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  1. Hi all; Long time reader/lurker during which I have received loads of good info! I thought i would ask a question of my own. I am going through a claim for IBS (3rd time), I am considered a Gulf War Veteran and I am trying to claim it under presumptive condition since it has already been diagnosed by the local VA hospital here in Virginia. Following my C&P exam, the VA wants some documentation about Gulf War Illness which I will provide, but I have noticed I have a mysterious second C&P scheduled at the local VA hospital? So far, I have not received any formal information in the mail. Also I see on e benefits that a new request has showed up which states: Request 3 Due Date: Not available Status: No Longer Needed Exam Request - [Contention] What does Exam Request - [Contention] most likely mean in this context? Thanks in advance, Croz...
  2. Hi, This afternoon I have my C&P exam for PTSD secondary to MST, with a contracted provider. I found out Friday evening after work. Fed Ex had delivered the paperwork earlier, but I didn't get a chance to see it until I got home from work. To say that I am nervous would be the understatement of the year. I am desperately trying to hold myself together. My digestive system is all out of whack. I did spend an hour on the phone last night with a wonderful person from a non VSO group. She is a Marine and has trauma history, so that made the connection pretty easy. She gave me a lot of good tips, if I could only remember them when it's crunch time. One of my biggest fears is that this will be just like my previous mental health C&P...where that examiner, a VA employee, when straight for the jugular and ignored my heaps of physical evidence. I don't know why I am even doing this. I fully expect to get more of the same....nothing. If I do get granted SC, the shock of that may well kill me...because that goes against the grain of what the VA has given me over the years....tons of grief and denials. Anyway, just wanted to write this down as some kind of therapy... No body has to read it, or respond. I'm not here anyway.........
  3. Hello Fellow Vets, I'll try to make this a quick an easy read. I joined the Navy in July 2008 and served 5 years of continuous duty. By the time I was out I had several issues that were not present at my join date and eventually filed a claim for my benefits. Upon departure from the Navy, I filed a claim and was denied benefits for headaches, depression, a left knee and right knee condition. When I received my decision packet, it stated that these conditions could be granted a rating if found service connection. When I met with the DAV representative, he stated that if I could have my primary care doctor write a letter and say the conditions were service connected I would be able to have it reconsidered. So my Primary Care Doctor who is a medical doctor, reviewed my medical record and she drafted a nexus letter that supported my claim (with proper language *more than likely service connected) for all the conditions I listed above (and others I will have to go back and file for at a later date). In addition, she diagnosed my headaches as being migraines as opposed to just headaches ( after I gave her the symptoms I had been experiencing). I submitted this letter in June of 2016. In September 2016 my claim went to preparation for decision and then was kicked back and the VA requested a C&P exam. This exam was conducted by a Nurse Practitioner. She opined that my headaches were due to elevated levels of estrogen and that I was cleared from physical therapy in August 2012 so neither condition was service connected. As I result I dug through my medical record and found evidence of reports of "severe and unusual headaches" on documents that were dated as early as October 2008 before I was ever on birth control. And reports of me complaining of knee pain after I was cleared from physical therapy in the year 2013. Though I found proof that I had been reporting these issues and nothing was being done about it, I also questioned how a science assumption could be made in this matter. If indeed I was suffering from elevated estrogen levels, shouldn't the NP have conducted some sort of blood work? It was not done....EVER. So my question today is Do you think that the opinion of the NP will out weigh the opinion of my MD ( who is also an employee of the VAMC in Atlanta, GA? Thanks For your time!
  4. In recently received my C&P exam and here is a summary of the results. What do you believe my raiting would be? This was done using the DSM 5 standards.The examiner found that you do have a diagnosis of PTSD that meets the DSM V criteria. He also opined that your PTSD was at least as likely as not incurred in or caused by the claimed in service stressor event. It was also noted that your primary diagnosis is bi-polar Veterans Diagnosis: Depressed mood Anxiety Suspiciousness Chronic Sleep Impairment mild memory loss, such as forgetting names, directions or recent events disturbsncea in motivation and mood difficulty in adapting to stressful circumstances including work or work-settings suicidal ideation impaired impulse control, such as unprovoked irritability with periods of violence i do well when I work and worry if I get 100% if I cannot continue my contracting for the military which would really hurt my kids support and make things more stressful. Though I have difficulty working when things get bad, Is it possible to be 100% without unemployability? just would like some feedback and opinions Sincerelrey Just Some POG
  5. I finally received a hard copy of my recent C&P exam. I had to travel to the actual VAMC in DC to retrieve it even though I submitted a paper request about a month ago. Anyway, here are the results… Please tell me what you think my chances of receiving a favorable rating are. My claim was remanded back to the VARO by the BVA for further development and a C&P exam. Here are the results… ICD code: 309.28 (F43.23) Mental Disorder: Adjustment Disorder with Mixed Anxiety and Depressed Mood Under #3 Occupational and social impairment [X] Occupational and social impairment with reduced reliability and productivity is checked For VA rating purposes, check all symptoms that apply to the Veteran’s diagnosis: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Impaired judgement [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining work and social relationships [X} Difficulty in adapting to stressful circumstances including work or a work like setting [X] Impaired impulse control such as unprovoked irritability with periods of violence Remarks: The diagnosis obtained was based on the criteria contained in the Diagnostic and Statistical Manual of Mental Disorders -5 (DSM-5) 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. b. Based on this examination and veteran’s current symptoms described in the examination report, the veteran meets diagnostic criteria for Adjustment Disorder with Mixed Anxiety and Depressed Mood (with alcohol use) as outlined in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Therefore, the current diagnosis is at least as likely as not related to the veteran’s fear of being deployed to the Gulf War during his Active Reserve Duty Training in 1990. Thanks in advance for all your help and advice.
  6. So I'm wondering if anyone else has ever had a C&P exam that they do not have to be at?? I did this past Thursday!!! I found out about it because for the past week the ebenifits site has not been working right for me. I cannot check my status or most information that is of a personal nature. I keep getting this error code. I reported it. Talked to a tech on the phone he took all the necessary information and said they would contact me via email. Well that was over a week ago. But I keep checking to see if they have fixed the problem. But they haven't! Anyway I called again an was taking to someone at the 800 # that you would call about status. And I happen to click into the VA appointment area. And Holy SHIT there is an appointment that had been scheduled at 0800 Thursday! And I knew nothing about it. And the appointment indicates it is a C&P appointment!!??? WTF?? And what is really screwy is that I was at the VA on Thursday because I have a standing appointment on Thursdays 2 1400. So I ask this person on the phone what they hell that is all about, considering I was never notified of the appointment and the status appears that it was CANCELED by ME??? And believe me I am really pissed at that point!!! SO this person explains to me that this appointment was scheduled by the VA and it was a C&P appointment but the type that I don't need to attend. I said REALLY? And can you tell me exactly how they perform an exam without the patient being present?? And this person tells me they use the records they have from the VA??? I told him that was going to be the shortest exam in VA history considering I only go to one area of the VA for a class which wouldn't help in any way with my current claims, so honestly EXACTLY WHAT INFORMATION and who is giving this MEDICAL information that supposedly has anything to do with me and any of the claims I have open at this time? This person said they didn't know and that these exams are a normal part of all claims???? WELL I don't know about anyone else on this site. But I certainly find that rather STRANGE that a Veteran can have a C&P exam done with out being physically present??? I also want to know EXACTLY the who, what, when and where of any medical information that was obtained Thursday morning and EXACTLY how it is to be used as far as any open claim I have at this time with the VA?
