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Found 5,838 results

  1. 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.........
  2. 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.
  3. 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.
  4. 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!
  5. 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?
  6. 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.
  7. I went online to EBenefits this morning to see if nothing changed after my C&P last month. It said claim closed and Decision letter sent. After checking around I found a 70% rating for PTSD and MDD and a 3/15/17 effective date which was when I filed my claim. I hadn't set up banking info yet so I did that. Some questions: 1. Will they mail a retro pay check since I didn't have banking set earlier? 2. I know I need to wait for the letter but is EBenefits usually accurate with the rating? 3. Is there a certain day of the month VA sends payments (Like social security is always at the start of the month) or is it the claim date each month? 4. Where can I find information on how my VA class will change? I was class 8 before (big copays). 5. I have a very good private therapist I'm paying for myself. Now that I'll have a rating will the VA pay for him or do they only cover their own therapists? Thanks for the help! JW
  8. Hello everyone, It has been a while but I finally received my C&P examination for mental health. Currently am 50% for Major Depression, seeking 70%. I went to my examination in stained sweats, faded shirt, flip flops, unshaven, and hair frizzy and not brushed. For some reason, I believe my C&P examiner was wishing I did not come so she could go to lunch early based on her reaction to my arrival and her BSing with the receptionist prior. Anyway, I feel angry after reading her assessment and would like to know what you all think. I think she checked the box for 30% which is a decrease but all the symptoms are 70% looking. It feels really bad she is trying to make me out to be a liar when she doesn't know how I really feel. I have been suicidal, I have made attempts, I have researched the best methods, made plans, etc. The closest I have come is purchasing roper, tying it in a noose, and testing out a bar at work to see if it could support me in hanging myself. But I have really been feeling like crap and feel I have to fight really hard to not let my thoughts become the truth. All things she did not ask. What do you think will happen based on the below exam results? I thank you for your time and responses. CaliBay Mental Disorders (other than PTSD and Eating Disorders) Disability Benefits Questionnaire Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No SECTION I: - - - - - - - - - - 1. Diagnosis - - - - - - - - - - - - a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder? [X] Yes [ ] No ICD code: F33.2 If the Veteran currently has one or more mental disorders that conform to DSM-5 criteria, provide all diagnoses: Mental Disorder Diagnosis #1: Major Depressive Disorder, severe, recurrent ICD code: F33.2 Mental Disorder Diagnosis #2: Generalized Anxiety Disorder, with panic attacks ICD code: F41.1 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): severe sleep apnea 2. Differentiation of symptoms - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [X] Yes [ ] No [ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses Depression - depressed mood, not feeling pain, poor motivation, nightmares, few friends, feel worthless and helpless. Anxiety: doesn't like to leave his house, uncomfortable in crowds, some paranoia shakes c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 3. Occupational and social impairment - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [X] No [ ] No other mental disorder has been diagnosed If no, provide a reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: symptoms of GAD and MDD overlap and it is nearly impossible to differentiate between 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 2. History - - - - - - - - - - a. Relevant Social/Marital/Family history (pre-military, military, and post-military): The veteran has been married for 25 years, and they have 4 children ages 17, 12, and 7. His father lives at their home, but he is self-sufficient and assists caring for the children. His spouse works at Kohls. b. Relevant Occupational and Educational history (pre-military, military, and post-military): He works for the Federal Government as Transportation Specialist at the GS-11 pay grade. He stated that his supervisor has made a verbal accommodation for his mental disabilities to let him come and go as he pleases including arriving late and leaving early for work for appointments. He states he does not know exactly what he does at work but feels like a government worker that is unqualified for his position and got lucky to obtain his current job. He states he answers email correspondence all day and surfs the Internet. He stated that his duties are not really defined and much of his job requires little effort mentally or physically. He creates spreadsheets in Excel and analyzes financial data for travel. He works from 8:00 am to 5:00 pm. He stated that he has used his all of his vacation and sick time because of his disability. He was out of work on FMLA for three months to receive mental health care and has returned in May 2017 with difficulty adjusting. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): He stated that he was feeling better during for two months in a 12-month period. Since he returned to work, his depression has increased and has frequent panic on a daily basis. He stated that he feels paranoid that someone is out to get him. He feels like he is worthless at work even though his managers have never told him his performance is poor. He does not recall periods of remission and stated that he only remembers all the bad things that have happened to him. He uses a CPAP machine but states he rips it off his face every night due to nightmares. He has always had nightmares of when his daughter passed away and escorting human remains off of military cargo planes. He estimates waking up every hour to check on his children to see if they are still alive. He self-admitted to a Mental Health Hospital for 3 months. He was suicidal and very depressed. He has not seen a Therapist but he has spoken to his Psychiatrist. Nightmares: never decreased, nightly or every other night. His nightmares are of the same theme. No exercise Medical records review: DBQ from private provider Statement from veteran Treatment records from Private Hospital Treatment records from Mental Hospital These records are consistent with a diagnosis of Major Depressive Disorder, and Generalized Anxiety Disorder. Many medications have been tried. He is at low risk of suicide at this point. Current Medication: Wellbutrin Abilify Prozac d. Relevant Legal and Behavioral history (pre-military, military, and post-military): None e. Relevant Substance abuse history (pre-military, military, and post-military): He drinks occasionally and states he is a “light weight” in consuming alcoholic beverages. Sometimes he inhales CO2 from whip cream to get a temporary high. f. Other, if any: No response provided. 3. 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] Flattened affect [X] Disturbances of motivation and mood [X] Suicidal ideation 4. Behavioral observations - - - - - - - - - - - - - - - - - - - - - - - - - - No response provided. 5. Other symptoms - - - - - - - - - - - - - - - - - Does the Veteran have any other symptoms attributable to mental disorders that are not listed above? [ ] Yes [X] No 6. Competency - - - - - - - - - - - - - Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 7. Remarks (including any testing results), if any: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - This 45-year-old veteran still struggles with depression and anxiety. I cannot diagnose him with PTSD because it appears to be secondary to MDD. He has not seeked therapy other than admitting himself to a Mental Health Facility. The veteran has been advised to get help for his symptoms and he has not complied. There doesn't appear to be any changes in his mental health status. The fact that this veteran continues to work without incident suggests that he may be functioning better than what he is showing. I recommend that this veteran receives intensive therapy and be re-evaluated after a year of consistent treatment.
  9. I am rated at 30% for PTSD and I have other things pending but after returning as a door gunner in Desert Storm, I started having severe headaches and TMJ. Both have been diagnosed and DBQ done by my medical Dr stating more likely than not related to the PTSD. I have an upcoming C&P exam with QTC for my diagnosed Bruxism, related to PTSD. I have broken several teeth from grinding at night and just broke another crown that they will see on Monday when I go in. Anyone else ever dealt with this or have any advice? I sleep with a mouth guard but I am on my 3rd one right now after chewing threw the first two. I also have been diagnosed with Sleep Apnea and sleep with a prescribed CPAP machine.. Any advise is appreciated. Semper Fi!
  10. Hello Hadit members, it has been a while since I posted. I believe that my last post was regarding an Earlier Effective Date NOD that I filed in 2015. I received the SOC last year, submitted my Form 9 this year, returned it and am now waiting to be certified to the BVA. A little background: https://community.hadit.com/topic/63190-70-service-connected/#gsc.tab=0 https://community.hadit.com/topic/63830-what-evidence-is-needed-for-an-eed/?tab=comments#comment-386303&gsc.tab=0 I sent a letter requesting a discharge upgrade in 2015 at the same time that I submitted the NOD. However, I did not file the proper form and never got a response. This year, due to another process that is going on, my General Under Honorable - Personality Disorder discharge came up again. At that moment, I realized that although its seems that I have not been affected by the stigma attached to that reason, when it comes to official business, it does harm veterans. The same day that I submitted the Form 9 for my appeal, I took the initiative to make copies and submit almost identical paperwork to the Board of Naval Corrections to have my discharge upgraded. On June 11th, “in the interest of justice” a decision was made and I am now an honorably discharged veteran (characterization). The narrative is being changed to Secretarial Authority and the reinlistment code was changed to RE-1J (Eligible to reenlist but elected to separate). I did not receive the letter because it was sent to my old address, but after many calls, bad numbers and full mailboxes a wonderful lady took the time to speak to me and personally forwarded me the information last week. I just want to say that I have spent countless hours online here at Hadit and other sites, reading BVA cases, reading WARMS, 38CFR’s, speaking to other veterans and watching Chris Attig and other videos on YouTube to get a good understanding of how the various processes work. I have decided that if I win this EED appeal then I will believe that I am able to help other veterans with their claims. I have done my share of sharing websites, videos and posting information on social media but I do not have the confidence to help on a larger scale. I am afraid that I will mess something up. Will I ever be a VSO? Probably not but at least I will be able to guide someone in the right direction. I just wanted to write this to encourage others to never give up and keep fighting for what’s right. I know that we all have had struggles with the VA but do not give up. It took me over 21 years to get service connected and over 26 years to get up the nerve to apply for the upgrade. Please please do not give up. I have been a member of Hadit for almost 10 years and although I do not post much I am always on or sending others this way for help. Love and hugs, txcooper aka 1994 and counting
