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Found 5,835 results

  1. I would like to thank you all for the information that helped me gather my information in my other question. Took most of the year, but finally filed PTSD due to personal trauma, early Jan 2019. Intent to file was running out. I did file some secondary conditions as well. I have just been called by VES to have my C&P PTSD exam in March. A question and answer exam I was told, 30-45 min. Glad I have researched similar exams here. Berta, Andy, Buck, Geekysquid, Thanks for the help and guidance. Was able to a buddy statement, CID records, VET center records from before I was discharged and current, and other current discipline records from work. Good statements from my wife and I as well.
  2. I recently did a new C&P for PTSD when I filed for I.U. He neglected to mark a lot of my symptoms. I am currently rated at 50% PTSD, was wondering if you think this keeps me a the same or warrants an increase. He did forget to mark my suicidal ideations and a few other symptoms though so I am worried I won't be rated correctly. 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: F43.10 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD ICD Code: F43.10 Mental Disorder Diagnosis #2: Panic Disorder ICD Code: F41.0 Mental Disorder Diagnosis #3: Major Depressive Disorder, Recurrent ICD Code: F33.1 Mental Disorder Diagnosis #4: No Axis II disorder 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? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: The PTSD is currently the more severe and responsible for the veteran's current level of impairment; the clinical depression and the Panic Disorder are certainly significant, however. The depression and Panic Disorder are seen as more likely than not caused by the chronic PTSD symptoms. It is difficult to ferret out the contribution of the three disorders due to the overlap of symptoms and variability of degree; at times any of the three disorders may be the more severe, but the PTSD is responsible for the current level of impairment. 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 [X] No [ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: The PTSD is currently the more severe and responsible for the veteran's current level of impairment; the clinical depression and the Panic Disorder are certainly significant, however. The depression and Panic Disorder are seen as more likely than not caused by the chronic PTSD symptoms. It is difficult to ferret out the contribution of the three disorders due to the overlap of symptoms and variability of degree; at times any of the three disorders may be the more severe, but the PTSD is responsible for the current level of impairment. 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. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: Veteran received his previous PTSD C&P on Mar 2016. At that time he was living in an aparments. He still lives in but has moved to a different aprtment. He lives with a roommate. He is not in a relationship. The veteran is not employed. His typical day consists of going to school, "I have classes five days a week but "I only go two days a week because of panic attacks. When I'm home I sometimes lay in bed and cry or think about everything." He noted he does not sleep much at all. He said he only gets out for school; is roommate will cook and get most of the groceries. b. Relevant Occupational and Educational history: The veteran has not worked since he was discharged from the Air Force in 2016. He has applied for jobs and tried to do a work study but quit because of panic attacks; at times he will scream and hit his back pack. He started there in August and is taking 12 units. He is schedule to attend classes five days a week but rarely makes all five days. "I'm close to failing a couple of classes for attendance. c. Relevant Mental Health history, to include prescribed medications and family mental health: The veteran is current being followed by a staff psychologist every two weeks; he has being seeing her since August. He is also followed by a staff psychiatrist who prescribes: prazosin and Celexa. He has taken other medications. He said they help only a little bit. d. Relevant Legal and Behavioral history: Denied by the veteran. He did say he got into an altercation about two weeks ago at the gym when he through a dumbbell at the floor; he was kicked out. e. Relevant Substance abuse history: The veteran has not drank alcohol for over one years; he denied ever abusing it. He does not use illegal substances. f. Other, if any: No response provided. 3. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threatening situations (non-combat related stressors). Do NOT mark symptom s 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) Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). 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, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] 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] Panic attacks more than once a week [X] Mild memory loss, such as forgetting names, directions or recent events [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Neglect of personal appearance and hygiene 5. Behavioral observations -------------------------- No unusual behaviors observed. 6. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [X] Yes [ ] No If yes, describe: The veteran reports having suicidal thoughts 3-4 times a week but doesn't dwell on them. He said he would never attempt suicided because of his kids. 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 8. Remarks, (including any testing results) if any: --------------------------------------------------- No remarks provided.
