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Found 5,484 results

  1. Hello all. I had a c&p exam for my ptsd/mst claim on 1/19/17 at the VA Outpatient center in Fort Worth and just got the results back today. I was quite shocked by the notes. I feel that the c&p psychologist did not review the merits of my case properly and just opined hat I was exaggerating my symptoms based on a 15 question "MENT" test which consisted of me differentiating between happy, angry and sad faces. She also asked me to remember 5 items after 5 minutes (which she gave me the answer after I couldn't remember 2 of them). She asked me nothing about my symptoms or about the events of the trauma. She picked what parts of my VA medical records she included in the report (i.e., sleep disturbance). I feel like I have been shafted. She is basically refuting the diagnosis given by my TWO VA psychiatrists, VA psychologist and my VA social worker. I waited over 25 years to file my sexual assault claim due to me being extremely embarrassed and unable to bring myself to talk about the events that occurred while I served as a submariner in the Navy. The assault happened in 1988; back before don't ask, don't tell. Needless to say I was traumatized and afraid of being kicked out. Nonetheless, I was medically discharged a year later due to asthma brought on by anxiety and panic attacks while onboard my duty station. So, now I am at the point where I am finally seeking help and I spend 20 minutes with a c&p psychologist who seems to be indifferent about my condition. I almost feel like I should have just retreat back to my home in silence instead of being treated like a liar!!! What can I do about this? Here is my c&p exam: LOCAL TITLE: COMP & PEN MENTAL HEALTH/PSYCHOLOGY EXAM STANDARD TITLE: PSYCHOLOGY C & P EXAMINATION CONSULT DATE OF NOTE: JAN 19, 2017@09:30 ENTRY DATE: JAN 19, 2017@11:27:37 AUTHOR: EXP COSIGNER: URGENCY: STATUS: COMPLETED Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: 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 2. Current Diagnoses a. Mental Disorder Diagnosis #1: No Diagnosis Comments, if any: Psychological Testing A test of response bias specifically related to PTSD symptoms was administered to the veteran during this examination to assess the credibility of his self-report. The name of this measure is withheld in this report in order to protect the integrity of the test. This test was specifically standardized on a sample of veterans applying for financial remuneration for a claim of disability resulting from PTSD. The veteran's score on this test was significantly above the established cutoff, indicating that his performance was not consistent with persons diagnosed with PTSD but was consistent with the test performances of disability claimants simulating symptoms of PTSD. As such, there is reason to suspect symptom exaggeration and a response style indicative of attempts to portray himself as worse off than he actually may be with regard to PTSD symptoms. Based on the Veteran's scores, additional testing was performed to further evaluate the possibility of overreporting or exaggeration of mental health symptoms. A second test of response bias was given that was specifically designed to assess the credibility of reported psychopathology symptoms of response bias related to mental illness. Each item on this test was designed to evaluate constructs and behaviors useful in identifying overreporting. This test was developed and validated using both simulation and known-groups designs to identify individuals attempting to overreport symptoms of mental illness. In addition, the validity of this exam has been generalized across various racial/ethnic groups, genders and settings. The Veteran's total score on this measure was above the cutoff, indicating that his responses were not consistent with persons diagnosed with any mental illness. In addition, the Veteran's scores on this interview indicate that his behavior was inconsistent with his reported symptoms and he endorsed very extreme and uncommon symptoms, symptom combinations that are both unlikely and inconsistent with common mood and psychotic disorders, and he had a tendency to endorse severe and unusual psychotic symptoms. He also endorsed an unusual course of illness that is inconsistent with the course of most psychiatric disorders recognized in clinical practice. It is possible that the veteran suffers from a mental illness. However, I am ethically unable to provide a diagnosis at this time given the veteran's response pattern of overreporting on three objective, reliable and valid psychological tests. Providing a diagnosis would require this examiner to resort to mere speculation and would violate the American Psychological Association's (APA) Ethical Principles of Psychologists and Code of Conduct. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Deferred to a physician 3. Differentiation of symptoms a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [X] No 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] No mental disorder diagnosis 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 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 Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 2. History a. Relevant Social/Marital/Family history (pre-military, military, and post-military): Family - Veteran was raised in a "normal" environment by his mother. "I wasn't that close to my father." Veteran has two brothers and two sisters. Veteran's mother was a kindergarten teacher and his father was a "mobile home constructor". Veteran denied any childhood medical/mental health problems. Veteran denied a family history of mental illness. Marital - Veteran has never been married. His last relationship ended around October of 2016 due to his "agitation." "She wanted to talk about stuff and I didn't want to discuss issues with her." Veteran has three sons (ages 16, 20 and 22). "My oldest two sons I don't really talk to since they're gone-one is overseas and the other I think moved up North. I call them every now and then and try to reach them but I hardly get in contact with them. I have a close relationship with my youngest son. He keeps me going." Social - "I had a lot of friends growing up but over the years they sort of fell to the wayside. I had friends going into the military and in boot camp but after sub school I stayed to myself. I had some associates but I didn't want to make any friends after sub school. Currently I have a few associates but I wouldn't call them friends." Prior to the military, the veteran enjoyed running track, playing football, singing in the choir and being in the art club ("I was the cartoonist for the school paper."), science and chess club. "During the military I didn't have any activities other than working on my rating. After I got out I got into oil painting, swimming, cycling and home renovation. I can no longer cycle or swim because of my back and respiratory issues. I haven't attended church in three years and my mother is now a pastor." b. Relevant Occupational and Educational history (pre-military, military, and post-military): Educational - Veteran earned a Bachelor's Degree in Electrical Engineering in 1995 and a Master's Degree in Biomed Engineering in 2009. Veteran informed that he was a good student and denied a history of suspensions, expulsions or learning problems. Occupational - Veteran's job history prior to the military includes custodian and lawn care (self-employed). Veteran serve in the Navy from July 13, 1987- May 16,1989. Veteran was a college student from 1990-1997 and 2004-2009. Since being discharged from the military the veteran has worked as an RF engineer/consultant (1997-2004: "I got into an argument with my supervisor because he always wanted to include me on projects he was working on and I thought that was inappropriate. I thought he had an interest in me even though he didn't say it outright. He wanted to go out and do stuff outside of work hours."); and bioengineer/prosthetic designer for the Department of Commerce (2010-March of 2016: "I got in several arguments because of space and eventually withdrew and stopped producing. I had to share a small space with a coworker and he was constantly rolling back in his chair asking me questions and tapping me on the shoulder so it finally came to a head."). Occupational problems reported include poor social interaction ("Shouting at people and avoiding contact with guys in the office. I worked better with females."), difficulty concentrating ("Because I was focused on not being in a vulnerable position. I missed deadlines or didn't finish tasks because I couldn't focus. I asked to have my own office but you can't have one as a junior engineer."), difficulty following instructions ("If men tried to get close to me because it reminded me of sub school and the threat of not being advanced or promoted."), forgetfulness, and increased absenteeism ("In 2015 I couldn't deal with the office so I started working from home but my supervisor didn't want me to sever myself from the office totally. I had anxiety about going back and sharing an office with another male. I felt better working by myself because I was more productive."). In regards to reprimands, the veteran informed that he was written up for poor work performance, absenteeism, being AWOL and conflicts with his officemate. "The conflicts with my officemate led to me being fired." Veteran informed that he has