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  1. I think that I have enough medical evidence for sizable increase but I don't know for sure or how to word my statement because the medical notes and tests are Greek to me. I don't want to ask my VHA provider to opine. Should I get an IMO? I know that it might be overkill. Or should I get another doc to fill out a DBQ?
  2. I am looking for a little advice on how to proceed with my current claim. After several years of TBI treatment with the local VA hospital, I filed for a TBI claim. I am still awaiting the decision but just received my C-File that I requested a few months ago. From what I can tell, my DBQ DR did a horrible job and I am going to get underrated when the final decision comes. I was in and out within 25 minutes and no testing was performed. Once I told the DR that I had already done Neuropsych testing with the VA hospital the exam ended shortly after. When viewing my C-File and the record of the TBI DBQ exam I noticed that the DR service connected my TBI but didn't accurately record the symptoms identified in the Neuropsych exam. The DR just cut and pasted the Neuropsych summary but missed some ptretty big details from the rest of the report. My DBQ DR listed my TBI symptoms as; - Memory, attention, concentration, executive functions - A complaint of mild memory loss (such as having difficulty following a conversation, recalling recent conversations, remembering names of new acquaintances, or finding words, or often misplacing items), attention, concentration, or executive functions, but without objective evidence on testing. - Motor activity (with intact motor and sensory system) - Motor activity normal - Visual spatial orientation - Normal These results were drastically different from my neuropsych exam which listed the following issues; My neuropsych exam listed severe impairment of several memory functions, processing speed, visual spatial orientation. It also listed mild impairment of motor functioning. I am not able to cut and paste the records I have for the Neuyropsych so I can't give the full report without showing my name. Does anyone have experience with a DBQ that is different from VA treatment records? What should my next steps be? Should i do a higher level review? Hire an appeal lawyer?
  3. So I have always just assumed that you find an Independent medical examiner to perform an Independent Medical Exam that renders his Independent Medical Opinion to provider a NEXUS letter; the Nexus letter being the 1.) inciting event on active duty, 2.) official diagnosis of condition and 3.) the Medical Rational/pathology linking 1 to 2 "more likely than not" . The Caluza elements is a brand new term completely but upon my very basic understanding of these elements....are they not the same 3 elements of a nexus letter? Also while reading through some of the post it kinda seems like maybe IMEs, IMOs, and Nexus reports are not all the same and so now am pretty sure I'm confused. What are the differences and what holds more value in obtaining for a successful claim? Also, is there any value in having both a Nexus letter and a DBQ performed by independent medical examiners? If a nexus letter cost $500 and a DBQ cost $500 and you only have $500..... which one would you buy or would you borrow anther $500 from a friend to get both?
  4. The VA web site doesn't work for me. I get a message that says "The document you are trying to load requires Adobe Reader 8 or higher." Can someone please tell me where I can find the latest MH DBQ?
  5. My last 3 C&P's were ALL done by VES. I know they done show up on Blue Button and I know you can go to the VARO in person to get them printed off for you. Problem is i the closest VARO is over 3 hours away and not doable for me at the moment. I have sent 2 letters to the VARO requesting both my denial letter form 2019 (that will determine if my EED claim is correct or not) and for the C&P exam notes but havent received any correspondence back. Are there any other avenues that anyones knows about that i can get access to these?