  3. Looking for some guidance. I served on active duty in the Navy from 87-90 overseas on a ship. My original plans when I enrolled was to do 20 years, Back in Dec of 2018 I met with and amazing Veterans Service Officer about a tinnitus claim which was approved. While there she had handed me a bunch papers about claims and one was on PTSD and MST. She was copying and I was reading the PTSD-MST document and it triggered a bunch of emotions where I started shacking and tearing up. The VSO walked in and noticed my state and asked me if I was ok. I tried to answer her but, couldn't she went and got a male VSO and a male nurse to come in. Once the nurse helped calmed me down the male VSO noticed the document I was reading and we talked for awhile about it and I briefly explained a little. He recommend that I file a DBA for PTSD-MST and recommended the following. I document everything I can remember about the events is causing my stressors: I wrote an eight page document in details about the events. Talk to my wife about what happened and have her write a document on what she sees and how it effects our relationship: After having an very hard emotional talk with her, she wrote a two page document. My 20 year old son also wrote a two page document on things he as seen, even though he only knows a little about what happened. Talk to my doctor about what happened: Made an appointment and discussed detail what happened and he diagnosed me with severe PTSD and anxiety placed on Xanax as needed. He wrote a Nexus letter and has sent it into the VA for me Now I explain a little about what when on when arriving on ship I was assigned to a steam generator room and assigned watch with two other sailors one was a 2nd Class Petty officer and the other a 3rd class. At the time we were doing 12 hour watches 12 on 12 off. The first few watches went well. We were getting ready to pull into Subic Bay Philippines for a few days before heading back to Japan. They both stated " We want you to come out and drink with us and then we can tag team a few girls". Now a little history alcoholism runs in my family and I don'y shy away from drinking I just know my limits. When we arrived in port I hung out with a few of my buddies instead. When we headed back to sea things went down hill. On my first watch back with them they yelled to me to come to the watch booth which was big enough for 2 chairs and a small table/chair between them the whole booth was maybe 4 feet by 6 feet with a center door and windows. When I went in I noticed they both had towels over their laps which wasn't unusual do to it being over 100 degrees in there. I was told to sit down and did then one of them stated we figured out why you didn't go out with use you must be gay and not like girls. I didn't get a chance to answer when they ripped the towels off and exposed themselves to me. I tried to leave but they held the door laughing. I was finally let out and was very shaken up. This happened many time the next few day the both continually exposed themselves to me. I would ask them to stop and would be ignored. I went to my Chief Petty officer and told him what was going and and got this remark back " Why you trying to get them in trouble they are just playing with you". I went to back to my watch and was cornered by them and verbally threatened to keep my mouth shut. With out going in two many details things escalated to the point where I wold come done to watch and they would be masturbating in the open I'd try to move away and they would chase me around. One time I was working in the bilge( bottom area of ship lots of stinky water and valves) under the floor of our work space crawling around attempting to fix a valve when I felt what I thought was water coming down on me upon looking up realized they were urinating on me. A lot more worse things happened. I was very depressed and felt helpless. I tho ought about suicide many time and even cut my wrist once when things were at its worst. Got scared and told everyone I fell and sliced it still have the scar. Other than my failed attempt to tell my Chief about it I never told a soul about it. I ask myself why didn't I fight back? Lets put it this way at the time I weighed about 125 lbs soaking wet and about 5'7". They both were about 170-180 and were both over 6 feet. I was working in a space alone with them at anytime they could injury me say I got hurt working it was my word against the 2 of them. Why has it taking so long for me to open up about this? I always thought that Sexual trauma only happened to woman. I was scared and embarrassed to admit he happened to me. How has this affected me. I have nightmares weekly. I have flashbacks. Something will trigger memories and I'll have panic attacks. I have intimacy issues. I have ED issues that started at an early age. I have issues in places where there may be Male Public Nudity ( Locker rooms, even public restrooms I'll use a stall ) Just because it triggers flashback of them and what they did. I have issues with Male authority figures. I have the tendency to back down from and conflicts even though and right. Fear retaliation And the big one still fear retaliation from them. Still fear after almost 30 years that exposing them and what happened they will find away to get me. Thank you to everyone who reads this. Now my questions: Is there anything else I should include to help my case? I'm aware that after my meeting with the VSO they will set me up with a DBA with someone from the VA. What can I expect from that meeting and how should I prepare for it? What about secondary PTSD symptoms what applies? After meeting with my personal doctor he actually interned at the VA center I going to. He suggested apply for ratings secondary to the PTSD rating for the following. Erectile dysfunction, hypertension. Do you feel that these are ok? Are there others that I should consider or be aware of?
  4. Hello All, Ive been coming to this site on and off for a couple of years, but this is my first post. Lot of knowledgeable and great people here. Thank you to all the old timers and those with experience for everything you contribute here. You do a lot for people, even though it may not be evident. Im a 36 year old 100 P&T VA for combat related PTSD, TBI and other service connected issues. Former active duty 11B B4, fought with the 101st in OIF. Left active in 2009 as I was having issues. No one was helping me, didnt understand what was wrong with me, and of course the culture of "if youre not bleeding or missing a limb, dont go to sick call", ect. So I left, joined the reserves where Ive been ever since. That door is about to close as well, as I just cant do it anymore. I did my best to try and still contribute to my nation, feel some sense of worth and continue to serve, but my issues are too great and I have to step away. Even though the Army has changed a lot, I still feel a great sense of loss of over this. But, I have a family now and must do what is best for them. That alone is difficult for me. Those of you who have the same issues as me may understand, PTSD and TBI are what I call a "perfect storm of bull____". Our hardware and software are both busted and feed off each other in ways that I myself cannot even begin to describe. Damn near ruined my life and just trying to get through the average day takes everything Ive got. I used to be a mostly-normal, fun-loving, smart and well-adjusted guy and I was good at my job. Anyway, this ain't a therapy session, but Im sure a lot of you can understand where Im coming from. My latest battle is with SSDI. Denied. Appeal denied. Now Im onto the hearing phase. Hearing is set for April 5th. I have a lawyer firm I sort of just picked out of a hat. They arent even in my locale, Im in the Northwest, they are Philadelphia or something. They are supposed to be representing me. I have a hearing in April and I havent even talked to a real lawyer yet. Im worried and scared about this whole process. It has made me extremely anxious, among other things. Its causing a lot of extra stress. Im trying to find answers on how to maximize my chances of success. What Ive gleaned so far is of course, get all VA records. I still attend treatment every month (i would go more but Its a 4 hour round trip just to see them every month). Im sure its going to be harder to get SSDI because of my age too. Not to mention, the VA does not seem the best at keeping records. Most all of my treatment has been with the standard-issue social worker therapist type and of course, the docs/nurses who prescribe me my meds. My head is swimming. I am having a hard time making sense of all this. Im scared and I could really use some guidance. I dont trust these lawyer people to do their best for me. Im hoping there is not something critical I am missing. Im not good at describing my symptoms, reflecting on my life.... let alone in court in front of a judge. Sorry such a long post, sort of hard to collect my thoughts. Thanks for any input and advice.