applied for one job since being fired. When asked if he was a productive and reliable employee he stated, "As long as I was alone and no one was being touchy with me." Veteran denied the following occupational problems: assignment of different duties and tardiness An October 5, 2016 MH OUTPT NOTE states, "He is unemployed and uses income from renting rooms to pay living expenses." An October 5, 2016 MH Attending note states, "Lost his last job as a biomedical engineer in March 2016 after "tussling" with an older man in his office who would repeatedly come up behind him and touch/pat his shoulders which reminded him of his Navy experience...Owns home and rents out rooms for income." c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Mental Health Veteran began mental health treatment at the North Texas VA in August of 2016 and is compliant with his medication regimen of risperidone, prazosin and sertraline despite feeling "groggy and spaced-out." Veteran denied a history of psychiatric hospitalizations. An October 12, 2016 SLEEP TELEPHONE NOTE states, "I called the patient and explained their sleep test results in detail. I explained him that the study did not show significant sleep apnea despite his sleeping on his back. He is unable to sleep on his side due to his shoulder problems...Encouraged the patient to lose weight." A November 2, 2016 MH PTSD INDIVIDUAL NOTE states, "Veteran believes that gay men are going to hurt him. He also informed worker that he has experienced a lot of fear and worry this Halloween with people who are transgender, to the point that he is not sleeping for fear they will break into his home. Veteran is worried that he may have to "barricade" his home with bars on the windows." A November 3, 2016 MH Attending Note states, "Updates that since last appt, his GF ended their relationship, "she said I was over agitated." Last week, he describes an incident at a restaurant when a transgendered person was standing by him, he turned and saw the person, got so upset that he ran out of the restaurant and vomited. Since last week has felt progressively worse. "It's harder to tell which people to stay aware from.. it's a whole new ballgame with transgendered [people]...I don't know who my enemy is." He states he needs to set a perimeter on his house, put bars on his windows/doors, and update his security alarm. Reports poor sleep, gets out of bed 3-4x/night to check doors/windows and frequency of NMs has increased. Appetite is low. Feels that he cannot focus, "I'm constantly thinking how to avoid these people." Reports hearing male voices talking outside of his windows so he fears they will break in (reason for "setting perimeter"). When he is in public he has thoughts of "I need to get them before they get me" when he passes male strangers. Has not had any violence but does say he has had verbal arguments (told someone in the Wal-Mart line to back up and they argued with him, for example)...+ MST in Navy- unwanted taunts, suggestive remarks and genital contact and kissing from supervisor." A December 5, 2016 MH ATTENDING NOTE states, "Updates writer that he has spent ~$3000 since last visit adding bars to the outside of his first floor home window and installing a security system with cameras. Reports he still plans to add more cameras to monitor his roof because "maybe someday deterred by the barricade downstairs might want to get in up there." Reports vague AH of hearing footsteps on his second floor when he is down on the first floor. Denies hearing voices from upstairs or outside his window like he endorsed last visit. Reports nighttime is the hardest for him because "that's when they are outside...the enemy, the transsexuals." Denies actually seeing anyone outside of his house at night. Reports he is comfortable with certain people coming up to his house, like the mailman, but states he is not comfortable when strangers come up. States he is not aggressive but tells them to go away. Does not take his gun with him to the front door. States he now feels better with his house more protected. Is able to watch movies and enjoy them during the day. His security system is on his phone app and he checks it every 3 hours. At night he "secures the perimeter" every 2 hours, has an alarm set." d. Relevant Legal and Behavioral history (pre-military, military, and post-military): Behavioral - "In 2005 I grabbed a guy that was dressed like a female. We were meeting for a date but his profile said he was a female. Two months ago a person behind me in line was transgender. I pushed him to the side and ran outside." Legal - Veteran denied a history of legal problems. e. Relevant Substance abuse history (pre-military, military, and post-military): Substance Abuse - Veteran denied a history of substance abuse. 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: MST February-April of 1988: CPRS states, "A male teacher began touching him during class and stepped over lines trying to get too close that made him feel very uncomfortable. Veteran says there was never genital contact because there was touching and kissing on the part of the instructor." Veteran's stressor statement states, "One trainer would come up behind me and massage my shoulders. He also grabbed my waist and pressed himself against me. I could feel his erect penis against my buttocks. He also made sexual innuendos and jokes. He also asked me if my nipples were hard because I was glad to see him. He then said, 'I bet you have a nice sized tool'. He then touched my left nipple and kissed my neck. When I confronted him he stated that if I didn't cooperate, I may not pass through with my classmates. He then grabbed my crotch and said, 'Pass or no pass. You make the determination.' My relationship with my long time high school sweetheart ended that summer (June of 1988) because I withdrew fro the relationship and was too ashamed to confide in her." Please note that this last statement is in contrast to the statement provided by his former girlfriend who stated that the veteran "mentioned that a sexual assault happened to him during training that changed him and that he needed time to work through it." 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 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. Veteran's treatment records, buddy statement and stressor statement were reviewed. However, there are no markers in the veteran's STRs or personnel records which the VBA has confirmed. 4. PTSD Diagnostic Criteria No response provided. 5. Symptoms No response provided. 6. Behavioral Observations MENTAL STATUS EXAM - Appearance, Behavior, and Speech Veteran's appearance and dress were appropriate for the exam. His speech was normal in rate and tone. Veteran's response to the evaluation was guarded but engaged. Rapport was easily established with the Veteran who put forth a conscientious effort to answer all questions to the best of his ability. Thought Process - There was no evidence of loose associations, flight of ideas, circumstantial, or tangential thought process. Veteran completed similarities and interpreted proverbs accurately. Thought Content - Veteran denied having any obsessions or suicidal/homicidal ideations. However, delusions regarding the security of his home and transgenders were reported. "Transgenders are trying to get back at me because I grabbed the transgender that I was supposed to go on a date with. His profile said he was female. I have to hone in and decipher whether someone is male or female because my initial problems came with my sexual assault in training so I've distanced myself from males who are the enemy. The transgender caught me off guard and now they're trying to trick me. It's a whole new ball game." Perceptual Abnormalities - "I keep hearing my instructors voice in my head. Especially if I get around someone who has to make choices that involve me. I keep hearing 'pass or no pass' which is what he said to me. I hear a human voice outside my windows. When I go look there's nothing there so I don't know if they've run away or what. That's why I put up security cameras." Mood and Affect - Veteran's mood was "indifferent" and his affect was flat. Sensorium and Cognition - Sensorium was clear. Veteran was oriented to time, place and person. Immediate memory was good as he was able to repeat five of seven numbers forward and six of seven numbers in backwards sequence. Recent memory was fair as he recalled two of three items after five minutes. Remote memory was fair as he recalled the names of the last three presidents, the name of his high school, his youngest son's birthday, and his first job. Veteran was unable to recall the name of his elementary or junior high school nor his siblings or two oldest sons birthdays. In regards to concentration, Veteran spelled world forward and backwards and completed simple mathematics, serials 3's, and serial 7's. His intelligence appeared to be average. Judgment and Insight - Veteran's insight is good as he understands the outcome of his behavior and the choices he makes. His judgment is impaired but he informed that he would return a library book to the library if found, pull over for the police, and return a wallet he found to the owner. 7. Other symptoms Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 8. Competency Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any Financial: "My brother pays any bills that I can't pay online." NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application.
