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Found 5,835 results

  1. 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.
  2. 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
  3. 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
  4. 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.
  5. 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.
  6. New here so sorry if i am confusing Can anyone give me some insight on if MST/PTSD claims are paid back to the service/discharge date? I just recently opened a claim for disability, part of which is a MST claim. Sadly, I was unaware I could open a claim, I was an activated navy reservist and once I was off deployment I never looked back, didnt ask questions, i just wanted to put my deployment behind me. with that being said, i dont recall or have record of ever getting a discharge physical. I have heard multiple answers which i am sure all are correct, but maybe someone can clarify why some claims are paid back to the service date and some only to the claim date. Also, I know there are appeals and such, but there is another service member that personally knows of her friend getting back paid to the date of service on her first initial claim and it was 3-4 years past her discharge date. Oh I have my claim physical and psych eval on the 28th, and i am honestly really nervous and dont know what to expect.. some pointers would be greatly appreciated thanks. USNR 2004-2008 IRR:2008-2012 ACTIVE 2006-2007
  7. I cannot answer individual claims questions. All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account. Some Tips from one of our members on posting on the forums. 1. Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’. Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on. 2. Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out. Leading to: 3. Post clear questions and then give background info on them. Example is: A. I was previously denied for apnea – Should I refile a claim? I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile? B. I may have PTSD- how can I be sure? I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help? This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc. Note: Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview. This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
  8. Hello all, Q: Is there somewhere besides the JSRRC that would keep Marine Corps helicopter accident records. I was diagnosed (by the VA) with PTSD related to a helicopter accident that I was in in the late 80's. I prepared and submitted a PTSD claim that includes details of the accident as well as a buddy statement from someone involved in the investigation of the accident. In my claim I requested assistance from the VA in checking the JSRRC for the related records to prove the accident and my involvement as I did not have the date of the incident. I requested that the VA (and JSRRC) look in 60 day increments during the 1986-1987 years. They denied my claim because they stated they could not locate the incident. Thanks for any and all assistance. Mike
  9. History, Going on for over 12+ years since left the militray .First raiting 50% Went for increase this was from my DBQ C&P .. Thoughts all? See below Is this 70 (most would say 70). could it sway 100%? If you think 100% do you believe sched or temp? I did not apply for IU but I am told they have to consider it anyways. The doctor also used some verbage that was interesting It is not possible to differentiate what portion of each symptom is attributable to each diagnosis because all of the veteran'schronic PTSD and bipolar symptoms have been chronic, progressive, biologically and behaviorally interactive, and thesymptoms are concurrent and overlapping. The veteran’s alcohol abuse is in remission but was a result of maladaptive copingand dealing with the PTSD an bipolar symptoms.Per DSM-5 Individuals with PTSD are 80% more likely than those without PTSD to have symptoms that meet diagnosticcriteria for at least one other mental disorder (e.g. depressive, bipolar, anxiety, or substance use disorders) (p 280)It is not possible to differentiate what portion of the impairment is attributable to each diagnosis because all of the veteran'schronic PTSD and bipolar symptoms have been chronic, progressive, biologically and behaviorally interactive, and the symptomsare concurrent and overlapping. The veteran’s alcohol abuse is in remission but was a result of maladaptive coping and dealingwith the PTSD an bipolar symptoms. [X] Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinkingand/or mood. 3. PTSD Diagnostic Criteria Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threatening situations (non-combat related stressors.) Do NOT mark symptoms below that are clearly not attributable to the Criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 – “Other symptoms”. Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) Witnessing, in person, the traumatic event(s) as they occurred to others 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; or, experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related No criterion in this section met. Page 6 of 8 Contractor: VES 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). 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). Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). No criterion in this section met. Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(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). No criterion in this section met. 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: Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). 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”). Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead to the individual to blame himself/herself or others. [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) No criterion in this section met. 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. Reckless or self-destructive behavior. [X] Hypervigilance. Exaggerated startle response. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). No criterion in this section met. Criterion F: [X] Duration of the disturbance (Criteria B, C, D and E) is more than 1 month. Veteran does not meet full criteria for PTSD Criterion G: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The PTSD symptoms described above do NOT cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Veteran does not meet full criteria for PTSD Criterion H: For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks that occur weekly or less often Panic attacks more than once a week Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events Impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete tasks Memory loss for names of close relatives, own occupation, or own name Flattened affect Circumstantial, circumlocutory or stereotyped speech Speech intermittently illogical, obscure, or irrelevant Difficulty in understanding complex commands [X] Impaired judgment Impaired abstract thinking Gross impairment in thought processes or communication [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a work like setting Inability to establish and maintain effective relationships Suicidal ideation Obsessional rituals which interfere with routine activities [X] Impaired impulse control, such as unprovoked irritability with periods of violence Spatial disorientation Persistent delusions or hallucinations Grossly inappropriate behavior Persistent danger of hurting self or others [X] Neglect of personal appearance and hygiene [X] Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene Disorientation to time or place IF YOU HAVE PROVIDED ANY ADDITIONAL DIAGNOSES, OR IF THE ESTABLISHEDDIAGNOSIS HAS CHANGED IN ANY WAY, PLEASE SELECT AT LEAST ONE FROM THEFOLLOWING:A. THERE IS NO CHANGE IN THE SERVICE CONNECTED DIAGNOSIS AND NOADDITIONAL DIAGNOSES HAVE BEEN RENDERED.B. THE NEW DIAGNOSIS IS A CORRECTION OF THE PREVIOUS DIAGNOSIS.C. THERE IS A WORSENING OF THE VETERAN’S SYMPTOMS HOWEVER NO CHANGETO THE SERVICE CONNECTED DIAGNOSIS AND NO ADDITIONAL DIAGNOSES HAVE BEENRENDERED.D. ADDITIONAL CONDITIONS WERE FOUND WHICH ARE DIRECTLY DUE TO ORRELATED TO THE SERVICE CONNECTED DIAGNOSIS (I.E. A PROGRESSION).E. ADDITIONAL CONDITIONS WERE FOUND WHICH ARE UNRELATED TO THESERVICE CONNECTED DIAGNOSIS (I.E. A NEW AND SEPARATE CONDITION).***FOR OPTION E, PLEASE SPECIFY WHICH OF THE VETERAN’S SYMPTOMS AND/ORFINDINGS CORRESPOND WITH EACH DIAGNOSIS, IF FEASIBLE.***F. THE SERVICE CONNECTED DIAGNOSIS HAS RESOLVED. Answer Question 1: C. There is a worsening of the veterans symptoms however no change to the service connected diagnosisD. Additional diagnosis is alcohol use disorder in partial remission which is a new and separate conditionbut is related to the service connected conditionsAdditional Question 2: FOR OPTIONS OTHER THAN A AND C PLEASE PROVIDE YOUR MEDICAL RATIONALE. Answer Question 2: D. It is related as alcohol use disorder is often secondary to his PTSD and bipolar disorder and is currentlyin remission but was a result of maladaptive coping with his symptoms in the past and he still hasoccasional relapses./ THE VETERAN’S ESTABLISHED DIAGNOSIS IS POST-TRAUMATIC STRESS DISORDERWITH BIPOLAR DISORDER .IF YOU HAVE PROVIDED ANY ADDITIONAL DIAGNOSES, OR IF THE ESTABLISHEDDIAGNOSIS HAS CHANGED IN ANY WAY, PLEASE SELECT AT LEAST ONE FROM THEFOLLOWING:A. THERE IS NO CHANGE IN THE SERVICE CONNECTED DIAGNOSIS AND NOADDITIONAL DIAGNOSES HAVE BEEN RENDERED.B. THE NEW DIAGNOSIS IS A CORRECTION OF THE PREVIOUS DIAGNOSIS.C. THERE IS A WORSENING OF THE VETERAN’S SYMPTOMS HOWEVER NO CHANGETO THE SERVICE CONNECTED DIAGNOSIS AND NO ADDITIONAL DIAGNOSES HAVE BEENRENDERED.D. ADDITIONAL CONDITIONS WERE FOUND WHICH ARE DIRECTLY DUE TO ORRELATED TO THE SERVICE CONNECTED DIAGNOSIS (I.E. A PROGRESSION).E. ADDITIONAL CONDITIONS WERE FOUND WHICH ARE UNRELATED TO THESERVICE CONNECTED DIAGNOSIS (I.E. A NEW AND SEPARATE CONDITION).***FOR OPTION E, PLEASE SPECIFY WHICH OF THE VETERAN’S SYMPTOMS AND/ORFINDINGS CORRESPOND WITH EACH DIAGNOSIS, IF FEASIBLE.***F. THE SERVICE CONNECTED DIAGNOSIS HAS RESOLVED.Answer Question 1: C. There is a worsening of the veterans symptoms however no change to the service connected diagnosisD. Additional diagnosis is alcohol use disorder in partial remission which is a new and separate conditionbut is related to the service connected conditionsAdditional Question 2: FOR OPTIONS OTHER THAN A AND C PLEASE PROVIDE YOUR MEDICAL RATIONALE.Answer Question 2: D. It is related as alcohol use disorder is often secondary to his PTSD and bipolar disorder and is currentlyin remission but was a result of maladaptive coping with his symptoms in the past and he still hasoccasional relapses.
