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So I went in Friday. Saw two examiners. I didn't have time to submit my Statements in Support of Claims (PTSD & knees) my wife and adult children filled out but I had them read them while I was there. I just uploaded them on Monday. The first wa a Nurse Practitioner. She checked my feet and knees. Don't know if this was the smartest idea but I didn't wear my AFO or knee brace at first, because I wanted her to see how I walk, move unassisted. I put it on after her examination and showed her how I'm still not stable on that leg no matter which apparatus I'm using. I explained my quality of life at work sucked becaue there's only one elevator, which means I walk twice as far to use it. I work upstairs and have almost fallen several times. I also told her I was concerned because the last rater wrote I was doing good with my orthotic insoles, when I 100 percent told him that I can't use the Navy issued insoles for regular shoes. My feet rating was decreased because of that. So I made it clear verbally that I was not getting better. For the Migraines increase i showed her my migraine tracker chart and she barely looked at it. It shows that I missed over 100 hours of work last year due to migraines. The second was the Psychiatrist She didn't ask me much about anything my VA psychologist wrote in her nexus letter. She skimmed over my buddy statements. She asked me about 6 questions, pretty much (yes or no) when was my last fight about my job am i taking my medications have I been arrested about my work history about my sleep It lasted about 15 minutes. So who knows what is going to happen. All I know is I left there without any confidence that the evidence nor my exams helped. We'll see.

Hi there, Recently actually yesterday the 21st of February the VA gave me notice that my supplemental claim had been decided and that they had sent out the letter that morning as well (meaning the decision was actually made on the 20th). This of course prompted me to check Ebenefits, where I saw no change in my rating. I'm currently rated at 40% for other issues. And in the past Ebenefits updated almost instantly leading me to believe that this supplemental claim was denied. I originally submitted my Epilepsy claim back in august, it was denied about 4 months later due to conflicting phraseology given by one of my doctors (mind you i still have a diagnoses of Epilepsy with 15 witnessed Grand Mal seizures at this point). Once i got the original decision letter I contacted my County VSO's office and set up an appointment. After they reviewed everything they we surprised that my claim was denied as it has a clear nexus and on top of that falls under the conditions; that if they manifest within a year its considered service connected (I separated 02/01/2019, first seizure onset was 05/25/2019). They did review the 112 pages of evidence from my civilian doctors and did see the conflicting phraseology. They told me that if I could get my Neurologist to just confirm my diagnoses and say i was and have been under treatment since 05/25/2019 that we could submit a supplemental claim since that's the fastest route. So that's what we did. That brings us to now. Under the standards for Epilepsy I was looking at a single rating of anything between 80%-100%. An 80% from 40% would have resulted in something Close to 90%. While i'm holding out, since in either case the retro pay (if my claim was awarded) would be greater then 20K that the additional signatures required are slowing down Ebenefits from updating, but as in most cases if the letter has sent and Ebenfits doesn't updated, 90% of the time you Claim/Supplemental/Appeal is denied. ( I mean correct me if I'm wrong). Whats the moral of the story? No matter how much evidence you have to support you the VA will be the VA. I'm lucky that I'm rated for other conditions so that I can at least have the VA help me cut down on the costs of treatment for Epilepsy, but it would have been nice to have it service connected so that I wouldn't have to wait months on months for Neurology appointments since I don't have priority. If any one has any information for me that might help moving forward, I'm all ears as once my letter is received and upon reading of the denial ill be filling an appeal.