  7. Camp Lejeune Horror Story

    Sort of Long I joined the United States Marine Corps Reserve in July of 1986, and received an honorable discharge in July of 1994. For approximately 45 days in early October of 1986 until late November of 1986, I was stationed at Camp Lejeune, NC with the Warehouse Unit (3051) for training (ACDUTRA). Several years after my separation from service in approximately 1993, I really began to experience the effects of consuming the contaminated water at Camp Lejeune. My mood changed drastically and I began to have major panic attacks. At one point in 1995 I was even taken by ambulance to the hospital for shortness of breath and the fear that I was having a massive heart attack. During this same year, I was formally diagnosed with suffering from Bipolar Disorder and Manic Depression. The strange thing about it is that I have never suffered from any psychological issues prior to my service at Camp Lejeune and do not have a family history of any psychiatric disorders. Over the next nineteen years, I took medication and occasional psychotherapy for my psychiatric condition. In spite of this my condition never really improved to the point that I felt normal. Since approximately 1992, I have had literally dozens of jobs. This is true, because my psychiatric condition makes it nearly impossible to hold down a job for any considerable amount of time. I have real trouble concentrating and focusing on things for long periods of time. Due to my educational background, I have been afforded some really good and high paying jobs like the Social Security Administration and school teaching. However, because of my lack of ability to focus, I am unable to sustain meaningful employment for more than a few months at a time. The stress of the workload and my inability to handle authority make it very difficult to remain on any job for very long; as a result, I ultimately quit. I reason that I can do better working alone and for myself and that I’ll earn a lot more working for myself, but that never seems to manifest either. I would say that most of my family members and close friends believe that there is seriously something wrong with me. I have been out of work for a year and a half and drive for Uber from time to time to earn money for gas and auto insurance. I prefer to spend most of my time alone and have pretty much cut off all contact with friends. I no longer have good health insurance like I did when I was married. Since it is difficult for me to maintain employment, I don’t have regular insurance coverage. As a result, I have not the taken much needed psychiatric medication for approximately four years. Consequently, my alcohol consumption has increased greatly and I weigh more than I ever have in my life. In my heart of hearts, I truly believe that my condition is the direct result of my exposure to the contaminated water that I consumed while at Camp Lejeune, NC. According to the EPA, the levels of PCE, TCE and other chemicals at Camp Lejeune were at least 1000 times higher than normal. Apparently the Marine Corps was aware of this situation and did nothing to correct it. Hundreds of thousands of Marines and their families have been victimized by this situation. In 2012, President Obama signed into law the Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012 (P.L. 112-154), which guarantees those veterans who served at Camp Lejeune from 1953 to 1987 for a minimum of 30 days and suffer from any of fifteen identified conditions, free treatment through the VA. I content that I suffer from Neurobehavioral Effects, which is one of the identified conditions. Depression falls within the realm of Neurobehavioral Effects. Perhaps there is a “light at the end of this long tunnel,” because, a Veterans Law Judge, in his appeal letter stated that my service record confirms that I was stationed at Camp Lejeune for training, which falls within the range of subjects identified as potentially exposed to VOCs during my service and that my VA treatment record shows that I have a history of depression and that I have received treatment from the VA for such. Aside from this I also show a history of being treated for years by outside psychiatrist. As a result, I will be afforded the elusive P&C examination as part of my case; I am finally going to receive the due process that I deserve. I keep getting denied! What would you do?
  8. Asked this question earlier -- please excuse if it has been answered somewhere in the archives -- my brother recently had his C&P Exam. Where can I get a copy of his Examination findings ? His MyhealteVet online does not have any records whatsoever. Do they come with the VA Rating Decision ?
  9. hi everyone, if anyone has any insight on the results of my C&P exam it would be greatly appreciated. i was sexually assaulted while AD AF, my claim was quick start filed 5 months ago, i had the exams over a month ago and things seemed to be going well, it went to pending decision approval two weeks ago and then all of a sudden dropped back to gathering of evidence and a pending appointment request. my AMVETS lady never answers me and when she does she says she will get back to me... and never does. my PTSD is at an all time high not knowing what all of this means. i also have a few other claims in for chronic pain and chronic gastritis (gastritis c&p stated that it was more likely psych related) 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: 309.81 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD ICD code: 309.81 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Chronic Pain 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 [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 [ ] 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 (hard copy paper C-file) reviewed? [ ] Yes [X] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: If no, check all records reviewed: [X] Military service treatment records [X] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [X] 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 [X] Other: VBMS, CPRS 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 was raised in ________by her biological parents. She described her childhood as "really good, compared to people I served with and hearing where they came from I was definitely blessed." She described her relationship with her parents as "normal" and indicated that they did not get along while she was an adolescent, but are now "best friends." She denied any experiences of abuse growing up. The veteran is currently living in ________ with her husband who is currently active duty in the military. She has no children and no other marriages. The veteran reports that they were married just 2 weeks prior to her sexual assault which occurred while they were stationed at separate bases. She indicated that although she is living with him now, they are estranged because of her ongoing symptoms since the assault. She plans to move in with her parents as soon as they have room for her to do so. She indicated that her husband says she's not the same person he married and that he doesn't know her anymore even though they've been together for 6 years. They have not been physically intimate since her assault. The veteran indicated that they plan to proceed with a divorce once she has addressed her medical and military issues. The veteran indicated that at present she is engaged in very few activities and spends the majority of her time at home. She indicated that she tries to take care of chores around the house or go grocery shopping, but she finds even those tasks to be challenging and her husband often has to remind her to do them. She indicated that she has few friends and that "I don't like people, I don't like talking to people, social settings." Prior to her sexual assault she describes herself as being a "social butterfly." Now, she spends a lot of time watching shows on Netflix. She typically would enjoy going to the gym, but has been unable to because of a back injury. b. Relevant Occupational and Educational history (pre-military, military, and post-military): The veteran's highest level of education is a high school diploma. She The veteran is currently unemployed both due to physical limitations (she has difficulty standing for long periods of time due to a back injury) as well as mental health issues (she is afraid of people). She has no income and her husband is currently supporting her financially. She was never deployed to an area where she received hazardous duty pay. Her Veteran received an honorable discharge due to "Hardship; Service Member Initiated Due to Dependency." The veteran reports that prior to her sexual assault she loved the work she did in the military and got along with her coworkers; she was "really happy and really proud." After the assault she reports that she was "emotionally checked out" at work and was reprimanded for insubordination by a superior officer. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The veteran reported receiving sporadic mental health treatment through the Air Force following her sexual assault. Her medical records in VBMS reflect this. She was prescribed medication to assist with sleep and mood including melatonin, biotin, prozac, flexaril, and trazodone. She indicated that prior to this she was also seen for evaluation and treatment for ADD and was prescribed ritalin. The veteran indicated that since discharging she has run out of her medications and has not been on anything for several weeks. The veteran described symptoms including intrusive thoughts, flashbacks, nightmares, emotional and physical distress at trauma cues, avoidance of trauma related memories/feelings/conversations and situations, gaps in her memory of the event, emotional numbness, disconnection from others, negative change in beliefs about herself/others/world, persistent negative emotional state, anhedonia, irritability, difficulty sleeping, poor concentration, hypervigilance. She also reported having panic attacks daily (with increased heart rate, throat swelling, difficulty breathing, face flushed, feeling out of control, shakiness, uncontrollable tears) and feeling depressed. The veteran described feeling like she's on a "roller coaster." She indicated that she has nightmares of her assault nightly and finds herself triggered by other people who she now fears may be similarly harmful to her. Additional triggers include hearing the "Law-and-Order SVU" theme song and hearing about Bill Cosby in the news. She has not been back to base despite being able to get free healthcare there (because her husband is active duty), in order to avoid being triggered to remember what happened. She has a sense of "impending doom" and always feels that she needs to keep her guard up because something might happen. The perpetrator's family is involved in illegal activity and she worries that they might come after her, or that he will once he is released from prison. She has been sleeping in a separate bedroom from her husband and keeps the door to her room locked at night. On one occasion he heard her screaming and crying in the middle of the night and entered her room, and she punched him before she was fully aware of what was happening. She has difficulty sleeping at night because at the time of her assault she was sleeping next to someone she trusted, so now even sleep does not feel safe. She reported that when she was still working at ________, she would often miss work because her sleep medication would "knock me out for half the day." She indicated that she has been unable to relate to/open up to anyone and feels that she can't connect with others, even friends from childhood. She is embarrased about what happened and doesn't want others to know. She indicated that whereas she used to enjoy fashion and getting dressed-up, she now makes an effort to look unattractive; she does not shave her legs or wear make-up anymore. She goes days without showering and only does so when her husband directs her to. She reports that she often will not leave her house for days at a time. She spends a great deal of time watching Netflix and cooking in order to avoid memories of the event. She indicated that she has to force herself to eat, but that she often throws up what she's eaten. She has chronic gastritis and she indicated that the stress of the assault caused it to "flare-up." The veteran indicated that immediately after the assault she considered suicide, but got support from a friend and did not take any action. Since then she has had suicidal ideation, but no plan or intent. She reports that she last had thoughts of suicide at the end of January 2016. She continues to feel hopeless and has thoughts such as "I don't know what the point of all of this is," but has had no recent active suicidal ideation. She denied current or past self-injurious behavior. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): The veteran denied any current or past legal problems with the exception of the case related to her military sexual assault. e. Relevant Substance abuse history (pre-military, military, and post-military): The veteran reported that she typically drinks one bottle of wine per month. She reported that for a week after the sexual assault she was binge drinking, roughly one bottle of wine daily every day of that week. She indicated that she stopped because she was having difficulty functioning at work and did not want to be sent for substance abuse treatment. She denied any history of drug use or experimentation. f. Other, if any: The veteran reported that 2 weeks following her marriage she was sexually assaulted by a friend. A court martial was pursued against her assailant, and the veteran, along with other victims testified against the perpetrator. The perpetrator was sentenced to time in prison, loss of rank, and dishonorable discharge. Please see documentation in VBMS for additional details. The veteran reported that the period between the report of her assault, and the completion of the court martial has been very difficult. She indicated that she feels her case was mishandled by the military for several reasons. First, she reports that she was encouraged to drop the charges initially which was "the biggest slap in the face." She also reports that at one point her supervisor addressed her in front of her peers about the incident. She indicated that once others became aware of what had happened she was ostracized. Male friends gave her the "cold-shoulder" because they worried she would "call rape" on them. She indicated that she was further harassed by another supervisor who interrogated her about what happened and then slapped her on her behind and called her "fake tits." The veteran reports that she continued to have negative experiences even after she was transferred to a different unit. She was told that she was insubordinate by a supervisor and people continued to ostracize her. 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: Sexual Assault 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 If no, explain: Related to military sexual trauma that occurred stateside Is the stressor related to personal assault, e.g. military sexual trauma? [X] Yes [ ] No If yes, please describe the markers that may substantiate the stressor. Sexual assault case was brought to trial in the military and the veteran's assailant was sentenced to time in prison, dishonorable discharge, and loss of rank. Veteran's symptoms began to emerge shortly after the assault and medical records show that she was seen for mental health treatment at that time and received medication. 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 #7 - 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) Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] 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). [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 negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. [X] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Panic attacks more than once a week [X] Chronic sleep impairment [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Suicidal ideation [X] Neglect of personal appearance and hygiene [X] Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene 6. Behavioral Observations -------------------------- The veteran presented for the evaluation on time, appropriately dressed and groomed, and appearing her stated a ge. She wore an oversized sweatshirt. The veteran was alert throughout the evaluation, and was oriented to person, place, and time. Speech was normal in rhythm, rate, tone, and volume. Content was coherent and goal directed. Affect was full range and appropriate, and her mood appeared to be anxious and depressed. There was no evidence of hallucinations or delusions. Cognitive functioning was grossly intact. Insight and judgment were fair. The veteran denied current suicidal and homicidal ideation, plan, and intent. 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 currently meets DSM-V criteria for a diagnosis of PTSD stemming from her military sexual trauma. Her symptoms fall within the severe range and have had a significant impact on her functioning in all domains since the incident. Please see above for a full accounting of the veteran's symptoms and their impact, as well as a detailed account of the assault and its aftermath. With appropriate treatment, veteran's symptoms may improve over time. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application.
  10. Hi, I had an interesting and bewildering C&P exam with a Dr. covering three items of evaluation; lower extremity varicose veins, piriformis syndrome (left hip), and lumbar condition with herniation (for a disc bulging 5 mm to the left at L4-L5). Here is about how it went… Firstly, I had filled out the summarized history questions for each of the three items. The papers I had diligently filled out simply laid on his desk the entire exam though, and he simply asked me questions as he went through his DBQs. I was very well versed in my medical record and could tell him the brief history (or development) of each condition (along with my medications) in a quick, concise fashion. He was reasonably personable, and he seemed to be pretty pleased with my being quick and to the point (it was towards the end of the day and he was delayed in getting to me). And he seemed to whip through the DBQs with speed. He did inspect my legs for varicose veins (which are really obvious). I was surprised that he didn’t ask if I had aching and fatigue in my legs after prolonged standing or walking or if the compression hosiery I was wearing was helping. He could have found out the answers to those questions if he had read the packet I filled out (he didn’t bother to read that it seemed, nor did I get sense that he read my medical record). I had to specifically say that I had aching while standing for long periods of time, and I didn’t realize I had varicose veins for years until recently. I think he should have asked me that when filling out the Artery & Vein Conditions DBQ at 3B. And I hope he filled that part out… I also explained how I had hip/low back issues after some long runs and landing weirdly on my left leg while playing volleyball. He had me walk (which is in my case limp, barely putting my left foot forward to step) to the office door and back to see my gait. He had me try to lean backwards, forwards, side-to-side, and twist. I could do all pretty well except the leaning forward to touch toes. I could only lean forward maybe 15-20 degrees. I glanced at his notes, and they almost all looked like they said 30 degrees (normal) except I don’t know what he put for forward flexion (I saw nothing but 30 degrees on the sheet, and I don’t know if he put something down later to give an accurate reflection of my forward flexion). I’m wondering about this because the Back (Thoracolumbar spine) conditions DBQ specifically says in Section III (before 3A) to “Measure ROM with a goniometer.” In fact it says 3 repetitions of ROM (at a minimum) are needed. I only did forward flexion twice, and that was because the first time I leaned over he didn’t seem to like it that I couldn’t lean down very far, and so he stood up and showed me how to lean down to touch one’s toes to demonstrate what he was looking for from me. Again I leaned down about as far as I could without pain (which was not much). I don’t know what he wrote down, and I never saw a goniometer once in the exam. Should he have used a goniometer? He didn’t examine me at all, as in seating me on the table, having me attempt to perform straight leg raise tests (which is required at step 12) or palpating for tenderness, etc. It was most like a reporter’s interview (aside from him observing me having trouble touching my toes and him encouraging me to try to do it). One thing he did do that I thought was indeed good was to run a pointy object up and down my legs while I was seated. Interestingly, I had slightly less sensation on the left leg, and I told him this. He also didn’t test my hip flexion, or ankle flexion/dorsiflexion, great toe extension, etc, which is required per the DBQ at step 8A. That seems like that would have been a pertinent thing to assess, especially after observing how small of a step I took with my left foot while demonstrating walking for him. And he was supposed to test for piriformis syndrome (left hip) during this exam, and I even told him that just last week I was also diagnosed by the VA Pain Mgt clinic with IT band syndrome of the left hip for my tension and pain along the outside of the left hip. I have no idea what he put for ROM for my left hip... He got to the end of the last DBQ form that he whipped through (after skipping what I think are essential parts), and then he finished the exam abruptly saying, “Well, that’s it. That’s all. We are done.” When I asked if there was anything else, he was like “No. That’ll do.” At the end of the exam, he seem to notice the envelope full of the papers I had filled out along with my medication list I had diligently prepared. He was like, “What’s this”? I was like, “That is for you, which my medication list and everything.” He acted like “Oh,” and seemed to grab it and take it somewhere. I wonder what he did if anything with that. He seemed to be completely done with me at that point. My Questions: How can I get record of his notes and when might they become available? Is this super relaxed approach, and skipping through what I think are required sections normal? Is this anything like how a C&P exam should go? Is this lack of use of an accurate measuring device going to lend itself to an accurate rating? Should I document that he did not use any accurate measuring device and have my own physician measure my ROM with a goniometer (or would that come later with a VA attorney after the VA denies my claim)? What just happened? Was I supposed to be somehow more demanding during the exam, and if so how could I have done so appropriately? Any advice appreciated!