  6. Don't know if this has been posted. DBQs back.... https://www.benefits.va.gov/compensation/dbq_publicdbqs.asp
  7. Hello team, I'm about to file my claim for Occipital Neuralgia. I want to use my private doctor with a DBQ. My issue is that I don't know which DBQ to use. There are two neurological DBQs that I think could be the one I need but, they don't list the occipital nerve on them. Can someone that is familiar with this help me? Peripheral Nerve Conditions http://www.vba.va.gov/pubs/forms/VBA-21-0960C-10-ARE.pdf Cranial Nerve Conditions http://www.vba.va.gov/pubs/forms/VBA-21-0960C-3-ARE.pdf I'll also have the doctor fill out the Headaches DBQ since this causes god awful headaches. Thank you in adanced, Stephens
  8. Only musculoskeletal DBQs (back upper and lower, knees, feet, hips, shoulders, arms, hands, etc.). Nothing else. The VA does them for FREE but if you need help (i.e. your claim is taking too long, VA will not examine you, or you need a second opinion), this guy I believe is among the best most qualified orthopedic surgeons I've seen in my life. He will be fair so please bring all your evidence to him. He will get paid no matter the outcome (favorable or unfavorable) of the exam. I felt he was fair on my exam. His contact information: Regional Orthopaedic Medicine: Weiss David DO Address: 201 Woolston Dr, Morrisville, PA 19067, United States Phone:+1 215-736-2410 IMPORTANT: His time is very limited because this practice is very busy. He did 3 (2 for claims for increase and one for new claim) DBQs for me and assured me that he could help other Veterans in a limited basis. He charged me $500 for all 3 which I thought was good. He also prepared a medical opinion for one of them. You should be LOCAL (NJ, PA, or even NY, DE, WV, or be willing to travel or flight to include hotel). You can tell him if you want to that I referred you to him. Please be patient with him as I think he is a really good doctor but found the process with DBQs to be a bit tough, but he did them for me, and said he will help other Veterans if they call and adjust to his busy practice. Just wanted to provide this information in case any Veteran needs it.
  9. I have some questions and wondering what some of your observations are. I had a c and p exam recently and got ahold of the DBQ. All the boxes the doctor checked were good for me. She checked all the right boxes and checked that I had PTSD and all the symptoms they went with it but in some of the comments she made, they seem really bad. So I'm wondering what matters more, the doctors observations or the boxes she checked? I'm rated at 60% currently with anxiety NOS and Tinnitus. I did not initiate the exam for an increase. It was one of the random c&p to see how things are going. This is from the PTSD initial DBQ that she filled out 1) yes 2) PTSD, paranoid personality disorder with avoidant features, other specified anxiety disorder with depressive symptoms 3) a. Yes. B.no 4.) A.Occupational and social impairment with deficiencies In most areas work, school , family relations...etc B. Yes--most impairment is attributed to PTSD and anxiety disorder with paranoia secondary. Under PTSD criteria she checked 2 in A, 3 in b, 2 in c, 6 in D and 4 in E . 6) Argumentative and irritable veteran who is hiding behind his wife and looks at her instead of the examiner; has poor eye contact; unable to tolerate questions without interrogating examiner about "meaning" of question; makes people want to avoid him due to his paranoid arguing. Hopeless attitude; does not accept hopeful comments; arrogant and appears to think he knows more than others; thinking was designed to perceived threat, not to answer questions; emotional overactivity; exaggerated affect; affect constricted; everything annoys him; meds do not touch symptoms and he does not sleep; problems with lack of trust. 7) " he may be playing this up out of a desire to avoid working at jobs that are low pay---he has no job skills and comes from a highly educated family --father is lawyer, sister a geophysicist; he may prefer the sick role, rather than go back to school and stretch himself; there is an element of malingering and playing to an audience." I found this highly offensive because I've been going to the VA for at least 5 years. I didn't initiate the exam so I'm not trying to get more money. However, I wasn't honest in my first c&p in 2011 because I was ashamed and held back a lot of the really bad things I experienced. This time around I made sure that I was brutally honest. I know that I'm supposed to tell them about my "worst" day and how bad it really is and I did. And now my sincerity is questioned? The lady was incredulous that my wife married me even though I didn't have a job and still don't. I said that I don't believe I can work which I don't think that I can because I barely can stand to leave the house and that I hate being around people because I'm constantly thinking in my head that I'm going to be attacked or have to attack someone else. I also don't sleep, I have diagnosed insomnia from the VA. Because of all this I don't think I'd be able to hold down a serious job. Is that