  10. I've been having issues for years but didn't even realize for a long time they were related to my time in service (88-92). I just pushed the feelings down deep inside and avoided thinking about it. When I finally went to a civilian Dr for my depression back in 2003/2004 I was put on every drug available but nothing worked for long. When I lost my job and went back to school to get an associates degree I had to find a way to continue treatment so i started going to the VA. Problem is while I would sometimes be honest with my Dr about how I was feeling, other times I would deny currently suffering. I didn't want to appear weak, especially if it was a woman treating me. I know that my fault, partly because of how I was raised and partly due to my time in the Marines. Depending on who saw me, their DX differed. My primary care Dr and a social worker suspected PTSD, but the Psychiatrists DX was MDD and SAD. Finally after I graduated college and started a new job I lost the ability to cope and had trouble concentrating and handling the stress. I was let go and spiraled out of control. For the past 3 years now I havn't worked and I only leave my house every couple weeks to buy groceries late at night or to visit my Dr at the VA (if I don't end up canceling or missing my appt due to feeling sick at the thought of leaving the house). I finally decided to apply for compensation as my family who has been supporting me has reached their financial limit. I hoped for the best as I now know I really have a horrible problem and need help to survive and not end up under a bridge somewhere. I will post the C & P examiners exam results now and hope someone can find something to help me with my next step. Also he references several other mental health evaluations. I will post those as replys to myself as this is going to be a LONG post. I will only be editing out my and the examiners name, everything else I will leave in. I know now I can't get help if I leave out information. Thank you for any advice in advance. Semper Fi Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [ ] Yes [X] No If no diagnosis of PTSD, check all that apply: [X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [X] Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire: 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Major Depressive Disorder ICD code: F33.1 Comments, if any: Less likely than not due to, caused by, or incurred during military service. Military records indicate no treatment for this condition and discharge physical exam indicated no mental health problems. The veteran did not have any mental health treatment until many years after military service. Mental Disorder Diagnosis #2: Social Anxiety Disorder ICD code: F40.10 Comments, if any: Less likely than not due to, caused by, or incurred during military service. Military records indicate no treatment for this condition and discharge physical exam indicated no mental health problems. The veteran did not have any mental health treatment until many years after military service. Mental Disorder Diagnosis #3: Attention Deficit/Hyperactivity Disorder (ADHD) ICD code: F90.0 Comments, if any: Less likely than not due to, caused by, or incurred during military service. Military records indicate no treatment for this condition and discharge physical exam indicated no mental health problems. The veteran did not have any mental health treatment until many years after military service. Furthermore, ADHD, by its very definition and nature, begins in childhood, and his not caused by any external events. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): GERD, history of headaches, history of neck pain 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: Due to symptom overlap and multidirectional interactions among the disorders. 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 deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [X] No [ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: Due to symptom overlap and multidirectional interactions among the disorders. 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 [X] Other (please identify other evidence reviewed): The vet brought a copy of his recent Statement in support of claim which was on his smart phone screen. This examiner reviewed that. It had not been submitted yet to the Regional office. The veteran also brought in a wooden plaque with a Marine Corps Meritorious Mast award on it dated 12/14/1989 indicating that he was involved in capturing an intruder on their base in the Philippines as part of their patrol. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): This veteran has had a number of past mental health evaluations here at the VA. Please see the 12/16/2011 psychology evaluation, the 4/272012 psychiatry intake, and the 10/17/2016 psychology mental health treatment plan for details of his history. The veteran is 47 and is divorced since 2001 (past records noted above suggest this seems to have had little to do with his mental health issues). His last relationship ended in 2012 he reported today that she apparently had another man already lined up, as she was dating him just a couple days after they broke up. He reported no current/recent relationship. He reported he really has not been getting out much at all - says he does not like himself and reported he worries others will judge and talk about him. He says he is watchful and on guard for others' negative evaluations. He resides alone, with his small dog. Mother and brother are 2 hours away in XXXXXXX. He has little contact, avoiding her alot and her possible questions about his job hunt. He used to play some online gaming and still does, but only occasionally. No groups, clubs, organizations or church. No close individual friends. He reported no other recreation/leisure. He says he sleeps on the couch since his relationship breakup about 5 years ago, as the bed reminds him of her. He says his sleep schedule is widely varied and he will do alot of daytime sleeping, watches some TV. He only rarely goes to the store and does so late at night so as to avoid other people and their perceived judgement. He reports he has had little motivation to attend to household tasks and becomes easily overwhelmed and thus avoids or procrastinates. As a result, he reports there are many empty grocery bags laying around, and he simply piles the mail on the kitchen table. Part of that may also be due to avoiding what might be in the mail. He reports he keeps phone ringer off so as to avoid contact from the bill collectors. He says he owes $50,000 in school loans and years ago put $20,000 of his girlfriend's school loans on his credit card and cannot pay fully. It seems his attempt at coping is through avoidance, which then adds to the problems he has. MILITARY: The veteran enlisted into the Marine Corps and served August 1988 to August 1992. He rose to an E4 rank and had an honorable discharge. He served time both in the Philippines and in the Persian Gulf during the Desert storm/desert shield.. His MOS was mortars. His statement in support of claim seen on his cell phone screen today listed two events, one of which he reported occurred in the Philippines in May 1990. He says he and his girlfriend at the time work in the marketplace and then went to a bar down the street. Not too long afterwards, he and others in the bar found out that two airman had been shot in the market area where he had been not long before. This examiner notes that while this could be an upsetting or shocking bit of information to find out, the veteran did not experience any actual trauma. He did not witness the shooting and was not even aware of it until being told shortly after it occurred. The second incident he reported was from February 1991 in Kuwait and reported that they took small arms fire at one point and also took enemy mortar fire and they were in a mortar battle. He felt the enemy mortars were getting closer, as close as 50 yards away, until the enemy position was neutralized. This event would meet DSM?five trauma criteria for PTSD. Other VA notes also refer to the veteran being next to a man who almost committed suicide, but a sergeant apparently prevented it. This would also not meet trauma criteria as nothing actually happened. There was no trauma witnessed, and the veteran himself was not in significant threat. The veteran today said he really wanted to have a career in the USMC, but also noted that the reason he actually got out was due to a Reduction In Force at that time. b. Relevant Occupational and Educational history (pre-military, military, and post-military): This veteran has had a number of past mental health evaluations here at the VA. Please see the 12/16/2011 psychology evaluation, the 4/272012 psychiatry intake, and the 10/17/2016 psychology mental health treatment plan for details of his history. Vet reported today that he has had mental health treatment in the private sector starting about 2003/2004 regarding ADHD and was placed on Adderal as well as a number of antidepressants. He started here at the VAMC in 2011, dealing with issues of ADHD, Depression and Anxiety (particularly Social Anxiety). He has seen psychiatry, psychology and social work at various times since then, up until the preseent. He also had Neuropsychological testing on 10/14/2011 regarding an ADHD eval. Psychiatry records indicate medication has not been all that effective regarding his depression and social anxiety. He currently is treated with Adderal for ADHD and recently was (re)started on escitalopram. He has also been in and out of psychotherapy for the above conditions. This examiner notes that the previous evaluations noted above assessed for PTSD but indicated he did not meet criteria. Those evaluations also indicated that the veteran's depression condition really worsened in recent years following the breakup of his long-term relationship about five or six years ago, though a little bit before that there was some increased depression. Furthermore, those evaluations also indicate the veteran has felt that he always has tended to be rather anxious and depressed with low self-esteem. The records indicate a history of a very strict and harsh, verbally abusive, father as well as a history of being bullied in school, though did not get any mental health services. Curiously, VA social work notes from more recent times such as 5/18/2017, seem to describe the social anxiety as being caused by or started in the military, related to harsh treatment by a corporal. This is not likely accurate given the previous treatment notes described in the first paragraph above that indicate a long history of this type of feeling even in his youth, as well as more recent onset/worsening of symptoms just a few years ago following the relationship breakup. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): This veteran has had a number of past mental health evaluations here at the VA. Please see the 12/16/2011 psychology evaluation, the 4/272012 psychiatry intake, and the 10/17/2016 psychology mental health treatment plan for details of his history. None e. Relevant Substance abuse history (pre-military, military, and post-military): This veteran has had a number of past mental health evaluations here at the VA. Please see the 12/16/2011 psychology evaluation, the 4/272012 psychiatry intake, and the 10/17/2016 psychology mental health treatment plan for details of his history. None. f. Other, if any: n/a 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: Small arms fire and mortar battle in Gulf War 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? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the 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) [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] No criterion in this section met. 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] No criterion in this section met. 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] No criterion in this section met. 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] No criterion in this section met. Criterion F: [X] No criterion in this section met. Criterion G: [X] No criterion in this section met. Criterion H: [X] No criterion in this section met. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: No response provided. 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [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 6. Behavioral Observations -------------------------- The veteran's affect was broad, though mood appeared dysphoric and anxious. He was quite talkative and animated at times. He was polite and cooperative. Eye contact and behavior were normal. 7. 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 has a history of attention deficit/hyperactivity disorder (ADHD), inattentive type. Please see the DSM?five as well as the neuropsychological testing from 10/14/2011 for details of such symptoms. 8. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any -------------------------------------------------- The exam request form states/asks: "Exams on this request: DBQ INITIAL PTSD ** Status of request: Pending, reported to MAS -------------------------------------------------------------------------- ------ DBQ PSYCH PTSD Initial _________________________________________________________________________ The following contentions need to be examined: PTSD Active duty service dates: Branch: Marine Corps EOD: 08/02/1988 RAD: 08/01/1992 DBQ PSYCH PTSD Initial: Please review the Veteran's electronic folder in VBMS and state that it was reviewed in your report. MEDICAL OPINION REQUEST TYPE OF MEDICAL OPINION REQUESTED: Direct service connection OPINION: Direct service connection Does the Veteran have a diagnosis of (a) PTSD that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) Combat Action Ribbon during service? Rationale must be provided in the appropriate section. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion. POTENTIALLY RELEVANT EVIDENCE: NOTE: Your (examiner) review of the record is NOT restricted to the evidence listed below. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. Tab A (DD Form 214 in VBMS): TAB A- CAR COMBAT ACTION RIBBON IN DESERT STORM AND DESERT SHIELD dated 06/27/2017 If more than one mental disorder is diagnosed please comment on their relationship to one another and, if possible, please state which symptoms are attributed to each disorder. If your examination determines that the Veteran does not have diagnosis of PTSD and you diagnose another mental disorder, please provide an opinion as to whether it is at least as likely as not that the Veteran's diagnosed mental disorder is a result of an in-service stressor related event." ------????????? As noted above, this veteran does not appear to meet criteria for PTSD, lacking sufficient number, frequency, and severity of symptoms to warrant such a diagnosis. The veteran does have depression and anxiety (mainly social anxiety) and ADHD conditions described above, though it is this examiner's opinion that they are less likely due to, caused by, or incurred during military service for the reasons noted above. Today, the veteran denied any delusions or hallucinations. There are no panic attacks and no OCD. He denied any suicidal or homicidal ideation. He says that he knows if he were ever to kill himself, it would hurt his mother significantly and he would did not want to do that. He does report frequently being in a low, sad and depressed mood. He reported crying spells, decreased hope, low self-esteem, feeling easily overwhelmed, feeling "stuck" and self critical. He described feeling depressed over various regrets he has in his life. He also reported a lot of anxiety. Some of this is regarding his current life situation including financial difficulties, though a lot also appears to be related to socially related anxiety feelings. He feels others judge and evaluate him in a negative manner. He feels he just does not measure up and worries when others are looking at him, that they are thinking negative thoughts or critical thoughts about him. This also creates not only emotional anxiety, but also physical symptoms such as nausea. Regarding PTSD issues, the veteran says he has sometimes dreamt that he is in the US Marine Corps but is out of shape. He reported no recent issues with any actual trauma related nightmares. He also says he has negatively dreamed recently about his most recent ex-girlfriend (from five years ago). The veteran did not describe upsetting intrusive trauma memories nor severe distress at any particular cues. The veteran does not appear to actually meet criteria for HYPERvigilance. He seemed to deny his issues with anxiety around people have to do with actual fear for his physical safety. This avoidance of people and public has to do more with worrying about their judging him. He reports when driving he is aware of other cars and where people are around him, though this does not appear to be related to trauma or represent any PTSD. The veteran seems to describe having no real set sleep schedule and he will go to sleep at widely varying times. He says he has some difficulty falling asleep but once he is asleep, he will sleep for as long as 12-16 hours. This may be related to his nonservice related anxiety/depression condition and his negative coping strategy of avoidance. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. XXXXXXXXX XXXXXX, PhD Clinical Psychologist