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: Posttraumatic Stress Disorder ICD code: F43.12 Comments, if More likely than not secondary to military combat trauma. Mental Disorder Diagnosis #2: Persistent Depressive Disorder, with persistent Major Depressive Episode ICD code: F34.1 Comments, if any: More likely than not incurred during active duty military service. Mental Disorder Diagnosis #3: Alcohol Use Disorder ICD code: F10.20 Comments, if any: More likely than not secondary to diagnoses 1 and 2. b. Medical diagnoses relevant to the understanding or management of the mental health disorder (to include TBI): Obesity 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [X] Yes [ ] No [ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: The veteran's symptoms can be partially differentiated. The symptoms specifically attributable to PTSD include those that reflect a reexperiencing of trauma (for example, nightmares, flashbacks, and intrusive memories), hyper arousal (for example, exaggerated startle reflex and hypervigilance), and avoidance of trauma reminders. Other symptoms are nonspecific and may reflect PTSD and/or depression. These symptoms include irritability, depressed mood, negative cognitions about self and others, sleep disturbance, diminished participation in significant activities, and disconnection from other people. The veteran's excessive use of alcohol can be understood as reflective of the avoidance symptoms of PTSD; the effect of the alcohol is to cause intoxication that allows the veteran to temporarily avoid other PTSD symptoms through alcohol "self-medication." 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 occupational and social impairment, is it possible to differentiate which impairment is caused by each mental disorder? [ ] Yes [X] No [ ] Not Applicable (N/A) If no, provide reason: The impact of the veteran's mental conditions on social and occupational functioning is interrelated and overlapping, and therefore it is not possible to reliably differentiate the independent impact of each one on the veteran's functioning. c. If a diagnosis of TBI exists, is it possible to differentiate which occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] Not Applicable (N/A) SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder [X] CPRS Evidence Comments: The veteran's electronic claims file and VA records were reviewed. The veteran's claims file includes a DD 214 document showing entry into the US Army on November 17, 2009 with an honorable discharge at a rank of E4 on July 22, 2014. The reason for separation is listed as weight control failure. A separation medical examination dated April 20, 2014 is marked "normal" for psychiatric clinical evaluation. In support of the veterans claim for PTSD he provided written statements describing 2 stressful incidents as follows: 1) artillery attack in Afghanistan in January or February 2011, 2) Suicide of best friend on Christmas Day 2013. The veteran's VA records show that he was seen at the Newburg CBOC by the primary care mental health integration staff on July 27, 2016 at which time he was reporting symptoms including depression, feelings of worthlessness, sleep disturbance, and frustration. The diagnoses listed were "anger, anxiety." Records do not indicate the veteran followed up this appointments with additional sessions. The veteran was seen on January 17, 2019 at the Dayton VA Medical Ctr Prime care mental health integration program, where his chief complaint related to depressive symptoms that had begun shortly after his grandfather's death in 2011. He also reported the loss of 2 friends to suicide in 2012 and 2013. He reported symptoms including anergia, amotivation, depressed mood, irritability, and increased appetite as well as some anxiety symptoms that began in 2014 after separating from the military and included wanting to leave crowded situations and vague hypervigilance symptoms. The veteran reported that his depressive symptoms were his primary concern. He was diagnosed with unspecified depressive disorder (with rule out for major depressive disorder versus persistent depressive disorder) and unspecified anxiety disorder, (with rule out for generalized anxiety disorder versus PTSD). Records show the veteran was scheduled for group treatment following the initial assessment, but did not show, and has not returned to the VA for mental health treatment since then. 2. History a. Relevant social/marital/family history (pre-military, military, and post-military): The veteran reported that he was raised in a small town in Ohio, living with his mother and grandparents until about age 10. His natural father was not in the picture. The veteran's stepfather entered his life when he was about 8, and later adopted him. The veteran also has 3 younge r sisters. He reported that he was treated very well by his parents and grandparents. He was involved in baseball and other sports, and had no significant academic problems. He graduated high school on time then briefly attended college. The veteran was married to his first wife before entering the military, but she left him when he was deployed to Afghanistan. That marriage never produced children. The veteran and his current wife have been married 7 years, and they have 2 children, ages 4 and 2. The veteran stated the relationship is "shitty" right now because he doesn't talk to his wife and he pushes her away. He said that she has talked about separating, and it was in January of this year that he finally sought treatment because she threatened to leave and take the children. The veteran stated the children are the only thing that brings a smile to his face. b. Relevant