  5. I hope you can help me; not sure what I should do. I was rated Service Connected Disable for PTSD on August 21, 2012 @ 70%. I didn't expect this at all. If anything, I thought I would get a low rating for my physical aliments............(neck, back head shoulder). When I applied in 11/2011, I had been out of work for 3 yrs and was totally distraught,confused and disoriented. Needless to say, I finally got a job in 02/12 and it is no where near what I use to do or the money I use to make. I'd like to know what your advice would be for this: I see where I do have serious social and economic problems and believe I am totally diasable & want to ask for 100% PTSD, Permanent and Total. I'm still on this job that wrecks my nerves, can't stop the obsessive thoughts and wants to hurt people because I don't work well with people at all. I took this week off because I couldn't pull up the gumption to go back in there after the week, mentally. What should I do; appeal my rating 1st and then apply for TDIU while working or do I go ahead and let the job go in order to apply for TDUI and then appeal the VA's decision? Thanks in advance.
  6. 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.
  7. First, What Cannot be CUE? The Code of Federal Regulations provides that the following situations do not constitute CUE: (d) (1) Changed diagnosis. A new medical diagnosis that ‘corrects’ an earlier diagnosis considered in a Board decision. (2) Duty to assist. The Secretary's failure to fulfill the duty to assist. (3) Evaluation of evidence. A disagreement as to how the facts were weighed or evaluated. (e) Change in interpretation. Clear and unmistakable error does not include the otherwise correct application of a statute or regulation where, subsequent to the Board decision challenged, there has been a change in the interpretation of the statute or regulation. 38 CFR 20.1403 (d)(3) above is most interesting. As long as the VA relied on some negative evidence that was in the record, even the most dubious and slimmest of evidence, a veteran cannot argue that the analysis was flawed. It doesn’t matter if the evidence on the veteran’s side amounted to a mountain and the negative evidence on the other side amounted to a mole hill, so long as the VA relied on the negative evidence to reach its finding of fact adverse to the veteran, it cannot be challenged as CUE. The CAVC put it this way: “when there is evidence that is both pro and con on the issue it is impossible for the appellant to succeed in showing that ‘the result would have been manifestly different.’” Simmons v. West, 13 Vet.App. 501 (2000). If you find yourself in this situation, the best route is to reopen the claim with new and material evidence that specifically rebuts the VA’s previous rationale for denying the claim. What IS CUE? Analyzing a BVA Decision for the following types of substantive errors: BVA findings of material fact that are "clearly erroneous": Whether constitutional provisions, VA statutes, regulations, or M21-1 provisions were violated or misapplied Failure to comply with a BVA or CAVC remand order Failure to reopen a claim supported by new and material evidence Failure to consider a claim or legal theory reasonably raised by the record Failure of BVA to State its Reasons or Bases for its Findings of Fact and Conclusions of Law BVA Findings on Medical or Vocational Issues of Fact Unsupported by Competent Evidence in the Record The BVA's Failure to Explain Why It Rejected Positive Evidence Supporting the Claim Some Examples of CUE Failure to Fully & Sympathetically Develop Claim Even though the failure of the VA to fulfill its duty to assist a veteran is not grounds for a CUE claim, the courts have allowed CUE claims based on the VA’s failure to “fully and sympathetically develop a veteran’s claim to its optimum.” Moody v. Principi, 360 F.3d 1306, 1310 (Fed. Cir. 2004). This means that the VA must “give a sympathetic reading to the veteran’s filings by ‘determining all potential claims raised by the evidence, applying all relevant laws and regulations.’” Moody 360 F.3d at 1310. Therefore, if there was evidence when the previous decision was made that the veteran was eligible for compensation for a claim not raised by the veteran, and the VA did not adjudicate that claim, this constitutes CUE. For example, if a veteran applies for benefits for back problems relating to an incident while serving in Vietnam and subsequent VA medical exams reveal the veteran has Hodgkin’s disease, the VA has a duty to adjudicate a claim for Hodgkin’s disease on the veteran’s behalf (Hodgkin’s disease is a presumptive service-connected condition for veterans who served in Vietnam). Failure of the VA to adjudicate a claim for Hodgkin’s disease would be CUE and the effective date for the Hodgkin’s claim will date back to the date of the back injury claim. 38 CFR 3.156© Using Newly Added Service Records You can use 38 CFR 3.156© to get an earlier effective date “if the VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim.” So, if after reviewing your C-file you find official service records that were added to your file after the denial, and these documents would have manifestly changed the decision, you can argue for CUE based on 38 CFR 3.156©. An example would be a previous denied claim for PTSD because of lack of a stressor in service. If an official service document is added to your file after this denial that clearly shows the veteran suffered a stressor in service, the veteran can use 38 CFR 3.156© to get an earlier effective date equal to the date he originally filed the claim for PTSD (assuming you have the proper nexus and medical opinion). Thanks to Katrina Eagle, and John Forristal