  11. So I went to the QTC office for my TWO C&P exams today. First one was at 1300 and it was my MH C&P exam for PTSD/MST and my eating disorder. Was with the doctor for about 1-1/2 hours and we went through everything thorough. Apparently the reason I had this C&P was the fact that the VA originally rated me for Anorexia Nervosa back in 2014 separately from my MH PTSD/MST/Anxiety. Looks like I should be under Bulimia rating because of my binging/purging with laxatives and the abuse of the laxatives. The discussion was good, she did not have me 'totally' relive the disgusting event but we did touch on certain aspects. I was personally assaulted resulting with a pregnancy where I lost the child in my late first trimester/early second trimester. I felt pretty good about the exam and thanked her. So I had a few hours to kill before my next C&P at 1615 so I went and got something to eat and chilled. Got back to the office around 1530. Now mind you I was already a bit anxious from my discussion a few hours prior. This exam coming up was for an increase to my L ankle. I am currently on a knee bike and I have an ankle brace on my left foot. So there I am sitting in the waiting room minding my own business. Look at FB to kill time and I over hear a conversation taking place behind the glass in the office area. Now keep in mind, I suffer from MST! here is the conversation: Employee #1 - So this lady was raped 12 years ago. It's apparent you can't do a rape kit. How does she prove this? Employee #2 - Well the VA takes there word I guess. Employee #1 - Well that doesn't sound right, how do they know if she is telling the truth or not SO I F***** LOST IT! I MEAN I FREAKED THE F'OUT! Went up to the glass and said "who the hell do you think you are to even be talking about a patient and their personal file like that?" And "who are you to determine whether the person is lying or not?" "It's not up to you but rather a doctor!!!!!" I asked for his name and he told me it and I asked for a supervisor...Well guess who the supervisor was! That guy! WTF! I got the other ladies name and by now he had brought into the back b/c of how upset I was and just kept saying "I'm sorry" "I'm Sorry" Are you serious? By now the doctor who had examined me for my MH C&P came out and brought me to her office to console me. I was sobbing, I am mean literally sobbing like a baby. She said that was uncalled for and I told her "you are damn right it is". I am going to report this to the VA, the QTC corporation, anyone I can get ahold of! Needless to say I had to get myself together so that I could do my next C&P exam for my left ankle. That doctor, too, heard the whole situation and was so appalled at his actions. I told her thank you. We were able to get through my L ankle C&P. She said b/c of my right foot in a "non-weight bearing status" she couldn't do the "normal" testing of both feet/ankles. She said I am noting it and she also said that the knee bike I am using now for my right foot, is probably causing even worse issues to my left foot ankle b/c now I have all the weight on my left foot/ankle. She told me that I should get a wheel chair and to discuss with my podiatrist. My calf muscle is significantly smaller now on my right foot but that is to be expected. Over all the this exam went well and I believe favorable too. So with all that going on today I am just completely devastated and reverting back to my old self.... Thank you for letting me vent!
  12. My question is in regards to a recently completed C&P exam I had taken for MH. I am quite worried about the statements made by the examiner and a few other sections as well. I have tried to highlight the sections that worried me I am not sure if I had missed anything of importance. Normally I would take this issue up with my VSO but she is out sick. I do not know who else or where else to turn to for information about this. I am most worried about the statements made by the examiner in the final paragraph. I did as I was told by my VSO and others in the VA and are assisting me currently in matters of mental health. That was be honest and it will all be okay. Well turns out it might not be okay and I was completely honest with this examiner!!! Date/Time: 21 Jan 2016 @ 1330 Note Title: C&P MENTAL DISORDER Location: Chalmers P Wylie VA Outpatnt Signed By: Co-signed By: Date/Time Signed: 21 Jan 2016 @ 1650 ------------------------------------------------------------------------- LOCAL TITLE: C&P MENTAL DISORDER STANDARD TITLE: MENTAL HEALTH C & P EXAMINATION CONSULT DATE OF NOTE: JAN 21, 2016@13:30 ENTRY DATE: JAN 21, 2016@16:50:27 AUTHOR: EXP COSIGNER: URGENCY: STATUS: COMPLETED *** C&P MENTAL DISORDER Has ADDENDA *** Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: 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 [ ] No 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Diagnosis Deferred Comments, if any: The veteran was asked to be evaluated for PTSD, the stressor has been conceded as he has been awarded the Combat Infantry Badge. The diagnosis is deferred as the examiner is unable to offer a specific diagnosis with any level of scientific certainty. The veteran was administered the MMPI-2-RF, although it appears he understood and responded to the items in a consistent manner, the remainder of the profile is not able to be interpreted due to an over-reporting of symptomatology that is not common even in individuals with known severe psychopathology. There are a number of potential reasons for this profile to include it being a "plea for help", it may be a phenomenologic style to over report and to be traumatized (this pattern is frequently seen in Dependent and Histrionic Personality Disorders and Depressive Mood Disorders) or the individual is trying to look worse than they are for some secondary reason. Unfortunately it is impossible to determine the reason behind this pattern of responding in this case without resorting to speculation. His service treatment records suggest that he did not report PTSD symptoms while in the military. While he has been diagnosed and treated recently for PTSD, the requirements for a clinical diagnosis differ from the requirements for an independent/forensic evaluation. In the latter situation the examiner is required to consider other factors for an individual's complaints while a clinician takes their patient's report as being valid. Please note that the 2507 requested that the examiner complete both the mental disorder and Initial PTSD DBQ's, only the Initial PTSD DBQ will be completed as completing the Mental Disorder DBQ is redundant. In regards to the question as whether or not the veteran's sexual dysfunction is at least as likely as not approximately due to or the result of PTSD, while the veteran reports he has some difficulties sexually due to his prescriptions the veteran remains sexually active and furthermore there are other physical conditions as well as medications that may be negatively impacting his sexual dysfunction, as such the final decision is deferred to a physician. In regards to question whether the veteran's insomnia is at least as likely as not approximately due to are the result of PTSD; this would be a redundant opinion as chronic sleep difficulties are a symptom of PTSD (and depression), they are not a separate diagnosis/syndrome. Mental Disorder Diagnosis #2: Cluster B traits Mental Disorder Diagnosis #3: Alcohol Use Disorder - in self-reported remission b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): see medical records 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? No response provided. 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) No response provided. 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? No response provided. 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 (hard copy paper C-file) reviewed? [ ] Yes [X] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: If no, check all records reviewed: [ ] 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 [X] Other: The veteran's electronic medical records (CPRS & VistAWeb) were reviewed. The veteran was referred for a compensation and pension examination. The veteran was informed verbally of the nature and purpose of the examination and confidentiality limits. He appeared to have a basic understanding of the purpose of the examination and confidentiality limits. He was provided with a chance to ask questions about the evaluation procedures. All questions were answered to reasonable satisfaction or referred to other resources. He was informed that this examiner is not his treating clinician or the legal determiner of compensation or pension benefits. Instead, he was informed that this examiner is an independent provider of clinical information and expertise to assist those who review and make legal compensation and pension claim decisions and would not be participating in his healthcare. He was given information about the Veteran's 24 hour Crisis Line. The veteran indicated understanding of these terms and explicitly and freely consented to the evaluation. The judgments of symptoms and opinions in this evaluation report are offered to a reasonable degree of psychological certainty and are only based upon the information available at the time of the evaluation. The DSM 5 criteria have been considered in this evaluation. This report was dictated using Dragon Naturally Speaking dictation software, the report has been proofread however due to time constraints there still may be some typographical errors due to the nature of the dictation software. 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 a 28-year-old single male, he is not currently in a relationship. He currently lives in a homeless shelter, he has one roommate in addition to 6 other veterans living in the house. He has no children. [Later during the interview the veteran reported having met a woman using a smart phone dating app (Tinder), although they are not in a relationship they still get together occasionally for sex]. The veteran is the younger of 2 children, he does not get along with his sister saying "she had a rough time with drugs." The veteran says that he does not like "the way she treats my mother and my nephew." Apparently one of her 3 children is living with the veteran's mother and this causes difficulties in that relationship as well as the veteran's relationship with his sister. The veteran says his parents were never married saying "my father left prior to my birth." He would continue to see his father for a couple of weeks a year however. The veteran says his mother never remarried however she had several long-term boyfriends. The first long-term boyfriend entered the picture around the time of the veteran's birth, this gentleman died of a heroin overdose when the veteran was 6 years old. His mother then started another long-term relationship, they are still together, the veteran says he considers this man to be his stepfather/father figure. He maintains a good relationship with this man as well as then "outstanding" relationship with his mother. The veteran notes that his mother lives in Massachusetts and he has not been able to see her in the past 2-1/2 years although they talk several times a week. The veteran is hopeful that he will be able to buy a house and have his mother, her boyfriend and the veteran's nephew all moved to Ohio so that he can take care of them. The veteran says he has an "okay" relationship with his