crazy? I haven't worked in a long time. I stay at home and take care of our kids. I said something like at least I can feel useful like that. The woman seemed stunned by this. I'll admit I was extremely uncomfortable during the exam because I hate talking about this stuff and prefer to not think about it. And she interpreted it in the way above. Her comments seem contradictory to all of the boxes she checked. If I'm "malingering and playing to an audience" why did she check all of the other boxes? It's driving me crazy. This feels really bad for me. I'm having anxiety attacks almost daily thinking about this. Am I crazy to worry about how this will turn out for me? This woman was in her late 70s or early 80s. The exam was through VES and was done at her in home practice
  10. So, as some know I have been having a little war with the VA and my VSO, the American Legion, about getting my DBQ's. So today I went to the VSO's office in the VARO building during their "walk in" hours since I could not get them to give me an appointment. On the door was as sign saying the office was closed for the week for training and left the 800 number for Washington DC office. I knock on the door anyway. Two ladies answer. Tell them what I want and that I need them to do it today. They invite me into the office. I hand them a typed sheet with the Dates and Dr's of my C&P's and a list of documents for each one that I need. The first lady says she doesn't know why I am there. The second lady says she will help me. The first lady says show me how we do this. Okay I tell them again what I want and the 2nd lady says why do you want to file a NOD, I tell her. She says you don't need these files to file an appeal.......The VA already has them. I tell her I need to know exactly what the DBQ says and what the letters to and from VA says. I also need the code sheets as they existed at each point for each approved and denied C&P. She tells me no i don't and if I insist on filing a NOD I should just file an HLR.. I told her no, that would not work for this and the HLR results are not typically veteran friendly. She then spends 20 minutes more telling me that I need to listen to her because veterans don't know what they want and don't know anything about the VA and how to win their claim. She then says "We work for the VA not for you, and the VA knows what it is doing". this of course makes me mad and I say to her " I am asking you to get me these files. nothing more. I have heard your opinion and all you need to do is get me copies of these files." She then starts in again trying to convince me not to file. I get more insistent and tell her that i heard her but I expect her to do exactly as I requested, nothing more. She then says "Well you don't need those files so let me file the NOD" I tell her NO. Resoundingly empathically NO> She then tells me I know how to file a NOD. She then remembers I am filing a CUE and says "you shouldn't file a CUE because you will never win and then the VA will be mad at you"...... Just f'ing wow. Then I tell her once again to do what I asked her to do and to stop trying to dissuade me from what I want. I tell her she is wasting her time and mine and that all I want is her to get those documents. She then yells to the other woman to get "Bill". Man comes in and says "those are VA files you don't get to have them". I tell him he is wrong and ask who he is. He refuses to answer. I look at woman 2 and say Please tell me your full name so I have a record. She wants to know why. I tell her point blank, that the next time I speak to AL in DC I am going to reference her and what she has said and not done. I then look at "Bill" and ask his name. He tells me 'you don't need to know that". I tell him I do because saying "Bill from AL means nothing to anyone". He snaps back 'I don't work for AL I work for VFW". I ask him why he is sticking his nose into an AL situation? He gets mad and leaves. She writes down her name, at least I think it is her name, date and time . Then says all she is going to do is fill out a FOIA. At this point I decide to let her do that and get a copy to submit with my complaint to the AL. She then asks me what I want. Types that I want my C-file and the files on the attached sheet, prints it, shoves it at me and says to Sign it. I tell her no it is not accurate and ask for a pen and write explicitly what I want. She literally tries to argue with me. I tell her to stop arguing and write the FOIA the way I tell her. She writes it wrong in her own phrasing and i made her redo it. Then I made her add Time is of the essence on the form. When she handed it to me. I initialed before and after the typing and drew a line threw the blank space. She gasped and asked why I did that. I said "its blank space and anyone could add words to that blank space. She then started to say, and got half way through saying 'I needed to put more stuff...." and then shut up as she realized she was admitting to falsifying a FOIA over my signature. I am not sure which is worse, having the people with my POA try and screw me over or having the VA which is supposed to be on my side try and Screw me over.