  8. Hi there! Long time member here but been MIA for awhile. Life has been busy and I have been dealing with health issues. Long story short, I went through a battery of tests to find out what is wrong with me. I did an ANA-TITER test, and it was positive for an auto immune disease. Was referred to the RA doctor for further testing to see if I had lupus. The RA doctor did blood tests and determined I don't have lupus. We did additionally physical exam at the VA back in May and he determined I had Fibromyalgia and diagnosed me with it. We discussed that my Fibromyalgia co-exists with PTSD/MST and IBS. We also discussed that Fibromyalgia can be secondary to my already service-connected PTSD/MST or even maybe my IBS. I discussed this with my representative and we decided to file a claim for Fibromyalgia (non-service connected disability) to an already service-connected disability. Either PTSD/MST or IBS and we asked that they evaluate either causation or aggravation. We filed in July and I had my C&P exam in September. The examiner was asked by the rater to give his medical opinion as to the Fibro being secondary to my PTSD/MST. The rater did not ask if it was possible to be secondary to my IBS like we requested. The examiner did a C&P DBQ for Fibro and that was positive. I do have Fibro, that isn't the issue. The medical opinion is what was disturbing. I was with the examiner for less than 5 minutes. He stated he physically examined me when he did not and he seemed very unknowledgeable about Fibro/PTSD-MST/IBS as co-existing and determining either causation or aggravation. Of course the medical opinion stated, "less likely than not". I was floored, so I went to work for my claim. I contacted my RA doctor and we talked with my representative on the phone as well. By the end of the call he was confident enough to link my PTSD/MST as aggravation to my Fibromyalgia. He wrote a one/two paragraph letter on my behalf. We sent that to the rater. Then I spoke to my MH provider last week and she too wrote me a very good NEXUS letter. That was sent to the rater yesterday. Both my doctor's are at the VA and both stepped out on a limb for me. I am hoping their medical opinions outweigh the negative C&P medical opinion. I am attaching the C&P exams (redacted), the two medical opinions (redacted) - I am hoping I am successful because this will make me 100% scheduler. I am currently 94% overall rated. C&P _Redacted.pdf nexus 2_Redacted.pdf redacted.pdf redacted2.pdf
  9. 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
  10. C&P Exam PTSD:MST Eating Disorder.pdf ^^^^^^Well the attached report indicates to me a 10% PTSD rating. I am currently 30% and I do not understand how this happened but I might be in for a reduction. I thought the exam went well. I had a PTSD and Eating Disorder C&P. Regarding the occupational/social impairment she checked the one that resembles 10% and for "b" she marks YES and goes on to say my trauma impacts my occupational/social impairment. Look at the symptoms she notes: Anxiety; Panic Attacks more than once a week; Chronic sleep impairment; difficulty in establishing and maintaining effective work and social relationships She even stated in the exam that I was BDD (Body Dysmorphic Disorder) but her reports indicates while I have BDD characteristics I don't warrant the BDD rating. She states for the VA established diagnosis of SPECIFIED TRAUMA AND STRESSOR RELATED DISORDER, there is NO CHANGE in the diagnosis. At this time the claimant's condition is active. Does this Exam mean I am going to be reduced or would I fall under the below??? 3.344 Stabilization of disability evaluations. (a) Examination reports indicating improvement. Rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of disability evaluations consistent with the laws and Department of Veterans Affairs regulations governing disability compensation and pension. It is essential that the entire record of examinations and the medical-industrial history be reviewed to ascertain whether the recent examination is full and complete, including all special examinations indicated as a result of general examination and the entire case history. This applies to treatment of intercurrent diseases and exacerbations, including hospital reports, bedside examinations, examinations by designated physicians, and examinations in the absence of, or without taking full advantage of, laboratory facilities and the cooperation of specialists in related lines. Examinations less full and complete than those on which payments were authorized or continued will not be used as a basis of reduction. Ratings on account of diseases subject to temporary or episodic improvement, e.g., manic depressive or other psychotic reaction, epilepsy, psychoneurotic reaction, arteriosclerotic heart disease, bronchial asthma, gastric or duodenal ulcer, many skin diseases, etc., will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. Ratings on account of diseases which become comparatively symptom free (findings absent) after prolonged rest, e.g. residuals of phlebitis, arteriosclerotic heart disease, etc., will not be reduced on examinations reflecting the results of bed rest. Moreover, though material improvement in the physical or mental condition is clearly reflected the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. When syphilis of the central nervous system or alcoholic deterioration is diagnosed following a long prior history of psychosis, psychoneurosis, epilepsy, or the like, it is rarely possible to exclude persistence, in masked form, of the preceding innocently acquired manifestations. Rating boards encountering a change of diagnosis will exercise caution in the determination as to whether a change in diagnosis represents no more than a progression of an earlier diagnosis, an error in prior diagnosis or possibly a disease entity independent of the service-connected disability. When the new diagnosis reflects mental deficiency or personality disorder only, the possibility of only temporary remission of a super-imposed psychiatric disease will be borne in mind. (b) Doubtful cases. If doubt remains, after according due consideration to all the evidence developed by the several items discussed in paragraph (a) of this section, the rating agency will continue the rating in effect, citing the former diagnosis with the new diagnosis in parentheses, and following the appropriate code there will be added the reference “Rating continued pending reexamination ___ months from this date, §3.344.” The rating agency will determine on the basis of the facts in each individual case whether 18, 24 or 30 months will be allowed to elapse before the reexamination will be made. (c) Disabilities which are likely to improve. The provisions of paragraphs (a) and (b) of this section apply to ratings which have continued for long periods at the same level (5 years or more). They do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating.