biological father although he said "we just don't talk very much, we don't have much in common." When asked to describe his childhood the veteran says it was "okay, there was a lot of issues. I had everything I needed and occasionally stuff I wanted." The veteran says at the time he thought his childhood was very good and that he was spoiled however he says looking back on the situation and comparing his childhood with the childhood of different people he has met over the years he realizes his childhood was not necessarily very good. The veteran says his mother was using drugs during his childhood although she stopped her drug use when the veteran was 14 years old. When asked about physical or sexual abuse the veteran says "just small (stuff), hitting and stuff." b. Relevant Occupational and Educational history (pre-military, military, and post-military): The veteran says that he graduated from high school in 2008, when asked how he did in school he says "not good", he says his grades were "roughly D's and C's. I had pretty severe anger issues. I just wanted to fight everybody." He did not repeat any grades although he had to take night school the last semester of classes for English and math so he could graduate. He did not participate in any special education services. The veteran did not participate in any extracurricular activities. While in high school the veteran worked for Sears as a mechanic. The veteran says that after graduating from high school he decided to join the military because "there was nothing there." The veteran felt that if he stayed at home he would "be deeper into drugs." The veteran served in the Army from 2008 until 2014, his MOS was 11B, the veteran received a general discharge with a final rank of E-5. The veteran says he was administratively discharged for misconduct, he had received a felony conviction. The veteran was deployed to Iraq in 2010/2011 into Afghanistan in 2012. The veteran says that he moved to Ohio to move in with one of his friend's family. The veteran says he was on probation for the felony conviction in Hawaii and in order to relocate from Hawaii he had to be able to prove he had a job and a place to live. He worked for his friend's father for 2 or 3 months doing interior paining until he got a better job. The veteran worked for 2 months at Columbus Castings, he stopped working after a failed suicide attempt in 2015. The veteran says he has recently appealed a Social Security Disability denial, he is hopeful he will eventually qualify for these benefits. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The veteran says he currently sees Dr. McGill for psychotherapy although he notes she is on maternity leave currently. The veteran says that therapy was "going great", and he is hopeful he will be able to return to therapy upon her return. The veteran currently sees Dr. Schwartz for psychiatric services, he is prescribed Zoloft, prazosin and quetiapine. When asked how the medications are working for him the veteran says "I haven't seen much of a difference." The veteran says that in April 2015 he had tied a rope to a guard rail, he tied the other in to his neck he then drove away in his truck the rope apparently broke however he sustained significant internal scarring to his neck and currently has a tracheotomy and feeding tube. While in the military the veteran completed the ASAP program twice (following DUIs), he also recently completed the SATP program through Chillicothe. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): The veteran says he was frequently suspended while in school for fighting or misconduct towards teachers. While in the Army the veteran received one article 15 in 2011 for DUI, he says they did not pursue the second article 15 proceedings following his second DUI because being separated from the military. The veteran reported being arrested in 2011 for DUI, in 2013 he was arrested and convicted of a felony for unauthorized entry into a vehicle. He received his second DUI in 2014 however he says his lawyer was eventually able to get the charges dropped. The veteran is currently on probation for 3-1/2 years for the felony conviction. e. Relevant Substance abuse history (pre-military, military, and post-military): When asked about his current alcohol use the veteran says that "currently I'm trying to do the sober thing" the veteran says he last drank "just after Christmas", he says he had 3 L of Mad Dog 20/20. The veteran says he would have to mix the liquor with ice so that he could drink it. In the past the veteran says he has poured alcohol straight into his feeding tube. When asked about current drug use the veteran denied any. Veteran says he last had any drugs in late 2014, at the time he was using cocaine. The veteran says he stopped his drug use because he is on probation. f. Other, if any: ===================================================================== **IMPORTANT NOTE** ---> There is a glitch in the DBQ reporting software such that if the examiner does not check off any of the boxes in Section II, Number 4 ("PTSD Diagnostic Criteria") [below], because the Veteran does not exhibit those symptoms, the software will produce "No response provided", which makes it sound as if the examiner simply forgot to answer those items, which is not the case. In this instance the software should, instead, produce something like, "No PTSD diagnostic criteria were found during this exam." ===================================================================== ===================================================================== **IMPORTANT NOTE** ---> There is a glitch in the DBQ reporting software such that if the examiner does not check off any of the boxes in Section II, Number 5 ("Symptoms") [below], because the Veteran does not exhibit those symptoms, the software will produce "No response provided", which makes it sound as if the examiner simply forgot to answer those items, which is not the case. In this instance the software should, instead, produce something like, "None of the listed symptoms were found during this exam." ===================================================================== 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: Only one stressor was elicited from the veteran, he was rather uncomfortable during this portion of the evaluation and since the stressors are being conceded the examiner chose not to inconvenience the veteran by forcing him to recall more than 1 stressor. The veteran says while he was in the convoy the vehicle in front of them was hit by an IED and flipped over. The veteran says he was afraid that all of the occupants were dead, fortunately they were able to survive. Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No 4. PTSD Diagnostic Criteria --------------------------- No response provided 5. Symptoms ----------- No response provided 6. Behavioral Observations -------------------------- No response provided 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 -------------------------------------------------- On a brief mental status exam he was able to freely recall 2 of 3 words presented after a brief delay, he was able to recall the final word after being provided with a simple verbal prompt. He was able to recall 6 digits forward and 4 digits backward. He was able to complete a serial 7 subtraction task with no errors to 7 places. He was able to spell the word WORLD forwards and backwards. He was able to complete simple 2 digit addition and subtraction. His responses to proverbs were good. Although the veteran denied current suicidal ideation saying "I don't want my mom to bury me", however he says that "if my mom died ..." (He would seriously consider making another suicide attempt). The veteran denied any homicidal ideation. He denied hallucinatory experiences. When asked to describe his mood on most days the veteran says he is "depressed and anxious." The veteran reports significant episodes of anxiety says he has "never had one where I'm frozen." Based on his report of symptoms he would appear to be depressed, anxious and suspicious. The veteran says he forgets "simple things", he has never been diagnosed with a head injury although he claims he suffered a concussion in the military where he was momentarily disoriented. The veteran says he knew that if he sought medical attention he would be taken off admission status and he felt he could not do that to the soldiers under his command so he convinced the medic to not report this incident. While the veteran complains of memory problems he did not display significant memory problems during the evaluation today. The veteran says he has significant problems motivating himself saying that occasionally he still will stay in bed all day. He says this occurs about 2-3 times a week. Socially the veteran described himself as being isolated saying "I have a hard time connecting with people." The veteran says "I don't talk to anyone." The veteran says the only activities he engages in is to go to the gym 2-3 times a week "if I can." He describes his energy level is "awful" saying "other than the gym I can't exert too much." The veteran says that occasionally he may go over to his female friend's house while she is at work and spend time with her dogs. The veteran says that he averages 4-5 hours of sleep "lately, he feels that the weeks leading up to the different C&P examinations have been hard on him prior to this he was getting "around 6" hours of sleep per night. The veteran says he has difficulty falling and staying asleep. The veteran says he has dreams/nightmares "at least 3 times a week." The veteran says although he may try to take a nap "it's just more me laying there." The veteran says he tends to avoid situations involving a lot of noise. He also attempts to avoid talking about his traumatic stresses. He appeared to be particularly relieved when the examiner said it was only necessary to focus on one traumatic event. Based on his self-report veteran reports exaggerated negative beliefs about himself and the world, he tends to blame himself scribed traumatic stressor saying that he was too complacent. The veteran describes his temper control is being currently "fairly good", historically prior to the military he appears to have had very poor temper control. The veteran was administered the MMPI-2-RF, although it appears he understood and responded to the items in a somewhat consistent manner remainder of the profile is not able to be interpreted due to an over-reporting of symptomatology that is not common even in individuals with known severe psychopathology. There are a number of potential reasons for this profile to include it being a "plea for help", it may be a phenomenologic style to over report and to be traumatized (this pattern is frequently seen in Dependent and Histrionic Personality Disorders and Depressive Mood Disorders) or the individual is trying to look worse than they are for some secondary reason. Unfortunately it is impossible to determine the reason behind this pattern of responding in this case without resorting to speculation. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. Clinical Psychologist Signed: 01/21/2016 16:50 01/21/2016 ADDENDUM STATUS: COMPLETED C&P Exam completed in Capri by PhD; procedure code 99456. /es/PhD Clinical Psychologist Signed: 01/21/2016 17:28 Any assistance or opinions on this matter are greatly appreciated!!! Thank you for your time and for reading this as well!