  11. I have some questions and wondering what some of your observations are. I had a c and p exam recently and got ahold of the DBQ. All the boxes the doctor checked were good for me. She checked all the right boxes and checked that I had PTSD and all the symptoms they went with it but in some of the comments she made, they seem really bad. So I'm wondering what matters more, the doctors observations or the boxes she checked? I'm rated at 60% currently with anxiety NOS and Tinnitus. I did not initiate the exam for an increase. It was one of the random c&p to see how things are going. This is from the PTSD initial DBQ that she filled out 1) yes 2) PTSD, paranoid personality disorder with avoidant features, other specified anxiety disorder with depressive symptoms 3) a. Yes. B.no 4.) A.Occupational and social impairment with deficiencies In most areas work, school , family relations...etc B. Yes--most impairment is attributed to PTSD and anxiety disorder with paranoia secondary. Under PTSD criteria she checked 2 in A, 3 in b, 2 in c, 6 in D and 4 in E . 6) Argumentative and irritable veteran who is hiding behind his wife and looks at her instead of the examiner; has poor eye contact; unable to tolerate questions without interrogating examiner about "meaning" of question; makes people want to avoid him due to his paranoid arguing. Hopeless attitude; does not accept hopeful comments; arrogant and appears to think he knows more than others; thinking was designed to perceived threat, not to answer questions; emotional overactivity; exaggerated affect; affect constricted; everything annoys him; meds do not touch symptoms and he does not sleep; problems with lack of trust. 7) " he may be playing this up out of a desire to avoid working at jobs that are low pay---he has no job skills and comes from a highly educated family --father is lawyer, sister a geophysicist; he may prefer the sick role, rather than go back to school and stretch himself; there is an element of malingering and playing to an audience." I found this highly offensive because I've been going to the VA for at least 5 years. I didn't initiate the exam so I'm not trying to get more money. However, I wasn't honest in my first c&p in 2011 because I was ashamed and held back a lot of the really bad things I experienced. This time around I made sure that I was brutally honest. I know that I'm supposed to tell them about my "worst" day and how bad it really is and I did. And now my sincerity is questioned? The lady was incredulous that my wife married me even though I didn't have a job and still don't. I said that I don't believe I can work which I don't think that I can because I barely can stand to leave the house and that I hate being around people because I'm constantly thinking in my head that I'm going to be attacked or have to attack someone else. I also don't sleep, I have diagnosed insomnia from the VA. Because of all this I don't think I'd be able to hold down a serious job. Is that crazy? I haven't worked in a long time. I stay at home and take care of our kids. I said something like at least I can feel useful like that. The woman seemed stunned by this. I'll admit I was extremely uncomfortable during the exam because I hate talking about this stuff and prefer to not think about it. And she interpreted it in the way above. Her comments seem contradictory to all of the boxes she checked. If I'm "malingering and playing to an audience" why did she check all of the other boxes? It's driving me crazy. This feels really bad for me. I'm having anxiety attacks almost daily thinking about this. Am I crazy to worry about how this will turn out for me? This woman was in her late 70s or early 80s. The exam was through VES and was done at her in home practice
  12. May 2016 SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence review ------------------ In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: ------------------------- Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes [ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [ ] Yes [X] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: If no, check all records reviewed: [X] Military service treatment records [ ] Military service personnel records [X] Military enlistment examination [ ] Military separation examination [X] Military post-deployment questionnaire [X] Department of Defense Form 214 Separation Documents [X] Veterans Health Administration medical records (VA treatment records) [X] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [X] Other: VHA medical record (CPRS) and VA e-folder (VBMS records) were reviewed. There was no physical C-File available as all documents were available in e-folder per C&P exam instructions. b. Was pertinent information from collateral sources reviewed? [ ] Yes [X] No 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): Pre-military: Veteran was born in Weslaco, Texas and raised in Alamo, Texas. He was raised by both parents and grew up with a brother. Veteran described his childhood as "okay, my mom was a stay at home mother, my dad worked, and was also an alcoholic, always talking down to me and hitting my older brother when he was drunk." Veteran reported that he got along with other children and teachers while growing up. He participated in baseball and football while in school. Military: Veteran reported that he got along "pretty good" with other soldiers. Post-military: Veteran lives with his spouse and two children, seven year-old son and one year-old daughter. Veteran and his wife have been married since 2005. He described his relationship with his wife as "married, have our ups and downs." Veteran described his relationship with his children as "nice." He spends most of his time with his daughter. His hobby is to "coach a travel selected team for softball." He stated he spends time with friends "on the weekends" barbecuing. b. Relevant Occupational and Educational history (pre-military, military, and post-military): Pre-military: Veteran obtained a high school degree from Pharr-San Juan-Alamo High School. He reported that his grades were average and denied having any learning or attention problems. Military: Veteran served active duty in the Army from April 17, 2002 to April 16, 2005. MOS: 92F, Petroleum Supply Specialist. Rank at Discharge: E-3. Discharge: Honorable. Veteran was awarded the Army Lapel Button, National Defense Service Medal, Global War on Terrorism Expeditionary Medal, Global War on Terrorism Service Medal, Army Service Ribbon. Veteran served in Southwest Asia from February 7, 2004 to August 24, 2004. Post-military: Veteran completed a certificate for medical assistant in 2015 from Southern Careers Institute. Veteran is current unemployed; he was last employed February 2015. Veteran stated he was a heavy equipment operator for the city of Donna from December 2014 to February 2015. He stated he was fired because his "director told [him] [his] position was no longer needed." He denied having disciplinary problems at this job. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Pre-military: Veteran denied mental health history including hospitalizations for mental health problems. Veteran reported that his father was "always drinking alcohol." Military: Veteran stated that he was diagnosed with depression "January 2004." He reported that he was hospitalized for two weeks at John Randolph hospital in Virginia. Veteran reported, "When I came back from my tour in 2004, I woke up one morning and decided to cut my wrist with my Gerber knife. Then I realized what the hell I was doing, I drove myself to the local hospital in Virginia." Veteran denied seeing anyone wounded, killed or dead during deployment when he completed September 2, 2003 Post-Deployment Health Assessment. He did endorse feeling like he was in great danger of being killed. Veteran denied having little interest in doing things, feeling depressed, nightmares, avoidance behavior, hypervigilance, and feeling detached from others. He reported that his health in general was "very good." According to Report of Consultation from John Randolph Medical Center dated January 19, 2005, Veteran was "admitted to psychiatric services with depression." According to the Behavioral Health Initial Assessment from John Randolph Medical Center dated January 15, 2005, "He is in the process of getting divorced from his wife who lives in Texas. He said that he has been feeling stressed since this past weekend and yesterday he held a knife in his hand and wanted to hurt himself. He reported feeling depressed, having decreased energy, decreased appetite, decreased sleep. He has been having some flashbacks and nightmares about the war in Iraq." Post-military: Veteran is prescribed Buspirone and Fluoxetine; he stated he is compliant with psychotropic medication. Veteran attended primary care mental health integration initial appointment on January 19, 2016. He then attended mental health initial evaluation on February 10, 2016. Veteran attended VPTT Consult on February 23, 2016. He was no-show to follow-up appointment for VPTT on May 2, 2016 and May 9, 2016. Veteran denied current auditory and visual hallucinations. He denied current suicidal and homicidal ideation, intent, or plan. Nonetheless, he was provided with Veterans Crisis Line information. Veteran was instructed to monitor symptoms, including emergence of suicidal or homicidal ideation, and to utilize this number, call 911, or go to nearest ER at closest hospital, in case of mental health emergency. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): Pre-military: Veteran denied legal and behavioral history. Military: Veteran reported he lost rank "for being late so many times." He denied receiving Article 15s. Post-military: Veteran denied legal and behavioral history. e. Relevant Substance abuse history (pre-military, military, and post-military): Pre-military: Veteran denied substance use including alcohol and cigarettes. Military: Veteran reported that he drank alcohol "like every weekend." He stated that he smoked cigarettes "just the weekends probably like six or seven cigarettes." Veteran denied use of other substances. Post-military: Veteran reported that he drinks "2 - 3 beers a week." He stated he is no longer smoking cigarettes. Veteran denied use of other substances. f. Other, if any: No response provided. 3. Stressors ------------ Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: Veteran reported that he served in Kuwait and Iraq. He denied engaging in direct combat. Veteran reported, "We were, I was doing guard duty one night and we heard the patriotic missiles, there were SCUD missiles coming in," "cause we were near Camp Virginia," "and we had to put on MOPP [mission oriented protective posture] gear" "because there was blood pathogen in the air." He stated, "one of my friends getting killed" "something I heard about." "We saw some dead bodies on our way back from Iraq," "we were 50 miles close to border line, coming back to Kuwait." 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? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No 4. PTSD Diagnostic Criteria --------------------------- No response provided 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Anxiety [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships 6. Behavioral Observations -------------------------- Veteran was alert and oriented x3. Dress was casual but appropriate. Attitude was cooperative and polite. Speech was clear, coherent, and relevant. Mood was "pretty good." Affect was consistent with mood and topics discussed. Thought processes were logical, linear, and goal-oriented. Thought content was WNL, with no signs or reports of A/V hallucinations, delusions, paranoia, or homicidal ideation/plan/intent. Veteran denied current suicidal ideation/plan/intent. Memory appeared intact. Judgment appeared adequate. 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 -------------------------------------------------- Please note that level of impairment is only based on Unspecified Trauma-and Stressor-Related Disorder and Major Depressive Disorder, in partial remission. Veteran has physical impairments, which were not assessed today. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. /es/ MARIA T Artiaga, PsyD Supervised Psychology Staff Signed: 05/31/2016 11:28 Receipt Acknowledged By: 06/05/2016 16:22 /es/ DESI A. VASQUEZ, PHD SUPERVISORY PSYCHOLOGIST ------------------------------------------------------------------------- November 2016 2nd C&P Exam Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: Edgar Sandoval SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [ ] Yes [X] No If no diagnosis of PTSD, check all that apply: [X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [X] Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire: 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: unspecified trauma-and stressor-related disorder ICD code: F43.9 Mental Disorder Diagnosis #2: persistent depressive disorder ICD code: F34.1 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): deferred to medical 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: symptom overlap c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] 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: symptom overlap 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): He was born in Weslaco, Texas and raised in Alamo by his biological parents. He has one brother. He stated that his father was an alcoholic and would "talk down at [him]." He was also physically abusive. He got along with peers and teachers and played sports in school. The veteran was living with his wife, daughter, age two and 8-year-old son, but they separated and he is now living with a friend. He visits with his children regularly. He stated that he was arguing and irritable with his spouse and that he was "swearing" in front of his children. "I was getting mad for no reason." His mother died in a nursing home with stroke (09/2016) and his father died of "alcoholism" (10/2016). He stated the symptoms of depression have increased since they died. "The whole world's on top of me." He continues to coach softball with teenage girls on the weekends. Relationships were good in the military. b. Relevant Occupational and Educational history (pre-military, military, and post-military): He graduated high school with average grades. There were no learning or attentional problems. He worked part-time at a department store during his teenage years. He was active duty Army (2002-2005) with highest rank SPC and rank at discharge of PFC due to disciplinary problem. Discharge was honorable. He received GWOT, NDSM, Global war on terrorism expeditionary medal. He was in Southwest Asia (2004). Post-military, he received a certificate for medical Assistant (2015). He has been unemployed since February 2015 after having productivity problems in a position as heavy equipment operator. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): He did not report pre-military mental health issues or family history of psychiatric problems, though his father drank heavily. Records indicate he was admitted to John Randolph Medical Center in January 2005 with "depression." Recent VA records show he has been receiving mental health treatment for trauma-related disorder and depression since January 2016. He has received both group and individual therapy. The veteran stated that symptoms of depression have been increased since his parents died 1-2 months ago. Currently, he reports symptoms of depression including feelings of guilt, decreased pleasure and interest in activities, decreased energy, irritability, tiredness, and problems sleeping. He stated that he feels guilty for not being with his parents anymore or with his family. He reports symptoms of trauma- and stressor- related disorder including occasional distressing dreams or intrusive memories, reactions to cues in the environment (seeing people with Middle Eastern clothing"), decreased interest in activities, irritability, hypervigilance, and problems sleeping. Medications: Buspirone, lisinopril. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): none e. Relevant Substance abuse history (pre-military, military, and post-military): 6-pack of beer per month. 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: Feeling that his life was threatened during deployment with danger of being killed. 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? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No b. Stressor #2: Seeing "dead bodies" when coming back from Iraq. 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? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No c. Stressor #3: Hearing that one of his SM friends was killed. 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? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the 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) [X] 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; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. 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] 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: No response provided. 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 negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. 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] 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 [X] Stressor #2 [X] Stressor #3 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Chronic sleep impairment [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 6. Behavioral Observations -------------------------- MENTAL STATUS EXAMINATION Appearance: Casual, appropriate. Behavior: cooperative. Speech: WNL Mood/Affect: WNL, appropriate to content. Orientation: Oriented to all spheres. Cognitions: WNL, not formally tested. Safety: Danger to self/others? NO Safe to return home? YES Risk Factors assessment: [NO] Patient has current thoughts of hurting or killing themselves? [NO] Patient has current thoughts of hurting or killing someone else? [NO] Patient has is looking for a way to kill themselves or has a plan? [NO] Patient has taken actions to activate plan? [NO] Patient has history of compromised impulse control? Judgment: FAIR Insight: FAIR 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 -------------------------------------------------- Please comment on the effect of the Veteran's service connected disabilities on his or her ability to function in an occupational environment and describe any identified functional limitations. Please refrain from opining on if the veteran is unemployable or employable; instead focus and reflect on the functional impairments and how these impairments impact occupational and employment activities. Comment: The veteran is able to function independently and engage in activities of daily living. He is able to drive an automobile and research jobs or prepare for job interviews. However, symptoms of depression and trauma-and stressor-related disorder would negatively impact his motivation. Problems sleeping and tiredness may negatively impact performance and productivity. Irritability may cause interpersonal problems on the job. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. **************************************************************************** Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: Edgar Sandoval ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS MEDICAL OPINION SUMMARY ----------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: Does the Veteran have a diagnosis of (a) unspecified trauma and stressor related disorder with major depressive disorder that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) friend killed in action during service? b. Indicate type of exam for which opinion has been requested: DBQ 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: STRs show treatment for depression during service (2005). He served in Southwest Asia, feared for his life and found out that a SM friend of his was killed in service. He currently reports symptoms of depression and trauma-and stressor-related disorder, such as irritability, low energy, problems sleeping, intrusive memories, distressing dreams, reactions to cues in the environment. ************************************************************************* /es/ Paul Loflin, PhD Clinical Psychologist Signed: 11/23/2016 12:21
  13. I have some questions and wondering what some of your observations are. I had a c and p exam recently and got ahold of the DBQ. All the boxes the doctor checked were good for me. She checked all the right boxes and checked that I had PTSD and all the symptoms they went with it but in some of the comments she made, they seem really bad. So I'm wondering what matters more, the doctors observations or the boxes she checked? I'm rated at 60% currently with anxiety NOS and Tinnitus. I did not initiate the exam for an increase. It was one of the random c&p to see how things are going. This is from the PTSD initial DBQ that she filled out 1) yes 2) PTSD, paranoid personality disorder with avoidant features, other specified anxiety disorder with depressive symptoms 3) a. Yes. B.no 4.) A.Occupational and social impairment with deficiencies In most areas work, school , family relations...etc B. Yes--most impairment is attributed to PTSD and anxiety disorder with paranoia secondary. Under PTSD criteria she checked 2 in A, 3 in b, 2 in c, 6 in D and 4 in E . 6) Argumentative and irritable veteran who is hiding behind his wife and looks at her instead of the examiner; has poor eye contact; unable to tolerate questions without interrogating examiner about "meaning" of question; makes people want to avoid him due to his paranoid arguing. Hopeless attitude; does not accept hopeful comments; arrogant and appears to think he knows more than others; thinking was designed to perceived threat, not to answer questions; emotional overactivity; exaggerated affect; affect constricted; everything annoys him; meds do not touch symptoms and he does not sleep; problems with lack of trust. 7) " he may be playing this up out of a desire to avoid working at jobs that are low pay---he has no job skills and comes from a highly educated family --father is lawyer, sister a geophysicist; he may prefer the sick role, rather than go back to school and stretch himself; there is an element of malingering and playing to an audience." I found this highly offensive because I've been going to the VA for at least 5 years. I didn't initiate the exam so I'm not trying to get more money. However, I wasn't honest in my first c&p in 2011 because I was ashamed and held back a lot of the really bad things I experienced. This time around I made sure that I was brutally honest. I know that I'm supposed to tell them about my "worst" day and how bad it really is and I did. And now my sincerity is questioned? The lady was incredulous that my wife married me even though I didn't have a job and still don't. I said that I don't believe I can work which I don't think that I can because I barely can stand to leave the house and that I hate being around people because I'm constantly thinking in my head that I'm going to be attacked or have to attack someone else. I also don't sleep, I have diagnosed insomnia from the VA. Because of all this I don't think I'd be able to hold down a serious job. Is that crazy? I haven't worked in a long time. I stay at home and take care of our kids. I said something like at least I can feel useful like that. The woman seemed stunned by this. I'll admit I was extremely uncomfortable during the exam because I hate talking about this stuff and prefer to not think about it. And she interpreted it in the way above. Her comments seem contradictory to all of the boxes she checked. If I'm "malingering and playing to an audience" why did she check all of the other boxes? It's driving me crazy. Am I crazy to worry about how this will turn out for me? This woman was in her late 70s or early 80s. The exam was through VES and was done at her in home practice
  14. This appears to be a favorable exam but I am confused. I was previously denied for PTSD so I submitted new evidence and also claimed Depressive disorder. I just went to my exam last week and this was the results. The doctor checked the box that would warrant a 30% rating but I definitely feel this is a low ball. My life has not been the same and just keeps declining. He noted in here my suicide attempt and the ideation that still occurs so would that help in the ratings game? I honestly just think that working isnt going to happen much longer. I think IU is in my future but if you could help me understand what the rater may choose I would appreciate it. LOCAL TITLE: C&P MENTAL DISORDER STANDARD TITLE: MENTAL HEALTH C & P EXAMINATION CONSULT DATE OF NOTE: SEP 20, 2017@10:00 ENTRY DATE: SEP 20, 2017@16:45:06 AUTHOR: RAY,CHRISTOPHER L EXP COSIGNER: URGENCY: STATUS: COMPLETED *** C&P MENTAL DISORDER Has ADDENDA *** Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * 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: Posttraumatic Stress Disorder ICD code: F43.10 Mental Disorder Diagnosis #2: Other Specified Depressive Disorder ICD code: F32.89 Mental Disorder Diagnosis #3: Unspecified Attention-Deficit/Hyperactivity Disorder ICD code: F90.9 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Knee pain, sleep apnea, diabetes. 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: Some symptoms, such as his insomnia, irritability, trouble concentrating,and social withdrawal characterize both PTSD and Other Specified Depressive Disorder. His concentration deficits also characterize ADHD. It is difficult to differentiate what portion of each symptom is attributable to each diagnosis without resorting to speculation. 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 occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [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: It is difficult to determine to what extent his three conditions are impacting his social and occupational functioning. This is because of shared symptoms. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS Evidence Comments: The veteran was referred for a compensation and pension examination. The veteran was informed of the nature and purpose of the examination and confidentiality limits. He was also informed of the risks and benefits of the current examination. He was provided with a chance to ask questions about the evaluation procedures. He voiced an adequate understanding of the evaluation procedures. He was informed that this examiner is not his treating clinician or the legal determiner of compensation or pension. Instead, he was informed that this examiner is an independent provider of clinical information and expertise to assist those who review and make legal compensation and pension claim decisions and would not be participating in his healthcare. The veteran indicated understanding of these terms and explicitly and freely consented to the evaluation. He was also notified that judgments of symptoms and opinions in this evaluation report are offered to a reasonable degree of professional certainty and are only based upon the information available at the time of the evaluation. He was notified that a copy of the C&P mental disorder evaluation report would be provided to the Veterans Benefits Administration (VBA) and that a copy can be requested through VBA or through the Release of Information Department at the Columbus VA. The psychological evaluation consisted of a review of the veteran's CPRS records, a review of his VBMS/Virtual VA records, JLV records, a clinical interview, and the veteran's assessment results. On 6/1/17 the veteran had an initial evaluation of residuals of TBI with Dr. Lin. Although the veteran had difficulty with concentration, memory, and comprehension, these issues were not due to a TBI but attributable to other causes. Multiple records showed no evidence of TBI. The veteran's CPRS records indicate that he has received mental health treatment at the Columbus VA since 12/6/10. The veteran's most recent meeting with Dr. Haraburda, a VA psychologist, was on 10/28/16. The veteran was upset about a C&P exam when he was not diagnosed with PTSD due to overreporting. The veteran said he was interested in couples counseling. The veteran was diagnosed PTSD and Alcohol Abuse. The veteran's most recent psychiatric appointment was with Dr. Churchill, a VA psychiatrist, on 8/17/17. The veteran was diagnosed with ADHD, Combined Type, PTSD, Chronic and Major Depressive Disorder, Recurrent. The veteran indicated that his mood was low and his anxiety was always high. He was psychiatrically hospitalized at the VA in 2012 for 3 days and received substance abuse treatment as well as vocational rehabilitation. Theveteran indicated having problems with depression after returning from Iraq inlate 2010. He said he had been on multiple medications and once made a suicide attempt in January 2012. On 9/1/17 the veteran met with Dr. Nigl, a VA neuropsychologist. Dr. Nigl had previously assessed the veteran in 2011 at which time no significant primary cerebral dysfunction was detected although some ADHD symptoms were endorsed consistent with the veteran's developmental history. Dr. Nigl indicated that even though there was no evidence of primary brain dysfunction, ADHD was not ruled out. Dr. Nigl told the veteran that one or 2 concussions in years past would not be anticipated to lead to permanent brain damage. The veteran was glad to learn that his current concerns were not TBI-related. The veteran stated that his cognitive concerns included forgetting details of conversations, misplacing things, zoning out and needing to write much more down. The veteran was informed that chronic ADHD symptoms are likely being exacerbated by increased depression, PTSD, pain, and sleep that was not optimally controlled by OSA. The veteran's cognitive concerns were more likely than not due to problems with attention and/or encoding. The veteran was diagnosed with PTSD, Depression and ADHD. A statement written by the veteran's wife was reviewed. She indicated that their relationship had been "rocky." Wife noted that the veteran tends to be very jumpy and has trouble going places because he does not want to be around groups of people. She noted that he has not been the same since he went to Iraq. She referenced how he attempted suicide in January 2012 and was psychiatrically hospitalized at the Chillicothe VA. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): The veteran stated that he was born and raised in Columbus, Ohio. He indicated he grew up with his parents, who divorced "when I was 10 or 11. I lived with mom and we moved to Newark. My dad stayed on the East side of Columbus." The veteran added, "Both of my parents remarried. My mom and stepdad moved to South Carolina and I stayed 6 months but didn't like it and came back to Ohio to live with my father and stepfmother." The veteran said he has one stepbrother. The veteran did not report being abused or neglected. When asked about his relationship history, the veteran reported,"I married the same woman twice. I got hurt in Iraq and things went downhill. I drank a lot." The veteran stated that he and his wife were married the first time for 2 years, and they have been married the second time for 4 years. According to the veteran, "Ourrelationship is not the greatest. We dated after the divorce and found out we're having our first son. She's left a few times and we argue quite a bit. We have ups and downs." The veteran said he has two children ages 1 and 4. Regarding his social support system, the veteran stated, "My wife is a nurse and says she is supportive of my mental health issues, but she has said I don't have as bad of a case of PTSD as I make it out to be." The veteran added, "I don't really talk to my mom or dad about things." The veteran noted that he keeps up "with some people I went to basic training with on Facebook." When asked about his interests or hobbies, the veteran reported."I used to love to do a lot but don't really do much anymore. I kind of go to school, work, and then go home." b. Relevant Occupational and Educational history (pre-military, military, and post-military): The veteran stated that he graduated from high school. He said that he had a 3.4 GPA. The veteran reported that he did not have any learning disabilities and was never enrolled in special education classes. He said he took Adderall "for about a year. My mom thought I had ADHD (Attention-Deficit/Hyperactivity Disorder) but I stopped taking the medicine on my own and didn't notice a difference." The veteran reported that he attends Park University. He noted, "I seem to have a hard time now understanding and remembering material." He noted, "I failed quite a few classes. I have pretty good grades in some classes. I'm in Voc Rehab right now." Before the military, the veteran stated, "I worked at Golden Corral in Whitehall." The veteran reported that he served in the U.S. Army from January 2008 until January 2014. He stated that his highest rank was E-5. The veteran indicated that his MOS was military police. The veteran reported that he was deployed to Iraq from August 2009-August 2010. He noted that he received the Combat Action Badge among other medals. The veteran's DD-214 contained in his VBMS records indicates that he was awarded the Army Commendation Medal, National Defense Service Medal, Global War on Terrorism Service Medal, Iraq Campaign Medal with Campaign Star, Army Service Ribbon, Overseas Service Ribbon, Armed Forces Reserve Medal with M Device. Notably, there was no mention of the Combat Action Badge. The veteran reported that he had an honorable discharge, which is consistent with his DD-214. Since the veteran left the military, he stated, "I was a police officer from December 2013 until February 2017. Now I work as a criminal investigator. I left the police officer job since I had anxiety and I didn't trust myself carrying a side arm.I have a letter from my old patrol supervisor. She noticed that I had a lot of anxiety and panic attacks." The veteran indicated that his job performance at his current job "is ok but my big problem is my memory. There are things I've left out and forgot in my cases. I have good days and bad days." c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The veteran denied receiving mental health treatment before the military. The veteran reported that while in the military "after my deployment to Iraq I started coming to the VA. I saw Dr. H, and had a break while I was going to the Chillicothe VA. I did the domiciliary and vocational rehab then came back up here. I reconnected with Dr. H up here." The veteran added that he receives psychiatric care with Dr. C. According to the veteran, he is prescribed venlafaxine and nortriptyline hcl. The veteran indicated that his medications are partially helpful in alleviating his mental health symptoms. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): The veteran denied any legal problems before the military. The veteran did not report receiving any Article 15s, non-judicial punishments, infractions or arrests while in the military. The veteran denied receiving any criminal charges since leaving the military. e. Relevant Substance abuse history (pre-military, military, and post-military): Before the military the veteran stated that he tried "pot (marijuana) a few times but that was it." While in the military the veteran did not report consuming illegal drugs. He acknowledged that while in the military he drank alcohol "especially after Iraq. That's when I abused pain meds (Vicodin and Percocet)." After the military the veteran said his use of alcohol has "waxed and waned. I don't know that I've been addicted." The veteran stated, "I have not had a beer in a few weeks." In the past the veteran noted that he has had cravings for alcohol but not recently. The veteran denied any recent negative impact on jobs or relationships. The veteran reported that he has not used opioids since January 2012. f. Other, if any: The veteran reported that he is service connected "for both knees. It shoots into my hips. I also have sleep apnea, diabetes, and high blood pressure." His CPRS records show the following active problems: Code Description 719.46 Knee: arthralgia (ICD-9-CM 719.46) 305.1 Nicotine Dependence (ICD-9-CM 305.1) 836.0 Meniscus Tear, Med (Current) (ICD-9-CM 836.0) V71.09 No Diagnosis or Condition on Axis I (ICD-9-CM V71.09) R52. Pain (SCT 22253000) 110.9 Tinea (ICD-9-CM 110.9) 692.6 Contact dermatitis and other eczema due to plants (except food) (ICD-9-CM 692.6) 309.24 WITH ANXIETY (ICD-9-CM 309.24) Z63.0 Partner relationship problem (SCT 1041000119100) R03.0 Essential hypertension (SCT 59621000) F33.8 Chronic depression (SCT 192080009) F10.10 Alcohol abuse (SCT 15167005) 305.50 Opioid abuse (ICD-9-CM 305.50) F43.12 Chronic post-traumatic stress disorder following military combat (SCT 699241002) His CPRS records show the following active medications: 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: Removed for privacy 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? [X] Yes [ ] No b. Stressor #2: Removed for privacy 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? [X] Yes [ ] No c. Stressor #3: Removed for privacy 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? [X] Yes [ ] No 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the 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) [X] 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; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. 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 negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Problems with concentration. 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 [X] Stressor #2 [X] Stressor #3 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events 6. Behavioral Observations -------------------------- The veteran was alert and oriented to person, place, the date, time, and situation. The veteran's clothing was appropriate to the situation and weather. He maintained appropriate eye contact. The veteran exhibited acceptable hygiene. His speech was within normal limits with regard to rate, rhythm and volume. He walked with a normal gait. The veteran was cooperative and actively participated in the evaluation procedures. His affect was appropriate to discussion and well-modulated. The veteran described his mood as "down." The veteran endorsed symptoms of depression including sadness, low energy, sleep disturbance, concentration deficits, loss of pleasure, agitation, indecisiveness, and hopelessness. The veteran reported suicidal thinking (without current intent or plan). He noted one past attempt "when I drank a lot and took a lot of Ativan. That was in January 2012." He denied thoughts of harming others. The veteran did not report nor were there clear indications of obsessions, compulsions, or manic symptoms. Regarding the veteran's mental content, his thought processes were linear. The veteran's associations were goal-directed. There were no indications of delusions or hallucinations. Regarding ADLs, he reported that he keeps up with his personal hygiene. The veteran stated that he is able to cook, clean, and complete other basic household chores. The veteran reported that he has a bank account and driver's license. The veteran's judgment in hypothetical situations is intact. The veteran exhibits adequate abstract reasoning and comprehension. The veteran was able to remember events from the past indicating no significant long term memory issues. On a forward digit span task the veteran correctly repeated back 6 digits. The veteran accurately recalled 3 of 3 words after 5 minutes on a brief word learning task. He accurately recalled the months in reverse order. He correctly spelled the word WORLD forwards and backwards. The veteran responded accurately to four basic calculation tasks. Overall there is no obvious evidence of possible short-term memory and/or concentration deficits. The veteran's intellectual functioning appears to be in the average range based upon his educational attainment and vocabulary. DSM-5 ASSESSMENT OF PTSD: I REMOVED THIS PORTION FOR PRIVACY BUT NOTE THAT THE DOCTOR INDICATED THAT I MET ALL CRITERIA NEEDED 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 -------------------------------------------------- Assessment Results: The MMPI-2-RF was administered to measure symptom patterns associated with particular classes of psychopathology. The test includes validity scales to identify unusual test-taking attitudes, including the detection of possible feigning or denial of symptoms. Possible underreporting is indicated in that the veteran presented himself in a positive light by denying some minor faults and shortcomings that most people acknowledge. Inconsistent responding was ruled out. Any absence of elevations on the substantive scales were interpreted with caution as they may underestimate the problems assessed by those scales. The veteran's test scores indicate preoccupation with suicide and death. His test scores suggest that he may have recently attempted suicide. These test results also indicate the presence of helplessness and hopelessness. According to the veteran's test results, he reported feeling anxious. This testing profile suggests the presence of intrusive ideation, anxiety and anxiety-related problems, sleep difficulties, including nightmares and posttraumatic distress. According to the veteran's test results, he reported not enjoying social events and avoiding social situations, including parties and other events where crowds are likely to gather. His test results suggest that the veteran is introverted, has difficulty forming close relationships, and is emotionally restricted. Opinion & Rationale: It is my opinion, with reasonable professional certainty, that it as likely as not (a 50% probability) that his Posttraumatic Stress Disorder resulted from his Iraq trauma stressors. My opinion is based upon my clinical experience and expertise, a review of the veteran's CPRS records, a review of his VBMS/Virtual VA records, the results of a clinical interview, and the veteran's assessment results. The veteran showed no signs of significant exaggeration or feigning of mental disorder symptoms on objective testing. Remote records reviewed by Chillicothe VA staff, however, suggest that the veteran's commanding officer had confronted the veteran because his reported military experiences either did not occur or did not occur to the veteran. Also, during the clinical interview the veteran said he had a Combat Action Badge, which was not located on his DD-214. On the other hand, his VBMS records contain a statement written by battle buddy, who provided information consistent with the veteran's statements about his trauma stressors. Overall, it is beyond the scope of the current evaluation procedures to determine if the veteran's statements concerning his trauma stressors are accurate. Assuming that the veteran's statements about his trauma stressors are true, there appears to be a direct link between his PTSD symptoms and his trauma stressors experienced in Iraq. The veteran's CPRS records suggest that a number of treatment providers have diagnosed him with PTSD. It is my opinion that it is less likely as not (less than a 50% probability) that the veteran's Other Specified Depressive Disorder is proximately due to his physical pain associated with his knees. Although his physical pain likely contributes to some degree to his feelings of depression, there are multiple factors that explain his chronic feelings of sadness. Some of these include his relationship problems with his wife and military trauma stressors. In the past his excessive use of alcohol and drugs have also exacerbated his depressive symptoms. Of note is that the diagnosis of Other Specified Depressive Disorder was chosen because the veteran was vague about the frequency of his depressive symptoms. Concentration deficits were endorsed because even though his mental status did not specifically show concentration issues, information from Dr. N suggests that the veteran's concentration deficits likely are associated with the veteran's mental health concerns, pain, and sleep problems due to obstructive sleep apnea. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. /es/ CHRISTOPHER RAY PHD ABPP Psychologist, C&P Signed: 09/20/2017 16:45 09/20/2017 ADDENDUM STATUS: COMPLETED The veteran's C&P exam was completed in CAPRI. /es/ CHRISTOPHER RAY PHD ABPP Psychologist, C&P Signed: 09/20/2017 16:46
  15. The appellant was first diagnosed as having PTSD in July 1991, and his current PTSD symptomatology is based upon stressors associated with having worked around chemical weapons, including nerve gas, during service. Moreover, a VA physician opined in September 1994 that the appellant’s “varying levels of constant threat of mortal danger” while working in close proximity to chemical weapons was a sufficient stressor to establish the diagnosis of PTSD. After careful and longitudinal consideration of all procurable and assembled data, the Board believes that the appellant’s statements and testimony concerning inservice stressors are at least consistent with and not contradictory to the information provided by ESG. Therefore, the Board finds that the evidence of record demonstrates the existence of stressful events of the quality required to support the appellant’s current diagnosis of PTSD. Accordingly, service connection is granted for PTSD. ORDER Service connection is granted for PTSD. You will note that the veteran had NO combat exposure, no CAB/CAR, only an impending feeling of doom/PTSD due to the stresses of fear of death due to the proximity of deadly chemical weapons. I thought that this was an interesting case, based upon his experiences on Johnston Island Atoll, Hawaian Islands.
