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Service Connected Disability

  1. Hello all, I'm having a hard time finding a Dr willing to fill out VA DBQ forms. Va docs will not fill out I've seen two private orthopedic Dr's. They are to busy to fill out they say. I'm rated 10% each R/L hip bilateral coxa vara, 10% osteoarthritis right knee, 10% osteoarthritis of lumbar spine. My conditions have worsened docs recommend PT, I do twice a week have received shots for pain no relief. My other question the coxa vara was documented prior to enlistment, fit for duty, aggrevated and documented throughout enlistment also at ETS physical. According to AR 40-501 coxa vara is a condition listed. I've been asked by VA Dr how I was even able to join the ARMY. Waiver I suppose. Also the two private docs looked at Mri done 6 yrs ago at Va and noticed torn meniscus, patella something, on knee, scoliosis, herniated discs, alot more things with my back can't remember right now. My hips are uneven causing the domino effect. I'd like to get the increase in what I have now before I submit other secondary claim.Getting frustrated with everyday pain.
  2. HI everyone, I am helping my dad with his recently submitted claim. He requested an increase to his 30% rating from 2003, among other things. On ebennies it has DBQ PTSD Review recommended under "evidence needed." I sent quite a bit of evidence showing worsening conditions since 2003 when I submitted the FDC in December. Will not providing one hold up the process? Does he need to submit this DBQ? If he does, will it take him out of the Fully Developed Claims for submitting new evidence? Thanks for the help as usual.
  3. HI everyone, I am helping my dad with his recently submitted claim. He requested an increase to his 30% rating from 2003, among other things. On ebennies it has DBQ PTSD Review recommended under "evidence needed." I sent quite a bit of evidence showing worsening conditions since 2003 when I submitted the FDC in December. Will not providing one hold up the process? Does he need to submit this DBQ? If he does, will it take him out of the Fully Developed Claims for submitting new evidence? Thanks for the help as usual.
  4. I recently finished a series of C&Ps for various conditions and I was hoping to get some input on just what exactly it all means - I was wondering what if any kind of rating might I be looking at? Is there a possibility for getting back pay? What can I do (possibly in an appeal) to do more to strengthen my case? At this point my case should be done with the gathering evidence phase (I can't check because ebenefits is being weird). All C&P's are done and everything that needed to be turned in is (I hope). The first C&P/DBQ I'd like assistance with is my claim for "Lower Back Condition". Originally I had claimed "chronic lower back pain" only to later find out that really isn't a thing and thus I was denied. When I went in for this most recent exam the reviewing doctor first went to my C-File and saw that I had claimed "chronic lower back pain" back in 2004. He then went into my military treatment record and found considerable amounts of treatment records for several issues in my lumbar spine and beyond. "They should have connected you back in 2004" he said to me. Sufficed to say that his positive first impressions put me a little more at ease with the C&P (which normally turns me into an anxious, nervous wreck). I've now gained access to the DBQ and would like any information that you well informed folks could provide. I've cut it down as much as I thought I could. If a question is missing and/or option is missing assume it wasn't checked. All non-pertinent information I cut out and did some heavy editing as far as formatting goes. Here it is: Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire Indicate method used to obtain medical information to complete this document: [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: VA medical records. 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 [X] Lumbosacral strain [ ] 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: LS strain, chronic, with LLE radiculopathy Date of diagnosis: 2000s 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's thoracolumbar spine (back) condition (brief summary): During military service, the Veteran did develop chronic left lower back pain with radiation down the left buttock to the calf. On 6/10/2003, an MRI of the LS spine was performed with the following findings: Broad based posterior/central disc bulging at L4-5 without associated neural impingement. After service discharge in 2004, the Veteran continued with intermittent lower back and LLE problems. Repeat lumbar MRi in 2009 was read as normal. Currently he continues with chronic daily left lower back pain with LLE weakness and paresthesias. He is taking Ibuprofen and has a TENS unit as needed. He deniesbowel/bladder/sexual dysfunction related to his lower back. 