occupational and educational history (pre-military, military, and post-military): Prior to entering the military, the veteran briefly attended college, and then went to NASCAR tech school in North Carolina, but "it wasn't for me." He joined the military approximately at age 22. He was trained in artillery and deployed to Afghanistan in 2011. The veteran's duty in Afghanistan included providing FOB security, and tell her guard duty. Occasionally, they shot artillery. Military trauma: Stressor #1: Early in his tour while stationed in Bagram, the base was attacked with artillery fire. The veteran stated he was terrified and petrified. He was out smoking near the command post when the shells started hitting. He dove between some barriers and other people dove on top of him. He could hear the shells hitting and recalled turning over to see them flying overhead. After the shelling stopped, the veteran was frozen. His Sgt. slapped him. They had taken many incoming that day, and though nobody was killed in his platoon, the veteran doesn't know if others on the base were harmed. After that day, he remained always on alert and tried not to think about it. Stressor #2: Later, he was stationed in Salerno, Afghanistan when another artillery strike occurred. Again, the veteran froze. Stressor #3: A third incident occurred when he was stationed at COB Zormat - they took incoming artillery and returned artillery in response. Once again, the veteran froze, and was taken aside by his Sgt. who chewed him out, shamed him, and told him to hide his fear. The veteran stated he was afraid to say anything to anyone because he feared he looked like "a xxxxx." While in Afghanistan, the veteran received word from his wife that she wanted a divorce. The veteran stated that his friend helped him through his distress. In 2013, on Christmas day, his friend committed suicide. The veteran stated that when he heard of this, he was angry, including anger at himself for not seeing the warning signs. Veteran stated that his friend's suicide has ruined Christmas for him ever since. Post military occupational functioning: The veteran has been unable to maintain employment since his military discharge. In the first few years post discharge he held 4 to 5 different jobs, the longest being less than a year. Then, he found work as a corrections officer in a prison in Kentucky. However, the veteran's depression, drinking, calling off work, anxiety, and irritability, resulted in him being terminated after about 2 years. He got into trouble for losing his temper with the captain and cussing her out. In May 2018, he moved to Ohio having landed another job as a corrections officer with a prison in London. He was there less than 6 months before being terminated. Again, he was having difficulty due to anxiety, irritability, depression, poor attendance, and drinking. He briefly worked at the Post Office as a mail carrier after that, but couldn't get enough sleep, felt depressed, and felt that everyone who worked there was from the military. He couldn't stand it. The veteran has been unemployed for some months now. He wishes to return to school and earned his bachelor's degree. Even at school, he had difficulty because people wanted to ask him about his military service and he always wanted to avoid it. c. Relevant mental health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The veteran stated that he was never the same after his deployment. He has felt fearful, depressed, and worthless. He experienced the loss of his grandfather while he was deployed, and the loss of his friend to suicide in 2013. The veteran stated he sleeps poorly, waking up many times throughout the night, and dreaming about artillery attacks. He has intrusive thoughts about his military trauma and other negative military experiences, and at times has physical symptoms including rapid heart rate, shortness of breath, sweating, and trembling. He drinks excessively as an apparent avoidance technique. He has problems with anger outbursts and irritability. He has hypervigilance, problems concentrating, exaggerated startle reflex, feelings of guilt, feelings of inadequacy and worthlessness, inability to connect with others, and wonders if others would be better off if he were dead. The veteran second-guesses his actions in Afghanistan and thinks he could've done better and "I should've manned up." He said he feels worthless. He wonders why he cowered when his base was attacked. He shakes when he hears loud noises, and can't tolerate fireworks. He rarely does activities unless he must, and generally just wants to be by himself. He sees others as threatening, and feels disconnected from everyone including his wife, with the exception of his children, and more recently, his therapist Dr. Ward. The veteran stated he has lost interest in things he used to enjoy, most notably sports. He overeats and drinks excessively. He avoids his friends because he doesn't want to talk about the military. He dropped out of school because people kept asking about his military service. He hates going to his parents home because his mother has erected a "shrine" to him in their living room, and he is to fearful of disappointing his parents to tell them how much he hates it. The veteran sought treatment earlier this year, and has now been working with a psychologist in Spring field, Dr. Ward, for 4-5 months. He stated that Dr. Ward is the one person he feels close to. They recently began EMDR therapy. The veteran has been referred for medication, but is awaiting his first appointment. d. Relevant legal and behavioral history (pre-military, military, and post-military): The veteran has no history of legal problems. e. Relevant substance abuse history (pre-military, military, and post-military): The veteran has been drinking excessively since his return from Afghanistan. He estimates that he was drinking a bottle of hard liquor per day at his peak. It has decreased somewhat recently as he has been engaged in therapy, but he continues to drink quite heavily. 