  16. Thank You in advance! (First question after reviewing this book I wrote here should probably be, do i need to separate all of these questions into the different subject forums or is this OK ?) I've been procrastinating now for almost 10 years (mainly because of denial, I volunteered, tough guy, I know guys that seen/did worse and horror stories with the VA) and have just this year decided to attack this VA Claims Process. Putting it off for too long and ready to get the information needed to hopefully (fingers crossed) have a smooth process. I have not filed for anything, have no medical records or injuries documented while active or since (I have just requested my military records from the right place after all these years, because I assumed the VA would have them and keep them safe, so I didn't need a copy. MISTAKE #1, Naive I know) and have not been to see a private doctor for anything. I medicate with over the counter and always have, but have never been officially diagnosed with anything. Just last month I made an appointment with advice from an amazing local veteran group with a psychologist outside of the VA and she diagnosed me with PTSD. It was extremely hard to even talk to her, I've never talked to anyone about it just denied it or pushed it back. (I know I'll still need a VA exam). I was also seen by an outside, but VA referred hearing specialist and was diagnosed with tinnitus in the 3k range and hearing loss. 6 months after release from active duty in 2007 I was seen at the local VA for hemorrhoids and treated. I have had issues with roids, constipation, diarrhea etc ever since. This is also the only thing I have ever been seen for at the VA. My wife has also complained for years about sleep apnea and me startling her in the middle of the night when I sleep, should I get an evaluation for sleep apnea. She doesn't remember ifI did it when active or not, but does that matter for service connection ? I have already made the intent to file as of last month and am wondering how I should proceed from the above mentioned. I have not been seen for IBS, by any professional but it reads like that is a high possibility, so do I need a diagnosis from outside of the VA or should I get one prior to filing? Should I file IBS, if diagnosed under "presumptive illness" (BALAD IRAQ 2005-2006) ? Should I get on the Burn Pit or Gulf War Registry (Is there anything I should know prior to going to these registry appts) ? Should I file for PTSD with just an outside evaluation (How are stressors confirmed, all mine are personal accounts and encounters) ? Should I file for hearing loss or tinnitus or both I served as a firefighter and have read that as being on some list hearing related jobs ? And finally, Should I file for all of these now at one time or should I wait and do them individually ? My main concern is going into this and not being fully prepared, if there is anything you believe would aid in the above filings please let me know. I know there is a long road ahead, but I don't see any point in going alone and appreciate you all. Thanks again!
  17. jfrei

    From S to R2?

    I was most recently diagnosed with a seizure disorder and was referred to University of Pittsburgh for a case study along with the Mayo Clinic. Here is his letter Attention Mayo Clinic/University of Pittsburg concussion Center ; As noted in Mr. Frei’s history, he underwent severe trauma while active duty military. He has since been retired from the military with posttraumatic stress disorder and traumatic brain injury which is not fully been compensated yet. Traumatic brain injury is definitely a component. I have been his primary care physician for approximately the last year as he has started with the VA in Wilmington, Delaware. After his military career. He was a helicopter pilot in the military, then a aircraft mechanic at Philadelphia international Airport. However, his memory was so impaired and headaches as well as circadian rhythm disturbance due to his union schedule. He lost his job at Philadelphia and was until recently working on helicopters down in Maryland. Once they found out memory issues. They terminated his employment. Most importantly patient has the chronic symptoms of PTSD associated with anxiety as well as some slight physical residual symptoms from the motor vehicle. He suffered while active duty. On several occasions approximately 2 times per year. He has had sudden episodes of loss of consciousness where he is found on the ground and after just a minute or so is conscious. He has never swallowed his tongue. He has never been foaming at his mouth. He has never had loss of urine. MRI shows consistency with TBI. There is no evidence of significant seizure workup as well as etiology and combination to create one full situation of posttraumatic stress disorder associated with seizure disorder associated with traumatic brain injury. At this point, I believe Jamie Frey would be most benefited by a a full team approach medical evaluation by the Mayo Clinic for University of Pittsburg concussion Center as the current system of addressing one issue at a time at different facilities is not coming up with an answer and this is a 31-year-old white male in very good physical condition with physical injuries and former military service. If accepted to the program. I suspect we will have a good chance of having her in the Veterans Administration cover costs, but cannot guarantee. Until that is actually submitted If the hospital turns it down he said it a good chance it will be approved couldn't I use this as a way to get SMC-R2? This makes my life a living hell with the timing my wife's pregnant, has lymphoma during pregnancy doctor thinks. Son has a minor birth defect my daughter has a heart defect. Worrying about my own health issues is trivial in my eyes. Dealing with 2 black outs a year and headaches with short term memory problems seem minor to my pregnant wife. Life's full of curveballs
  18. I'm new here and am re-posting under this topic as it may be a more appropriate forum. First off, let me say this site has been extremely helpful to me in developing my brother's VA claim. He's a former Marine - served in Vietnam 1969-70 and was WIA by tripping a grenade booby trap - Purple Heart. He was unemployed for approximately 4 years of the first 8 years he was back. Then in the 8th year, he attempted suicide, taken away in a straight jacket, hospitalized and diagnosed with Schizophrenia, Paranoid Type. In the 5 years that followed, he underwent long-term mental health therapy, was incarcerated for hitting a police officer with his truck (charged with intent to maim/kill), received a Felony conviction, put on Probation, and lost his license. There were many other bizarre behaviors too numerous to list here. My father filed a VA claim for his "nervous condition" in 1982 - The VA denied it saying "evidence did not establish service connection for PTSD - and disorder not shown by the evidence of record - your nervous condition not shown to have been incurred in service." With my parents now gone, my husband (retired USA LTC) and I now financially support my brother, who lives below the US Census Poverty level. His only income is SS retirement. He's on food stamps. This prompted me to re-file his claim. They came back with "disabilities claimed" of PTSD - reopen; Non-service connected Pension - new; Schizophrenia, residual type, competent; Scars - increase; Compentency - new; and Special Monthly Pension - new. My biggest obstacle has been gathering medical evidence for this claim. I was only able to submit the written diagnosis from his hospital for schizophrenia in 1978 (quite detailed though citing suicide attempt, paranoia, second coming of Christ hallucinations and all that); emergency center invoice from the local County Community Mental Health center in 1982, a physician's report of medical status (schizophrenia-form episode with depressive symptoms) in 1983. I also submitted relevant documents including the Probation Officer's consult with his mental health therapist agreeing his behavior arose from Vietnam combat experience, a Circuit Court judge probation condition that he undergo a year of mental health treatment, and a DMV suspension letter indicating license would only be reinstated on the condition that he file a psychiatric evaluation annually. I've reached out to the hospital, the mental health center, even the County Court reporter to get further documentation. All records have been destroyed in accordance with the state record destruction policy because it's been so long. The VA has now come back asking for "medical evidence of his permanent inability to obtain/maintain gainful employment". They didn't ask for a medical exam, they didn't offer a medical exam or Field Examination. They made no reference to PTSD or Schizophrenia. (Are they planning to deny it outright or are they perhaps accepting it based on his booby trap trauma??) There is no other medical documentary evidence to be had! I am creating a time line of sorts for them - showing his below poverty earnings and unemployment correlating to the times he was hospitalized and undergoing mental health therapy. DOES HADIT or ANY VET out there have any other suggestions for me as to how to tackle this lack of evidence in my response to the VA? Please come back to me --- they are asking for my response back within 3 weeks. Would greatly appreciate any comments.
  19. I just submitted my first claim for PTSD from MST. When I was overseas, I was on guard duty was an infantryman. When in a guard tower, he exposed his penis and started playing with it. He was looking at me and wanted to me "help" him out. We were locked and loaded so I was fearful on what this man was going to do next. I just froze. I told his SGT and he was detained and sent back to garrison. The rules changed and I was looked at a different way since the incident. There was no touching but this incident has impacted my life and my sense of security. I'm fearful of everything and what's worse is that it's now effecting my children and my marriage and that's why I'm now filing. I haven't talked about it openly with my friends and now I'm expected to talk about it with a stranger for my c&p appointments? Any advice on what to expect and how long the whole process take.
