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Found 11 results

  1. Yesterday when reviewing my medical records I noticed an examiner did a C and P/DBQ addendum. Im currently 70 percent and submitted for an increase(12 months ago) and also filed for IU(2 months ago). I don't know what this nexus means and would like to know if the exam was for the IU or increase claim. This examiner did a table top review as I wasn't present for it. See below: Please utilize this form when responding to VBA requests for either addendums or clarifications of prior VHA examination reports. This Veteran was seen for a C&P examination in December, 2017. At that time it was felt that the most appropriate diagnosis was that of a mood disorder, which was considered to be severe. At that time it was noted that the Veteran had been able to complete a college degree. In July of this year the Veteran was admitted to inpatient treatment, which he successfully completed, and he continued in treatment throught the remainder of this year. Treatment notes reference some improvement in functioning, with the Veteran reporting boredom. At this point, given the available information, I believe it is as likely as not that the Veteran's severe mood disorder would make it impossible for him to maintain employment over an extended period of time. Perhaps vocational rehabilitation, combined with his continuing in treatment might make it possible for him to obtain and maintain employment at a later So my question is.. Does the nexus look favorable? What was this exam for(IU or my increase)? My increase is in front of the DRO and was filed in December of last year after my initial award. The IU claim was only filled a month or two ago. The C and P exam was done 15 days ago. Any assistance would be greatly appreciated
  2. So I had a C & P appointment. I got an attorney a couple years ago after my claim was denied. My claim is for Bipolar, PTSD, and Depression. My attorney sent a NOD a little over 2 years ago and I was scheduled for a C & P appointment. The examiner that I had was the same examiner that I had on the claim I was initially denied on. He basically said "there wasn't anything wrong with me after the service". So I had my C & P appointment and the examiner pulled a note that described me mentioning taking anti-depressants prior to the military. I honestly forgot about this. I have attached the nexus letter which makes a link to the military aggravating my condition. Could someone please explain to me what can happen next? I was initially thinking award. But I'm wondering if they are going to ask for records prior to my military(teenage and young adult)... which I wouldn't be able to produce. I'm kinda freaking out because it seems like the link was made but not in the way I was expecting. Attached nexus--- 2. Current Diagnoses ------------------- a. Mental Disorder Diagnosis #1: unspecified bipolar disorder ICD code: F31.9 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): none 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 2. History --------- Page 26 of 139 a. Relevant Social/Marital/Family history (pre-military, military, and post-military): The Veteran has been married for approximately one year; he said lately their relationship has had problems because he feels his wife has not understood his problems. b. Relevant Occupational and Educational history (pre-military, military, and post-military): The Veteran said he had had eight jobs in the past year. He completed a bachelor's degree in psychology at UCA a year ago. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The Veteran is followed in mental health at CAVHS. He takes lamictal, prazosin, and lithium carbonate. He also sees a private counselor. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): n/a e. Relevant Substance abuse history (pre-military, military, and post-military): The Veteran reports drinking every day, having two 30-packs over the course of a week. His last marijuana use was about two and a half years ago. f. Other, if any: n/a 3. Stressors ----------- Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: hearing a soldier getting raped 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 Page 27 of 139 4. PTSD Diagnostic Criteria -------------------------- No response provided. 5. Symptoms ---------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Inability to establish and maintain effective relationships [X] Suicidal ideation 6. Behavioral Observations ------------------------- The Veteran was cooperative. He displayed some dysphoria. 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 ------------------------------------------------- The Veteran's symptoms appear to be more consistent with a mood disorder than with those of PTSD. He reported depression while still in the military, but also reported he had been treated for depression prior to the military. In today's examination the Veteran denied depression prior to the military but then conceded it was possible he had been depressed as a teenage, but could not recall details of his depression or the treatment he received. However, the same note indicated that in 2007 the Veteran reported that he had responded well to medication, suggesting that it was possible that his depression was relatively mild. Page 28 of 139 The Veteran's current bipolar disorder is severe. Therefore, it is more likely than not that any mood disorder present before the Veteran's military service was exacerbated by his time in the military. Given the Veteran's ability to complete a bachelor's degree, I did not find evidence that his bipolar disorder precluded all employment; however, it definitely makes it difficult for him to sustain employment. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's