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: Artillery attacks at Bagram and Salerno, Afghanistan 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 --------------------------- Note: Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criterion A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with 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 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] Reckless or self-destructive behavior. [X] Hypervigilance. [X] Exaggerated startle response. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment [X] 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 arrived on time for his scheduled examination. His identity was confirmed by having him provide his full name and date of birth. The veteran presents as a tall, obese, Caucasian male who appears the stated age. He was dressed casually and exhibited good grooming and hygiene. He had tattoos visible on his lower and upper extremities. His posture, gait, and psychomotor activity were within normal limits. His manner of interaction was cooperative, courteous, and friendly. His speech was normal in rate, rhythm, tone, and volume. His thought processes were clear, logical, coherent, and goal-directed. Veteran reported his mood to be depressed, with affect congruent. He denied suicidal ideation, but admitted to thoughts of death and wondering if others would be better off without him. He denied homicidal ideation as well as auditory and visual hallucinations. 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 -------------------------------------------------- In my opinion, the veteran meets DSM 5 diagnostic criteria for posttraumatic stress disorder, which is more likely than not secondary to military trauma. In this veteran's case, there is a strong component of shame that is also associated with his military service and is foundationally related to his depressive disorder. His experience of freezing during 3 artillery attacks is something that is associated with feelings of overwhelming shame, worthlessness, helplessness, and inadequacy for the veteran. These thoughts and feelings contribute significantly to his depressive condition, and contribute meaningfully to his PTSD symptoms as well. The veteran also experienced significant losses during military service that have likely aggravated his PTSD and depressive conditions. Notably, the veteran's grandfather died in 2011 when the veteran was deployed to Afghanistan, and his best friend committed suicide on Christmas day in 2013. Both losses were experienced by the veteran as emotionally traumatic and contribute to his symptomatology. The veteran has developed a dysfunctional coping mechanism of excessive alcohol intake in his efforts to suppress negative feelings associated with his traumas. As his excessive alcohol use appears to be largely in the service of avoidance of distress and suppression of intrusive/reexperiencing symptoms, it is my opinion that his alcohol use disorder is secondary to his PTSD and depressive disorders. The veteran's mental health symptoms have severely impaired his functional capacity. He is socially disengaged and avoidant. He has difficulty expressing himself emotionally, showing empathy, or forming emotional bonds with others. Occupationally, the veteran has exhibited significant dysfunction as he has been unable to maintain employment due to anxiety, depression, avoidance, alcohol abuse, irritability, shame. Hs shame about his reactions of freezing during artillery attacks prompts him to avoid interpersonal interactions as much as possible as he fears that the topic of his military service will arise. Recently, the veteran has begun outpatient mental health treatment in the form of individual counseling, and he is awaiting an appointment for trial of medication.

I have the results of my C and P exam. I am hoping for some feedback. In particular the references to work. It does note I left my Federal job from anxiety from working with men. However, they state I have been self-employed for 20 years. That is true but as a way for me to feel like I am making some contribution. My average income from the business is $1500 per year. If you have advice on what to do with that information it would be appreciated. I really want to put all this behind me and get on with life. C AND P RESULTS (Personal information has been removed. The went back to the examiner for additional information which is included.) Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire SECTION I: 1. Diagnostic Summary This section should be completed based on the current examination and clinical findings. Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? X Yes 0 No If no diagnosis of PTSD, check all that apply: O Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria 0 Veteran does not have a mental disorder that conforms with DSM-5 criteria 0 Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorders Questionnaire. 