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: Increased pain and stiffness c. Does the Veteran report having any functional loss or functional impairment of the thoracolumbar spine (back) (regardless of repetitive use)? [X] Yes [ ] No If yes, document the Veteran's description of functional loss or functional impairment in his or her own words. Stiffness/LLE radiculopathy 3. Range of motion (ROM) and functional limitation -------------------------------------------------- a. Initial range of motion [X] Abnormal or outside of normal range Forward Flexion (0 to 90): 0 to 75 degrees Extension (0 to 30): 0 to 20 degrees Right Lateral Flexion (0 to 30): 0 to 30 degrees Left Lateral Flexion (0 to 30): 0 to 30 degrees Right Lateral Rotation (0 to 30): 0 to 30 degrees Left Lateral Rotation (0 to 30): 0 to 30 degrees If abnormal, does the range of motion itself contribute to a functional loss? [ ] Yes (please explain) [X] No Description of pain (select best response): Pain noted on exam on rest/non-movement If noted on exam, which ROM exhibited pain (select all that apply)? Forward Flexion, Extension Is there objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine (back)? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): There is localized tenderness over the bilateral paralumbar muscles and the left SI joint and left sciatic notch. 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? [ ] Yes [X] No If the examination is not being conducted immediately after repetitive use over time: [X] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Not currently flared up. d. Flare-ups Is the exam being conducted during a flare-up? [ ] Yes [X] No If the examination is not being conducted during a flare-up: [X] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups. Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Not currently flared up. e. Guarding and muscle spasm Does the Veteran have guarding or muscle spasm of the thoracolumbar spine (back)? [X] Yes [ ] No Muscle spasm: [X] Not resulting in abnormal gait or abnormal spinal contour Provide description and/or etiology: Left lower back muscle spasm is noted today. Localized tenderness: [X] Not resulting in abnormal gait or abnormal spinal contour Guarding: [X] None f. Additional factors contributing to disability In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: [X] None 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: [ ] 5/5 [X] 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: [ ] 5/5 [X] 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: [ ] 5/5 [X] 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: [ ] 5/5 [X] 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: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 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: [ ] Normal [X] Decreased [ ] Absent Foot/toes (L5): Right: [X] Normal [ ] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent 7. Straight leg raising test ---------------------------- Provide straight leg raising test results: Right: [X] Negative [ ] 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? [X] Yes [ ] No a. Indicate symptoms' location and severity (check all that apply): Constant pain (may be excruciating at times) Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Intermittent pain (usually dull) Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Paresthesias and/or dysesthesias Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Numbness Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe b. Does the Veteran have any other signs or symptoms of radiculopathy? [ ] Yes [X] No c. Indicate nerve roots involved: (check all that apply) [X] Involvement of L4/L5/S1/S2/S3 nerve roots (sciatic nerve) If checked, indicate: [ ] Right [X] Left [ ] Both d. Indicate severity of radiculopathy and side affected: Right: [X] Not affected [ ] Mild [ ] Moderate [ ] Severe Left: [ ] Not affected [X] Mild [ ] Moderate [ ] Severe 10. Other neurologic abnormalities ---------------------------------- [ ] Yes [X] No 12. Assistive devices --------------------- [ ] Yes [X] No 13. Remaining effective function of the extremities --------------------------------------------------- [X] No 14. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [X] Yes [ ] No If yes, describe (brief summary): Vital signs are stable; Lungs are clear; Heart is without m/g/r; Abdomen is soft, and without masses or organomegaly or tenderness; Genitalia are normal, no hernias or testicular lesions, the testicles and epididymii are tender to touch bilaterally; 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 15. Diagnostic testing ---------------------- a. Have imaging studies of the thoracolumbar spine been performed and are the results available? [X] Yes [ ] No If yes, is arthritis documented? [ ] 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? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): Repeat lumbar MRI has been ordered and is currently pending; when completed and reported, I will review it and add any additional comments as indicated. 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: The Veteran's current lower back condition would limit his ability to perform repetitive heavy lifting, pushing or pulling. 