  11. Can MDMA "cure" PTSD? https://www.independent.co.uk/news/health/mdma-ecstasy-mdma-post-traumatic-stress-disorder-veterans-a8332561.html https://www.ncbi.nlm.nih.gov/pubmed/16499508
  12. I am just wondering to what extent does the VA's Duty to Infer reach? I keep seeing it mentioned but I am not finding any particular bounding rules or interpretations, so any links or opinions would be great. Take for example a post I read this morning. OP was initially rated as 70% PTSD and was not/had not been working. Said it was in his file. Asked if VA should have inferred IU. So what has to be in their file to trigger the Duty to Infer? Is simply stating they are unemployed enough to trigger the question? is a mention in their intake memo enough? from their Primary Care doc? Psychiatrist? does a discussion with the 1-800 number trigger this duty? What if they are homeless or near to becoming homeless is that enough? Do they have to have an extensive statement saying they have not worked in two decades (or whatever) and don't think they ever will again? Would the duty to infer by itself require the VA rating decision to mention IU or send the IU form with an explanation? For example my latest rating decision for SMC K include a statement that I might have a claim for Voiding Dysfunction and tells me to file a "new" claim if I want to explore being rated for it. To my mind this is a Duty to Infer action on the part of the Rater; taking that back to the 70% PTSD example should there also have been a statement inferring possible IU and the forms needed to process such a claim? What about something like sleep apnea? I know the rules have changed on needing a statement that CPAP is "Medically necessary" but what if under the old rules a sleep study is done, a cpap issued and following that a C&P finds the veteran to be Service Connected for PTSD and has Chronic Sleep issues? Should the rater 'infer' that C&P is in order, or does the veteran have to intuitively know (yeah right) that SA is a ratable condition and then has then file a new claim? what about under the new rules? how would a new veteran know that their sleep apnea might be a ratable condition if service connected? doesn't the VA have an obligation to tell us if some condition is potentially a ratable condition or secondary to a rated condition? I cannot imagine it was the intention of Congress for Veterans to have to know things and rules they could not possibly be aware of before they file claims, particularly veterans new to the VA process. In that light it makes zero sense that legal requirements such as a Duty to Infer would/could be narrowly interpreted. Any links, discussions, BVA or CAVC results, etc would be appreciated.
  13. So, i submitted a claim for "PTSD secondary to sleep apnea". I had no evidence of sleep apnea in the service, except for a few buddy statements. I submitted a package from Dr. David Anaise for the nexus....Had my C&P Exam... the dr (who i would love to share the name of cause shes seriously did not know what the hell she was talking about) kept telling me that "Sleep apnea cannot be secondary to ptsd because it does not cause it", i told her "it aggravates it"... i asked "Why would it be an option for me to choose "sleep apnea secondary to ptsd if it doesnt exist? why would the va even give that option to us".. she said "I dont know". I had all the studies printed out to give to her (as well as submitted in the claim by dr. anaise and myself).. she didnt even read it.. Just kept telling me that ptsd does not cause sleep apnea. I was going back and forth telling her "You dont think that my ptsd aggravates my sleep apnea?" "She says i dont know if it does or not"...... She then said she will grant me "Sleep Apnea" but not secondary to ptsd.. i was like i am not putting in for just "sleep apnea" i am putting it into connection with ptsd. She had no idea wtf she was talking about and had no general understand. I uploaded a statement after the C&P Exam stating all my points. I even showed her a BVA decsion showing that veterans have been service connected for it in the past even (i know) that all claims are individual... she wouldnt have any of it. Just kept denying me and saying not worry as i will get service connected anyway.... Well few monthes go by and i got service connected for it. Amazing... that was like 6 monthes ago.... Fast foward to today and i go through my blue button on myhealthyvet and i saw that that doctor DENIED me and said "b. The condition claimed is less likely than not (less than 50% probability) proximately due to or the result of the Veteran's service connected condition. c. Rationale: Obstructive sleep apnea is caused by narrowing of the upper airway leading to obstruction while sleeping. This needs to occur on average a minimum of 5 times per hour to have a diangosis of ostructive sleep apnea. There is currently not enough medical evidence to show that PTSD causes obstructive sleep apnea." also she stated:"I reviewed his medical chart, VBMS records, letters from an outside physician and studies he presented. total time spent 1 hour. After extensive discussion, Veteran did not agree with my medical opinion"Has anyone ever heard of being granted service connection for something that the C&P doc denied you for? i did not appeal or do anything, i was simply granted.... I would really like this doctor to see that she got rejected as bask in all my glory. She was something else... Good luck to all and if you have questions please feel free to ask me.... attached is a letter i submitted after my claim disagree with the c and p doc... stating shes an idiot in kinder words
  14. Does the Veteran have a diagnosis of PTSD DSM-5 criteria on today's eval? [X] Yes [ ] No 2. Current Diagnoses,1PTSD 2Panic Disorder 3Agorophobia 4Major Depressive Disorder b. Medical diagnoses relevant. obstructive sleep apnea, fibromyalgia, hypothyroidism. 