2. Current Diagnoses a.Mental Disorder Diagnosis #1: 309.81 Post Traumatic Stress Disorder Comments, if any: __ Mental Disorder Diagnosis #2: 305.00 Alcohol Abuse, in remission Comments, if any: _ _ Mental Disorder Diagnosis #3: _ _ Comments, if any: __ Mental Disorder Diagnosis #4: _ _ Comments, if anv: Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or OoO Use Only* If additional diagnoses, describe (using above format): __ b. Medical diagnoses relevant to the understanding or management of the Mental Health disorder (to include TBI): __ Comments, if any: __ 3. Differentiation of symptoms a. Does the Veteran have more than one Mental disorder diagnosed? X Yes 0 No If yes, complete the following question (3b): b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? X Yes 0 No 0 Not applicable (NIA) 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: __ If yes, list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: All symptoms are related to PTSD. The alcohol abuse is in remission and was related to coping with anxiety associated with MST. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? 0 Yes X No 0 Not shown in records reviewed Comments, if any: __ If yes, complete the following question (3d): d. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? 0 Yes 0 No X 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: __ If yes, list which symptoms are attributable to each diagnosis: __ 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) 0 No mental disorder diagnosis 0 A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication 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 0 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 0 Occupational and social impairment with reduced reliability and productivity 0 Occupational and social impairment with deficiencies in most areas, such as work, school , family relations, judgment, thinking and/or mood 0 Total occupational and social impairment 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 bv each mental disorder? Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only* X Yes 0 No 0 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: __ If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: The social and occupational impairment is related to PTSD. The alcohol abuse is in remission and was related to coping with anxiety associated with MST. 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? 0 Yes 0 No X No diagnosis of TBI 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: __ If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: __ SECTION II: Clinical Findings: 1. Evidence review In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. Medical Record Review Was the Veteran's VA claims file reviewed? 0 Yes X No Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? X Yes O No If yes, li st any records that were reviewed but were not included in the Veteran's VA claims file: If no, check all records reviewed: 0 Mi litary service treatment records 0 Military service personnel records 0 Military enlistment examination 0 Military separation examination 0 Military post-deployment questionnaire O Department of Defense Form 214 Separation Documents 0 Veterans Health Administration medical records (VA treatment records) 0 Civilian medical records O Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) 0 No records were reviewed 0 Other: b. Was pertinent information from collateral sources reviewed? 0 Yes X No If yes, describe: __ 2. History Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or OoO Use Only* a. Relevant Social/Marital/Family history (pre-military, military, and post-military): The veteran was born in Nevada and raised in Washington State. Her father left the family when she was age 9 and she was raised by her mother. She is the youngest of her siblings and has 1 brother and 3 sisters. She describes her childhood as having a dysfunctional family, but she has no history of abuse. In her youth, she enjoyed showing horses. The veteran has been married for 26 years and they have one daughter, who is an independent adult. Her hobbies include gardening and outdoor activities. She has a group of friends she socializes with regularly. b. Relevant Occupational and Educational history (pre-military, military, and post-military): The veteran graduated from high school and describes herself as a "little above average" student. After finishing high school, she attended college for 2 years, but did not obtain a degree. She worked as an office manager for her brother for 4 years, then joined the military. She served in active duty for 2 years and reserved duty for 4 years. She obtained the rank of E4 and worked as radar operator in active duty and in personnel support in the reserves. She received an honorable discharge. She is currently self-employed as a website designer and has been working in this type of work for 20 years. She was working for the Small Business Administration until March 2015, and is now self-employed. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military: The veteran describes her mood as "a rocky last 3 years," but "I have been doing fairly well for the last couple months." Xxxxxxxxxx The veteran had a lot of difficulties with emotional outbursts and problems in her marriage to the point the her husband was going to leave her. The veteran participated in counseling from April to October 2014, but she has not had counseling since then because her counselor has been on medical leave. She reports that the counseling was "very helpful." xxxxxxxxx Her current medication is clonidine 0.1 mg hs prn, which is helpful. She reports that she has not had to take this medication "for awhile." She reports no history of suicidal or homicidal ideation. She reports no history of psychiatric hospitalizations or hallucinations. She reports a history of panic attacks that have improved in the past 3 months. The veteran describes her sleep as 6 hours per night which is her normal sleep pattern . She reports a history of nightmares related to military sexual trauma, but this has improved. She reports a history of flashbacks and intrusive memories of military sexual trauma, but this has improved. She reports avoidance behaviors and has difficulty tolerating being around men. She quit her job last April because she was uncomfortable around her male co workers. She has problems with self-image and tries "to make myself invisible." When she is around men, she has anxiety. She is distrustful of men. She has a history of anger and irritability that has improved. The veteran reports no history of head injury or loss of consciousness. The veteran reports no pre military service history of psychiatric disorders. She reports no family history of psychiatric disorders. Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire *Internal VA or OoO Use Only* d. Relevant Legal and Behavioral history (pre-military, military, and post-military): The veteran reports no legal history. e. Relevant Substance abuse history (pre-military, military, and post-military): The veteran describes her current alcohol consumption as very rare. She reports a history of alcohol abuse before she was pregnant with her daughter related to coping with anxiety. She stopped drinking after this time. She does not use marijuana. She reports no history of illegal drug abuse. She does not use tobacco. She drinks 2 cups of coffee per day. f. Other, if any: _ _ 3. Stressors The stressful event can be due to combat, personal trauma , other life threatening situations (non-combat related stressors). NOTE: For VA purposes, "fear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire ; or attack upon friendly military aircraft. Describe one or more specific stressor event (s) the Veteran considers traumatic(may be pre-military, military, or post-military): a. Stressor #1 : XXXXXXXXXXXXXXXXXXXXXXXXXX Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? X Yes 0 No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? 0 Yes X No If no, explain : The stressor is military sexual assault. Is the stressor related to personal assault, e.g. military sexual trauma? X Yes 0 No If yes, please describe the markers that may substantiate the stressor: The stressor is sexual assault. b. Stressor #2: XXXXXXXXXXXXXXXXXXXX Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? X Yes 0 No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? 0 Yes X No If no, explain: The stressor is sexual harassment. Is the stressor related to personal assault, e.g. military sexual trauma? X Yes 0 No If yes, please describe the markers that may substantiate the stressor: The stressor is sexual harassment. c. Stressor #3: XXXXXXXXXXXXXXXXXXXXXXXxxx Does this stressor meet Criterion A (i.e. , is it adequate to support the diagnosis of PTSD)? X Yes O No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? 0 Yes *No If no, explain: The stressor is sexual harassment. Is the stressor related to personal assault, e.g. military sexual trauma? X Yes 0 No If yes, please describe the markers that may substantiate the stressor: The stressor is sexual harassment. d. Additional stressors: If additional stressors, describe (list using the above sequential format): __ 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 (DSM-5). 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) 0 Witnessing, in person, the traumatic event(s) as they occurred to others 0 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 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: 0 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) . 0 Dissociative reactions (e . ~ .. 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). 0 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 event(s) occurred, as evidenced by one or both of the following: 0 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: O 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). O 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 to the individual to blame himself/herself or others. X Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). 0 Markedly diminished interest or participation in significant activities. 0 Feelings of detachment or estrangement from others. O 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. 0 Reckless or self-destructive behavior. 0 Hypervigilance 0 Exaggerated startle response. 0 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 Criterion H: * 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 Suspiciousness 0 Panic attacks that occur weekly or less often 0 Panic attacks more than once a week 0 Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively 0 Chronic sleep impairment 0 Mild memory loss, such as forgetting names, directions or recent events 0 Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks 0 Memory loss for names of close relatives, own occupation, or own name 0 Flattened affect 0 Circumstantial, circumlocutory or stereotyped speech 0 Speech intermittently illogical, obscure, or irrelevant 0 Difficulty in understanding complex commands 0 Impaired judgment 0 Impaired abstract thinking 0 Gross impairment in thought processes or communication 0 Disturbances of motivation and mood O Difficulty in establishing and maintaining effective work and social relationships X Difficulty in adapting to stressful circumstances, including work or a worklike setting 0 Inability to establish and maintain effective relationships 0 Suicidal ideation 0 Obsessional rituals which interfere with routine activities 0 Impaired impulse control, such as unprovoked irritability with periods of violence 0 Spatial disorientation 0 Persistent delusions or hallucinations 0 Grossly inappropriate behavior 0 Persistent danger of hurting self or others 0 Neglect of personal appearance