  2. zuluvictor81

    Male Mst

    I have a few questions that I hope this site can answer. Back in 2000 I joined the army national guard and was sent to AIT while there and living in the barracks we had what i guess is called hazing going on. I was the new guy who already had a unit patch, rank and a list of ribbons so i was already out of place in the barracks. At first stupid stuff like being called a FNG or a NUG and lifting my bunk off the ground while i was in it and slamming it to the ground, or a tossed bunk or my lock pooped and my locker tossed. Yes it pissed me off but nothing worth crying to the drill sergeants about. After a few weeks a couple of my class mates where standing around and laughing looking at pictures and one calls me over and ask me if i knew what Tea Bagging was i honestly had no clue and said making a cup of tea. Then the kids shows me a Polaroid picture of me asleep in my bunk and another male placing his private parts on my face. I was told that this had happened many times. I went down to the office and proceeded to inform our Senior drill sergeant/acting first sergeant who tell me he will look into it. I leave think of i reported shit is going to hit the fan. Instead the Senior Drill sergeant came upstairs into our bay and tells everyone to gather round. I was thinking her we go.. Instead he yells out that he understands some teas bagging on going on and that it was just gay to let another man put his bare nuts on your face and that he better not see any of that stuff going on. I was shocked and freaking out because I am not gay never was and never will be. After this i began getting threatened and call a blue falcon i was woken up one night to chem light being poured in my mouth and other night having actual pubic hair sprinkled over my face. Other times buckets of water would be thrown onto me in my bunk i was to hyper vigilant that if they could not get close enough to me to mess with me they would throw boots or other objects at me. I called and talked to my home unit PSNCO and told him what was going on and refereed me to contact our home SGM in charge of all training which i did. He told me to avoid them and he was making some calls. The next day i got called over to the base national Guard liaison SGM who proceeded to yell at me to suck it up and stop whining and that if i was such a xxxxx i never should have joined the Army. Again i reported it and WTF is going on. I left and called my home SGM and told him what had happened and he just said WTF and told me to keep my head down and avoid them at all cost that there was not much he could do from where he was. In the middle of all this i had slipped on some heavy ice and went down a flight of stairs and was on a profile and going through rehab for my knee and lower back. One mourning i got my Sick call slip signed before the battalion went on there run at 0400. The rule was no one is allowed up in the barracks during PT period which meant i had to go into the day room until my scheduled therapy time. I was the only on a profile at the time so it was just me. I screwed up and fell asleep and over slept (at this time i was barley sleeping so i crashed hard.) I woke up and saw the time was 0800 and freaked out ran up stairs changed uniforms and caught a cab to school. A few hours later one of our Drill Sergeants came and pulled me out of class and asked me why i missed my rehab appointment and i told him the truth. The next day at lunch time i was called into the office where the SR DS handed me a counseling statement and saying that i had forged a sick call slip to get out of PT. I said i never forged a slip and he said that i had filled out a slip and had them sign it and that i did not use the slip for it intended purpose and i was getting a AR15 i asked to see JAG and was told i would be taken within 3 days. 3 days went by and i asked one of the DS when i would be going to JAG and was told opps we forgot to schedule you. That afternoon i was called over to the SGM NGB Liaisons office again. Where he proceeded to yell at me for getting into trouble and pulled out another counseling statement and began writing that i had supposedly gotten 3 AR15's and that he was chaptering me out on a chapter 14. I said that i had not even received 1 yet that the only thing i got in trouble for i have not seen JAG for so 3 was impossible. At this point tons of yelling lots of curse words and a demand to shut the hell up and just sign the document i once again asked to see JAG and was told i would be scheduled. A few more days go by and i get called into the commanders office where he wants me to sign my chapter papers and i once again say i have not even seen JAG yet. He tells me it does not matter i am just being sent back to my unit with a Under Honorable Conditions and that as long as i do not get into any more trouble for 6 months it will convert to full Honorable. I get back to my unit and they place me on none reporting status and tell me to go to the VA for MH and to finish rehabbing my knee and back. I got turned away from the VA with them telling me that they had not received my medical files and that i did not have enough concurrent active duty time to qualify for services. I tell my unit and they hook me up with a civilian doc who ended up doing surgery on my knee less then a year later. During my recovery after surgery i get a letter in the mail that i was discharged from the National Guard and in the signature box just said soldier not available. I called my unit and they were just as shocked as i was and said that there was nothing they could do about it now. Years have gone by and i was diagnosed with severe anxiety and PTSD. This is the tricky part the Doctor who diagnosed me was a civilian i saw at his private practice but he also worked full time at a VA CBOC. I honestly tried to live in denial of what happend and began drinking and did some dumb things and that is all on me. I hit pretty low and began seeing a shrink who helped me quite drinking and helped me with some coping tools like caring a calendar around so i would stop forgetting stuff. About a year my counselor who was also a vet told me to apply to the VA for PTSD and i told him that i had tried back in 2002 and was denied because they could not locate any of my medical files or service files. I was told by a bunch of VFW guys that because i did not complete the training that i would never get approved anyway that i was technical never a soldier. MY counselor told me things have changed and to file again. So i did on my own we don't have and VSO's out where i live and they only come through once a month and they only alot 30 mins for you anyway. I am embarrassed that what happened to me did. I was supposed to be a soldier and stronger then that a defender to the weak how was i so weak that it happened to me. I chocked up my fear and filled out the 781 and sent it in. I submitted all my doctors and just last week got a letter in the mail telling me that what i wrote on my 781 was not enough they needed more. Also calling the 800 number they still can not find my medical file so that's a major problem. So i sit down a write out a 7 page explanation of before during and after and resubmit it. Can someone please tell me how this will work out and if denied then what. I was told that if they can not find proof they will not even give me a comp and penn appoint and just deny me. I do not know if i am strong enough to do a appeal and have to go tell my story in a court room... Can some please walk me through this process and help turn the crazy down in my brain a little bit please?
  3. Hi, I have recently started the claims process with the VA (I filed an informal claim on 04-Sept-2013 I see a private therapist and have a current diagnosis of PTSD, Bipolar II, poly substance abuse. My therapist agrees with me that my disorders are SC I've taken the initiative already to get copies of my DD214 as well as my private medical records. Currently I'm trying to track down my records from when I was placed on a 72 hr hold in a psych ward in 2000. My prescribing Psychologist, who puts in time at the practice I go to, is also a VA doc. I guess my question is this. If my therapist tells me that they have diagnosed me with the above disorders does that mean that my Psychologist (the VA doc) had to have signed off on the diagnosis and if so does this mean that I should have an easier time with the VA? I'm also concerned that I may have to track down treatment records from the Army (I assume those would be in my DD214?) Where would I look for any SMR's that I may need? I also wonder if maybe I should try and track down any relevant records from my old Unit to show things such as an Article 15 and any evaluations done that would show the onset of my conditions. Also if anybody could advise me of what else I should be doing at this early stage to present an effective claim please feel free to advise me. Thank you in advance for any and all help Jason
  4. My husband is a purple heart disabled veteran with a current rating of 50% (due to shrapnel injuries from mortar blast). He was in Iraq from ’04-’05. He has just started talking to the VA about filing new claims for PTSD, TBI and a knee injury. While speaking with the VA social worker, she informed him he was diagnosed with PTSD in 2007 and TBI in 2013. He was never informed of these diagnoses at that time. Everything we read online says that there is no way to get an earlier effective date other than the date of his most recently filed claim (March 2018). Looking for advice if anyone has been successful in winning an EDD due to never being notified of the diagnosis? Any other advice you can share while going through this process? Thanks so much in advance for your help.