17. Remarks, if any: -------------------- The Veteran is claiming service connection for a lower back condition. Opinion: It is as least as likely as not that the Veteran's current lower back condition is proximately due to or caused by military service. Rationale: The C file was reviewed. The STRs do document a two year history in 2002 of chronic lower back pain with LLE radiculopathy. This is also noted on separation exam in 2004. I was able to elicit the same symptoms ongoing today, as well as to confirm this on phyiscal examination. Repeat lumbar MRI has been ordered since the last study was in 2009; when completed and reported, I will review it and add any additional comments as indicated. Thus, the service connection is substantiated. 12/23/2015 ADDENDUM STATUS: COMPLETED The Veteran underwent a lumbar MRI on 12/21/2015 with the following findings: L3-4: Mild facet arthrosis with minimal posterior disc bulge L4-5: Mild facet arthrosis with minimal posterior disc bulge L5-S1: Mild facet arthrosis with minonal posterior disc bulge ------END------- Any help interpreting this would be greatly appreciated. The "service connection is substantiated" is pretty straight forward. I'm curious whether or not I have a chance at getting the SC backdated to my original claim. It seems to me (a total non expert) that the evidence is there to support it. I am also curious about whether or not I can refute some of the conclusions that this doctor came to. While an awesome C&P doctor a back expert he is not. Since the writing of the C&P I had a chiropractor evaluation who found several more things than this doctor did. I'm curious if any of it will be enough to make a 10% difference when the rating comes down. In addition I am curious if within my C&P as well as the most recent chiro consult if there isn't evidence for a possible future claim for nerve pain in my lower body. "Many times spinal conditions have other conditions that contribute to the severity of the spinal condition. For example, many spine conditions also cause radiculopathy. These secondary conditions can sometimes be independently ratable." In my C&P I believe I meet all these conditions. I am diagnosed with lumbosacral strain - chronic, as well as Lower Left Extremity radiculopathy. In addition the C&P also diagnosed me with LLE weakness and paresthesias. The following is a list of conditions that the Chiropractor diagnosed me with just 8 days after the C&P doctor finalized his report. ----------Chiropractic Evaluation-------------- LOCAL TITLE: PM&R CHIROPRACTOR CONSULT RESULT STANDARD TITLE: PHYSICAL MEDICINE REHAB CONSULT DATE OF NOTE: DEC 31, 2015@11:04 Midback pain: medial scapula, left worse than right Quality: Burning (small area "about the size of a dime") Radiating: Patient Denies 0-10: 9/10 Timing: Intermittent Worse: working in a "hunched" or bent over position. Better: Standing up /stretching Low Back Pain: Thoraco-lumbar and lower L4-5-S1. Quality: Dull/Ache/sometimes sharp/Throbbing Radiating: buttock/thigh and foot ("tasered"), left worse than right 0-10: 6-7/10 Timing: Intermittent Worse: Standing/coughing while bent over Better: changing positions/activities Trunk ROM: Flexion:Mod dec Pain:Severe Extension:Mild dec Pain:No pain Rotation:Mild dec Pain:No pain Lateral Flexion:Mild dec Pain:No pain Muscle Atrophy: No Seated SLR: Positive L Supine SLR: Positive R (low back pain) Hip hyperextension test: Positive R Kemps test: Negative R L Spinous Process Tenderness: T3-7, L2,3, Right SI Myofascial Tenderness: Bilateral Rhomboids, Thoraco-lumbar paraspinals bilaterally. Lumbar MRI 12/21/2015 Impression: 1. Mild facet arthrosis and minimal disc bulges of the lower lumbar spine without thecal sac or neuroforaminal stenosis. Oswestry Disability Index Questionnaire Section 1 -- Pain Intensity: 2. The pain is moderate at the moment. Section 2 -- Personal Care (Washing, Dressing, etc.): 2. It is painful to look after myself and I am slow and careful. Section 3 -- Lifting: 2. Pain prevents me lifting heavy weights off the floor, but I can manage if they are conveniently placed e.g. on a table. Section 4 -- Walking: 1. Pain prevents me walking more than 1 mile. Section 5 -- Sitting: 3. Pain prevents me from sitting more than one-half hour. Section 6 -- Standing: 2. Pain prevents me from standing for more than 1 hour. Section 7 -- Sleeping: 2. Because of pain, I have less than 6 hours sleep. Section 8 -- Sex Life (if applicable): N/A Section 9 -- Social Life: 3. Pain has restricted my social life, and I do not go out very often. Section 10 -- Traveling: 2. Pain is bad but I manage journeys over two hours. DISABILITY INDEX SCORE: 38% Segmental Dysfunction: L3LP, RPIN, RAI_Sacrum, T3LP, T5LP Assessment: 1. Lumbar: Segmental dysfunction 2. Lumbar: strain 3. Pelvic: Segmental dysfunction 4. Sacrum: Segmental Dysfunction 5. Thoracic: Segmental dysfunction Alright. If you've made it this far thanks for taking the time to read this massive wall of text. If you have some information or experience to offer let me thank you in advance!