  3. I've been having issues for years but didn't even realize for a long time they were related to my time in service (88-92). I just pushed the feelings down deep inside and avoided thinking about it. When I finally went to a civilian Dr for my depression back in 2003/2004 I was put on every drug available but nothing worked for long. When I lost my job and went back to school to get an associates degree I had to find a way to continue treatment so i started going to the VA. Problem is while I would sometimes be honest with my Dr about how I was feeling, other times I would deny currently suffering. I didn't want to appear weak, especially if it was a woman treating me. I know that my fault, partly because of how I was raised and partly due to my time in the Marines. Depending on who saw me, their DX differed. My primary care Dr and a social worker suspected PTSD, but the Psychiatrists DX was MDD and SAD. Finally after I graduated college and started a new job I lost the ability to cope and had trouble concentrating and handling the stress. I was let go and spiraled out of control. For the past 3 years now I havn't worked and I only leave my house every couple weeks to buy groceries late at night or to visit my Dr at the VA (if I don't end up canceling or missing my appt due to feeling sick at the thought of leaving the house). I finally decided to apply for compensation as my family who has been supporting me has reached their financial limit. I hoped for the best as I now know I really have a horrible problem and need help to survive and not end up under a bridge somewhere. I will post the C & P examiners exam results now and hope someone can find something to help me with my next step. Also he references several other mental health evaluations. I will post those as replys to myself as this is going to be a LONG post. I will only be editing out my and the examiners name, everything else I will leave in. I know now I can't get help if I leave out information. Thank you for any advice in advance. Semper Fi Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [ ] Yes [X] No If no diagnosis of PTSD, check all that apply: [X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [X] Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire: 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Major Depressive Disorder ICD code: F33.1 Comments, if any: Less likely than not due to, caused by, or incurred during military service. Military records indicate no treatment for this condition and discharge physical exam indicated no mental health problems. The veteran did not have any mental health treatment until many years after military service. Mental Disorder Diagnosis #2: Social Anxiety Disorder ICD code: F40.10 Comments, if any: Less likely than not due to, caused by, or incurred during military service. Military records indicate no treatment for this condition and discharge physical exam indicated no mental health problems. The veteran did not have any mental health treatment until many years after military service. Mental Disorder Diagnosis #3: Attention Deficit/Hyperactivity Disorder (ADHD) ICD code: F90.0 Comments, if any: Less likely than not due to, caused by, or incurred during military service. Military records indicate no treatment for this condition and discharge physical exam indicated no mental health problems. The veteran did not have any mental health treatment until many years after military service. Furthermore, ADHD, by its very definition and nature, begins in childhood, and his not caused by any external events. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): GERD, history of headaches, history of neck pain 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: Due to symptom overlap and multidirectional interactions among the disorders. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [X] No [ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: Due to symptom overlap and multidirectional interactions among the disorders. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS [X] Other (please identify other evidence reviewed): The vet brought a copy of his recent Statement in support of claim which was on his smart phone screen. This examiner reviewed that. It had not been submitted yet to the Regional office. The veteran also brought in a wooden plaque with a Marine Corps Meritorious Mast award on it dated 12/14/1989 indicating that he was involved in capturing an intruder on their base in the Philippines as part of their patrol. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): This veteran has had a number of past mental health evaluations here at the VA. Please see the 12/16/2011 psychology evaluation, the 4/272012 psychiatry intake, and the 10/17/2016 psychology mental health treatment plan for details of his history. The veteran is 47 and is divorced since 2001 (past records noted above suggest this seems to have had little to do with his mental health issues). His last relationship ended in 2012 he reported today that she apparently had another man already lined up, as she was dating him just a couple days after they broke up. He reported no current/recent relationship. He reported he really has not been getting out much at all - says he does not like himself and reported he worries others will judge and talk about him. He says he is watchful and on guard for others' negative evaluations. He resides alone, with his small dog. Mother and brother are 2 hours away in XXXXXXX. He has little contact, avoiding her alot and her possible questions about his job