  11. Mailed off my PTSD secondary to MST on Monday. I don't know where to go from here. My life is falling apart around me. My marriage is on the rocks, my work is suffering. I've been in therapy at my VAMC for 2 years now. I don't know if I will survive. I got a letter that the VA wants to reduce my back...I can't deal with that, and this...and I'm at my breaking point. On January 23rd my life changed forever. I had sexual assault reporting and prevention training at work a few days earlier, which triggered my memories. They had been blocked. I had always thought what happened was consensual gay sexual activity...at least that's what that predator had told me he would say if I talked. And that he would kill me and hide my body in the woods. I have been having memories drown me ever since that time....I have 37!!!!!!!!!!!!!!!! years of sexual, child sexual assault, physical assault, domestic violence abuse.....how the crap am I even still alive??????? I know I can't talk about anything that didn't happen during my service years. So that limits me to 4 sexual assaults, 2 by females and 2 by same male predator. The last was a drunk female Sailor while I was on deployment. She tackled me then began assaulting me. She was drunk off her butt, and I was automatically the perpatrator...sober male Marine, versus a drunk female Sailor...who do you think is guilty??? I can't comprehend...37 years of garbage history in the last 10 weeks....I am utterly worthless
  12. Good Evening Everyone! Okay I have a few questions regarding my Disability claim as well as my husband. First let me start off by listing all my service connected disabilities: 1.) PTSD-100% 2.) 60% Asthma 3.) 50% Migraines 4.) 50% Endometrosis with IBS 5.) 10% Eczema 6.) 10% Rt. Knee 7.) 10% Left Knee 8.) 0% scar left breast 9.) 0% hernia 10.) 0% rt breast scar I'm currently rated 100% SMC S and I'm paid at the housebound rate. I'm a little confused. Another veteran told me I should be rated L or L1/2 because I was getting paid the housebound rate prior to Migraines and Asthma being increased from 10% to now 50% and 60%. Is this true? I read on one forum (can't remember where) that I should receive the letter S and 3 K's which ultimately equals L. Just confused. Also, my husband was medically retired due to Lupus. He's currently rated at 100% for Lupus and 100% for Depression. I recently applied for Aid & Attendance because with two kids and my own disabilities (no family within 2 1/2) its extremely hard. When he has flares he can't do anything. He has flares anywhere from 2 to 3 times a month lasting anywhere from5 to 7 days. His civilian dr filled out the Aid & Attendance form and explained how bad he needed this benefit. Well of course the VA denied it. They stated Aid & Attendance is for someone in regular need of assistance. They also stated since he can walk with a cane 25 ft he doesn't need it as well. I'm really at the end of my rope with the VA. To add insult to injury, when I filed a claim for his kidenys (he has stage 3 kidney failure) they said that falls under Lupus. I understand if I opened a claim regarding back, joint or neck pain, but Kidney failure! We have a two young kids and we will make due, but I can't make it to my MST meetings unless I have someone here with my husband. Sorry, folks I had to vent. Please help
  13. My apologies in advance if this question has been asked before. I searched the site and could not find the answer. I am 80% but rated at 100% IU. 70% PTSD and 30%Recurrent Shingles I want to try working again as I have difficulty maintaining employment due to my PTSD. My Psychologist and Psychiatrist also suggested that I try working again as well as it may improve my mental health and assist in me overcoming anxiety and social phobias. I've lost 5 jobs in the last 11 years due to exacerbation of my symptoms. I will be requesting an ADA accommodation due to my PTSD. (I have been applying for a position at the local VA hospital. ) I am a Registered Nurse and I usually make a descent hourly wage. Does an accommodation under the ADA qualify as employment in a protected environment?
  14. I was awarded 70% PTSD, 10% Tinnitus, and P&T Unemployability June 2013. A couple days ago I get a VA Form 21-4140 (Employment Questionaire ) from the RO. I did do some part time work last year which amounted to around $4000.00 total. I did this to help supplement my disability income so as to help pay the debtors . I did the work on the up and up and claimed the income on the IRS grab ("Render unto Caesar.......), so as not to get in any trouble with them. Do I have anything to worry about? My wife says I should just quit locating and doing odd jobs. I don't want to jeopardy losing the benefit as it does help me to keep the wolves at bay. Anxiously awaiting your advise. Ralph
  15. I was diagnosed at 70% for "Adjustment disorder with depressed mood and insomnia". My doctors have told me that i have PTSD, so I'm filing a new claim with VA. Can I be back paid to when I was diagnosed with the above disability, since I've really had PTSD this whole time?
  16. Hi everyone! Hope all is well. I just wanted to stop in and say hello. I haven't been on here since late last year. Life is going good. As most know my story and it was a doozy, I finally got everything I deserved! Overall 90% and I couldn't be happier. It took a lot of hard work and sleepless nights and a lot of C&P exams and fighting the VA but I prevailed. I was thankful for this sight b/c without it I would have never met a great guy that helped me with the final phase of my rating. I am now just waiting on an EED for my contentions but I am really not really worried about it and if it happens great and if not, I am good. Don't give up EVER!