  5. I have a TDIU claim that is awaiting to go to BVA since September 2011. I have a docket number. I recently put in a DBQ and IME saying I can't work at all and my condition is Catastrophic 100% disabling Permanent and total with reasonable medical certainty. I also have a Not Feasible for employment letter by Voc Rehab and am on social security. I now found out my case went to a DRO for review. Is this standard procedure for DRO to pull a case waiting for BVA and to relook at the case? Is this in my favor. I put in for TDIU could they give me Schedular rating instead. I still don't want to lose my place in line at BVA if the DRO denies some or part of my new DBQ, IME evidence. Thanks for any clarification
  6. On the Disability Benefits Questionnaire for my Doctor to complete (VA Form 21-0960N-1) (DBQ). It says select the veterans condition and then it has ICD code & Date of diagnosis. Is this the ICD code (Diag. Code) from my physician's statements? Can I submit to VA a copy of the physician's billing statement that has the diag. code on it along with a table of the explanation of the ICD CODE?
  7. So I reopened my case for major depression disorder and the VA instead of using the DBQ provided my psychologist, they rather asked me to go in for another QTC appointment for evaluation (second time- 2012/2014). I have already been diagnosed and currently being treated for Major Depression Disorder with psychosis/schizophrenia by the VA. Can someone tell me what the DBQ from QTC means? Am trying to figure out the possible rating decision if am even going to get a positive one. Thanks SECTION I 1. Diagnosis Does the Veteran now have or has he/she ever been diagnosed with a mental disorder? [X] Yes [] No Mental Disorder Diagnosis #1: Major Depression Disorder, recurrent Medical condition relevant to the understanding or management of the Mental Health disorder (to include TBI): Sleep Apnea 2. 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? [] Yes [] No [X] Not applicable (N/A) c. Does the veteran have diagnose traumatic brain injury TBI? [] Yes [X] No 3. 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? [] Yes [] No [X] No other mental disorder has been diagnosed SECTION II Clinical Findings Evidence review Medical Record Review a. Was the veteran’s VA claims file reviewed? [X] Yes [] No b. Was the pertinent information from collateral sources reviewed? [] Yes [X] No History Symptoms For VA rating purposes, check all that apply to the veteran’s diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [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 work like setting [X] Inability to establish and maintain effective relationships [X] Suicidal ideation Other symptoms Does the veteran have any other symptoms attributable to mental disorders that are no listed above? [] Yes [X] No Competency Is the veteran capable of managing his or her financial affairs? [X] Yes [] No 6. Remarks MEDICAL OPINION (To be completed by the examiner) Definitions Restatement of requested opinion Insert request opinion … Indicate type of exam for which opinion has been requested (e.g. Skin Disease): PTSD Evidence review Medical opinion for direct service connection a. Direct service connection OPINION: The claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness. Provide rational in section c. c. Rationale: Based on the records provided, it is at least as likely as not that claimant’s major depression disorder was incurred during his military service. Furthermore, it was caused by consistent harassment during his military service. The medical records reviewed which include in service treatment records. Am not too sure why she said the indicated exam used was PTSD and MDD. Also, I was told by the VA (regional office) that my case was closed accidently without rating decision given and that they are reviewing it again for a decision.