  11. I'm trying to make it easy for my doctor to help me with my VA claim. I'm filling out my DBQ for Migraines and I'm stuck on Section V 5B. I don't understand the section. Any advice would be much appreciated. Thank you
  12. I'm trying to make it easy for my doctor to help me with my VA claim. I'm filling out my DBQ for Migraines and I'm stuck on Section V 5B. I don't understand the section. Any advice would be much appreciated. Thank you
  13. Hello everyone I am new to the site. And I recent submit a the dbq for an increase for my PTSD and I trying to understand it but im just not getting it. So I figured would ask you all. Below is what the examiner put in the record. Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire Name of patient/Veteran: ========= Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes [ ] No ICD Code: F43.1 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD ICD Code: F43.1 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [X] No c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [X] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with reduced reliability and productivity b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [ ] No [X] No other mental disorder has been diagnosed c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS Evidence Comments: MENTAL HEALTH OUTPATIENT FOLLOW UP NOTE [excerpts] DATE OF NOTE: MAR 05, 2018 AUTHOR: ========,NP NURSE PRACTITIONER CHIEF COMPLAINT: "same old same old" INTERVAL HISTORY: Veteran is here for 6 week follow up for PTSD, Alcohol Use Disorder, unspecified, episodic. At last appointment, low dose venlafaxine was added, aripiprazole, prazosin, and melatonin were continued. He reports symptoms are about the same. His wife is pregnant with twins, so he is trying to minimize arguments at home. He worries he will not be able to connect with the babies, because he struggled so much with his daughter and points to her persistence as the reason they are close now. He see no change in sleep, remains irritable, and more hypervigilant due To recent car break ins on his street. He has cut down on drinking, and denies any binges since last appointment. He continues to have fleeting SI, but denies intent. He often has thoughts of hurting others, but strongly denies acting on the thoughts. No recent hallucinations. He does talk to himself when he is trying to work something out, but denies hearing voices other than his own. It can be embarrassing as coworkers and wife have caught him. ASSESSMENT AND TREATMENT PLAN GOALS: DSM 5 Diagnostic Impression PTSD Alcohol Use Disorder, Unspecified, episodic Goals: 1. Decrease irritability and anger- does not interfere with home or work life more than one time per month, ongoing, improving 2. Improve feeling of connection with others- enjoying and developing relationships, ongoing, no change 3. Decrease avoidance of social situations/crowds- can tolerate Wal Mart, enjoy outings with family, ongoing, no change 4. Improve sleep- no difficulty falling asleep, sleep 6 to 8 hours nightly, ongoing, worsening PLAN AND PROGRESS TOWARDS TREATMENT PLAN GOALS: reviewed records and discussed options - increasing venlafaxine to 75 mg - continuing aripiprazole, prazosin, and melatonin - suggested individual supportive counseling at the Vet Center after Dr. Bhatia leaves. - monitoring labs at next appointment - Will continue to follow closely. RTC 6 weeks/PRN 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: Last C&P PTSD DBQ May 2016 Lives in Moncks Corner, SC with wife of 9 years and daughter age 4. Daily routine: Lay down for bed 2100. Will fall asleep 2300. Wake frequently. "I have to do certain things to calm down. I need my gun next to me. I have to check the house make sure its locked. Make sure the alarm is on. If I hear something, it wakes me right up and I have to check it out." +Nightmares, night sweats. "Sometimes I'm swinging and yelling and talking in my sleep, so my wife leaves for a different room. I wake up and she's not there and it freaks me out." Prescribed melatonin for sleep, prazosin for nightmares. Abilify for PTSD. Diagnosed sleep apnea by sleep study in 2013, prescribed CPAP and is compliant. Relationship with wife: "We almost got divorced a few times. She didn't understand what was going on. She started reading up on it. The whole reason I went to mental health was because of her." Relationship with daughter: "She is scared of me. She has seen me Snap a few times. She is on guard. She doesn't know if I'm going to be up or down. She is my heart. She is the only thing that makes me feel normal." Will watch cartoons and read books together. Hobbies: play basketball, go to gym "but now I just sit in the House watch TV or just in the room." Likes anime. Support: father "he's been with me through everything." And is Veteran too, wife "but there is a wall there where I don't open up." b. Relevant Occupational and Educational history: Working for passport services for 3 years. "Its rough at times. There's a lot of people in there. They had to move my seat because I'm too jumpy. They moved it so I'm not around a lot of people. It is hard to focus. I have to use sticky notes. They have been pretty supportive. I've had good supervisors." Was counselled about days missing for work; "I had a blow up at my co-workers so they spoke to me about