  17. Hello everyone, I served in OIF at the onset of the war from 3/2003 - 4/2004 as a front line medic.I also did a tour in 2008. I am currently 70% PTSD/Major Depression, 20% Cervical Radiculopathy and receiving 100% IU P & T as of 5/2013 but have been receiving 100% IU for my PTSD since 2/2010 . I also receive 80% CRSC for both of those conditions since 2013. I was denied service connection for asthma/COPD and Sleep Apnea. Since 2013 new information, and I assume evidence, has come out to establish burn pits as a cause for COPD and that sleep apnea can be a secondary condition to PTSD. My question is 1. Should I attempt to get these two conditions service connected with the goal of a 100% scheduler rating rather than IU or will that most likely adversely effect what I have now? 2. Is sleep apnea secondary to PTSD and COPD linked to burn pits, combat related? So I can keep my CRSC or possibly get it increased?
  18. Yes you read it right. I got the envelope yesterday. VA cut my 100% for Prostate Cancer to 20% Then they awarded me SMC "K" for ED. So bottom line I get $96 a month more. I know that's a strange Success Story. Moved from $3143 to $3239 effective Feb. 1, 2011. 100% (70% PTSD, 30% TDIU) 60% IHD/AO Exposure 20% Prostate Cancer/AO Exposure SMC "S" SMC "K"
  19. My (one year) denial for PTSD increase in excess of the current 30% will be up in about 3 months. Rather than wait 3+ years for an appeal, would it be best to wait the one year limit out and put in a brand new claim? I realize that I would lose the difference in appeal money for a one year period which would be approx 4.5K but, claims are all they are working on right now and a new claim could be a couple of years faster than an appeal.
  20. 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.
  21. My husband is in need of a criminal lawyer who helps veterans asap. He did something while ptsd symptoms were high and now needs criminal help. Before these charges were given we were working on getting him help with his ptsd, which I told him he should go get help as this will show he is trying to not make this mistake again. The VA referred me to VSO who could only refer for help with claims, not criminal. I've contacted my caregiver coordinator, social worker and the primary, with no answer. I need to get on this asap and I know there are lawyers who only work with veterans but have hit a dead end. Any help, is greatly appreciated!
  22. A little history this has been an issue since 2001 and a hell of a ride, so I assume since 5 years will put me at 21 years it then will be a protected status. My original claim (15 years later) was 50%. I went for an increase about 10 months after.I went for an increase for my PTSD as things were progressively going downhill. It looked as I may have been granted 100%, though they came back with a 70% with no routine future exams stipulation. It was explained by my VA contact that this means I will receive this raiting until my death as long as I do not go back to try for any increase or attempt to as that could put me back in the line for a future exam. Has anyone heard of such a thing or the VA doing that with other claims? I would think the best bet is to let sleeping dogs lie, and never ask for an increase or at least wait until the 20 year mark has passed in the event the disability continued to worsen.Thoughts?
  23. 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 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: CH PTSD b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): PARKINSON'S, HIGH TRYGLYCERIDE. HEARING LOSS. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [X] No c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [X] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with 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 [ ] No [X] No other mental disorder has been diagnosed c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS [X] Other (please identify other evidence reviewed): STRESSOR NOTE. Evidence Comments: TALKED WITH HIS WIFE MELINDA. SHE STATES THAT GRADUALLY HAS BECOME MORE IRRITABLE, LOOSES HIS TEMPER VERY EASILY, SNAPPS AT HIS KIDS, ARGUMENT. AT NIGHT HE IS RESTLESS IN BED, YELLING AND STARTS SWINGING HIS HANDS AND FEW TIME HE HIT HER IN THE SLEEP. WHEN HE IS OFF MEDS, HE IS MORE WITHDRAWN, LESS ACITVE PHYSICALLY AND MORE IRRITABLE. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military) THIS VET ARRIVED HERE FROM SIGNAL MOUNTAIN, TN, DRIVEN HERE BY HIS WIFE.HE WAS BORN IN FRANCE, HIS FATHER WAS IN ARMY. RAISED IN JASPER, TN. HE WAS RAISED BY BOTH PARENTS. HE HAS ONE BROTHER AND ONE SISTER.NO HX OF ANY KIND OF ABUSE.HE IS MARRIED FOR 31 YRS, ONLY MARRAIGE. THEY HAVE 3 CHILDREN. HE JOINED THE AIR FORCE IN 1985 AND DCED IN 2008 WHEN HE WAS DXED WITH PARKINSON'S. HE HAD 6 TO 7 YRS OF ACTIVE AIRFORCE, STATIONED IN KUWAIT AND IRAQ. HE WAS DCED FROM AIRFORCE RESERVE IN 2008. HIS RANK AT DCED WAS MASTER SERGEANT. b. Relevant Occupational and Educational history (pre-military, military, and post-military): COMPLETED HIGH SHCOLL IN JASPER. HAS BACHELOR IN ORGANIZATIONAL MANAGEMENT.HE WORKED FOR TVA IN NUCLEAR PLANT AND DID ROOT COUSE ANALYSIT. HE WORKED LAST SEPTEMBER 2016 BECAUSE OF PARKINSON's. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): HE DID NOT RECEIVE ANY MH CARE BEFORE HE JOINED THE AIRFORCE, NONE WHILE IN AIRFORCE BUT AFTER DCED FROM AIRFORCE, HAD TO SEEK HELP AT CHATTANOOGA CLINIC.HE WAS THEN DEPRESSED, HIS MOTHER PASSED AWAY, COULD NOT HANDLE THE LOSS, HAD TO GIVE UP WORKING AND FELT HOPLESS AND HELPLESS.HE FELT LOW ELF ESTEEM.HE WAS THEN PRESCRIBED AND NOW HE IS STILL FOLLOWED BY PSYCHIATRIST AT CHATTANOOGA CLINIC.HE STILL FEELS DEPRESSED, SOME ARGUMENT WITH HIS WIFE.HE FREQUENTLY CRIES, FEELS HOPLESS AND SOME TIME GOES THROUGH MOOD SWING BUT DENIES ANY MANIC EPISODES.HE KEEP UP WAKING UP AT NIGHT, FIGHTS IN HIS SLEEP, FEW TIME HE HIT HIS WIFE IN SLEEP AND HAS HEPPENDED FREQUENTLY, FEELS GUILTY ABOUT.HIS WIFE TELLS HIM HE CRIES IN HIS SLEEP AND SCEAMING BUT HE DOES NOT REMEMBER DOING THESE. REPORTS THAT HE AVOIDS CROWD, FEELS MORE SAFE AT HOME. IF HE IS IN UNFAMILIAR SITUATION, DOES GET UNCOMFORTABLE.HE GETS FRIGHETEN IF THERE IS LOUD NOISE.VERY LIMITED SOCIAL LIFE, ONLY TIME GOES OUT WHEN HE ATTENDS THE CHURCH. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): NONE e. Relevant Substance abuse history (pre-military, military, and post-military): NONE f. Other, if any: HIS OWN PHSICAL CONDITION AND LEAD TO GIVING UP JOB AND ROLE REVERSAL WHEN HIS WIFE HAS TO WORK AND HE HAS TO STAY HOME. 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: 2001, AT AIRFORCE BASE IN QUATAR, WAS GOING TO DO PURCHASE WITH HIS PRCHASING AGENT, PERSON PULLS UP AT GATE AND PULLS OUT AK 47, START SHOOTING, HE WAS ONLY THIRD CAR FROM GATE., THIS PERSON WAS SHOTTO DEATH 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? [X] Yes [ ] No If yes, please describe the markers that may substantiate the stressor. MIDDLE OF ATTACK. b. Stressor #2: WHEN HE WAS STATIONED IN SAUDI DURING DESERT STORM, THERE WAS GR 1 TORNADO NEAR THE BASE, BRITISH PILOT HAD TO EJECT HIM SELF FROM Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [ ] Yes [X] No Is the stressor related to personal assault, e.g. military sexual trauma? [X] Yes [ ] No If yes, please describe the markers that may substantiate the s tressor. WITNESSING BRITISH PILOT EJECTING FROM AIRPLANE WHEN THERE WAS GR 1 TORNADO AT BASE. 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] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [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] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. [X] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Exaggerated startle response. [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 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment[X] Disturbances of motivation and mood [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Inability to establish and maintain effective relationships 6. Behavioral Observations -------------------------- ALERT,ORIENTEDX3,COOPERATIVE, CASUALLY DRESSED, POOR EYE CONTACT, CONSTANTLY MOVING IN THE CHAIR, VERY FIDGITY. AFFECT IS CONSTRICTED, DECREASED INTENSITY, ANXIOUS MOOD. RATE OF SPEECH NORMAL, GOAL DIRECTED. NO AH/VH OR ANY PERCEPTUAL DISTURBANCES. NOT SUICIDAL OR HOMICIDAL. NO COGNITIVE DEFICIT. 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 -------------------------------------------------- THIS VET DID EXPERINECE TRAMATIC STRESSORS AND HAS EXPERIENCED SXS OF PTSD WITH CO MORBID DEPRESSION AND UNDERGOING MH RX AT CHATTANOOGA CLINIC. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. ****************************************************************************
  24. Hello, I am having my first kid in July so im sorta freaked out about finances right now. Had my C&P last week, here are the results. Also, below that are results from a private psychologist who did a DBQ for me in June of 2016. I am currently rated at 30% for Anxiety condition and 10% for tinitus. Thoughts? Electronic copy finally showed up on Myhealthevet. I'm pretty sure I'm over stressing the issue, but I have a kid coming in July/August. First child, so im sorta scared Sh*tless about finances right now. Getting atleast a picture of what I have to work with might reduce my stress. Additionally, below this last C&P result are DBQ's from May 2016 filled out by a private Psychologist. Deployed OIF 2008-2009.please help: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: F43.12 2.Current Diagnoses--------------------a. Mental Disorder Diagnosis #1: PTSD ICD code: F43.12 Comments, if any: associated with depressive and anxiety symptoms 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [X] No b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): as in other evaluations c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [X] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with reduced reliability and productivity b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [ ] No [X] No other mental disorder has been diagnosed c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBISECTION II:----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply):[X] VA e-folder (VBMS or Virtual VA) Evidence Comments: all are contained in the veteran's claims folder reviewed electroncially through VBMS 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): Veteran was last evaluated April 2, 2016. No history of emotional or psychiatric disorders/ predisposition during childhood years. Brother has been discharged from the military due to Schizophrenia. Veteran has been living in the country since July 2016. He met a gf last August and decided to move in together in October. Vet said his gf is generally good for her. She provides the care he is wants and uses it as rationalization why he is staying with her. He admits that he has some doubts why she is putting up with him and suspects that she might have some ulterior motives (e.g. getting a better life in the US). "I don’t mind, our relationship is neutral, she gets benefits and so do I." -Vet endorsed trust issues. Vet has a tendency to check her phones, he made her quit her job because of fear that if his gf is not by his side, she