3. Differential a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No 4. Occupational and social impairment [X] Occupational and social impairment with reduced reliability and productivity b. For the indicated occupational and social impairment, is it possible to differentiate which impairment is caused by each mental disorder? [ ] Yes [X] No [ ] Not Applicable (N/A) Vet has multiple co-morbid psych dx and therefore cannot differentiate level of impairment due to each mental disorder due to overlap in symptoms. Does stressor meet Criterion diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [X] Yes [ ] No Criterion A: Exposure to [X] Directly experiencing the traumatic event(s) Criterion B: Presence of [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams [X] Dissociative reactions [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic [X] Marked physiological reactions to internal or externalcues that symbolize or resemble an aspect of the traumatic Criterion Persistent avoidance of [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, Criterion Negative alterations [X] Persistent and exaggerated negative beliefs or expectations about oneself, others [X] Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blameherself others. [X] Persistent negative emotional state [X] Markedly diminished interest or participation in significant activities. [X] FeelingsofdetachmentEstrangement [X] Persistent inability positive emotions Criterion E: Marked alterations arousal [X] Irritable behavior angry outbursts [X] Hypervigilance. [X] Exaggerated startle response. [X] Problems with concentration. [X] Sleep disturbance Criterion F: [X] Duration disturbis more than month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important Criterion H: [X] The disturbance is not attributable to the physiologicaleffects of a substance Criterion I: Which stressor contributed to the Veteran's PTSD diagnosis?: X] Stressor #1 5. Symptoms [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks more than once aweek [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recentevents [X] Flattened affect [X] Impaired judgment [X] Disturbances of motivation a [X] Difficulty in establishing and maintaining effective work and social [X] Difficulty in adapting to stressful circumstances,including worklike setting [X] Obsessional ritualsInterfereActivities [X] Neglect personalAppearance hygiene DSM 5 Diagnosis:PTSD-Panic d/o with agoraphobia-Generalized Anxiety D/o Vet meets the DSM-5 diagnostic criteria for PTSD as level of severity - severe. Relationship of mental disorders to each other Vet's MDD, recurrent,moderate is secondary to her PTSD.HerPanicDisorder, Agorophobia and FSAD are also secondary to her PTSD. It is my medical opinion that vet's MST stressor is as least as likely as not suppported by and consistent with the in service marker evidence. Her agorophobia preclude her from functioning satisfactorily in work environments.
  15. VA received my RAMP appeal on March 13 and still no answer after 142 days. Is this unusual? Any STATS out there on how long some of them go over? Peggy gives me different answers every time I call in beginning with very few go over the 125 to at 135 days if you don't get a letter in 30 days call us back. Nothing worthy on vets.gov My VSO is clueless and gives me only what I get myself. What is the point of RAMP if there is no real deadline at all, not even a few days over?
  16. SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [X] Yes [ ] No ICD code: F43.10 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Post-traumatic stress disorder ICD code: F43.10 Mental Disorder Diagnosis #2: Cannabis use disorder, mild ICD code: F12.10 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? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [X] Yes [ ] No [ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: Cannabis use disorder accounts for persistent use despite negative consequences and large amounts of time spent using. All other symptoms are due to the PTSD. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation b. For the indicated occupational and social impairment, is it possible to differentiate which impairment is caused by each mental disorder? [ ] Yes [X] No [ ] Not Applicable (N/A) If no, provide reason: Veteran has not had meaningful sobriety from cannabis in some time so it is not possible to determine the level of impairment caused by her PTSD alone. c. If a diagnosis of TBI exists, is it possible to differentiate which occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] Not Applicable (N/A) family mental health (pre-military, military, and post-military): Veteran first received counseling services as a child, related to DCFS involvement. She reported a history of suicidal ideation and self-destructive behavior around age 7-8. One inpatient hospitalization at this time. Still with suicidal ideation, "I really hate being here," estimated once per day. Has engaged in reckless behavior, like fast driving. Cites children as deterrent. Also fears not succeeding and being chronically disabled. History of self-injurious behavior (cutting and burning) 4-5 years ago. Cries daily. Limited enjoyment of activities. Able to care for children. Unclear how much assistance she receives from family me mbers. "I feel like a bad mom." Does not have many friends. Prefers to be alone. Currently attending therapy once per week. Cannot discuss trauma because she becomes too distressed. "I constantly remember or think about ways I could have gotten away or done things differently. I feel like a weak person. I can't protect myself. How can I protect my children?" Taking medications Seroquel and Lamictal along with sleep aid (Trazodone). Medications not helpful. No adverse side effects. Misses 2 doses per week. Sleep disrupted by dreams of "being trapped." Weight fluctuates along with eating. Prefers not to sleep. Wants to stay alert to surroundings. Occasionally sees "shadows." d. Relevant legal and behavioral history (pre-military, military, and post-military): Juvenile legal involvement for stealing and truancy. History of fighting as a juvenile. e. Relevant substance abuse history (pre-military, military, and post-military): 1-2 grams cannabis daily. Able to be sober 1-2 years while looking for a job or while pregnant. No problems related to use. History of alcohol use, which she stopped due to father's history of alcoholism. 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: 2 rapes by fellow service members 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. Unplanned pregnancy documented 9/4/2008. Delivery 5/4/2009. Disclosure of MST to multiple providers, including non-VA providers. Veteran's statement in support of claim dated 8/11/2018. 4. PTSD Diagnostic Criteria --------------------------- Note: Please check criteria used for establishing the current PTSD diagnosis. 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 #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criterion A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) Criterion B: Presence of (one or more) of the following intrusion symptoms to associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Intense or prolonged psychological distress at exposure internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with traumatic event(s). "I Criterion Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) 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] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Reckless or self-destructive behavior. [X] Hypervigilance. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 5. 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] Flattened affect [X] Disturbances of motivation and mood [X] Suicidal ideation 6. Behavioral Observations -------------------------- The Veteran arrived on time and alone for her appointment, and sat calmly in the waiting room until her name was called. She responded promptly, and walked steadily and without assistance. No psychomotor abnormalities, such as tics or tremor, were observed. The Veteran displayed fair eye contact and adequate grooming, and was generally cooperative with the evaluation. Her speech was spontaneous and fluent, with soft volume and slowed rate. She provided short responses to questions. The Veteran described her mood as "depressed." Affect was distressed, tearful, and congruent with her stated mood. Thought process was linear and organized. Associations were coherent. Thought content was without delusions or homicidal ideation. Veteran reported passive suicidal ideation without intent or plan. She has no firearms at home and cited deterrents for suicide. She planned to meet with her psychiatrist after her C&P appointment and was not considered an imminent risk of self harm. The Veteran reported atypcial hallucinations of music and shadows. She did not appear to be responding to internal stimuli during the evaluation. The Veteran was alert and oriented. Attention was intact via conversation. Intellect was estimated as average. Insight and judgment were thought to be intact. 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 MEDICAL OPINION SUMMARY ----------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: Military Sexual Trauma (MST) b. Indicate type of exam for which opinion has been requested: Psych-PTSD Initial TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. c. Rationale: The Veteran meets minimum diagnostic criteria for post-traumatic stress disorder. The current level of severity is moderate. Veteran reported ongoing symptoms despite medications and therapy. It is at least as likely as not that the Veteran's PTSD is due to her reported military sexual trauma (MST). It is patently impossible to determine whether or not the veteran's claimed experiences of MST are factual based only upon the evidence provided in her claims file. To be clear, the veteran has reported that these incidents occurred and there is nothing contained in her service treatment records that contradicts her report. There is evidence to support her claim starting with the diagnosis of pregnancy on 9/4/2008. This examiner can see no reason to doubt the veracity of the MST events that she has reported. The veteran's ongoing mental health symptoms are consistent with symptoms often reported by individuals who have a history of sexual assault, which serves to further substantiate the claimed events. In light of the evidence reviewed today, and the veteran's self-report, it is the opinion of this examiner that it is at least as likely as not that the MST events reported above did in fact occur. The Veteran's diagnosis of cannabis use disorder is a separate diagnosis and is not secondary to the PTSD. The mental disorders of PTSD and cannabis use disorder affect the Veteran's occupational functioning in terms of her ability to get along with others and maintain concentration. No formal cognitive assessment was performed today, nor has any been documented in records. Veteran did not display any overt cognitive deficits. She reported she is largely independent for activities of daily living, including caring for her three children. She is able to drive a car.
  17. I need to learn more about inferred claims and how they are decided/spotted by the va raters and acted on. The situation is I was rated 70% PTSD in 2013 around july was that C&P. In april 2013 I had a C&P for Bilateral Hearing loss and one for Sleep apnea. I knew nothing about secondary conditions, inferred claims, etc and by this time my VSO was awol dealing with pancreatic cancer (so I don't blame him). This year in July I was notified about a Review PTSD C&P, and that started me on the information hunt. I learned that ED, which was well documented in my VA med records before the first C&P, was/could be a secondary to PTSD. I also learned the Sleep Apnea was/could be a secondary to PTSD and my Sleep Study produced a CPAP and diagnosis of OSA and my Epworth Sleepiness Scale: 20/24 Since I knew nothing about secondary claims then I did not file for them then. With the PTSD Review this year I filed a claim for SMC-K for the ED. Today when Ebenefits was unaccessible I called Peggy who told me the claim was partially complete and a letter had been/was being mailed out today. The only issue left was on dizziness. This was in the A.m. Around 1 p.m. I tried ebenefits again and it was up. Under my disabilities tab it shows that I am 0% for ED Service Connected and awarded SMC-K1 with an effective date of 20 Aug 2018 the date I filed that claim I have filed an ItF on the SA claim but was waiting until this cleared. What I need to find out are the boundaries on "inferred claims". Meaning what does and does not need to be in the record for me to claim an EED back to the date of my PTSD claim. The ED was in my record before the PTSD C&P and the doc and I discussed it. He did not opine either way and the benefits award letter is completely void of any reference to it. Is it likely to be worth the trouble trying to file a claim for the EED on this? the evidence is there but no statement tying the two together back then, but I feel i should have been inferred by the rater. The SA claim is the same but a little different. The VA recently changed its requirements for granting service connection for OSA. It used to be, until this year, that being prescribed the CPAP was considered to be sufficient to read as "being medically necessary", but the new regs require that specific statement in the file. For this claim I know I have to have the diagnosis made as service connected as a secondary to PTSD so what I would like opinions on are what the value of asking to have the VA decide based on the old standard as I was unaware it was even a ratable condition. No one at the VA mentioned it. The rater on my initial Claim did not comment on it in the Award Letter. I believe this should also have been inferred. the two items are all over my records as being present months before the C&P and I am hoping that the Duty to Assist which includes a Duty to Infer will cover my claims. Any thoughts?