  5. Hello everyone I am new to the site. And I recent submit a the dbq for an increase for my PTSD and I trying to understand it but im just not getting it. So I figured would ask you all. Below is what the examiner put in the record. Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire Name of patient/Veteran: ========= Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes [ ] No ICD Code: F43.1 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD ICD Code: F43.1 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [X] No c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [X] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with reduced reliability and productivity 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 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 ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS Evidence Comments: MENTAL HEALTH OUTPATIENT FOLLOW UP NOTE [excerpts] DATE OF NOTE: MAR 05, 2018 AUTHOR: ========,NP NURSE PRACTITIONER CHIEF COMPLAINT: "same old same old" INTERVAL HISTORY: Veteran is here for 6 week follow up for PTSD, Alcohol Use Disorder, unspecified, episodic. At last appointment, low dose venlafaxine was added, aripiprazole, prazosin, and melatonin were continued. He reports symptoms are about the same. His wife is pregnant with twins, so he is trying to minimize arguments at home. He worries he will not be able to connect with the babies, because he struggled so much with his daughter and points to her persistence as the reason they are close now. He see no change in sleep, remains irritable, and more hypervigilant due To recent car break ins on his street. He has cut down on drinking, and denies any binges since last appointment. He continues to have fleeting SI, but denies intent. He often has thoughts of hurting others, but strongly denies acting on the thoughts. No recent hallucinations. He does talk to himself when he is trying to work something out, but denies hearing voices other than his own. It can be embarrassing as coworkers and wife have caught him. ASSESSMENT AND TREATMENT PLAN GOALS: DSM 5 Diagnostic Impression PTSD Alcohol Use Disorder, Unspecified, episodic Goals: 1. Decrease irritability and anger- does not interfere with home or work life more than one time per month, ongoing, improving 2. Improve feeling of connection with others- enjoying and developing relationships, ongoing, no change 3. Decrease avoidance of social situations/crowds- can tolerate Wal Mart, enjoy outings with family, ongoing, no change 4. Improve sleep- no difficulty falling asleep, sleep 6 to 8 hours nightly, ongoing, worsening PLAN AND PROGRESS TOWARDS TREATMENT PLAN GOALS: reviewed records and discussed options - increasing venlafaxine to 75 mg - continuing aripiprazole, prazosin, and melatonin - suggested individual supportive counseling at the Vet Center after Dr. Bhatia leaves. - monitoring labs at next appointment - Will continue to follow closely. RTC 6 weeks/PRN 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: Last C&P PTSD DBQ May 2016 Lives in Moncks Corner, SC with wife of 9 years and daughter age 4. Daily routine: Lay down for bed 2100. Will fall asleep 2300. Wake frequently. "I have to do certain things to calm down. I need my gun next to me. I have to check the house make sure its locked. Make sure the alarm is on. If I hear something, it wakes me right up and I have to check it out." +Nightmares, night sweats. "Sometimes I'm swinging and yelling and talking in my sleep, so my wife leaves for a different room. I wake up and she's not there and it freaks me out." Prescribed melatonin for sleep, prazosin for nightmares. Abilify for PTSD. Diagnosed sleep apnea by sleep study in 2013, prescribed CPAP and is compliant. Relationship with wife: "We almost got divorced a few times. She didn't understand what was going on. She started reading up on it. The whole reason I went to mental health was because of her." Relationship with daughter: "She is scared of me. She has seen me Snap a few times. She is on guard. She doesn't know if I'm going to be up or down. She is my heart. She is the only thing that makes me feel normal." Will watch cartoons and read books together. Hobbies: play basketball, go to gym "but now I just sit in the House watch TV or just in the room." Likes anime. Support: father "he's been with me through everything." And is Veteran too, wife "but there is a wall there where I don't open up." b. Relevant Occupational and Educational history: Working for passport services for 3 years. "Its rough at times. There's a lot of people in there. They had to move my seat because I'm too jumpy. They moved it so I'm not around a lot of people. It is hard to focus. I have to use sticky notes. They have been pretty supportive. I've had good supervisors." Was counselled about days missing for work; "I had a blow up at my co-workers so they spoke to me about that." Miss 2-3 days per month. "When I get to work, I drive around the Building and if I see something I don't like, I just go home." Military history: E4, MP, Separated 2014, Honorable, Served about 6 years. c. Relevant Mental Health history, to include prescribed medications and family mental health: Mental health treatment with prescriber and therapist. No history of hospitalizations. Was in group therapy "but I didn't like it." d. Relevant Legal and Behavioral history: "When I was in Japan I got us into trouble because of my alcohol abuse. I got into a car accident and hit 3 cars." Was sent to ADAP for anger and PTSD. A month ago got into a physical altercation with sister's boyfriend "I laid hands on him. So then I went to a hotel room and stayed there and then I went on a drink binge." e. Relevant Substance abuse history: Alcohol - "I abused it really bad. My PCM said it was affecting My liver." Was drinking4-5 25 oz beers, drink a bottle of liquor over The weekend. Now will drink 1-2 beers. Tobacco - 2-3/day Denies other substances. f. Other, if any: Current reported symptoms: Anger: "I black out and become very violent. I knock TVs off walls. My wife was ready to leave me." Triggers: "foggy day and rain." "Ignorant and stupid people." Social avoidance. "If a car is behind me too long, I start to think he is following me. There is a particular truck that I know and he gets too close to me. I got sick of it and one day I followed him home. I didn't do anything, but I blacked out mad. I knew I needed help." Flashbacks - "I was shopping with my wife, and this guy had a turban on his head and I thought I was back there. Its constant, its all the time." Hygiene - "My wife got on my because I went a week without washing And I didn't even realize it." Suicide - "I thought about driving into traffic at the light. One Time I sped up and got on railroad tracks when a train was coming. I thought, what am I doing? I went into store parking lot." Reports this occurred 2 weeks ago. "I keep a picture of my daughter in the car to keep me from [doing it]." 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 Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] Witnessing, in person, the traumatic event(s) as they occurred to others 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] 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). [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] 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 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. [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] Exaggerated startle response. [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 actively 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] Flattened affect [X] Impaired judgment [X] Disturbances of motivation and mood [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Suicidal ideation [X] Impaired impulse control, such as unprovoked irritability with periods of violence [X] Neglect of personal appearance and hygiene 5. Behavioral observations -------------------------- Veteran was open and forthright with no evidence of exaggeration or feigning symptoms. Affect blunted. Minimal eye contact. Speech regular rate, tone, volume. Thought process linear, logical, goal directed. Thought content absent for delusions, hallucinations, paranoia or HI. Endorses SI with no active plan, but drove car onto train tracks last week. Discussed safety, crisis line, Veteran has MHC appointment next week. Veteran reports safety to return home today. 6. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 8. Remarks, (including any testing results) if any: --------------------------------------------------- PCL-5 score 72, indicating probable diagnosis of PTSD. Veteran continues to meet criteria for PTSD. He reports social withdrawal, sleep problems, memory problems, irritability, anger that is both verbal and physical, suicidal thoughts. He has work accommodations because of his PTSD symptoms. He misses several days of work a month because of his symptoms.
  6. Have a question. I was investigated by the IG. No charges filed, but were substantiated. This ended the career. I have developed several mental health issues because of this. Long story on the investigation that I do not want to get into but looking for advice. 1. Can I put in for PTSD on this? 2. Or should I put in for MDD/Anxiety? This condition has led me to a couple of suicide attempts, and massive other health issues. I am seeing a shrink and therapist weekly. This issue will affect the rest of my life and all future employment opportunities. The investigation was such BS and over something that is so small that I get so angry and depressed over it. What is the best strategy for approaching this to the VA.
  7. I am still active duty. Having a number of mental health issues due to my health (heart arrhythmia) and the results of an IG Investigation. No charges but substantiated claims and my next rank that I was selected for was removed. My record now has me as a FTS (fail to select - basically passed over) and I have put in to retire (27 Yrs, 1 mo). I am seeing a military shrink and military therapist, each weekly and have been doing so for the past 6 weeks. Lots of paper in my record and a variety of diagnosis - PTSD, MDD, but mainly anxiety disorder. Question: Should I ask to have more psychological testing completed and get that in my record. I am think the MMPI-2 test (567 question so it is not little test). I would think that would help establish more firmly the service connection nexus and give a stronger diagnosis. It couldn't hurt right?
  8. I'm new to this site, and somewhat novice with claims as I've ignored them since my discharge in 2012, but I have some questions that I've yet to find answers for that hopefully someone can help me with: In a nutshell, my story is I did my four years, two hellish combat tours to Afghan, got out in 2012, immediately filed my claims for a few disabilities like back and shoulder issues and got a 40% rating total. I've since not looked back as none of that concerns me. My issue now is that I was sent to a mandatory PTSD screening during one of my visits that year, and the examiner kind of went about the thing blase, and although I did tell her most of my traumatic experiences, she gave me 0% for "Combat PTSD not related to military service" as it says in their justification, whatever that means. I don't think they even attempted to listen to me as my experiences were extraordinarily traumatic and have been a detriment to my mental health and quality of life since. And yet I now have an effective date of a PTSD claim from day of discharge 6 years ago for 0%, says it right on eBenefits. I think you know where I'm going with this... After 6 years of dealing with a slew of issues related to PTSD, I decided this week to start looking into trying to re open the case. My questions for you are.... Would I be entitled to any back pay if I could prove that I've suffered from PTSD since then, and that they made their original decision in error? And if so, how could I go about receiving the exact paper work / medical records from that one specific screening I had in 2012? I've looked everywhere and I don't really know how to navigate either of these situations... Thanks a lot!