  20. Hi, This afternoon I have my C&P exam for PTSD secondary to MST, with a contracted provider. I found out Friday evening after work. Fed Ex had delivered the paperwork earlier, but I didn't get a chance to see it until I got home from work. To say that I am nervous would be the understatement of the year. I am desperately trying to hold myself together. My digestive system is all out of whack. I did spend an hour on the phone last night with a wonderful person from a non VSO group. She is a Marine and has trauma history, so that made the connection pretty easy. She gave me a lot of good tips, if I could only remember them when it's crunch time. One of my biggest fears is that this will be just like my previous mental health C&P...where that examiner, a VA employee, when straight for the jugular and ignored my heaps of physical evidence. I don't know why I am even doing this. I fully expect to get more of the same....nothing. If I do get granted SC, the shock of that may well kill me...because that goes against the grain of what the VA has given me over the years....tons of grief and denials. Anyway, just wanted to write this down as some kind of therapy... No body has to read it, or respond. I'm not here anyway.........
  21. All, I competed my C & P exam for TDIU claim for PTSD and Lumbar DDD. I am uploading the notes from my C & P exam for PTSD. The examiner stated I do not know why you are here because your last C & P was in March. If anyone has experience with interpreting the notes I would appreciate your help. I did delete her extensive notes about what I said about my family and events.... My previous C & P exam was 70% for PTSD and total rating of 90% 40 lumbar ddd and radiculopathy, 10% for each knee, 10% for tinnitus. Also I was just diagnosed with Moderate to severe Sleep apnea.... but I have not filed for disability. I would have to get a nexus letter from doc stating secondary to PTSD. If I am denied TDIU I will start that process.... I would like any advice on the results below and also what should I do with sleep apnea claim... I also have High BP... not sure if I should submit Sleep apnea claim and try to go for SC 100% Thanks in advance for your "time and your help" 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 had a diagnosis of PTSD? [X] Yes [ ] No 2. Current Diagnoses ------------------------------ If the Veteran currently has one or more mental disorders that conform to DSM-5 criteria, provide all diagnoses: a. Mental Disorder Diagnosis #1: Posttraumatic Stress Disorder ICD Code: F43.10 Mental Disorder Diagnosis #2: Major Depressive Disorder ICD Code: F33.9 b. Medical problems relevant to the understanding or management of the mental health disorder(s): Physical health problems that he described as affecting his day-to-day functioning or requiring the use of daily medication or medical devices include back pain and sleep apnea. Just got a CPAP yesterday. Please see his medical records for additional information about his physical health conditions. 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: These conditions can co-occur, and there is some overlap in their symptoms and associated features, which precludes attribution of certain specific difficulties to JOHN DOECONFIDENTIAL Page 22 of 68 one condition or another without resorting to speculation. Consequently, these conditions cannot be fully differentiated from each other. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed Comments: Not applicable. d. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [ ] No [X] Not applicable (N/A) 4. Occupational and Social Impairment ------------------------------ a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [X] No [ ] Not applicable (N/A) 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: As these conditions cannot be fully differentiated from each other, their associated functional impairments cannot be differentiated without resorting to speculation. 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 and Virtual VA) [X] CPRS [X] Other (please identify other evidence reviewed): VistaWeb or JLV JOHN DOECONFIDENTIAL Page 23 of 68 2. History ------------------------------ Relevant Family and Social History: Relevant Mental Health History: EVALUATION AND TREATMENT HISTORY EMOTIONAL AND BEHAVIORAL PROBLEMS: SUICIDAL OR SELF-INJURIOUS IDEATION OR BEHAVIOR: Other Relevant History: None reported. 3. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the 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) JOHN DOECONFIDENTIAL Page 26 of 68 sexual violence, in one or more of the following ways: [X] Witnessing, in person, the traumatic event(s) as they occurred to others [X] 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; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. 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] 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). JOHN DOECONFIDENTIAL Page 27 of 68 [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] Hypervigilance. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the symptoms described above in Criteria B, C, D, and E is more than 1 month. Criterion G: [X] The 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] Panic attacks more than once a week [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks [X] Flattened affect [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships CONFIDENTIAL Page 28 of 68 [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting 5. Behavioral Observations --------------------------- The Veteran arrived on time for the appointment. His appearance was unremarkable, and his grooming and hygiene were appropriate. He was alert and oriented to person, place, time, and situation. The nature and purpose of the evaluation, the examiner's role in the disability claims adjudication process, and the limits of confidentiality were discussed with him. He verbalized understanding and consented to participate. He engaged well with the examiner, and his responses to inquiries were appropriate in content and level of detail. While no formal evaluation of his mental status was conducted, his cognitive functioning appeared to be adequately intact for the purpose of the present interview. His thoughts were logical, coherent, and goal-directed. His speech was clear and intelligible, and of normal rate, volume, and prosody. There was no evidence of significant expressive or receptive language impairments. There was no overt evidence of perceptual disturbances, delusional beliefs, or perseverative thoughts. His attention, concentration, and motor activity were unremarkable. His mood and affect were appropriate in nature, range, and intensity to the situation and to the topic of conversation. He was tearful throughout much of the interview. He denied current suicidal or homicidal ideation, intent, or plan. He appeared to be a reliable historian and credible informant, and there were no overt indications of malingering or of symptom overreporting or underreporting. 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: [X] Irritable or angry mood [X] Loss of interest or pleasure in activities [X] Appetite disturbance [X] Weight disturbance [X] Fatigue or loss of energy [X] Difficulty thinking, concentrating, or making decisions [X] Feelings of worthlessness or guilt CONFIDENTIAL Page 29 of 68 [X] Emotional numbing and detachment 7. Competency --------------------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No If no, explain: Not applicable. 8. Remarks, (including any testing results) if any: -------------------------------------------------- JOHN DOE: is a 45-year-old male who was in the Army, and who had a deployment to Iraq in xxxxxxx. He has a service connection for PTSD, with a current rating of 70%. This examination was focused on his functioning since the previous examination on 3/15/2017, although information regarding prior history was reviewed and obtained where relevant to the issues in question. Please see the report of the previous examination for relevant prior history. The present examination was based on a face-to-face interview with the Veteran and review of records as indicated above. Except where otherwise indicated, historical information presented above is taken from the interview. Results of the examination indicate that the Veteran's difficulties are consistent with current diagnostic criteria for PTSD. They also indicate that he experiences symptoms supporting a diagnosis of Major Depressive Disorder (MDD) at this time. These are considered to be separate, comorbid conditions which share some symptoms and a common etiology. Due to the overlap in symptoms and associated features of these disorders, it can at times be difficult to determine--and clinicians may reasonably differ regarding--whether the clinical picture might be better accounted for by a single diagnosis or by multiple diagnoses. Results of the examination indicate that as a result of his mental health conditions, he is experiencing significant impairments in a number of domains, including occupational functioning. As he is no longer working, his occupational functioning is inferred from his past work history, from his current social functioning, and from the nature and severity of his current symptomatology. He has not held paid employment since February 2016, when he lost his job due to irritability and angry outbursts. He indicated a previous history of work-related difficulties due to anxiety and panic. Taken together with fatigue, problems with attention and concentration, forgetfulness, intrusive thoughts, hypervigilance, discomfort in interpersonal interactions, and a propensity for social withdrawal and avoidance as a means of coping with stress, these difficulties would significantly limit his ability to secure and maintain gainful employment. He would likely experience challenges in adjusting successfully to a work environment due to difficulty establishing and maintaining effective work relationships, as well as to reduced reliability, productivity, efficiency, accuracy, and timeliness in JOHN DOECONFIDENTIAL Page 30 of 68 attending work and fulfilling job responsibilities. ***This DBQ was completed solely for the purpose of a disability evaluation, and does not represent the results of a comprehensive clinical or forensic evaluation of this Veteran. It represents the information and impressions which could be gathered and reported within the constraints of the time allotted for interview, review of records, and documentation, and within the constraints of this mandated format. DBQs are completed in highly specialized ways that conform to the requirements of the disability claims adjudication and appeals processes. Some items may be left blank or diagnoses may be omitted where the symptoms or disorders might actually be present but, for example, cannot be attributed to a specific cause or etiology, cannot be attributed to the specific condition for which the C&P examination was requested, or cannot be linked to the Veteran's military service on the basis of evidence that conforms to the required standards. The conclusions and opinions documented on this form were based upon the information available to the examiner at the time the evaluation was completed, and may differ from those of professionals who have evaluated the Veteran in a clinical setting and/or from the findings of any previous C&P examinations. New or additional information might result in changes to the examiner's interpretations, conclusions, or opinions as documented on this form.*** NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application.