may be doing some other business that will put their relationship at risk. Vet admits that he doesn't trust her fully yet he is considering marrying her. Vet is expecting a child with her. Vet denied any close heterosexual relationship with anyone in the past. He had commercial sex to satisfy his need. He had one "relationship" back in 2014 but did not turned out well. He felt "used" for investing on her and it was not reciprocated. Veteran said he has problems with relating to others. "other people don’t listen... i don’t know how to talk to them." Vet said he cannot connect with servicemen's sense of humor, overall demeanor. He said he can act very aggressively, imposing and threatening. He has a high expectation of how things are supposed to be done and expected this on other people. When he does not get the things he expected, it frustrates him and can become very aggressive. Vet said this change of character around 2007-2009 when he was on his 2nd duty station. This kind of short temperedness was also endorsed outside of the military. b. Relevant Occupational and Educational history (pre-military, military, and post-military): Noted Veteran's educational and occupational background as contained in VAE done April 2016. Veteran said he had a job after he was fired from his job in Qatar in April 2015. Doing sandwich delivery but did not last long because he had an accident that prevented him from continuing with that work. NO other kind of productive employment since that time. Vet is into using his GI bill (a benefit he started using back in 2012). Vet is pursuing a course in Culinary since Oct 2016. Vet said he likes cooking and knows how to cook, hence his desire to pursue a course in culinary. He however said the class is alienating because of the language barrier that made him cuss inside. He finds the teachers egotistical. He is pursuing this course as a possible opportunity that he can pursue in the future like a cake online business where he just bakes and take orders online without interacting with people. He anticipates the next school year in June. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Index event: combat deployment in 2008. There was an explosion that hit about 100meter from him when he felt terrified. Vet is aware of his how their hostile enemies are capable off and thought his life was really in danger. Vet froze up for about a minute but then realized that they have a job to do and powered up to prepare for retaliation. He related that it was only after about a day that they were told that it was not a missile that exploded rather an airplane accident that carried missiles that happened. Index event 2: veteran wrote a statement about his experience in public showers where he received being slapped at, touched in sensitive places that he did not like. Veteran endorsed that he had to deal with it at that time since it was a common thing to happen and didn’t really want to report the incident for fear of being alienated in the unit or get somebody in trouble. Vet endorsed feeling helpless that he cannot do anything to escape/ or address the situation that he was in at that time. He endorsed feeling embarrassed and some guilt for not having the courage to do anything at that time. Veteran endorsed overly accommodated thinking about taking future assignments/duty stations seriously and got easily pissed off with other members of his unit who just tend to jerk around and not take their duties seriously. He became short tempered. Vet endorsed developing startle reactions when he sees people with their hand on their side that has the potential of accidentally hitting his crotch area. People don’t care anyone but themselves. People are selfish, everything do things for a gain. This has led him to avoid them as far as possible. Social interaction has suffered and became more reclusive. Vet said that his motivation to go out and engage in social activities is no longer there. He identifies his best friend *FRIENDS NAME* as the person he can trust. He is trying his best to make his current relationship to work for him. He has a tendency to think that his life now has somewhat been "oriented" but cannot really say if he is already focused or goal oriented. He is considering a married life and being a responsible father. He admits having some anxieties with it at this time. Vet endorsed having dreams/ nightmares about the explosion and things that happened in the military that can happen 2-3 times per week, resulting to early morning waking up and feeling relieved that he was not there. Sleep impairment is endorsed having episodes of recollections of his index event usually triggered by stresses and events and cues that reminds him of it. It used to occur about 1x/week and more current only when reminded of it. Alcohol effect can trigger it, hence he tries to avoid it. Vet said he would feel sad about it and would want to isolate himself to deal with the memory. Vet self-esteem affected because he felt he didn’t have to freeze up at that time; Made him think that he had to be very diligent in his subsequent work ever since then because of the history of freezing up in his job when it happened. Vet endorsed some doubts about his abilities.... "I’m not good enough for a lot of things;" "maybe I’m not as good enough as i thought i am". Veteran said he easily gets nervous when feeling intimidated and verbally aggressive when having a hard time convincing other people of his stand especially when knows he is right. Vet said he can get easily wound up and anxious when meeting a deadline. Vet endorsed recurrent preoccupation about what is going to happen, what is his next move. etc. Panic attacks can happen sporadically as triggered by unexpected sounds or noise, or negative news on tv. Social situations that he is unfamiliar with also triggers it. Noted treatment records from *Florida VA facility* where he is maintained on Duloxetine, Trazodone and Prazosin. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): Vet used to live close to his grandfather. He reported a volatile relationship with him due to difference in opinion. Vet endorsed that police has been called multiple times to settles down his temper that has a tendency to become really aggressive. NO charges has been filed against him. Vet had a intense altercation with a girl he met when he first moved in the country around August of 2016. The altercation came to the point of his antagonist pulling out a knife to threaten him. He said he was being aggressive and loud at that time. This was no police involved. e. Relevant Substance abuse history (pre-military, military, and post-military): no problematic use of alcohol; no history of using illicit drugs except using marijuana to calm him down when he is feeling edgy and panicky. said he self-medicated. he has not smoked marijuana ever since he got into the Philippines.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: experiencing an explosion while on combat duty station in 2008 that turned out to be an airplane accident 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 [ ] NoIs the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No b. Stressor #2: unwanted sexual touching in the context of traditional military humor. Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] NoIs the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] NoIs the stressor related to personal assault, e.g. military sexual trauma? [X] Yes [ ] Nof yes, please describe the markers that may substantiate the stressor. Veteran developed trust issues with people and became more reclusive in dealing with social situations. Veteran developed assimilated and overly accommodated thinking as a result of his index event. He also developed inability to relate to people after the event that had occupational and social negative impact. Self-esteem and self-worth has been questioned. 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) 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: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:[X] Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined").[X] Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).[X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. 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] Exaggerated startle response.[X] Problems with concentration.[X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion 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 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks more than once a week [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 [X] Inability to establish and maintain effective relationships[X] Impaired impulse control, such as unprovoked irritability with periods of violence 6. Behavioral Observations -------------------------- Veteran came in alone, appropriately dressed for the interview. Generally cooperative with spontaneous and goal directed speech. Generally calm disposition. Mood was euthymic with a wide and appropriate range of affect Logical thoughts process (+) overly accommodated thinking as well as assimilated thinking as related to experience of the two index event disturbed motivation, arousal symptoms of irritability poor to fair impulse control, some insight to symptoms influenced judgement no suicidal ideations .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 -------------------------------------------------- The current diagnosis is the better description of the etiology of the vet's symptoms rather then broader and non-specific implication of his previous diagnosis of unspecified depressive disorder. This is a progression of the previous diagnosis as more symptoms about the current diagnosis became evident. Veteran exhibited cognitive symptoms consistent to a person who has suffered a trauma in his life and developed symptoms that fulfills the criteria for PTSD based on DSM V. All evidences on record considered and was built on. Veteran's current symptoms will likely affect successful social interaction that would make a typical employment environment challenging. Other forms of productive pursuits can be considered that does not place too much emphasis on social interaction to deliver its "products," NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application___________________________________________________________________________________________________________________________________Here are the additional DBQ's from a private Psychologist I went to for a few sessions before leaving the country.As far as I know, he was objective, I didn't know him like a PCP or anything.Here are the items checked on one for mid-2016 from my private Psychologist I was seeing for an extended time for treatment:X OCCUPATIONAL AND SOCIAL IMPAIRMENT WITH DEFICIENCIES IN MOST AREAS, SUCH AS WORK, SCHOOL, FAMILY RELATIONS, JUDGMENT, THINKING AND/OR MOOD X The Veteran experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. X The Veteran's response involved intense fear, helplessness or horror. X Recurrent and distressing recollections of the event, including images, thoughts or perceptions. X Recurrent distressing dreams of the event. X Acting or feeling as if the traumatic event were recurring; this includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur on awakening or when X intoxicated. X Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. X The traumatic event is not persistently re-experienced. X Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. X Efforts to avoid thoughts, feelings or conversations associated with the trauma. X Efforts to avoid activities, places or people that arouse recollections of the trauma. X Inability to recall an important aspect of the trauma. X Markedly diminished interest or participation in significant activities. X Feeling of detachment or estrangement from others. X Restricted range of affection (e.g., unable to have loving feelings). X Difficulty falling or staying asleep. X Irritability or outbursts of anger. X Difficulty concentrating. X Hypervigilence. X Exaggerated startle response. X The duration of the symptoms described in Criteria B, C and D is more than 1 month. X The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning X Depressed mood X Anxiety X Suspiciousness X Panic attacks that occur weekly or less often 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 Flattened affect X Impaired judgment X Disturbances of motivation and mood X Difficulty in establishing and maintaining effective work and social relationships X Difficulty adapting to stressful circumstances, including work or a work like setting X Inability to establish and maintain effective relationships X Impaired impulse control, such as unprovoked irritability with periods of violence X Neglect of personal appearance and hygiene
  25. Voiceless Veterans We arrive, angry, confused, hurt, untrusting, extremely defensive, with a strong tendency for coming off "rudely direct" and somewhat scatter brained. By the time, we finish speaking, we've likely already "pissed off" our intended receivers. Then, we receive our threat of VA police intervention, unless we comply, and speak with respect. Who are we? We are the "voiceless members" of the "highest VA risk group" known as "mentally challenged veterans". We perhaps impact the high rate of suicide, more than any other group, found among veterans, past and present. Everyone is concerned for our well fair and rightfully so. Yet..... We all witnessed a veteran act out and take the lives of five Dallas police officers. We all read about the veteran taking his life the day before thanksgivings in Tennessee. We watched again as a veteran drove his car into a crowd in New Jersey. These were all members of my group. They each acted out in horrible ways. They acted with purpose. Each were previously rejected help, by the VA! Replace the acronym "PTSD" with "HULK" and everyone will understand us better. PTSD, as in my case, has not diminished intelligence, it clouds my use of it. The CCVA, addressed the plight of the mentally challenged veteran in Clemons v Shinseki, 2009, emphasizing the inability of a mentally challenged veteran, to narrow their own claims, before a more knowledgeable and experienced VA employee. We would have hoped a ruling from the highest VA court, would have produced a wide range of assistance and protections for us mentally challenged veterans. The court declared it to be enough that a veteran apply with a mental health claim to trigger the special attention required under Clemens. What good are CCVA decisions when VBA directors have no responsibility to follow them, at least that's the way the Tennessee region applies it. Rulings are muted, as veterans in my group have no way to address them. We are threatened with police action, by the VA, defenseless before the DOJ, ignored by politicians, called crazy by caretakers, and all is well, once again, in the life of a stressed out government employee. Our lives are ripped apart, stress increased beyond belief, we end up living in a shed for years, waiting on the VA to respond. We once believed ourselves more than just a veteran, we thought we answered the call for something, more than that. We stood the ground assigned and completed our small part in the defense of our Nation. We stood for all of our nations people. We stood for our own constitutionally protected rights and believed ourselves protecting them. From one Generation to the next, less than 3% of Americans have served their country and even less during time of war, is it to much to ask for a voice? Is it to much to ask that we not be required to sacrifice everything we had worked so hard and so long for. The wars we fight are not in your neighborhood. If you let the 2% keep getting treated this way, the next one will be. I'm a Vet, too, has become an excuse, not the badge of honor it was intended to be. We stood up when you called and we came home different. Will you not stand up for what our families are loosing, because we chose to defend you? To quote the late Paul Harvey " Now you have, the rest of the story." Stand on Clemons and force the VA to address all of the material facts. Now read Bevins and six unknown narcotics agents and the new VA accountability law. This will force the VA to address the whole disability picture the first time they touch the record or they fail Clemons. Do not pursue the adjudicator, pursue the signing authority as they have a written obligation to ensure the law has been followed. The new accountability law is specifically positioned to tag these individuals for failing their signing obligation, therefore failing Clemons. My claim went from 50% to 100% based on the same medical evidence. No new exams, no bull, claim Clemons and point to your Disagreement, then let them assume liability for failing Clemons.
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