  8. So I reopened my case for major depression disorder and the VA instead of using the DBQ provided my psychologist, they rather asked me to go in for another QTC appointment for evaluation (second time- 2012/2014). I have already been diagnosed and currently being treated for Major Depression Disorder with psychosis/schizophrenia by the VA. Can someone tell me what the DBQ from QTC means? Am trying to figure out the possible rating decision if am even going to get a positive one. Thanks SECTION I 1. Diagnosis Does the Veteran now have or has he/she ever been diagnosed with a mental disorder? [X] Yes [] No Mental Disorder Diagnosis #1: Major Depression Disorder, recurrent Medical condition relevant to the understanding or management of the Mental Health disorder (to include TBI): Sleep Apnea 2. 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? [] Yes [] No [X] Not applicable (N/A) c. Does the veteran have diagnose traumatic brain injury TBI? [] Yes [X] No 3. 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? [] Yes [] No [X] No other mental disorder has been diagnosed SECTION II Clinical Findings Evidence review Medical Record Review a. Was the veteran’s VA claims file reviewed? [X] Yes [] No b. Was the pertinent information from collateral sources reviewed? [] Yes [X] No History Symptoms For VA rating purposes, check all that apply to the veteran’s diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [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 work like setting [X] Inability to establish and maintain effective relationships [X] Suicidal ideation Other symptoms Does the veteran have any other symptoms attributable to mental disorders that are no listed above? [] Yes [X] No Competency Is the veteran capable of managing his or her financial affairs? [X] Yes [] No 6. Remarks MEDICAL OPINION (To be completed by the examiner) Definitions Restatement of requested opinion Insert request opinion … Indicate type of exam for which opinion has been requested (e.g. Skin Disease): PTSD Evidence review Medical opinion for direct service connection a. Direct service connection OPINION: The claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness. Provide rational in section c. c. Rationale: Based on the records provided, it is at least as likely as not that claimant’s major depression disorder was incurred during his military service. Furthermore, it was caused by consistent harassment during his military service. The medical records reviewed which include in service treatment records. Am not too sure why she said the indicated exam used was PTSD and MDD. Also, I was told by the VA (regional office) that my case was closed accidently without rating decision given and that they are reviewing it again for a decision.
  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. So I was reading over my C&Ps report and the VA rater is asking the C&P examiner to provide "an opinion as to whether or not the veterans service connected disabilities render the veteran unable to secure or maintain substantially gainful employment." Does this seem like a question the VA rater should be answering the C&P examiner according to new FL 13-13? I have attached a Page from C&P, take a look at highlighted area, Thanks.
  11. Hello everyone, I have a question relating to the DBQ that is used for asthma claims (linked below). RESPIRATORY CONDITIONS (OTHER THAN TUBERCULOSIS AND SLEEP APNEA) DISABILITY BENEFITS QUESTIONNAIRE http://www.vba.va.gov/pubs/forms/VBA-21-0960L-1-ARE.pdf My DAV rep wants me to send in a DBQ and says it must be filled out completely, including the PFT values. My asthma was rated at 60% because I received 3+ courses of oral or parenteral corticosteroids within a 12 month period. Because my asthma is rated due to this criteria, not the PFTs, would I still need to have the PFT scores? Should my doc send in the DBQ without PFT's or should they simply enter the values of my most recent PFTs from about a year ago? Thanks
  12. I have a pending claim for multiple sclerosis and sinusitis. The claim has a thorough IMO, SMRs, MRI images on DVD, and buddy statements. It is a "fully-developed" claim, with no further evidence to submit. However, no DBQs were sent in with my claim (based on multiple opinions from trusted folks that said they were not going to add any value). Because I am living and working in Afghanistan, attending any C&P exams will be quite difficult for me. Thus, I called my VARO to find out what I could expect with how my claim would be processed. The VA rep I talked to said that the appropriate DBQs will be mailed to me for what I claim, and I would have 60 days to have them completed. I can have any qualified physician (I'll use my IMO doc, of course) complete these to submit back to the VA. Are these recently launched DBQs now being used in place of showing up for C&P exams? That would be great if that were the case. I am guessing the VA is doing this to fray some of the costs and time to process claims? Seem like this is too simple a process...
  13. Hello. I was wondering if anyone knows which DBQ form is used for lung cancer? Thanks. Mil T
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