  18. I have an 80% service connected disability rating. 70% of that comes from PTSD. I spent 7 years as an infantryman in the Army. I got out in 2016. I am currently looking at going back in as a social worker. I was previously enlisted but the new career field I am interested in is a direct commission position. I am not sure if the 70% will disqualify me from returning to Active duty. I would actually argue that I have been experiencing post traumatic growth and my experiences would allow me to better serve those on Active Duty. Doe anyone have any knowledge or experience about returning to Active Duty with a disability rating? Edit** I am going to be attempting this in the next few months so I will update this with any new information that may be useful to other people who are experiencing similar situations.
  19. "During a live webcast on Oct. 16, VA's new Under Secretary for Benefits, Paul R. Lawrence, Ph.D. said that VA will begin reviewing tens of thousands of PTSD claims filed by veterans who suffered Military Sexual Trauma (MST). " https://www.military.com/militaryadvantage/2018/10/17/va-reexamining-military-sexual-trauma-claims.html Any veteran who has an MST claim or was rejected or low-balled on an MST claim should take note of the above. If you know a vet with this situation, please let them know. If you know a VSO, let them know. Hope it helps someone.
  20. OEF female vet here just starting the process of my PTSD/MST and Tinnitus claims. I'm gonna be really honest here : For many years I didn't file anything because I felt guilty filing claims next to soldiers missing limbs and suffering from TBI and other horrors. At the urging of a fellow friend and vet, I've started the process and have quickly gone from feeling guilty to becoming a total trainwreck. I met with a VSO last week and have slowly started working on my statement and I feel like a giant hole has been ripped open and everything is spilling over. It's affecting my job, my family, everything. I am having panic attacks and crying uncontrollably off and on. I really am shocked at what is coming out. I thought the two years of private therapy immediately after my deployment was enough. Did anyone else feel the same way? Please tell me that putting myself/family through this and reliving these traumas, coupled with the tedious maze of claim do's and don'ts is truly worth it? I think I may need to start counseling again to get through this. Thanks.
  21. 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?
  22. Hey Everyone, I provided a stressor -my best friend died when his boat sunk and I escorted his body home. The casualty records from when he passed away are not available so that wasn't verified however the VA conceded that he was my close friend as the statement I provided and he was also from my unit. I was diagnosed with PTSD on the VA exam and the Dr. provided a positive medical opinion stating -"the Veteran's current Posttraumatic Stress Disorder is at least as likely as not incurred in and/or caused by the Veteran's death of best friend and escort duty or remains following such death during service." I get the decision notice and I kid you not, I was denied and this was their rational - Based on a review of your military personnel records, service treatment records, and additional evidence of record, you did not directly witness the death of your close friend, evidence that you saw the body of your friend, or that you were placed on military orders to escort his remains home. The available evidence is insufficient to confirm a link between current diagnosis and the claimed in-service stressor. I'm wondering if that's correct. To me, it's pretty obvious that the rater missed the in-service stressor of Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental.
  23. Hello brothers & sisters, been trying to post on another thread, however, I can't post on the Veterans from OIF, etc. But I can post here.. Weird! Anyway, I wanted to post a question to those that have more knowledge than me. I want to notify my employer of my service disconnected disabilities, I'm currently rated at 90% and it's been a PITA to reach a 100% but that's a topic for another discussion. What would be the best way to notify my employer of my service connected disabilities without providing them with too much information? I fear that they will require me to release my VA medical treatment records, etc. I have been working for 11 years in my career field and my service-connected issues don't affect my job performance or the ability to do my job. However, I do struggle a lot. I tend to keep my employer in limbo when it comes to my service connected disabilities out of fear that they may retaliate or something, not sure. Also, can a employer try to force you, coerce you into giving them permission to release your medical records? Due to HIPPA I'm assuming they can't? During my performance of my duties there's nothing documented as far as safety concerns, performance issues, or any psychological problems or any other concerns that would raise a red flag. So what would be the best way? I’ve been offered a service dog for my PTSD and since I work long hours at work, I can’t leave the dog at home for long stretch of time. I recently got divorce, I was financially destroyed, my ex wife couldn’t cope or deal with me so she hit the high road and abandoned me. I’m recovering slowly from this set back but I find myself spending way too much time alone, and at times I find myself hitting the bottle way too often than not, but I keep my job separate and my counseling, VA treatment totally separate from my employer. I would appreciate some feedback on this issue. Sorry that I had to post here, but I couldn’t post on the other thread forum… Again, thank you all in advance for the assistance~
  24. hi all, this is not a question but information. Here is a link to a recent vidéo on french TV , talking about curing PTSD French Version https://www.francetvinfo.fr/economie/emploi/metiers/armee-et-securite/veterans-de-la-plongee-pour-surmonter-le-stress-post-traumatique_2976669.html#xtor=AL-54-[video] [Admin Note] Translated Article English version of text Hope this helps (see last comment on end of french version page) Ask me if need a traduction , no prob. Xav
  25. ok so went for a c&p Monday and was checking ebenefits appeal tool and found this? ok so obviously lumbar blah blah is still going forward but that granted....does that mean ive won?
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