that." Miss 2-3 days per month. "When I get to work, I drive around the Building and if I see something I don't like, I just go home." Military history: E4, MP, Separated 2014, Honorable, Served about 6 years. c. Relevant Mental Health history, to include prescribed medications and family mental health: Mental health treatment with prescriber and therapist. No history of hospitalizations. Was in group therapy "but I didn't like it." d. Relevant Legal and Behavioral history: "When I was in Japan I got us into trouble because of my alcohol abuse. I got into a car accident and hit 3 cars." Was sent to ADAP for anger and PTSD. A month ago got into a physical altercation with sister's boyfriend "I laid hands on him. So then I went to a hotel room and stayed there and then I went on a drink binge." e. Relevant Substance abuse history: Alcohol - "I abused it really bad. My PCM said it was affecting My liver." Was drinking4-5 25 oz beers, drink a bottle of liquor over The weekend. Now will drink 1-2 beers. Tobacco - 2-3/day Denies other substances. f. Other, if any: Current reported symptoms: Anger: "I black out and become very violent. I knock TVs off walls. My wife was ready to leave me." Triggers: "foggy day and rain." "Ignorant and stupid people." Social avoidance. "If a car is behind me too long, I start to think he is following me. There is a particular truck that I know and he gets too close to me. I got sick of it and one day I followed him home. I didn't do anything, but I blacked out mad. I knew I needed help." Flashbacks - "I was shopping with my wife, and this guy had a turban on his head and I thought I was back there. Its constant, its all the time." Hygiene - "My wife got on my because I went a week without washing And I didn't even realize it." Suicide - "I thought about driving into traffic at the light. One Time I sped up and got on railroad tracks when a train was coming. I thought, what am I doing? I went into store parking lot." Reports this occurred 2 weeks ago. "I keep a picture of my daughter in the car to keep me from [doing it]." 3. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threatening situations (non-combat related stressors). Do NOT mark symptoms below that are clearly not attributable to the Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] Witnessing, in person, the traumatic event(s) as they occurred to others Criterion B: Presence of (one or more) of the following intrusion Symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing Memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [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] Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined"). [X] Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. [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] Reckless or self-destructive behavior. [X] Hypervigilance. [X] Exaggerated startle response. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Flattened affect [X] Impaired judgment [X] Disturbances of motivation and mood [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Suicidal ideation [X] Impaired impulse control, such as unprovoked irritability with periods of violence [X] Neglect of personal appearance and hygiene 5. Behavioral observations -------------------------- Veteran was open and forthright with no evidence of exaggeration or feigning symptoms. Affect blunted. Minimal eye contact. Speech regular rate, tone, volume. Thought process linear, logical, goal directed. Thought content absent for delusions, hallucinations, paranoia or HI. Endorses SI with no active plan, but drove car onto train tracks last week. Discussed safety, crisis line, Veteran has MHC appointment next week. Veteran reports safety to return home today. 6. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 8. Remarks, (including any testing results) if any: --------------------------------------------------- PCL-5 score 72, indicating probable diagnosis of PTSD. Veteran continues to meet criteria for PTSD. He reports social withdrawal, sleep problems, memory problems, irritability, anger that is both verbal and physical, suicidal thoughts. He has work accommodations because of his PTSD symptoms. He misses several days of work a month because of his symptoms.
  14. Currently rated 10% for GERD and applied for an increase. Had my primary civilian doctor look over my medical records and asked if she would fill out a DBQ. Luckily she did because I know how some doctors would not. Anyone have any guess on if I could be getting an increase or not? Also, does anyone know if I will be scheduled for a C&P as well? It's no problem if I have to go but I just figured with a DBQ then it could easily be fast tracked without having to schedule a C&P since I had already been service connected. Thanks!
  15. I filed an agent orange cad claim by e-file using the option of a fully completed claim on March 5th. I received a 10 per cent disability decision this week. My mistake was I didn’t have my private physician Fill out a DBQ and complete the interview based METS section. My question is can I file another 21-526 EZ adding the new information for my approved 10 per cent by e-file? The approved 10 per cent is based upon medication only. I don’t want to appeal an approved claim and need to know how to correctly update that claim with new information .