hunt. He used to play some online gaming and still does, but only occasionally. No groups, clubs, organizations or church. No close individual friends. He reported no other recreation/leisure. He says he sleeps on the couch since his relationship breakup about 5 years ago, as the bed reminds him of her. He says his sleep schedule is widely varied and he will do alot of daytime sleeping, watches some TV. He only rarely goes to the store and does so late at night so as to avoid other people and their perceived judgement. He reports he has had little motivation to attend to household tasks and becomes easily overwhelmed and thus avoids or procrastinates. As a result, he reports there are many empty grocery bags laying around, and he simply piles the mail on the kitchen table. Part of that may also be due to avoiding what might be in the mail. He reports he keeps phone ringer off so as to avoid contact from the bill collectors. He says he owes $50,000 in school loans and years ago put $20,000 of his girlfriend's school loans on his credit card and cannot pay fully. It seems his attempt at coping is through avoidance, which then adds to the problems he has. MILITARY: The veteran enlisted into the Marine Corps and served August 1988 to August 1992. He rose to an E4 rank and had an honorable discharge. He served time both in the Philippines and in the Persian Gulf during the Desert storm/desert shield.. His MOS was mortars. His statement in support of claim seen on his cell phone screen today listed two events, one of which he reported occurred in the Philippines in May 1990. He says he and his girlfriend at the time work in the marketplace and then went to a bar down the street. Not too long afterwards, he and others in the bar found out that two airman had been shot in the market area where he had been not long before. This examiner notes that while this could be an upsetting or shocking bit of information to find out, the veteran did not experience any actual trauma. He did not witness the shooting and was not even aware of it until being told shortly after it occurred. The second incident he reported was from February 1991 in Kuwait and reported that they took small arms fire at one point and also took enemy mortar fire and they were in a mortar battle. He felt the enemy mortars were getting closer, as close as 50 yards away, until the enemy position was neutralized. This event would meet DSM?five trauma criteria for PTSD. Other VA notes also refer to the veteran being next to a man who almost committed suicide, but a sergeant apparently prevented it. This would also not meet trauma criteria as nothing actually happened. There was no trauma witnessed, and the veteran himself was not in significant threat. The veteran today said he really wanted to have a career in the USMC, but also noted that the reason he actually got out was due to a Reduction In Force at that time. b. Relevant Occupational and Educational history (pre-military, military, and post-military): This veteran has had a number of past mental health evaluations here at the VA. Please see the 12/16/2011 psychology evaluation, the 4/272012 psychiatry intake, and the 10/17/2016 psychology mental health treatment plan for details of his history. Vet reported today that he has had mental health treatment in the private sector starting about 2003/2004 regarding ADHD and was placed on Adderal as well as a number of antidepressants. He started here at the VAMC in 2011, dealing with issues of ADHD, Depression and Anxiety (particularly Social Anxiety). He has seen psychiatry, psychology and social work at various times since then, up until the preseent. He also had Neuropsychological testing on 10/14/2011 regarding an ADHD eval. Psychiatry records indicate medication has not been all that effective regarding his depression and social anxiety. He currently is treated with Adderal for ADHD and recently was (re)started on escitalopram. He has also been in and out of psychotherapy for the above conditions. This examiner notes that the previous evaluations noted above assessed for PTSD but indicated he did not meet criteria. Those evaluations also indicated that the veteran's depression condition really worsened in recent years following the breakup of his long-term relationship about five or six years ago, though a little bit before that there was some increased depression. Furthermore, those evaluations also indicate the veteran has felt that he always has tended to be rather anxious and depressed with low self-esteem. The records indicate a history of a very strict and harsh, verbally abusive, father as well as a history of being bullied in school, though did not get any mental health services. Curiously, VA social work notes from more recent times such as 5/18/2017, seem to describe the social anxiety as being caused by or started in the military, related to harsh treatment by a corporal. This is not likely accurate given the previous treatment notes described in the first paragraph above that indicate a long history of this type of feeling even in his youth, as well as more recent onset/worsening of symptoms just a few years ago following the relationship breakup. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): This veteran has had a number of past mental health evaluations here at the VA. Please see the 12/16/2011 psychology evaluation, the 4/272012 psychiatry intake, and the 10/17/2016 psychology mental health treatment plan for details of his history. None e. Relevant Substance abuse history (pre-military, military, and post-military): This veteran has had a number of past mental health evaluations here at the VA. Please see the 12/16/2011 psychology evaluation, the 4/272012 psychiatry intake, and the 10/17/2016 psychology mental health treatment plan for details of his history. None. f. Other, if any: n/a 3. Stressors ------------ Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: Small arms fire and mortar battle in Gulf War Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criterion A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] Witnessing, in person, the traumatic event(s) as they occurred to others Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] No criterion in this section met. Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] No criterion in this section met. Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] No criterion in this section met. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] No criterion in this section met. Criterion F: [X] No criterion in this section met. Criterion G: [X] No criterion in this section met. Criterion H: [X] No criterion in this section met. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: No response provided. 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting 6. Behavioral Observations -------------------------- The veteran's affect was broad, though mood appeared dysphoric and anxious. He was quite talkative and animated at times. He was polite and cooperative. Eye contact and behavior were normal. 7. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [X] Yes [ ] No If yes, describe: The veteran has a history of attention deficit/hyperactivity disorder (ADHD), inattentive type. Please see the DSM?five as well as the neuropsychological testing from 10/14/2011 for details of such symptoms. 8. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any -------------------------------------------------- The exam request form states/asks: "Exams on this request: DBQ INITIAL PTSD ** Status of request: Pending, reported to MAS -------------------------------------------------------------------------- ------ DBQ PSYCH PTSD Initial _________________________________________________________________________ The following contentions need to be examined: PTSD Active duty service dates: Branch: Marine Corps EOD: 08/02/1988 RAD: 08/01/1992 DBQ PSYCH PTSD Initial: Please review the Veteran's electronic folder in VBMS and state that it was reviewed in your report. MEDICAL OPINION REQUEST TYPE OF MEDICAL OPINION REQUESTED: Direct service connection OPINION: Direct service connection Does the Veteran have a diagnosis of (a) PTSD that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) Combat Action Ribbon during service? Rationale must be provided in the appropriate section. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion. POTENTIALLY RELEVANT EVIDENCE: NOTE: Your (examiner) review of the record is NOT restricted to the evidence listed below. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. Tab A (DD Form 214 in VBMS): TAB A- CAR COMBAT ACTION RIBBON IN DESERT STORM AND DESERT SHIELD dated 06/27/2017 If more than one mental disorder is diagnosed please comment on their relationship to one another and, if possible, please state which symptoms are attributed to each disorder. If your examination determines that the Veteran does not have diagnosis of PTSD and you diagnose another mental disorder, please provide an opinion as to whether it is at least as likely as not that the Veteran's diagnosed mental disorder is a result of an in-service stressor related event." ------????????? As noted above, this veteran does not appear to meet criteria for PTSD, lacking sufficient number, frequency, and severity of symptoms to warrant such a diagnosis. The veteran does have depression and anxiety (mainly social anxiety) and ADHD conditions described above, though it is this examiner's opinion that they are less likely due to, caused by, or incurred during military service for the reasons noted above. Today, the veteran denied any delusions or hallucinations. There are no panic attacks and no OCD. He denied any suicidal or homicidal ideation. He says that he knows if he were ever to kill himself, it would hurt his mother significantly and he would did not want to do that. He does report frequently being in a low, sad and depressed mood. He reported crying spells, decreased hope, low self-esteem, feeling easily overwhelmed, feeling "stuck" and self critical. He described feeling depressed over various regrets he has in his life. He also reported a lot of anxiety. Some of this is regarding his current life situation including financial difficulties, though a lot also appears to be related to socially related anxiety feelings. He feels others judge and evaluate him in a negative manner. He feels he just does not measure up and worries when others are looking at him, that they are thinking negative thoughts or critical thoughts about him. This also creates not only emotional anxiety, but also physical symptoms such as nausea. Regarding PTSD issues, the veteran says he has sometimes dreamt that he is in the US Marine Corps but is out of shape. He reported no recent issues with any actual trauma related nightmares. He also says he has negatively dreamed recently about his most recent ex-girlfriend (from five years ago). The veteran did not describe upsetting intrusive trauma memories nor severe distress at any particular cues. The veteran does not appear to actually meet criteria for HYPERvigilance. He seemed to deny his issues with anxiety around people have to do with actual fear for his physical safety. This avoidance of people and public has to do more with worrying about their judging him. He reports when driving he is aware of other cars and where people are around him, though this does not appear to be related to trauma or represent any PTSD. The veteran seems to describe having no real set sleep schedule and he will go to sleep at widely varying times. He says he has some difficulty falling asleep but once he is asleep, he will sleep for as long as 12-16 hours. This may be related to his nonservice related anxiety/depression condition and his negative coping strategy of avoidance. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. XXXXXXXXX XXXXXX, PhD Clinical Psychologist