  13. Ok so I have listed my VA Problem list first so you can see that the PTSD C&P notes left out the other mental health problems. My question is what should I do about it? Also stressor #2 is nothing I said or added. I did have more than one stressor and they are not mentioned. There are a total of 3 stressors. Below this list of VA PROBLEMS is the results from my PTSD C&P results. PLEASE ADVISE. Thank You. VA Problem List Source: VA Last Updated: Sorted By: Date/Time Entered (Descending) then alphabetically by Problem Your VA Problem List contains active health problems your VA providers are helping you to manage. This information is available 3 calendar days after it has been entered. It may not contain active problems managed by non-VA health care providers. If you have any questions about your information, visit the FAQs or contact your VA health care team. Problem: Anxiety Disorder (ICD-9-CM 300.00) Provider: DIVISION Status: ACTIVE Comments: per DSM-5, unspecified anxiety disorder Problem: Depressive Disorder NOS (ICD-9-CM 311.) Provider: Location: Status: ACTIVE Comments: per DSM-5, unspecified depressive disorder Problem: Nightmares (SCT 419145002) Provider Status: ACTIVE Comments: -- Note ******************************************* ******************************************** LOCAL TITLE: COMP AND PEN NOTE STANDARD TITLE: C & P EXAMINATION NOTE DATE OF NOTE: AUTHOR EXP COSIGNER: URGENCY: STATUS: COMPLETED 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 --------------- Was the Veteran's VA claims file reviewed? No If no, check all records reviewed: [X] Other: CPRS and VBMS MEDICAL OPINION SUMMARY RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: does veteran suffer from Post Traumatic Stress Disorder, and if so, does it appear to be service connected b. Indicate type of exam for which opinion has been requested: DBQ Initial PTSD and DBQ Medical Opinion 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: based upon clinical interview; review of records; application of DSM V criteria; clinical experience and expertise ************************************************************************ Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * Name of patient/Veteran: 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: 309.81 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD ICD code: 309.81 Comments, if any: previously diagnosed with disorders comprising the symptoms of PTSD Mental Disorder Diagnosis #2: Opioid Dependence (in remission) ICD code: 304.01 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): see medical chart ICD code: see medical chart 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: all symptoms seem to be related to his PTSD c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment 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 (hard copy paper C-file) reviewed? [ ] Yes [X] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: If no, check all records reviewed: [ ] 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 [X] Other: VBMS and CPRS 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): see reports dated 10/23/00 and 4/11/15 for details no significant changes since 4/11/15; does not describe father's death as a major trauma due to veteran's age at the time and lack of full awareness of impact b. Relevant Occupational and Educational history (pre-military, military, and post-military): see reports dated 10/23/00 and 4/11/15 for details as well as Stetments in Support of Claim contained in VBMS to saccounts of military traumas and experiences good student at Watertown High School; attended college Barton Community College and Monroe Commun ity College-Associates Degrees or certificates from both schools. following military, has worked in HVAC and is currently a Territory Manager for a local company. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): has been seen by Dr. Barry and receives escitalopram and prazosin; medication recently started and veteran does not know if they are effective. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): arrested for DWI in 2000 prior to treatment; served six months in Livingston County Correctional Facility e. Relevant Substance abuse history (pre-military, military, and post-military): see reports dated 10/23/00 and 4/11/15 for details was seen in residential ETOH treatment at Canandaigua in 2000 for 28 days; has been sober since; no use of illicit drugs, although he was addicted to opiates which were prescribed to him. Is now on suboxone 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: military experiecnes as set forth above in previous reports and Statement in Support of Claim 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? [ ] Yes [X] No b. Stressor #2: deaht of father from heart related illness 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 If no, explain: civilian/familial situation 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 #7 - 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) [X] Witnessing, in person, the traumatic event(s) as they occurred to others Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. [X] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Exaggerated startle response. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] 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] Panic attacks that occur weekly or less often [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [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 6. Behavioral Observations -------------------------- demure; quiet; reserved 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: cannot recite serial sevens or recite months of year correctly; consistently recalls seven digits forward; can spell selected word forward and backward; recalls two of three items after five minutes; recalls four of the last five presidents, though nor in correct order. 8. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any -------------------------------------------------- it is much more likely than not that veteran's military experiences are the critical stressors that underlie his PTSD and therefore his PTSD would seem much more likely than not to be service connected NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. Thanks Everyone.
  14. Hey all, would love your feedback... ....I wrote 3 posts giving 10 Tips on getting ready for a C&P Exam. Here's Post #1: 10 Tips to Help You Keep the C&P Exam in Perspective. Here's Post #2: Dealing with the C&P Exmainer. Here's Post #3: Paint a Picture when Talking to the Doctor. Would love to hear from ya'll....tell me what I missed, where I can do better or give more info.... .....I'm writing another Field Manual for the Veterans Law Blog called the "C&P Exam Field Manual", and I'd like to address as many of your concerns, fears, needs, etc., as possible, to make it the best resource available. Read the posts, and comment here or directly on the post page on the Veterans Law Blog. Thanks, Chris (Veterans Law Blog)
  15. I have submitted a couple of secondary conditions (nerve damage, depression) for my S/C DJD. I expected the VA to reopen the original DJD even though I didn't request an increase. However, I do not understand why they reopened my original claims for hearing loss and hips that were denied right after I got out of service 11 years ago. Is this normal, are they messing with me or am I completely missing something.