  22. Thank god for this community. I thought my military service was ancient history (NAVY 88-93), but it turns out I have lived longer than my capacity to continue running. May I ask for help here in navigating this? I've filed my claim and am on stabilizing medication, but I feel an almost adversarial relationship with the VA and my family is in crisis. Squatting in a falling apart rv on a now estranged friend's property. We have just received a VASH/HUD section 8 voucher and are hopefully getting into a place with plumbing in a few weeks, but our financial crisis will not be helped by our inexperience and naive handling of this claim, not to mention my current level of incapacity which is complete. About 7 years ago my life started to unravel. I was having difficulty with my job as a plant manager for a large bottled water company. I was missing easy things, forgetting important and essential deadlines and I was becoming less and less able to focus. I was prescribed adderal and that helped for a time, but by 2009 I had to resign. That began a downward slide into homelessness for me, my wife and 2 small kids as my capability was eaten away and replaced with panic, sudden bursts of anger and frustration and implacable feelings of it all ending very soon. I've become almost completely isolated and have been unable to support my family at all for 22 months now. I was hospitalized in december (st joes in tacoma) for 5 days due to suicidal thoughts and a comprehensive nervous breakdown. It was from here that I was able to see the events without conditioned filters and my wife (the absolute most patient woman in the world) helped me file a claim with the va. I've been diagnosed by a psychiatrist in Arizona, the staff at St Joe's and by the VA as having PTSD/MDD and am on a lot of stabilizing medication. During my active service while deployed to Diego Garcia in support of the gulf war effort I was told during a routine physical that I had blood in my urine. My flight surgeon was concerned because she did not have the necessary equipment on hand to rule out bladder cancer. The decision was made to take me off of flight status and medivac me to Japan for more detailed diagnostic testing. I was in Japan about a week and had several examinations that ruled out bladder cancer. During one exam, conducted alone and in an unprofessional manner by a naval officer I was sexually assaulted and it left me in a great deal of physical pain, feeling violated and deeply ashamed. When we were alone in the exam room, the doctor nodded at my wedding ring and asked if there was any ‘other’ reason that could be causing this problem. I said ‘No’. He pressed authoritatively, “You need to be honest with me, I’m your doctor, are you telling me that you have not fooled around on your wife on deployment?” I was concerned that there was evidence of something bad like HIV that needed my honesty to secure needed treatment and the truth was that I had cheated on my wife with a girl in my squadron. And though I was reasonably sure that the protection we had used and the time that had elapsed since our triste was enough to ensure that I was safe from such things, the doctor’s demand for complete honesty and the fact that I felt reasonably safe sharing the truth (he’s my doctor after all) had me answer his question in the affirmative with the explanation of why I didn’t think it material given the explanation of time and protection cited above. The doctor’s demeanor visibly changed. Like a mask had come off. He looked very disappointed, on the verge of open anger. His face grew red and his breathing changed, like he was trying to control his temper. “Now I’m going to need you to turn around and drop your drawers.” As a Naval air crewman, I’ve had over a half dozen prostate exams. Only one of them could be defined as digital sodomy. He held me forcefully and told me to, “BE QUIET” when I cried out from the shock and intense pain, begging him to stop or at least tell me what the hell he was doing. It felt like he was trying to force his entire hand inside of me in a procedure that lasted at least a full minute in which the doctor exerted a tremendous amount of effort, nearly lifting my feet from the ground several times. I started crying as he finished. He released my shoulder and told me to “HOLD STILL OR WE’RE GOING TO DO IT AGAIN” and he squeezed my prostate producing a burning and painful discharge of fluid from the tip of my penis that he collected on a glass slide. He removed his hand from me and said, “Get your clothes on and next time, keep your dick in your pants.” He did not answer me when I asked what he had done. The exam left me in a great deal of pain, feeling ashamed, punished and deeply violated. This proved to be a very destabilizing experience as I slowly began to realize through intense and intrusive flashbacks, that this was not the first time I had experienced this combination of emotions at the hands of an angry male authority figure. I began to withdraw from friends, I took myself off flight status, I was no longer able to shoot my bow, something that had always been effortless before. But now I was starting to unravel, unable to face the shame of the reality of what the doctor had done and the overlap it had with the, until now, completely repressed memory of being handcuffed and violently raped by my best friend’s uncle at the age of 7. By the time I was discharged from the service, I was suffering greatly. It was as though a plug had been pulled and I couldn’t stop the flow of effluent that was leaking out. And I couldn’t get away from it either. I desperately needed help. But I was terrified, confused, intensely embarrassed and depressed. Within a few months of discharge my increasingly impulsive and erratic behavior led to me causing a vehicle accident while street racing my car (something I had never done prior to the assault, but was now doing compulsively) that killed two elderly women returning home from church on a Sunday morning. My wife, pregnant at the time, lost the baby shortly thereafter and our relationship imploded. That KO'd me for a while. I shunned treatment, counseling anything associated or linked to the accident. My shame over having killed two people by my irresponsibility became a massive boulder that sealed everything associated with that event off like a tomb. I did not want to be seen as a victim myself and set out to become something. I worked my way up in a company willing to take a chance on a felon and went from a $10/hour night loader to the Plant manager and near 6 figures in 10 years without a degree. I started racing ATV's (I'd never ridden a motorcycle before) and in 4 years had climbed into the top 10 as a national pro. But my life chaos was increasing exponentially as was my self destructive behavior. after 13 years I again divorced. This coincided with resigning my position at the water company and and marrying my 3rd wife. From there we had our first child while we blew through my retirement trying to figure out what in the hell we were supposed to do. We moved in with friends and I got a job doing driveways for $12/hour. My degrading social skills put huge strains on the friendship status of the family that was good enough to help us. We ended up living in a small camper for 5 months with no plumbing. I called my old boss who now lived in Georgia and was running a consulting firm to the energy sector and asked for a job. This guy thought I walked on water at my last place of employment. We moved in late 2012 across the country. It was an unmitigated disaster. I lasted 18 months before I had to resign. the physical manifestations, panic attacks, loss of focus, inability to follow direction, intense and growing phobia for talking on the phone (it was phone sales job) and an increasing tendency to freeze in stressful situations. (on the phone or in person) just really weird long silence from me. We moved to Arizona to live with our in laws. My wife flew ahead and I met up with my father in law, who was only 6 years older than me in NM. 15 minutes after meeting up, he, died of a massive heart attack in front of me on the side of the road, I had to call my wife and tell her dad had died. the two years spent living in phoenix with a wrecked mother in law going through menopause and losing her mind over her grief now had me and my incapacity to focus her pain on. I started smoking pot heavily (I had not had a substance abuse issue prior to this) and my capability continued to recede. I was working in a tiny post office in a rural town for 4 hours a day. My beard hair fell out and my panic attacks were happening 3 - 12 times a day and everyone felt like the heart attack I saw my father in law have. My Daughter was born in August of 2015 The relationship with my mother in law deteriorated until she sold her house and bought us this little rv we are in now, early in 2016 I went to the doctor in phoenix for the first time in April of last year where he diagnosed me with PTSD and we picked up and moved back home here to washington to flee the intense stress from living in a dirt parking lot in July in Phoenix in an rv, not to mention the now open hostility directed toward me from my in laws who weren't buying any of it. By some miracle my wife was able to locate my Pink medical folder and it has the doctor's name in there and the dates, though he doesnt mention in the chart notes the procedure in question, at least from what I can tell. This guy was a ltcdr in the NAVY, I'm fairly confident I am not the only person he taught this lesson to. So now we are in process. My wife has done all the filing to date and has been as thorough as possible, but there is a lot of water left to cross and Im not entirely sure of the strength of our case and I dont want to learn on my own experience the lessons of those who have successfully navigated this. Any help is greatly appreciated.
  23. After failing a sleep private study and required to sleep with a CPAP machine and meds, my private psychiatrist wrote me a NEXUS letter linking the sleep apnea as secondary to the PTSD. Also I had my Dr fill out a DBQ also linking them together. I have been waiting on them to send me info on when to go to a C&P exam but nothing yet. So I called my Veterans Services Rep and they looked it up and said they see where the information has been sent out for a medical opinion. any idea if this means NO C&P or if they are looking info to see if they will even schedule one? thanks!
  24. What weight would a private psychologist have on my claim for PTSD. The VA keeps ducking saying it was due to childhood trauma. I am trying to get them to admit it exasperated any preexisting condition. I had a Top Secret Clearance from 92 to 96 and would (back n those days) NEVER received it with any hint of mental issues. I feel if I can get a professional to say this into my medical record I might have a fighting chance. I have been denied twice I think. Link for so many of us it has been a long journey... Thoughts? Also does anyone know of a Veteran friendly Private Psychologist in South West Florida?
  25. I received my C&P over the weekend. My exam was nearly three hours and I think the report is accurate and fair and represents how things are. I was as honest as I could be with the examiner and despite being nervous to the point of an anxiety attack about it the day before calmed down a bit and was OK during the visit. The doctor did a good job asking questions and made me feel at ease which is saying something. The report ended up being 18 pages which surprised me. I had PMd the results to a handful of people here on HADIT and a couple recommended I post it for more input. I was hesitant to do so but decided my desire for more information is more important than my paranoia of posting it. I'd really like to get the opinions of some senior HADIT posters like Berta and others. I'm thinking this is a good C&P for my claim but would like a more seasoned opinion than my own completely inexperienced one. I've posted the opinion and rationale below. . Thank you. JW. ___________________________________ 5. Symptoms For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Chronic sleep impairment [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] Suicidal ideation REQUESTED OPINION: Based on information from the clinical interview, review of records (C-file and VA medical records), and psychological assessment measures, It is my opinion that the veteran meets DSM-5 diagnostic criteria for (1) Post-Traumatic Stress Disorder (PTSD) due to childhood sexual trauma with delayed onset, and (2) Major Depressive Disorder (MDD), Recurrent, with Mood-Congruent Psychotic Features secondary to PTSD. While his PTSD and MDD were less likely than not to have been caused by an in-service stressor, both conditions were more likely than not incurred in service (i.e., delayed onset with clinically significant symptom presentation beginning while on active duty). PSYCHOLOGICAL ASSESSMENT / OBJECTIVE TESTING: Objective psychological assessment measures administered: -- Personality Assessment Inventory (PAI): valid profile without any evidence to suggest inattention, inconsistency, or negative/positive impression management; primary code type - DEP/ARD (97T/85T) * Summary/interpretation of results: Briefly, the veteran's responses on the PAI were suggestive of significant tension, unhappiness, and pessimism, with various stressors (past and/or present) contributing to low mood and self-esteem. Individuals with similar profiles often see themselves as ineffectual and powerless to change the direction of their lives and feel uncertain about goals, priorities, and what the future may hold. In addition to depression, the veteran endorsed significant distress on measures of suicidal thoughts, traumatic stress, and social discomfort or detachment. His profile was most consistent with major depression, and while some traumatic stress concerns were indicated, he did not endorse the full range of concerns typically seen among individuals with PTSD. RATIONALE FOR OPINION: 1. The veteran's symptoms meet DSM-5 diagnostic criteria for PTSD due to childhood sexual trauma. The veteran's history of childhood sexual abuse is well-documented across multiple sources and during the current evaluation, he endorsed the full range of trauma-related symptoms meeting criteria for a diagnosis of PTSD. He was first diagnosed with PTSD while on active duty in xxxx by a DOD psychiatrist and mental health records (private and VA) dating back to xxxx also show that multiple mental Health providers have diagnosed and treated PTSD. Although the veteran experienced some symptoms immediately following the assault (bed wetting, night terrors), these symptoms largely resolved by the time he was in middle school due to reported "traumatic amnesia." His only residual symptoms throughout the remainder of middle school and high school were associated with a chronic mistrust of others and related social detachment. His enlistment exam was silent for any relevant concerns, as were STRs from the time of his enlistment in xxxx until the first disclosure of the assault and associated symptoms in xxxx and xxxx. Thus, there is no evidence to suggest that the veteran was experiencing clinically significant symptoms of PTSD prior to his enlistment and thus the question of aggravation is moot. Records clearly document onset of symptoms while the veteran was on active duty and indicate chronic trauma-related symptoms and impairments since then. 2. The veteran's current mental health symptoms also meet DSM-5 diagnostic criteria for Major Depressive Disorder (MDD), Recurrent, with Mood-Congruent Psychotic Features, secondary to underlying PTSD. His current depressive symptoms are a continuation of those first diagnosed in service as Dysthymic Disorder, and the veteran has been treated for MDD by multiple mental health providers (private and VA) since at least xxxx. As indicated above (Rationale #1), there is no evidence to suggest Clinically significant symptoms of depression prior to military service, and he was first diagnosed with a depressive disorder while psychiatrically hospitalized in service (xxxx). Subsequent records indicate chronic problems with depression since his discharge from active duty. 3. The veteran's history is suggestive of some underlying Personality features which are likely contributing to some of his on-going concerns (e.g., schizoid and avoidant features). Although he was diagnosed with a personality disorder in service, there is insufficient evidence to warrant a personality disorder diagnosis at present, as some of his on-going symptoms can be attributed to underlying PTSD (e.g., mistrust of others, social/interpersonal detachment, avoidance of intimate relationships). 4. The veteran showed no signs of significant exaggeration/feigning or minimization of mental health symptoms on objective testing, during the interview, or when comparing his self-report to the evidence in the record. As such, information from this evaluation is believed to be an accurate reflection of the veteran's current mental health concerns and relevant background.
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