  4. So after five years of receiving my disability payments at 100%, the VA scheduled me for a reevaluation on my lower back degenerative disc disease, L4-S1. My other disabilities had already been given P and T, so I wasn't reevaluated on those. The doctor today did the measurement so quick that there is no way he could have line-up the measurement tool for an accurint reading. I am concerned that I will be given a lower rating on my back flexation. I have been regularly seen at the VA for PT on my back and have been scheduled for injections to reduce the pain. I have had an MRI as recent as two months ago that says my degenerative discs have not improved, but they have not gotten markably worse. I would like to know if anyone has had their back rating reduced based on maybe a 10 degree improvement in flexation, but that the flexation brings me to the 20% rating vs the 40% rating. I am not sure if the VA regional office will say a 10% increase is a marked improvement and lower my rating. Any comments will help my monkey mind on this particular subject.
  5. Hello all, I am new here so first off...Hi My c & P results state that based off of the exam and a review of my files that I do have PTSD Chronic and Depressive disorder, unspecified. It goes on to state that the effect of the PTSD, occupationally and socially has caused reduced reliability and productivity with flashbacks once to twice a week, constant anxiety, occasional panic attacks and exaggerated startle reflex. There is plenty more but I wanted to know if any of this verbiage was significant for determining a possible rating. I know anything is just a guess so no pressure and thanks. J.Bond
  6. I was reviewing 2015 BVA decisions regarding the New Orleans RO, and came across the following. I'm on a tablet and can't cut and paste the section, but scroll down to the second paragraph above the "Order" section. You'll find that this veteran's carriage and demeanor when she was called from the waiting room found its way into her C & P exam report and then into the BVA decision. http://www.va.gov/vetapp15/Files2/1512277.txt Always remember, your exam starts the moment you enter the exam facility. If you're there for a spine exam, your posture in the chair you're seated in, in the lobby, may very well be noted. There's plenty of literature on exams here at hadit, but I thought it would be useful to remind everyone that the exam begins upon entering the facility, not when entering the examination room.
  7. I received the notes from my C & P exam. Need your thoughts on what you think I will receive. I often have trouble with my PTSD and would like to get it fixed. I don't need the money, I would rather prefer to just be back to normal. However what can they rate me at based on the exam? 1. Diagnostic Summary ---------------------Does the Veteran have a diagnosis of PTSD that conforms to DMS-5 criteria based on today's evaluation? [X] Yes [ ] No ICD code: 309.81 2. Current Diagnoses --------------------a. Mental Disorder Diagnosis #1: Posttraumatic Stress Disorder ICD code: 309.81 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Please See Medical Records 3. Differentiation of symptoms ------------------------------a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [X] No 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 due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication 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 ------------------In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: -------------------------Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes [ ] No Was the Veteran's VA claims file reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: CPRS; CAPRI If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [ ] Yes [X] No 2. History ----------a. Relevant Social/Marital/Family history (pre-military, military, and post-military): The Veteran is age 2*. He has been in a common-law marriage for 2.5-3 years. He has a daughter age 1. The Veteran was raised by both parents. He has an older sister age 31 and a twin sister. He denied any childhood abuse. He described his childhood as great. b. Relevant Occupational and Educational history (pre-military, military, and post-military): He graduated high school in 2004, and was a B-C student. He was on the basketball team during his freshman and sophomore years. He denied any disciplinary issues in school. He joined the Marine Corps Reserves in 2005. From 2005 until 2008 he worked at the *CA. He then worked for the * Arizona *Department for two months until he transitioned into active duty status. The Veteran was on active duty from 2008 until 2009. He then was in the reserves until 2011. His highest rank was E-4 and he worked in artillery and rocket artillery. He denied any disciplinary issues in the military. He received an Honorable discharge. He has been employed since 201* at the * Department. He investigates internal affairs. This is a fulltime job. He has never been fired from a job. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The Veteran denied any mental health treatment prior to or during the military. He has received mental health services at the El Paso VA over the past year. His most recent appointment was in 09/13. He has never been prescribed psychotropic medication. He denied any psychiatric hospitalizations and he denied any suicide attempts. He denied any family history of psychiatric treatment. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): The Veteran denied any arrests or other legal difficulties. e. Relevant Substance abuse history (pre-military, military, and post-military): From 2009 until 2012 he drank excessively, which included binge drinking on the weekends, and having five drinks a night during the week. He significantly reduced his drinking on his own in 2012. He has about five drinks a week or every other week. f. Other, if any: No response provided. 3. Stressors ------------a. Stressor #1: "It was March or April 2009 and we were on Delaram post in Afghanistan. We were eating and we heard a loud bang and then another one. It was close to nighttime. A suicide bomber killed himself and killed a Marine in doing so. We saw it after it happened. I was terrified about dying there." Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No b. Stressor #2: :" This was on Delaram post in May 2009 in Afghanistan. There was a warrant officer, a big stout guy. He was leaving to go home soon. He went out on a convoy and got blown up by an IED that he was disarming." Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No c. Stressor #3: : "This was the first mortar attack. It was in February or March 2009 in Afghanistan. I had just finished my shift. I put on my kevolar. Everybody started running. It was fear of the unknown. Anyone could die at any time. " Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No 4. PTSD Diagnostic Criteria ---------------------------Please check criteria used for establishing the current PTSD diagnosis. Do not mark symptoms below that are clearly not attributable to the criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 - other symptoms. The diagnostic criteria for PTSD, referred to as Criteria A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DMS-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violatrion, in one or more of the following ways: [X] Directly experiencing the tramuatic event(s) [X] Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent 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] 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] 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. 5. Symptoms -----------For VA rating purposes, check all symptoms that apply to the Veterans diagnoses: [X] Depressed mood [X] Anxiety [X] Panic attacks that occur weekly or less often [X] Chronic sleep impairment 6. Behavioral Observations --------------------------MENTAL STATUS EXAM: Grooming and Hygiene-[X ] Good, [ ] Fair, [ ] Poor, [ ] Other: Eye Contact-[X ] Good, [ ] Fair, [ ] Poor, [ ] Other: Orientation- Alert, Oriented to [X ] Person, [X ] Place, [X ] Date, [X ] Situation. Behavior- [X ] Attentive and cooperative, [ ] Guarded, [ ] Angry, [] Demanding Speech- [X ] regular rate and rhythm [ ] Soft, [ ] Loud [ ] Hostile Mood- [ ] anxious [X ] dysphoric [ ] agitated [ ] labile [ ] expansive [ ] happy [ ] depressed [ ] fearful [ ] other Affect- [X ] congruent and appropriate [ ] incongruent. Thought process- [ X ] coherent, logical, goal oriented. [X ] Other: Thought Content- [X ] denies suicidal ideation [X ] Denies hallucinations Insight- [X ] Good, [ ] Fair, [ ] Poor, [ ] Impaired Judgment-[X ] Good, [ ] Fair, [ ] Poor, [ ] Impaired 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, if any ------------------PSYCHOLOGICAL TESTING: MMPI-2 RESULTS: L F K HS D HY PD MF PA PT SC MA SI Raw Score: 6 24 8 26 40 32 26 26 14 33 46 22 47 K Corr. 4 3 8 8 2 T Score: 61 110 35 90 93 76 64 50 64 81 98 59 75 ? Cannot Say (Raw): 0 F-K (Raw): 16 The Veteran produced an invalid MMPI-2 profile; therefore the testing results cannot be interpreted. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. **************************************************************************** Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: Indicate method used to obtain medical information to complete this document: [ ] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. [ ] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence. [ ] Examination via approved video telehealth [X] In-person examination Evidence review ---------------a. Was the Veteran's VA claims file reviewed? Yes If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: CPRS; CAPRI MEDICAL OPINION SUMMARY -----------------------RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: CLAIMS FILE BEING SENT FOR REVIEW BY THE EXAMINER. Contention: Veteran with service in Afghanistan 2008/2009 claiming numerous issues of joint and muscle pain, respiratory issues, neurological, skin, gastrointestinal, and mental issues. VA Treatment records provide contintuity of treatment. Opinion Requested: Direct service connection Are the Veteran's claimed conditions (See list) at least as likely as not (50 percent or greater probability) incurred in or caused by service in Afghanistan or exposure to environmental hazards that occurred 2008/2009. Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion. b. Indicate type of exam for which opinion has been requested: DBQ Initial PTSD TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. c. Rationale: The Veteran's PTSD is at least as likely as not (50 percent or greater probability) caused by military service. The Veteran had no history of mental health treatment prior to the military. In addition, he did not report any traumatic experiences prior to the military.
