasions for back problem related to this ailment. I lost a great union job over not being able to preform. They drugged me up with the strongest pain meds 3X daily. I filed for an appeal. I claimed that at my original exam, the C&P examiner forced me to over exert myself. I was actually treated for a bulging disk within a week of the exam. I just had my 2nd exam a 7 days ago. The examiner never used the geniometer (sp). I went until the pain started, which was nowhere near what i did at my 1 C&P exam. From everything I've gathered including tricking the VA person on the phone into discussing my claim, my claim was not increased. Benefits explorer and Ab8 both say 10%. I need to know if i should file an appeal for another exam, get a DBQ, or appeal and let the BVA decide. There is noticeable deterioration on my X-rays from my first exam after ETS compared to know. I had an MRI done that said the condition is causing my disk to bulge , and for bone on bone contact to happen. Is it too late for the DBQ? Do i even have a foot to stand on filing an appeal? Thank you all for helping
  23. Hello all! While I have referenced these forums before while filling out my paperwork, I haven't used them. My husband had his c&p exam today. I could use a little advice and perspective. We submitted the ptsd claim paperwork in January. [After much encouragement.] My husband is unable to maintain work, has difficulty in all social situations, has regular mood swings, trouble with anger, nightmares to name a few, very regular symptoms. Today, he had his c&p exam and I wasn't sure about the whole experience. The curator was gruff and very short. He told me that he needed to speak to my husband alone. [which I respected, assuming he would need to speak to me afterwards] My husband was with him for about 10-15 minutes. When my husband came back into the room he was really shaken. I understand this exam can be difficult, but my husband isn't very easily shaken. He was sweating, I mean like a lot. I realized after a few minutes that we were excused, the curator never came back into the waiting room. I asked the woman behind the desk to speak with him and he came into the waiting room to talk to me. [luckily there wasn't anyone else there] I could barely get out the things I wanted to make sure he knew. [Like the fact that my husband has such restless sleep that I have to sometimes lean on his chest while he is asleep until he calms down] Things my husband wouldn't know to tell him. He basically told me that my husband has severe depression. That we need to call the va to get him on different medication and they can look at his notes on the record. I understand that they have to be through to ensure they are giving to those who need it, I couldn't help but feel like this guy brushed us off. I couldn't get a whole sentence out. I am not a psychologist and I don't mean to questions someone who does this for a living but I am pretty sure my husband has ptsd not just depression, from all of the things I have read. My question is, is it common for the va to diagnose depression instead of ptsd? Is this how most c&p exams go? Also, do we have to fill out a second claim now for the depression? Thank you all for your help. This has been quite a process. I just want to make sure that my husband is able to get help and is taken care of in case anything were to ever happen to me. Thank you!
  24. Hi all Im new here and I'll try and keep it short. So last week I gave my rep my stress letter to send in along w another letter describing how ptsd affects me.. I did 3 tours in iraq in my 4 yr enlistment and I have all sorts of anger issues and. Basically most of the ptsd symptoms. Anyway so my question was whats next? & another thing if any vets from Washington State could give me some insight as to how vet friendly this state is id appreciate it. Ive also had my C&P a couple weeks ago. Semper Fi
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