  16. I have PTSD and diagnosed as bi-polar too. Personally, I think the bi-polar is not correct but, hey, I'm not a doctor. I missed my C&P exam in Houston TX in Oct 2011 (I moved back to Florida in August 2011 and did not get the notice). ANyway, I got notice in Dec 2011 that my claim for PTSD had been denied because I missed the exam. I went to my county VA office and the "&D&&" filed to wrong request -- he filed an appeal instead of requesting my case be reopened and requesting a new C&P date. Fast forward 3 years and here I am. I had my C&P exam this last Wednesday and personally don't know how it went. The doc was very straight laced with no personality (I think that's the way they're supposed to be). Hadn't slept well in about two-three days and only got about 1 hour on Tuesday night before the exam at 8:00am. I muddled through with the doc -- lasted about 45 min. and the took the mmpi2. The mmpi test results were "questionable validity with some validity scales elevated to the extent that profile interpretation is of limited utility". " Veteran endorsed many psychological symptons on a variety of clinical scales, often reporting moderate to severe levels of intensity. Overall this response pattern may indicate a sense of feeling overwhelmed, though exaggeration of psychological distress cannot be ruled out." Here's the summary of my C&P exam and I'd appreciate any feedback. Semper Fi. 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: 309.28 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD Mental Disorder Diagnosis #2: ALCOHOL USE DISORDER Comments, if any: moderate Mental Disorder Diagnosis #3: MOOD DISORDER, NOS b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): SEE CPRS 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: SYMPTOMS OVERLAP 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 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 [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: SYMPTOMS OVERLAP c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence review ------------------ In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: ------------------------- Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes [ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: ALL RELEVANT RECORDS REVIEWED 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 f. Other, if any: MILITARY HISTORY Service Discharge Type (Last): HONORABLE Service Branch (Last): MARINE CORPS 1967- 69, 69-79 Service Discharge Type (NTL): HONORABLE Service Branch (NTL): MARINE CORPS Service Entry Date (NTL): Did the veteran have combat experience: YES Combat service location: Vietnam 1968-69 Duties: Were combat wounds sustained: no Any mental health tx: NONE 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: SEE MILTARY HISTORY 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 #7 - 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) [X] Witnessing, in person, the traumatic event(s) as they occurred to others Criterion B: Presence of (one or more) of the following intrusion Symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Intense or prolonged psychological distress at exposure to Internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the Traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] 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). [X] Persistent negative emotional state (e.g., fear, horror, anger,guilt, or shame). [X] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Exaggerated startle response. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships 6. Behavioral Observations -------------------------- OTHER PSYCHIATRIC SYMPTOMS Today the veteran reports "I'm very agitated, didn't sleep well. Nerves raw" Current stressors: health The veteran described/endorsed the following symptoms associated with depression: Withdrawn, isolation, anhedonia, depressed mood, low energy, poor sleep, poor attention and concentration, forgetfulness, change in appetite, crying spells, guilt, helpless, hopeless, and worthless. Frequency of Symptoms: 4-5 days a week Duration of Symptoms: hours Onset of Symptoms: years Severity of Symptoms: mild to moderate The veteran described/endorsed the following symptoms associated with anxiety: restlessness or feeling keyed up or on edge, easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance, excessive worrying, second guesses, what if?, difficulties with decisions Frequency of Symptoms: frequently Duration of Symptoms: minutes Onset of Symptoms: years Severity of Symptoms: mild to moderate The veteran described/endorsed the following symptoms associated with Mania: inflated self esteem, decreased need for sleep, pressured speech, FOI, distractibility, increased goal-directed activities, reckless behaviors Frequency of Symptoms: no recent manic episdoes, often has bouts of depression Duration of Symptoms: hours Onset of Symptoms:years Severity of Symptoms:mild to moderate Denies psychosis MENTAL STATUS EXAM: Appearance: clean, neatly groomed, casually dressed Orientation: AOX4 Mood: subdued, mildly agitated Affect: constricted Attitude: cooperative Speech rate and tone: Unremarkable Language: Good Thought content and progression: Unimpaired Tangentiality: none Circumstantiality: none Loose associations: none Flight of ideas: none Delusional: none Difficulty in understanding complex commands: none Gross impairment in thought processes or communication: none Hallucinations: not present Delusions: not present Grossly inappropriate behavior: none Memory: Mild memory loss, such as forgetting names, directions or recent events Attention and concentration: "its shot" Fund of knowledge: Good Intelligence: average Insight and judgment: fair Abstract Reasoning: wnl and a function of intelligence not reduced by mood Obsessive-compulsive: used to be organized , now less so. Sleep impairment: chronic difficulties with delayed onset, has sleep apnea ADLs: no impact from mental disorder Suicidal ideation: in past Homicidal ideation: none Persistent danger of hurting self or others: none Relationships: limited to partner (see social history for details) Has difficulty with people, easily irritated in dealing with others. 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 -------------------------------------------------- MMPI2 RF- profile of questionable validity with some validity scales elevated to the extent that profile interpretation is of limited utility. Veteran endorsed many psychological symptoms on a variety of clinical scales, often reporting moderate to severe levels of intensity. Overall this response pattern may indicate a sense of feeling overwhelmed, though exaggeration of psychological distress cannot be ruled out. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. =========================================================================
  17. How will it take to get a decision after the C&P Exam?
  18. I would like to pass along info i learned about the VA OPC in Manila. First some general info i had my first C and P Exam for my first time FDC claim. Phone number for appointment C and P 02318-8358 or 02-318-8308 to cancel appointment call 02-318-8309 48 hours before or ASAP. toll free number 1-800-1888-8782.You must have an appointment to be seen.You will not get in period outherwise. Travel benifits are POV travel is at 41.5 cent a mile (1KM is 0.62 miles or 1 mile =1.62 KM) Lodging limited to $30 USD.Meals are $3.00 breakfast $5.00 for Lunch and $5.00 for Dinner. Total of $13.00 a day. Must have receipts for all above items. You will be paid in Peso at the daily rate for that day ie the day you filed your claim. I had 3 days of C and P exams all days were filled checked in at 0745 left at 4 PM each day. I have to go back next week to Manila i have appointments at Sto tomas university hospital and the VA OPC any one ever been to Sto Tomas any places to eat close by. The VA staff were great i had no issues at all. Not one single problem. i have heard the stories from friends who deal with QTC contracters in the U.S some good some not so mush. I filed my claim 30Sept 2013 C&P exams in late Nov and early DEC is very fast i know for a fact from friends of mine it is 6 to 9 months waiting on a C&P exam . not in Manila. Myself finish mine in a little over 2 months very good time. The only problem i had in manila were the Taxi cabs not wanting to use the meter and use bond rate only. I got out off over half the cabs in Manila due to this. 500 pesos from the Airport to the VA i got out of the cab right away. There has to be something said about the lack of honesty of half the white Taxi Cab Drivers in Manila it is a shame when half the taxi cab drivers try to steal from people by trying to charge 500 peso for a 100 peso ride. The white taxi cab drivers that use the meter i thanked them for there honesty. Yes i did this is what needed to be done. I used the white cabs only. Half the taxi cabs do not like it when you take a picture of there plates next time i will take a pic of them and if they try to rip me off put it on face book an see what happens. Update 2 I just finished up my C&P exams with the Manila OPC had to go to St Tomas for 5 tests from my last C&P exams in late Nov. The staff at St tomas(STU) was great billing just stamped my loa no questions no problems. The staff that did my test were very knowlageable and professional at all times. There english was spot on no comms problems at all. My thinking on it is that if the VA uses St Tomas why cant tricare and the VA approve hospitals that can be certifed by both VA and tricare oh yea i got in trouble just one time (not realy) in the Navy for common sences thinking that would save time and money of the U.S taxpayer. The only downside is the Manila OPC WILL NOT SEE YOU UNLESS IT IS SC/ Or C&P Exam NO IF ANDS OR BUTS ABOUT IT. I was just thinking it is not the VA that is bad at some places it is some people that give . the VA a bad name you will always hear about the bad ones but the Great and Good not so mush. so that is why i posted this. Take Care Charles