  9. Hello and TYIA for any responses and for reading my long post. BLUF: I would appreciate some insight or just plain ol speculatin on why the VA raters would submit me for a lumbar strain increase (that I didn’t submit for) while working on my current claim? Also, are secondary conditions disqualified in the 60% calculation for SMC Housebound? I know it says the 60% must be separate from the 100% condition, but how does this work if I’m on IU, with secondary conditions? I’m probably overthinking at 4am but why would they submit me for an increase for a condition when I didn’t ask them, and the increase has no bearing on the final rating due to VA math, unless it qualifies me for SMC, or they believe I should be qualified. I’ve never raised the issue of SMC and I’m still learning about it trying to figure out my claim, and I know they are supposed to do due diligence, but that’s not my first hunch since that’s why I’m still in this process. History: I filed a claim in 2015 for PTSD increase and TDIU, was granted increase in 2016 to 70% PTSD, denied TDIU. Combined, 80% with other SC conditions. BBE/VSO said I was denied increase to 100% even though I had a nexus statement from a psychologist saying total social and occupational impairment, at least as likely as not, etc., but they said because I was still employed (I was on long term disability leave but not yet “terminated” and yes they had the relevant evidence through my employer and insurance), and my VA treating provider’s opinion took precedence who didn’t feel my symptoms quite qualified me for total of course, though he‘s a CRNP versus a psychologist and I don’t think he even knows me. I thought they were supposed to take the rating and credentials that favor the Veteran but never mind me. I also survived and was approved for Social Security and life insurance premium waivers during this period without having to appeal, with the same medical information and evidence, with the same VA SC conditions, even coming from VA docs and providers. Of course I appealed the rating and TDIU denial (they can decide) in 2016. I also submitted a new claim for secondaries to PTSD, and in my fog, with that claim an increase for PTSD and TDIU, even though I already had those on appeal. I believe I read or was told somewhere (or maybe my brain made it up) that if I submitted new evidence, the raters could look back at the effective date and could EED to the original claim if the evidence shows and close the appeal. Or, they could approve me from the date of the new claim and the appeal could deal with the stuff before that. But what they did was what they are apparently supposed to do (according to Peggy and the VSOs): defer the appeal related claims to the appeal. DOH. Current Status: Early this month my claim progressed and I was granted an increase to 30% for IBS secondary to my 70% PTSD, and since I had a pre-existing 10% for nerve condition and 20% for lumbar strain, that brought me to 90%. My claim never went to complete and I never got the BBE, ebenefits bounced around from gathering of evidence to pending decision approval within days of my last C&P (I had one for PTSD and one for IBS). I’m not sure why they would give me a C&P for PTSD if they are deferring that part of my claim to appeal as I was told. Maybe they’re just giving me a checkup because my 30 appointments and inpatient stays and shock treatments over the past year weren’t enough medical evidence. I learned of the increase bc I got a small retro and my ebenefits letters and disabilities changed within days, but the claim stayed open. I found out by calling Peggy and VSO that it’s due to an increase for my lumbar strain that someone in the rating chain put in. I do have plenty of evidence in my medical records that show my back is also crap. I got sent to a C&P for my lumbar strain and now I wait in GOE. The C&P examiner, Peggy, VSOs specifically say I was submitted for an increase for my back, not a review. BTW, in ebenefiits in the disabilities section, the PTSD increase is still open, the TDIU disappeared, the IBS is rated, and the lumbar strain doesn’t appear. Yes, I know ebenefits is unreliable and I should find something else to do, but compulsively logging into ebenefits is an activity quite similar to playing a slot machine for me. Every 1 in 10000000 logins I might get a glimmer of hope, and it keeps me going lol. I Wonder: What difference does it make if I’m rated 20% or 30% for my lumbar strain? Why would this be raised since my overall rating won’t change from 90% either way? Trust me, I AM NOT COMPLAINING AND I AM GRATEFUL, anything they do (and they have been getting faster and more Vet-friendly it seems) positive for the Veteran that saves future agony and torture is an appreciated blessing. It would help in the future in qualifying for SMC, but I don’t qualify with the math now. Just wondering if they don’t have enough to do over there, because in the future I’d probably have to get another C&P. Also, I would have to have another condition at 30% for that math to work out, and I pray nothing else worsens enough for that to happen. Does “separate” mean it can’t affect the same body system or it can’t be a secondary condition? Because with secondaries, I could potentially qualify for SMC, and therefore the VA rater would be setting me up for success. Otherwise, it just seems like extra work for them when they could close my case and get their quota numbers and help another Vet...again, not complaining but whoever is on my file seems to be thorough regardless. I know they could be doing anything over there, and I’m glad they’re working on my claim, but just for s&g I’d appreciate any guesses or suggestions, and any help clarifying the SMC Housebound math thing please. Thank you all.
  10. I have been working with a VSO to file my claim. I am currently in the process of gathering information. Only thing, file for MST with PTSD or file PTSD. VSO was hung up on the sexual part of MST. Background: Was in service 1991-2000. In 1995 was involved with a female soldier, who also was involved with another male (married) soldier. After an exercise and the last night sleeping together she asked me to kill his wife. After the second time I went to CID and wore a wire twice. While the Article 32 hearing was going on she was let out of pre-trial and started harassing me, being around me. I was moved from my company to another, and ultimately to the brigade HQ (rear detachment). Brigade HQ was deployed then. Both the female soldier and male soldier were other than honorable discharged, but I was exiled for a year. Not the same after. As I was getting out in 1999 I learned that she had asked other people in the unit to kill me. I was seen at a Vet center into 2000. Same time as the Article 32, my chain of command was trying to discipline me for an Article 15/court martial. The incident was with the female soldier (before she had asked me) and was on a trumped up charge. Even had the 1st sergeant threatened me in his office about "if he could not get me on that charge he would find another". After my time in Brigade HQ I returned to almost a new unit, only 5% knew me. All I wanted was out, but he harassed me every day to change my mind and go to the promotion board. Would not even let anyone drive me to airport to PCS. It took my wife to point out that when I get harassed or witness it at work that I am affected by it. I am currently being seen for it by the Vet center I was seen at before. The vet center had listed me as PTSD and marked as military trauma. Also, I don't have anything from that time as I was not in a good place and as a 26 year old did not want the reminders in my barracks room. So if anyone knows how to get the CID or JAG records I am all ears.
  11. I am in the process of putting together a claim package for mental health issues related to MST. Try as I might, I cannot find a VSO with experience in my situation. It's taken me years to accept that I need help and that I need to address this once and for all, so when I say that I cannot handle doing this twice (submitting a sub par claim and then doing appeals) I really mean it. From day to day, I vacillate between thinking my problems are actually other people's inability to cope OR feeling like there is no point to me and that I'm a burden.If it weren't for the whole not being able to pay bills and risking alienating my kids for all eternity, I'd be perfectly content letting the world turn while I hang out at home and being maladjusted and mean. In my perfect world, there would be a check list of things to submit for a fully developed claim. On this checklist, there would be a list of key phrases or high points that would help sway the decision makers into awarding adequate compensation. I haven't been able to find anyone that has had success doing this with a case like mine. I have police reports from the MST. I have trauma counseling records and AD medical records that clearly state a d/x for PTSD related to rape on X date. My counseling sessions identified dissociation behaviors, PTSD, and anxiety. One doctor even noted that I was combative and stated that I wished harm on my attackers. Obviously, the Navy handled this clear cut case of rape, with evidence and my complete cooperation, like they do any scandal. They buried it and came after me. That might be a secondary stressor, but I've been warned that claiming a secondary stressor could hose up everything and to keep my mouth shut? kind of amazing that the advice that is meant to help, sounds a lot like the advice that sent me careening out of control all those years ago. Anyhow, I survived, got married, got out, and went in and out of counseling. Over the years, I've been diagnosed with PTSD, Chronic Depression, Chronic Adjustment Disorder, Agoraphobia, Generalized anxiety Disorder, and Dissociation Disorder. I don't trust military medicine or the government, so most of my counseling was done through non-profit organizations and women's shelters. They're so secretive, that I felt it'd be safe to tell them what I went through and my statements wouldn't end up in the Navy's summary of Mishaps... again. So, I don't really have records of those, except for prescriptions that were reported to Tricare. I do have my civilian medical records. It has page after page of doctors complaining that I broke down, was combative, emotional etc, etc. I do have a few sessions with shrinks at MTFs in the last couple years. They were not keen on actual diagnostics, they just gave me the pills I asked for. I'm shopping shrinks to assess me and give diagnosis. I'm not sure I need a nexus letter, but I'm thinking it wouldn't hurt. I have a letter from my ex boss describing how my work performance plummeted over the years and how he made accommodations to keep me on. I also have a letter from me, describing my bad days and my rituals to get through them. My husband and his best friend were witnesses to the fallout of my rape, in terms of the military's response to me. They can verify in statements that I did report it and go into counseling. They can also verify that I'm socially isolated and very codepenedent on them to meet new people or get involved in activities. I don't have a single friend that they didn't make for me, first. I do not know how to people. I don't have friends from work. I don't have "my own" friends from church. I don't even have people who like me well enough, and include me in things, without my husband and his best friend acting as intermediaries. oh, I also have the most recent sentencing transcripts for the ringleader of my attackers. The judge stated that he felt this dude was unrepentant and a monster. He cited his past sex crimes, "both in the record and that didn't make it to trial" and his history of convincing others to help him conceal his crimes. If that's not a shout out from the bench, I don't know what is. Anyhow, I guess my question is, has anyone here done a fully developed MST claim with multiple bullet points for anxiety, phobia, ptsd, and depression, and get 100% or at least, a high enough rating to qualify for unemployability? Without having to go through appeals and lawyers? Was a police report enough, even if the military dropped it? Should I give the C&P my evidence, letters, and my personal statement too? I'm sure I have 1000 more questions, but I'm mostly looking for someone who has done what I'm trying to do.