  8. I am 100% TDIU. rated 80% combined. What do I need to do to keep from being reduced? HELP! Thanks
  9. Ok this is an update with a few questions. Gulf War Vet, came back to the VA this past December with my list of issues. I’ve had lots of appointments, things talked and cried about, things shoved up one end and down the other, lots of different meds tried, with several failures. I was diagnosed with Anxiety, depression and severe PTSD, Psycho-therapist mentioned service dog, started researching and raising funds to get a service dog since the VA doesn’t prescribe them for PTSD, also been diagnosed with Barrett’s Esophagus and hiatal hernia, but they haven’t narrowed down what’s causing the chronic diarrhea, and appointments with rheumatology for further testing on chronic pain all over, sleep study for sleep disturbances, says no Apnea but Restless Leg syndrome. So I submitted a claim for the PTSD, anxiety, and depression, the first week of June while visiting my brother in Tennessee (short backlog). Came back home to Texas (long backlog) continued fund raising for dog. Contacted a Service Dog organization in San Antonio and worked / coordinated with them. A local news station heard about and did a story on my quest and fund raising efforts for a service dog including interviews with local VA personnel. Meanwhile the Director of the organization, Service Dog Express, is having meetings with local congressmen and she’s using me as an example with them. After a few weeks the VA pushed thru a prescription (and even allowed me to use the “non-ADI” organization and still provide VA benefits including continued training expenses for the specific tasks necessary for the dog to meet more needs) I picked up my dog, “Guess” a female Rottweiler rescue, on July 5th. Got a notice in the mail from the VA, here in Texas instead of Tennessee where I filed, that my C&P was scheduled for Aug 27th (today). BIG BY THE WAY HERE – For you guys that are worried about a C&P for PTSD, depression and anxiety – I was freaking out, I read pretty much every link that would come up on Google in relation to PTSD C&P’s. Here’s a GREAT BIG HINT – DON’T DO THAT! I worked myself up, couldn’t sleep for 3 days before the C&P, I threw up on the way to the VA this morning, right after we got set down in the office to start the exam I grabbed the trashcan from under the desk because I was about to throw up again. All of that was useless. Just go in therebe honest and be yourself, take your significant other if at all possible! My wife came in to the exam with me and was completely invaluable! The examiner would ask me a question and I would, being my typical self, understate my answer and my wife would be shaking her head then would give a more accurate and complete answer. The examiner was a sweetheart, bare in mind the examiners are there to get answers not to get you upset. By midway thru the exam the examiner was actually taking turns with my wife reminding me to use my breathing exercises to calm myself as we went thru triggers. At the end of the exam I asked her about her thoughts on the exam, she said, “Of course I don’t have anything to do with your actual rating but yes, I agree with the diagnosis and my report will be extremely favorable.” I asked if she had any idea about how much longer it would take, and she said, “Some of the people I’ve done exams on have told me about 60 days, but yours is marked “Rush” so I couldn’t say.” There is where the first question comes in, why would my claim be marked “Rush”? Possibly influenced by either the news channel interest or the Congressmen, or both? The next question – 2 weeks ago the VA rheumatologist said they had ruled everything else out and said he was diagnosing severe Fibromyalgia. This is a presumed SC for Gulf War, should I wait until after this claim is completely resolved, and hopefully make further progress on the Gastro stuff and maybe file it and the Fibro at the same time, or go ahead and file for the Fibro? Last question – I've read thru a lot on here and know about how the “pyramiding”(?) works so starting with being 100% able, first rating say is at 50%, then the next rating is figured like the remaining 50% is actually 100% of ability, so if second rating is again 50% that would be 50% of the original remaining 50% so a total of 75% disabled and still 25% able right? I’ve also seen guys mention things “rated separately” (not pyramided?) or something like that, what does that mean and how and in what situations does that come into play? I apologize, that got really long really fast but it sure felt good getting all of that out. Chuck.