  19. Hi everyone, I have been reading through several posts from people with similar issues. I have a few specific questions that I would love to get feedback on, though I also know that each and every claim is unique and there is no such thing as time frames or standards associated with a VA Disability Claim. However, any advise or personal experience you can share would go a very long way! Background on my story: I was medically separated from the US Air Force after a little over three years, honorably, after being found to be Axis 1 bipolar 2, Axis 2 personality disorder, self-defeating traits, and ADHD by a medical review board at Lackland Air Force Base in 2007. My separation paperwork clearly states that my condition was found to be NOT EXISTING PRIOR TO SERVICE and/or PERMANENTLY AGGITATED BY MILITARY SERVICE. This, I know, is in my favor. I didn't file a claim right away because I was unsure of how to go about it, then later found out that it can be done online, so that is what I did. I opened my claim for bipolar 2/ADHD along with degenerative disk disease (also diagnosed during service,) back in June of 2011 with the Chicago, IL Regional Office. We are coming up on a full year now and I have supplied more than sufficient documentation (including medical records during service, medical records for current treatment, letters of support from family and friends etc.,) and the VA has had it on file now since my claim entered "Review of Evidence" status on October 24, 2011, yet I have had ZERO correspondance from the VA. I have called on several occassions inquiring on the status to no avail. I continue to receive notifications stating that "We continue to review your claim and it will be processed as quickly as possible. We apologize for the inconvenience." I understand that the VA is very far behind due to being under-staffed, and the explosion of claims coming in from soldiers returning home from overseas (God bless them all.) I am not complaining about how long it has taken to this point, but I would like to know if there is a light at the end of this tunnell. Anyone shared in a similar claim that has any insight as to where it will go from here would be fantastic (i.e. will I need to have a C&P Exam since I was diagnosed while in the military and it was found to be not existing prior to service? How much longer might this go? What kind of rating can I expect? etc.) I believe I am at least 50% disabled due to this condition. I am writing this long post because I am going through yet another manic episode, shaking from the Adderall I have to take daily just to remain focused on my job and family. This condition has caused me to distance myself from those who care about me, contributed to several episodes of infidelity with my previous wife (obviously we divorced,) a loss of employment (working again, but was laid off due to work related issues,) extreme mood swings, sleep deprivation, mild memory loss, panic attacks, impussive spending, alcohol abuse, increase in narcasistic tendencies, eating disorders, drug abuse (not illicit drugs, but stimulants,) severe depression and self loathing, self-defeating traits etc. It has been terrible to deal with, needless to say. Not only for me, but for my family as well. I had a really rough experience while in the Air Force and I was both physically and verbally abused quite often, starting in basic training and all the way through my three + years. I began to lash out and fight back which made matters much worse. To this day, while I have fewer stressors, I continue to battle tendencies caused by this disease. I have documented all of these issues for the VA so that is all part of my claim. If you have read my entire rant and haven't run for the hills yet, I applaud you and sincerely appreciate you hearing me out. Like I said earlier, if anyone has any first-hand knowledge as to what I can expect moving forward, it would be wonderful. Here are the questions I would like to get some "best guesses" on: 1. Considering the evidence I have mentioned above, what would be a "reasonable" rating percentage in your best opinion? 2. How much longer can I expect to wait to hear about a C&P Exam, or my claim entering the prep for decision phase (considering the thoroughness of my claim and assuming they have everything they need to make a decision, of course.)? Once again, thank you in advance for any help you may be able to offer. Best Regards.
  20. I have a copy of my mental health C&P exam FINALLY and the diagnoses is as follows; 296.33 Major Depressive Disorder, Recurrent, Severe without psychotic features. Memory Remote Memory: Normal Recent Memory: Mildly Impaired Immediate Memory: Mildly Impaired MMPI-2 was administered - It is noteworthy for extreme elevations on scales 1, 2, and 3. This pattern is often referred to as "conversion V" referring to the tendency of the individual to "convert" psychological disturbances into a preoccupation with physical functioning (huh?), to a degree which exceeds what might be a normal focus in the possible presence of very significant medical issues. In addition to the significant elevation on scale 2 (depression scale), this profile reveals the presence of a sorely depleted reservoir of emotional energy (Man, that sure is true). This scale configuration is associated with a diagnosis of a major depressive disorder. This configuration also indicates the presence of disturbed, ruminative thought processes, as well as vulnerability to excessive use of alcohol. Individuals producing this profile acknowledge that life is a strain, and admit to feelings of depression and despair. They report difficulties with concentration and memory (absolutely) and acknowledge that they worry excessively... Comment on validity of results: Valid. GAF score: 53. Is there total occupational and social impairment due to mental disorder signs and symptoms? No. If there is not total occupational and social impairment, do mental disorder signs and symptoms result in deficiencies in the following areas; Judgment, thinking, family relations, work, mood or school? No. (SERIOUSLY???) Is there reduced reliability and productivity due to mental disorder symptoms? Yes. Examples and pertinent symptoms: The service member is vulnerable to impairments of attention, concentration and short-term memory. He is frequently preoccupied with disturbed, ruminative thought processes. His preoccupation with physical symptoms and concern about his future fuel his depressed mood. Does the patient have panic attacks? Yes. Frequency, severity, duration and effects of functioning; The patient reports periodic panic attacks. More than once per week. Is there presence of suicidal thoughts? Yes. Attention: Attention disturbance (Easily distracted), attention disturbance (Short attention span). Based on the VASRD, I'm not sure if this means a rating of 30% or 50%. Any feedback or questions are welcome. Thanks in advance for your help.
  21. I finally got a copy of my C&P exam and I am trying to interpret the results. I'm hoping to get some help understanding what I'm looking at so any and all feedback is appreciated. The ROM results are as follows; Cervical Spine ROM Flexion: 0 to 30 degrees. Extension: 0 to 39 degrees. Left Lateral Flexion: 0 to 30 degrees. Left Lateral Rotation: 0 to 60 degrees. Right Lateral Flexion: 0 to 30 degrees. Right Lateral Rotation: 0 to 60 degrees. Is there objective evidence of pain on active ROM? No. Additional limitation with repetitive motion; Is there objective evidence of pain following repetitive motion? No. Are there additional limitations after three repetitions of range of motion? No. Thoracolumbar Spine ROM Flexion: 0 to 60 degrees. Extension: 0 to 20 degrees. Left Lateral Flexion: 0 to 20 degrees. Left Lateral Rotation: 0 to 20 degrees. Right Lateral Flexion: 0 to 25 degrees. Right Lateral Rotation: 0 to 20 degrees. Is there objective evidence of pain on active ROM? Yes. Additional limitation with repetitive motion; Is there objective evidence of pain following repetitive motion? Yes. Are there additional limitations after three repetitions of range of motion? Yes. What is the most important factor? Pain. ROM After Repetitive Motion Flexion: 0 to 55 degrees. Extension: 0 to 25 degrees. Left Lateral Flexion: 0 to 15 degrees. Left Lateral Rotation: 0 to 5 degrees. Right Lateral Flexion: 0 to 20 degrees. Right Lateral Rotation: 0 to 5 degrees. Time lost from work during last 12-month period: 8 weeks. Cause: Con leave from back surgery. I didn't type every last word, I just wrote what I think matters. If I missed something or you have a question, please ask. The information regarding my cervical spine seems correct as I haven't had any issues with that part of my back until just recently. I'm getting epidural shots now and may need another surgery but that occurred after the C&P exam. If I'm reading the Thoracolumbar part correct, it seems that I should get a rating of 20% based on the Flexion ROM of 55 degrees or would it be; "Unfavorable ankylosis of the entire thoracolumbar spine......50?" But, since I had spinal fusion of T7-T8, I should get 60% because I missed 8 weeks of work and the VASRD states; "With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months ..... 60" It seems quite confusing to me, I hope someone can clear things up for me...thanks.