  12. Just saw on E-Benefits that my Sleep Apnea claim as secondary to PTSD was granted at 50%. For the Sleep Apnea: - No history of sleep issues while on active duty or in STRs - VA Psych requested sleep study, Sleep Study completed by VA-Outsoursed Hospital, Diag. w/mod. Sleep Apnea and issued a VA CPAP in May 2013. - My private Sleep/Pulminary Doc completed Sleep Apnea DBQ & wrote nexus letter stating "Based on my evaluation of the veteran, it is my opinion that it is at least as likely as not that Mr OEF21B's diagnosed OSA is aggravated by his service connected PTSD. I also feel that it is at least as likely as not that Mr OEF21B's PTSD is aggravated by his OSA." (17 JUL 15) Filed Sleep Apnea claim 28 JUL 15 - Sleep Apnea C&P in AUG 15 with the Veterans Evaluation Services (VES). Brought copy of DBQ and Nexus Letter as well as some of the articles linking PTSD & SA. I thought the C&P went well and the Dr. said that she would add the articles as well as my DBQ & Nexus letter to her final report. IMHO, I believe that my private doc's completion of a DBQ as well as his Nexus letter was key in meeting the requirement for service connection secondary to PTSD. I also believe that providing these along with the articles listed here in various places, and providing all of this to the C&P examiner helped. Semper Fi
  13. Ward868

    SMC-S, Filing Procedure, and Back Pay

    100% p&t, since 2012... (ptsd)... I want to file for smc-s, but frankly, cant remember how to get the ball rolling... My c&p exam in 2011, clearly stated agoraphobia...Any suggestions, would be appreciated..Also, when approved, do you believe retro will go back to 2012.. Thank you all, again, for your input, and advice... SEMPER FI
  14. Submitted CUE to Los Angeles RO on 5/6/15. Evidence included- 7/21/2004 VA Form 21-4138 stating I was homeless with no mailing address at the present time 10/21/2004 Denial Decision letter mailed to address I had told VA I no longer lived at. 01/19/2005 2nd mailing of denial decision letter sent to the same wrong address again. This time RO handwrote in "C/O New Directions" but sent the letter to the same wrong address. 08/31/2004 Social Work Progress Note from VAMC stating place, address and phone number of new address in Santa Barbara I could be located at 11/10/2004 VAMC Los Angeles inpatient progress note stating I was returning to Santa Barbara. 01/19/2005 VAMC Los Angeles discharge summery note stating I was again returning to Santa Barbara Rescue Mission. 21-4138 Stating VA failed to follow proper mailing procedures and did not provide me with appellate rights. That I later, in 2012 won service connection for PTSD with Bipolar Disorder, and that effective date of 4/13/2012 was clear and unmistakable error, as well as the other contentions of that 2003 claim remained appealable. So folks, do you think I've rebutted the presumption of regularity with this CUE claim?
  15. I separated from active duty service in the Air Force with in 2010 and had undiagnosed non-combat military connected PTSD with alcohol use in remission (According to my VA disability paperwork which puts me at 50% for ptsd.) This was granted the beginning of last year. I recently put in to have my discharge upgraded to honorable from general and have yet to hear back from them. (E-benefits say maybe I'll hear about it early February 2018.) There were a few selfmedicated incidents with alcohol that happened while I was active duty that resulted in going into a civilian rehabilitation facility, a perscription to an antidepressant, and a lot of suicidal ideation I recently admitted in my paperwork to the review board that I was afraid to admit to my command because they would do things like write someone up for a sunburn (destruction of government property), or purposefully keep spouses apart by writing one up for something they didn't do and keep them from going during their significant others' PCS (because someone else did it to them for five years and "they turned out fine"(There was no way to prove otherwise.)). I was recently reading about medical retirement from the military. It's a little confusing. I was wondering if there was a way to submit for reconsideration and medically retire from the military after separation?
  16. I see now the VA is using ecstasy on Veterans saying it helps cure mental illness. Ecstasy causes some major brain damage. The VA Hospital forcefully did lobotomies on 2000 WW2 Veterans and ruined their lives. Roman Tritz’s memories of the past six decades are blurred by age and delusion. But one thing he remembers clearly is the fight he put up the day the orderlies came for him. “They got the notion they were going to come to give me a lobotomy,” says Mr. Tritz, a World War II bomber pilot. “To hell with them.” The orderlies at the veterans hospital pinned Mr. Tritz to the floor, he recalls. He fought so hard that eventually they gave up. But the orderlies came for him again on Wednesday, July 1, 1953, a few weeks before his 30th birthday. This time, the doctors got their way. The U.S. government lobotomized roughly 2,000 mentally ill veterans—and likely hundreds more—during and after World War II, according to a cache of forgotten memos, letters and government reports unearthed by The Wall Street Journal. Besieged by psychologically damaged troops returning from the battlefields of North Africa, Europe and the Pacific, the Veterans Administration performed the brain-altering operation on former servicemen it diagnosed as depressives, psychotics and schizophrenics, and occasionally on people identified as homosexuals. The VA doctors considered themselves conservative in using lobotomy. Nevertheless, desperate for effective psychiatric treatments, they carried out the surgery at VA hospitals spanning the country, from Oregon to Massachusetts, Alabama to South Dakota. Roman Tritz talks about the scars from his lobotomy. The VA’s practice, described in depth here for the first time, sometimes brought veterans relief from their inner demons. Often, however, the surgery left them little more than overgrown children, unable to care for themselves. Many suffered seizures, amnesia and loss of motor skills. Some died from the operation itself. Mr. Tritz, 90 years old, is one of the few still alive to describe the experience. “It isn’t so good up here,” he says, rubbing the two shallow divots on the sides of his forehead, bracketing wisps of white hair. The VA’s use of lobotomy, in which doctors severed connections between parts of the brain then thought to control emotions, was known in medical circles in the late 1940s and early 1950s, and is occasionally cited in medical texts. But the VA’s practice, never widely publicized, long ago slipped from public view. Even the U.S. Department of Veterans Affairs says it possesses no records of the lobotomies performed by its predecessor agency. Musty files warehoused in the National Archives, however, show VA doctors resorting to brain surgery as they struggled with a vexing question that absorbs America to this day: How best to treat the psychological crises that afflict soldiers returning from combat. Between April 1, 1947, and Sept. 30, 1950, VA doctors lobotomized 1,464 veterans at 50 hospitals authorized to perform the surgery, according to agency documents rediscovered by the Journal. Scores of records from 22 of those hospitals list another 466 lobotomies performed outside that time period, bringing the total documented operations to 1,930. Gaps in the records suggest that hundreds of additional operations likely took place at other VA facilities. The vast majority of the patients were men, although some female veterans underwent VA lobotomies, as well. Lobotomies faded from use after the first antipsychotic drug, Thorazine, hit the market in the mid-1950s, revolutionizing mental-health care. The forgotten lobotomy files, military records and interviews with veterans’ relatives reveal the details of lives gone terribly wrong. There was Joe Brzoza, who was lobotomized four years after surviving artillery barrages on the beaches at Anzio, Italy, and spent his remaining days chain-smoking in VA psychiatric wards. Eugene Kainulainen, whose breakdown during the North African campaign the military attributed partly to a childhood tendency toward “temper tantrums and [being] fussy about food.” Melbert Peters, a bomber crewman given two lobotomies—one most likely performed with an ice pick inserted through his eye sockets. And Mr. Tritz, the son of a Wisconsin dairy farmer who flew a B-17 Flying Fortress on 34 combat missions over Germany and Nazi-occupied Europe. “They just wanted to ruin my head, it seemed to me,” says Mr. Tritz. “Somebody wanted to.” Counting the Patients A memo gives a partial tally of lobotomized veterans and warns of medical complications. A note about documents: Yellow highlighting has been added to some documents. The names of patients not mentioned in these articles have been redacted, along with other identifying details. All other marks are original. The VA documents subvert an article of faith of postwar American mythology: That returning soldiers put down their guns, shed their uniforms and stoically forged ahead into the optimistic 1950s. Mr. Tritz and the mentally ill veterans who shared his fate lived a struggle all but unknown except to the families who still bear lobotomy’s scars. Mr. Tritz is sometimes an unreliable narrator of his life story. For decades he has meandered into delusions and paranoid views about government conspiracies. He speaks lucidly, however, about his wartime service and his lobotomy. And his words broadly match official records and interviews with family members, historians and a fellow airman. It isn’t possible to draw a straight line between Mr. Tritz’s military service and his mental illness. The record, nonetheless, reveals a man who went to war in good health, experienced the unrelenting stress of aerial combat—Messerschmitts and antiaircraft fire—and returned home to the unrelenting din of imaginary voices in his head. During eight years as a patient in the VA hospital in Tomah, Wis., Mr. Tritz underwent 28 rounds of electroshock therapy, a common treatment that sometimes caused convulsions so jarring they broke patients’ bones. Medical records show that Mr. Tritz received another routine VA treatment: insulin-induced temporary comas, which were thought to relieve symptoms. ‘Anxious to Start’ The VA hospital in Tuskegee, Ala., asks permission to perform lobotomies. To stimulate patients’ nerves, hospital staff also commonly sprayed veterans with powerful jets of alternating hot and cold water, the archives show. Mr. Tritz received 66 treatments of high-pressure water sprays called the Scotch Douche and Needle Shower, his medical records say. When all else failed, there was lobotomy. “You couldn’t help but have the feeling that the medical community was impotent at that point,” says Elliot Valenstein, 89, a World War II veteran and psychiatrist who worked at the Topeka, Kan., VA hospital in the early 1950s. He recalls wards full of soldiers haunted by nightmares and flashbacks. The doctors, he says, “were prone to try anything.” https://taskandpurpose.com/fda-just-designated-mdma-breakthrough-therapy-ptsd-treatment/ http://projects.wsj.com/lobotomyfiles/