  10. KD13

    Newbie

    Hello All! It is an honor to be a part of yet another group that understands what it means to be a veteran. I am a veteran of 12.8 years of the US Navy, SC @ 60% with a whole host of issues, as I'm sure most of you have, however, chief among my ailments is ESRD (Stage 4), coupled with Diabetes II (mellitis). I have had a terrible time adjusting to getting ready to be on dialysis, though I have had plenty of time to think about it (diagnosis in 1998), it still remains an emotional battle for me and my family. Neurapathy, along with the other issues that come along with ESRD, like chronic fatigue, malaise, zero energy, have made it challenging for me to work. This is extremely tough for me as I HATE sitting around waiting for stuff to get done! I was advised to file for SSD, as I am headed for dialysis soon. I did, and was awarded SSD without a hearing, and within approximately 4 months. (That was unbelievable, and quite surprising) I was also advised (AMVETS) to apply for Individual Unemployability (IU), as my PCP has cited (in record) that I am unemployable for a variety of reasons, mainly because of the ESRD, though. I made, what I consider, a feable attempt at understanding the ratings table and how to calculate increases, and became sick to my stomach after about 30 minutes of that 'crap'. Old Medical Status and Current Disability Rating %: ESRD-30% Knees-20% Other-10% Total 60% I am currently hoping the VA sees it clear to grant me an increase in disability comp, as I have introduced new evidence via the Fully Developed Claim system, that clearly shows what the claim proposes. Based off of new (4 month old) labs, I now fall into another category (my Creatnine is 4.67), which says if Creatnine is between 4-8 mg, that qualifies for 80% on its own. (CFR) Current Medical Status and Current Disability Rating %: ESRD-80% Knees-20% Other-10% Total ??? Other than that, I am working hard to follow a strict diet (low animal protein), excrcising everyday, and following Nephrologist's advice tot he 'T'. My hope is to stave off dialysis for as long as it takes to receive a transplanted kidney. In the meanwhile, I also hope the 'powers that be', are able to get the process done quickly, and fairly. That's all for now! Thanks for allowing me to share a little. Peace!
  11. I just received a letter this weekend that the Cleveland VARO has ordered 3 C&P exams. A little background first. 10/2010 - Submitted TDIU claim 11/2010 - General C&P exam & Mental health C&P 04/2012 - Received Rating increase decision, which was automaticaly filed by VA when filing TDIU. Total rating stayed the same (70%), but was lowered on my back without a ROM exam even the C&P Doc put measurements in my exam results, which is the main reason for my NOD letter above. TDIU deferred. 04/2012 - TDIU deferred status goes back to gathering evidence phase. 08/2012 - NOD sent. See my profile for sample letter I sent disagreeing with general C&P that was performed in 11/2010. 01/2013 - VA acknowledges my NOD & I selected a DRO to review it. 01/2013 - VA requests new C&P exams. What can I do to guard against the VA using the C&P as the sole weight when deciding my claim? I hope this C&P doc is a good one & doesn't lie like the last one. It was a good thing he didn't perform the last C&P according to VA regs or it would of been my word vs his. Can I record the C&P? If yes, do I have to let the doc know I'm voice recording the C&P? I have the general C&P tomorrow, then another mental health & then a TBI next week. I hope they get it right this time, because I don't know how much more I can take of this! Any help is greatly appreciated! Thanks, ssgmajik
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