and hygiene 0 Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene 0 Disorientation to time or place Behavioral Observations: The veteran presents with mostly normal mood and affect. She was tearful while discussing the issues of MST. 6. Other symptoms Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? O Yes X No If yes, describe: __ 7. Competency Is the Veteran capable of managing his or her financial affairs? X Yes 0 No If no, explain: __ MEDICAL OPINION (to be completed by the examiner) Medical Opinion Disability Benefits Questionnaire If checked, please provide a discussion including name of doctor/facility, type of record, date, diagnosis and any pertinent findings: VA records 2014- mental health records depressive disorder, anxiety and military sexual assault. Civilian med records 2014- Ox PTSD 4. Medical opinion for direct service connection Choose the statement that most closely approximates the etiology of the claimed condition. a. X The claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness. Provide rationale in section c. b. 0 The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. Provide rationale in section c. c. Rationale: The military sexual trauma occurred while serving in the military as described in detail above. The VA records document the MST issues as the veteran describes them. 5. Medical opinion for secondary service connection a. 0 The claimed condition is at least as likely as not (50 percent or greater probability) proximately due to or the result of the Veteran's service connected condition. Provide rationale in section c. b. 0 The claimed condition is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service connected condition. Provide rationale in section c. c. Rationale: 6. Medical opinion for aggravation of a condition that existed prior to service a. 0 The claimed condition, which clearly and unmistakably existed prior to service, was aggravated beyond its natural progression by an in-service injury, event, or illness. Provide rationale in section c. b. 0 The claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. Provide rationale in section c. MEDICAL OPINION (to be completed by the examiner) IS THE VETERAN'S POST TRAUMATIC STRESS DISORDER AT LEAST AS LIKELY AS NOT (50 PERCENT OR GREATER PROBABILITY) INCURRED IN OR CAUSED BY MULTIPLE OCCURRENCES OF MILITARY SEXUAL TRAUMA THROUGHOUT SERVICE AND RESERVE SERVICE TO INCLUDE SEXUAL HARRASSMENT, ATTEMPTED SEXUAL ASSAULT AND SEXUAL ASSAULT THAT OCCURRED DURING SERVICE. Are these markers of a below average performance evaluation, marital/relationship problems, and voluntary discharge due to miscellaneous reasons be considered substantial markers to your previous evaluation of the PTSD stressors related to MST? PLEASE PROVIDE COMPLETE RATIONALE. b. Indicate type of exam for which opinion has been requested (e.g. Skin Diseases): PTSD 3. Evidence review Was medical evidence available for review as part of this examination? X Yes 0 No If yes, indicate evidence reviewed as part of this examination (check all that apply): *VA claims file (C-file) If checked, documents listed separately below tAat are included in a C-file. do not need to be additionally indicated. X Veterans Health Administration medical records (VA treatment records) X Civilian medical records X Military service treatment records X Military service personnel records O Military enlistment examination 0 Military separation examination 0 Military post-deployment questionnaire 0 Department of Defense Form 214 separation document 0 Previous disability decision letters If checked, please provide a discussion including name of doctor/facility, type of record, date, diagnosis and any pertinent findings: QTC eval- August 2015- dx PTSD 2014- mental health records - depressive disorder anxiety, military sexual assault Civilian med recs 2014 dx PTSD Military tx 4. Medical opinion for direct service connection Choose the statement that most closely approximates the etiology of the claimed condition. a. X The claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness. Provide rationale in section c. b. 0 The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. Provide rationale in section c. c. Rationale: This claim is based upon self report. The veteran reports that she experienced sexual harassment and sexual assault while serving in the military. This has been difficult for her to discuss, but the symptoms she reports are consistent with PTSD related to MST. The VA records reveal a history of being diagnosed with mental health issues including depression and PTSD. The only marker that is documented in the military records is the voluntary discharae. 5. Medical opinion for secondary service connection a. 0 The claimed condition is at least as likely as not (50 percent or greater probability) proximately due to or the result of the Veteran's service connected condition. Provide rationale in section c. b. 0 The claimed condition is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service connected condition. Provide rationale in section c. c. Rationale: 6. Medical opinion for aggravation of a condition that existed prior to service

Hello all! Do collateral sources help a C & P exam for PTSD, or let alone any exam and would it help increase a rating? I submitted documents the va provided me for family and friends to fill out and attached them to my claim to which the examiner noted yes on my exam. I had just noticed on other veterans postings of their exam results that most were checked off as no. I.E (b. Was pertinent information from collateral sources reviewed? [ ]Yes [x]No If yes, describe: _______________________) Thanks for the input! God Bless.