  17. Tbird has very good info at the hadit Home page on IMOs. I reworked a topic I posted here some time ago.and maybe it can be found better now: Independent Medical Opinions can often be the only way a veteran or widow can succeed on a VA claim. VA plays a war game called the War of the Words. The proper wording of an IMO is critical to VA's acceptance of it, as probative evidence. Opinions obtained from private treating doctors are often free yet most independent medical opinions are needed from doctors with full expertise in the field of the disability and can be very costly. However an award can easily absorb this cost with a few comp checks or the increases in comp that the claimant might never obtain without an IMO. A Valid IMO must contain the following: The doctor must have all medical records available and refer to them directly in the opinion. In cases involving an in-service nexus- the doctor needs to read and refer to the SMRs. Also the doc needs to have all prior SOC decisions from VA ,particularly those referencing any VA medical opinions and a copy of the actual C & P results is even better. The SOC or SSOC could parse or manipulate critical statements in the actual C & P exam. The IMO doctor should define their medical expertise as to how their background makes their opinion valid. They should be willing to attach to the IMO their CV (Curriculum Vitae that contains their medical background and any other info pertinent ,such as any symposiums they attended, articles they had published etc etc,if possible, that show their expertise .) A psychiatrist cannot really opine on a cardiovascular disease. An internist cannot really opine on a depression claim. They need to have expertise in the field of the disability you have claimed to make their IMO valid. They should rule out any other potential etiology if they can-but for service as causing the disability. They should briefly quote from and cite any established medical principles or treatises that support their opinion. They should point out any discrepancies in any VA examiner’s opinion-such as the VA doctor not considering pertinent evidence of record in the veteran’s SMRs or Clinical record. They should fully provide medical rationale to rebutt anything that is not medically sound nor relevant or appropriate in the VA doctor’s opinion. They should then refer to specific medical evidence to support their conclusion. They must use these terms: (VA is familiar with these terms) "Is due to- 100% More likely than not- Greater than 50% At least as likely as not- 50% (Benefit of doubt goes to Vet) Not at least as likely as not- Less than 50% Is not due to- 0% from an post by carlie “ It helps considerably to identify pertinent documents in your SMRs and medical records with easily seen labels as well as to list and identify these specific documents in a cover letter that requests the medical opinion. A good IMO doctor reads everything you send but this makes it a little easier for them to prepare the IMO as to referencing specific records. Send the VA and your vet rep copies of the signed IMO. And make sure your rep sends them a 21-4138 in support of it- you also- can send this form (available at the VA web site) as a cover letter highlighting this evidence. PS- Mental disabilities- make sure the doctor states that you are competent to handle your own funds- otherwise, if a big retro award is due-the VA might attempt to declare you incompetent and it takes times to find and have the VA approve of a payee. (unfortunately many PTSD claims these days depend on a VA MH professionals diagnosis of PTSD and an IMO diagnosing PTSD will not be accepted by the VA. See our PTSD forum for the 2010 regs on that. I need to add here that a secondary condition to an established SC condition wold not need the IMO doctor to read all of the SMRs. They just have to state with medical rationale why the second claimed disabilty is due to (secondary to) the initial SC disability. IMO docs must avoid words like 'maybe', 'possibly', 'could ' or 'might' be related to, or any other wording that VA could construe as speculative and then disregard the IMO for that reason. On the other hand the IMO doc should look for any purely speculative statements in the C & P exam report or in the C & P and overcome those statements by stating they are mere speculation and have no medical basis. DIC claims IMOs are different and the IMO doctor needs the death certificate and any autopsy findings and any past C & Ps as well as the entire clinical record (to include SMRs in some cases) and copies of any and all private records. They need the rating info on the vet and what his or her SCs were for. If the immediate cause of death is NSC but a service connected disability substantially contributes to death, the VA should award DIC. Often this type of DIC claim definitely needs an IMO to clarify a substantial contribution to a NSC death. 1151 IMOs are different too. The IMO doctor must identify the exact nature of the negligence with direct referrals to the med recs. Then the IMO doctor must make a strong medical statement with a full medical rationale that the veteran has a documented disability that is directly due to the VA's negligence and give a full medical rational for that. It is a good idea for a 1151 IMO doc to also add abstracts or citations from known medical practices in the 'standard medical community' to bolster a 1151 claim. What I mean is showing the VA proof that non VA doctors (the standard medical community) would have taken different steps to diagnose and treat the veteran and the VA's “omission” of these proper medical steps caused the veteran's additional and documented disability. Hope this all helps someone.
  18. Inarticulate&Distorted

    In the Trenches.....against our own people

    To list the many many Tags would have been ludicrous. My case is relatively new. I joined here last year, this place has always been great to calm burned out nerves. I sometimes don't make sense to myself let alone anyone else. But when I got out, I went tearing away from anything and everything that even REMOTELY resembled authority. People being able to control my life terrified me to the point where it has literally affected every single part of my life. I came here seeking help and I got it. So, if my story can help anyone else, and my opinions on what you can do to help your own Battle, because that's what this REALLY is, then I will feel like I have done a small and meager effort to pay it forward. My C-File isn't stuffed to the gills with medical records because I didn't serve long enough to qualify for VA Medical. My Claims were handled fairly fast compared to the average. My Story is simple, I got kicked out of the US Army Infantry, after Basic, but I did not finish my A.I.T. We were OSUT. How and why is my business, and I have completely accepted that now. I wasn't even aware I had "issues" until about 9 years after I got out of there. And, a further 6 years before I swallowed my pride and went and finally asked for the help, that I had been convinced by every Veteran I knew, that I now have. I filed my initial claim for PTSD with Anger and Depression. 5 months later they denied me without a C&P, oh gosh gee wilikers was I disappointed. But, once again, fellow Veterans pointed me the way. I went to my Second VSO, and they filled for Depression, and I was scheduled for a VA C&P Exam. Why do I emphasize the VA part, well, I had learned from reading here at Hadit that C&P exams don't show up on your VA website thingy. Which, I thought to myself, that IS kind of important, you know, so no one can "lose" your record of that particular exam. I must admit that my best decisions I have made after getting my actual 50% Service Connected decision letter last year was to continuously educate myself. Not just about me, but the VA itself. IT IS IMPORTANT THAT YOU BRING YOUR COPYS OF YOUR PERTINENT INFORMATION WITH YOU. Sure that really friendly guy on the phone making your appointment is probably say it's not necessary to bring any documents, the Examiner will have ALL your evidence. Bullshit, don't ever leave your case DEPENDENT on ANYONE else' actions! Seriously, I took that advice from someone here, and it saved my ass. A actual Lt. Col. in the US Army Medical Hospital Diagnosed me with exactly what i was filing for. Match the Words, don't try to guess, don't try to infer. Take all your important verifying information with you. Don't leave out anything that you feel may hurt your case, if you think the VA is going to not use any excuse to take away what they give you, you are DEAD wrong. They will dig for it and hunt it down. Be honest, give them everything. But remember, you are literally not DEFENDING yourself to these Raters, you are pressing your case base on verified fact. They will work harder to rip your benefits away, than they are supposed to help you get them.Tell them something is wrong if you don't know exactly, and make them give you an examination, it is your right as a Veteran. I see too many Vets who are always asking others for help, guess what, it's up to US. DO YOUR HOMEWORK Seriously, you need to know more about your Disability's then the people who wrote the books and TREAT you for it. No one knows your Disability's like you. Because they are literally YOURS, not as a statistic or a Roster Number. Because remember, these are not minor discomforts or passing ailments. These damages are severe enough to make us DISABLED. You are LEGALLY entitled to the compensation for the damages done to you, maybe that's why the VA Denies us so consistently. No matter how many changes in Technology or public opinion, they have NEVER done it at a pace that allows most of us to barely maintain our composure and dignity. As far as the Law goes, if you have evidence, you're solid, it is not the RATER who is processing your claim wrong, it is YOU. Every "T" must be crossed, every "i" must be dotted. You have to make your case so solid,that it would literally be a breaking of the Law not to Service Connect you, or a fair Scheduler Rating, or TDIU. You have to SLAM THAT Claim DOWN ON THAT RO's desk, and CHALLENGE him to find flaw in every single interpretation of the Laws, Rules, Regulations....... Become your own greatest weapon, by realizing that you personally can't do that, you have to show it through your work, every page has to be meticulous, don't give them any reason to take the scalpel to your pages. I have a theory, based on how fast I was Denied the first Claim, how fast I was sent for a C&P for my second and winning Claim, and the fact that I was approved the DAY after my C&P exam. I personally feel, as if the moment a Rater can find a reason, and Literally the first reason, he denies and kicks out. Because I was denied without even a C&P exam. Then, when my second claim got sent up, they took one look at it, and knew they were caught out, so as soon as they got my results, they gave me 50% and expected me to be grateful for it. Never stop, always press on, continually advance, and when you can't advance, you bear down, shield up, and dig in. You are now in the Trenches of the VA, and we are literally all here because we are STILL Brothers and Sisters in Arms, against our own people. My OPINION of VSO's and LAWYERS A VSO, no matter where he works, is not gonna fight for you, oh they will file paperwork.....if you tell them what to file, you see, they just mostly don't have the balls for you, because they have balls for EVERYONE. A Lawyer, on the other hand, is motivated by Passion, and Profit. Think about it, if you were to Arm yourself with a Hypothetical Spear-like weapon, would you not want the one with the longest reach, sharpest point, and stopping power? A Lawyer, will fight, because he will look at your Claim, in whole, at ALL the FACTS, and take your case ONLY IF HE BELIEVES THE LAW IS ON YOUR SIDE AND HE CAN WIN IT! That alone, is a boost of confidence that will sustain your Hope, while unfortunately also being a two-edged sword. If he doesn't take your case, then do MORE HOMEWORK. If you can convince a VA registered Lawyer to take your case, you're fairly solid. ONCE AGAIN, MY OWN PERSONAL OPINION. Always Dig Deeper than the Surface Picture that the VA forces on you,If the Law is on your side, stand firm, and advance,Remember that you are right, and you need not defend against their No, but insist on your Yes. Good luck y'all
  19. Trapperx6

    IU and SSDI

    I was just rated 70% for PTSD bringing my total disability to 90%. I have worked very part-time as a bus driver but have been let go due to the meds I'm on and my PTSD. I am planning on applying for IU and SSDI. Is there one I should be applying for first or can they be applied for at the same time? Any thoughts and comments are very much appreciated!
  20. HI, New here. Found the community through google. I'm still learning to navigate the site, so please bear with me. Searching got me in the right direction but not close enough. I was recently diagnosed with Service connected PTSD through the VA. I have not done a C&P exam yet. On the same day I was diagnosed with obstructive sleep apnea through a VA sleep study. I've read that there is a slim chance to connect my sleep apnea as a secondary to my PTSD. My VA psych Dr said they aggrevate each other, but a pulmonologist opinion would have more power than his. I've seen some advice from other members talking about letter templates, DBQs and supporting articles. However, I haven't been able to find them here. I've scheduled a civilian Dr. appointment with a pulmonologist in about 2 week and would like to come prepared with any information I can. Any help would be greatly appreciated. Thanks, Nova
  21. I filed a claim for PTSD back in 2014 and then had my C&P. At the C&P the outside VA examiner asked multiple questions and focused on my upbringing (which was good) and my Father almost insinuating that my MST really is from my Father. When I left there I was completed traumatized because of the line of questioning and that he didn't even ask about my military time and shortly after I was denied. At the same time I had already been diagnosed by my VA Mental health Dr and through a MST coordinator. I got the denial shortly after and because I was so upset just did nothing since I didn't want to go through it again. I still went to the VA for treatment and then 2017 I requested an increase for my TBI. They scheduled a C&P and I went and the VA this time and within 4 weeks I was went from 10% TBI to 70% for TBI/PTSD making my overall rating 100%. A few days ago, I received my narrative and I immediately requested my original claim of PTSD reopened requesting an effective date change to my original claim that was denied . My question is that because I did nothing from 2014-2017 will they deny or is there anything I can do to have my effective date changed since the first C&P went so wrong.
  22. I'm reading this VA Citation :NR 1231506 and the VA is saying that because a Veteran with PTSD is getting improvement from his psychiatric medication, that he's showing less symptoms because of it, that he is having his rating reduced from 70% to 30% for PTSD. The VA did reverse the reduction at the BVA. Is this still something to worry about? At a C&P exam does the Veteran have to make it clear that the medication is the reason for improvements and needed to sustain them? Citation NR: " An October 2009 VA medical record reflects that the Veteran reported that the medication he had been prescribed helped with ability to be out in public and that, while leery about being around people, he could go out in public much more easily. His mood overall was good, and he indicated that he continued to enjoy dining out with his wife and stopping by the VFW to socialize with friends. The examiner assigned a GAF score of 76-80". Over at Veteran's Law Blog it says "As an example, say a Veteran has been able to service-connect Irritable Bowel Syndrome (DC 7319). Undiagnosed, the symptoms of IBS might be a component of Gulf War Illness With prescribed medication, our hypothetical Veteran’s condition moderates from a severe form of the disease to a milder form. The severe form of IBS is rated at 30% and the moderate form of IBS is rated by the VA at 10%. Let’s say the VA gives the Vet a rating of 10%, claiming that the Veteran’s medication limits her symptoms. Is that 10% rating correct? No . The Diagnostic Criteria in the VA Rating Schedule for Irritable Bowel Syndrome does not specifically list the effects of medication. Therefore, the VA is not allowed to consider the relief it provides when determining the degree of disability. Has this happened to you? When have you seen the VA use “improvement due to medication” as an excuse to give a lower rating"? https://www.veteranslawblog.org/va-disability-claim-medication-reduce-va-ratings/ https://www.va.gov/vetapp12/files5/1231506.txt
  23. My heart goes out to all of my fellow survivors of MST ... For me, I have found I can no longer suppress and manage the daily physical and emotional affects of the sexual assault that took place on December 25, 1985 while serving on active duty. In effort to find some help, relief and hopefully someday healing I am starting the uphill journey to deal with this and try to share some of the highlights of my battle. I will be the first to admit I have no idea what I am doing and can only hope that God the father.... will guide my feet day by day. First step locating documentation of the event. A few weeks ago I was able to locate the police dept. and requested a copy of the report. I received a copy of the 15 page report this past week and it makes me emotionally and physically sick just to look at the envelope it's in. I also tried to locate medical records over the years from prior mental health therapists and physicians that would have documented my history as it related to these events, but the practices were closed or my records were no longer available due to time. April I called the VA to inquire about mental health services for MST and hesitated to start the process because the MST would not be marked in my record for all my providers to see. This was a big hurdle mentally as I have always hid this event at all costs from my providers. I am sure this did not help my physicians treat me and fully understand my ongoing medical problems especially those in which are usually brought on by some big life event which I always adamantly denied when asked. May 2nd 2017, I submitted a "intent to file". May 4th 2017, I went to a VSO rep?? to asked questions about the process to file a claim related to MST. The rep was belittling, insulting, hurtful, rude and I walked out of that office with no more information and the psychological affects were pretty devastating. At the encouragement from my daughter to go straight to the patient advocate office and file a complaint....I did just that. I found myself have a total mental breakdown just trying to give the details of what just went down and was thankfully met with support and many reassurances that I would have a team of people helping moving forward and that person would be brought in...dealt with and re-trained. I will spare you all the details. My next step is hearing from the mental health dept. to set up an appt. to do some type of baseline evaluation of my symptoms etc. as it related to MST... I guess to get an official diagnosis on record and to get me the specific therapy I need started. I will likely opt for tele-therapy once I have a few sessions onsite at the VA. That's it for now
  24. Anybody have any idea or know anything about the part of the PTSD criterion relating to derealization and or dissociation? I experienced them both during my multiple MST events...still do.
  25. Are there any other Veterans on here that were at the Pentagon 9/11-9/30 for search and rescue/recovery? I was denied PTSD in 2005 (VA said it wasn't service connected), I appealed it, but never received a letter that the appeal was denied, at that point I said f-it and gave up on the VA. I created an ebenefits account recently (December 2015) and it says that appeal decision (denied) was made in March 2006. I am still having issues. I am reopening the claim for PTSD. I have the VA ROI from 2005 that shows all the VA Psychologist and LCSW notes on file chronic PTSD and GAF:40. I was going to that VA clinic 2004-2006. went back in 2009 to get prescription for nightmares and flashbacks. shit is still not going away.
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