  16. PTSD) Disability Benefits Questionnaire Name of patient/Veteran: Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes [ ] No ICD Code: F43.10 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Antisocial personality disorder ICD Code: F60.2 Mental Disorder Diagnosis #2: Opioid use disorder ICD Code: F11.20 Mental Disorder Diagnosis #3: PTSD ICD Code: F43.10 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Deferred to medical 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [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: Antisocial personality disorder is responsible for contentious interpersonal relationships including threats, aggression, assault; failure to accept responsibility; violation of social norms and law; impulsive decisions and behaviors; and affective instability. In the symptom list below antisocial personality disorder is responsible for impaired judgment, disturbance of motivation and mood, difficulty establishing and maintaining effective social/work relationships, difficulty adapting to stressful circumstances, and impaired impulse control. Opioid use disorder has been in institutional remission June 2018, and is not at this time contributing to the symptom picture. Substance use is well known to have deleterious effects on mood, cognition, and behavior. When active, however, these symptoms likely take a predominant role. PTSD is responsible for the remaining symptoms below, which include depressed mood, chronic sleep impairment, and flat affect. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation b. For the indicated occupational and social impairment, is it possible to differentiate which impairment is caused by each mental disorder? [X] Yes [ ] No [ ] Not Applicable (N/A) If yes, list which occupational and social impairment is attributable to each diagnosis: As noted above regarding symptoms, Antisocial personality disorder is primary and PTSD is secondary. c. If a diagnosis of TBI exists, is it possible to differentiate which occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] Not Applicable (N/A) SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder [X] CPRS 2. Recent History (since prior exam) ------------------------------------ a. Relevant social/marital/family history: The veteran last completed a PTSD review DBQ 06/20/17, and he reported that since that exam he has moved from Columbus to Marysville. The veteran currently is in residential programming at Chillicothe VA, hoping for placement in the DOM. The veteran denied his family situation since last exam. Socially, the veteran said he is getting along well with other residents here. His girlfriend and mother visited him here. He said he is made some acquaintances in the programming as well as a couple friends. b. Relevant occupational and educational history: The veteran denied changes in education since last exam. He has completed a GED and some college, and has a license to work with fuel and chemicals for shipping. The veteran denied employment since May 2017. He worked in landscaping prior and occasionally for his mother after that. His mother's business is sales of retail and bank machines. He said his mother arranged his hours to suit him. c. Relevant mental health history, to include prescribed medications and family mental health: The veteran denied pre-military and military mental health treatment. Specifically, he denied a history of hospitalization, suicide attempt, outpatient therapy, and prescription of psychotropic medications prior to about 2001. CPRS and VBMS were reviewed with the following relevant mental health entries. 06/20/17: PTSD review DBQ. MSE: Mood and affect depressed, otherwise normal. Examiner opined significant impairment. 06/14/18: Medical certificate. The veteran requested admission due to depression, suicidal ideation, overdose attempt on Seroquel and alcohol last evening, and hearing voices telling him to kill himself every day. UDS was positive for oxycodone, Suboxone, and cannabinoids. DX: Cocaine dependence; alcohol abuse; cannabis dependence; opioid dependence; PTSD. 06/19/18: Medical certificate. Veteran seen for change in programming. MSE: Normal except for dysphoric affect. d. Relevant legal and behavioral histor y: The veteran denied arrest since last exam, however, he has 3 years and 3 months left on parole. As a juvenile, the veteran was arrested for trespassing, DUI, domestic dispute. He denied being remanded to juvenile detention. During military, the veteran was arrested for underage consumption. He also received NJPs for being late to work (up to 10 hours), possession of pornography, disrespect to a commanding officer, and drinking while on duty. After service, the veteran has been arrested for domestic violence 2, aggravated robbery 3, and theft. He served 10 years in ODRC. While in prison, the veteran reported that he ran the inmate "store" providing drugs, contraband items, and running gambling schemes. He received over 50 tickets for institutional rules violations while in prison. He was released in September 2016. e. Relevant substance abuse history: The veteran reported that historically he has rarely used alcohol, perhaps 1-2 times per month and none since June 2018. The veteran denied use of illicit drugs since June 2018. In the period immediately prior he primarily used narcotics and heroin. f. Other, if any: Nothing further. 3. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threatening situations (non- combat related stressors). Do NOT mark symptoms below that are clearly not attributable to the Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). 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). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined"). [X] Markedly diminished interest or participation in significant activities. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Hypervigilance. [X] Exaggerated startle response. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Chronic sleep impairment [X] Flattened affect [X] Impaired judgment [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Impaired impulse control, such as unprovoked irritability with periods of violence 5. Behavioral observations -------------------------- The veteran presented as guarded. We were able to establish adequate rapport through time. He initiated conversation and elaborated on topics, often to highlight the frequency and severity of symptoms. He was easily re-directed, however. He was cooperative in that he answered all questions asked. The veteran's mood was neutral and stable. His affect was mildly flat and mildly irritable, with limited mobility in range and intensity. The veteran seldom smiled and laughed, and seldom responded to humor. He was not tearful. There was no hopelessness and helplessness evident in his comments. There was no objective evidence of facial flushing, vigilance, arousal, tremor, perspiration, or muscle tension. Speech, thought processes, orientation, attention, and memory all were within expectations. Psychomotor was remarkable for bouncing a leg. Given vocabulary, and educational, employment, and military history, I estimate his IQ in the average range. The veteran denied recent changes in sleep, noting he experiences nightmares about 70% of the time. He appeared alert and rested and did not report functional loss due to sleep problems. He said his appetite is unchanged with some weight increase with abstinence from drugs. Thought content was negative for objective signs of psychosis and the veteran denied same. He also denied suicidal and homicidal ideation, but added "They call it passive SI. I'm getting better at telling people about it." Given several opportunities, the veteran reported current symptoms of: Nightmares; not liking to think about the military event; staying away from crowds; inability to interact with people; increased stress with work; blaming himself for the event happening; being aware of his surroundings; isolating from others; not sleeping well; drug use. The veteran reported abilities indicating that he retains considerable cognitive capacity (physical capacity is not assessed here). When home, he enjoys gardening, growing roses, and mowing his sisters grass. He told that he can drive independently. The veteran said he can perform personal care independently. The veteran told that he can use a calendar, clock, calculator, telephone, and computer. He reported that he can manage money, appointments, and medications, as well as shop and pay bills. For enjoyment he watches TV on his laptop, works out, watches OSU football, and does some light reading. He had good social skills on exam. Socially, the veteran said he is getting along well with other residents here. His girlfriend and mother visited him here. He said he is made some acquaintances in the programming as well as a couple friends. 6. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 8. Remarks, (including any testing results) if any: --------------------------------------------------- ****This forensic report is a legal document intended for the sole use of VBA in determining the veteran's eligibility for compensation and pension. This examination is very different from other psychological examinations, such as for treatment, with considerably different criteria and, thus, often with considerably different diagnoses and outcomes. As such, great caution is needed in interpreting this information and use of this report outside its intended purpose by VHA personnel, VSO, and/or the veteran is STRONGLY discouraged. This examination does not constitute a rating decision. Rating decisions are made solely by the Regional Office after all available data have been reviewed and verified. Note that "The examiner should not express an opinion regarding the merits of any claim or the percentage evaluation that should be assigned for a disability. Determination of service connection and disability ratings for VA benefits is exclusively a function of VBA" (VHA Directive 1046). Thus, any questions or concerns regarding rating decisions should be directed to the Regional Office or an Appeals Board.**** The veteran was seen today for this PTSD Review exam. I verbally provided the usual informed consent regarding: this being a VBA assessment, not treatment; the report becomes a legal document; the forensic role of VBA; the potential outcomes of a review exam; and limits to confidentiality. A written copy of Informed Consent was offered. Throughout the interview the veteran inserted nearly every symptom of PTSD listed in the DSM 5. He noted often that these symptoms are severe and prevent him from interacting with people and working with others. This was not particularly consistent with mental status and functional data. Some patterns of thought developed throughout the interview, such as when the veteran noted that when people try to enforce rules or consequences for his behavior he makes threats and blames them for causing him to use substances. He noted that all his criminal behavior and drug use is due to the military assault, even though he also reported that alcohol and drug use began at an early age, as did arrest. For example, the veteran said that the traumatic event in service caused and or heightened his drug use in response, but he also commented that "I figured out when I was younger that using drugs and alcohol makes problems like that go away." The veteran noted that he was found to have steroids in his jacket while at Bay Pines. He subsequently was discharged from the program. He then interpreted that as "people make me fail. That (being discharged from Bay Pines) put me in a bad place and made me attempt suicide. They deny my individual unemployability because they say I'll get better with treatment, then the treatment kicks me out and I'm worse now." This behavior and thinking is quite consistent with personality disorder. The veteran was diagnosed with PTSD in prior C&P exams, the diagnosis has been carried forward by treatment providers, and by his report continues with sufficient symptoms for the diagnosis. Thus the diagnosis of PTSD continues, as likely as not due to events in military service. Antisocial personality disorder was present well before military service, so it is less likely as not caused by military events, and there is no evidence that this disorder was exaggerated by military events. Also, alcohol and illicit drug use clearly was present prior to enrollment in military, so it is less likely as not caused by military service. There is no evidence that the veteran's substance use was due to events in military service nor has it progressed beyond the normal course for this disorder. Put another way, even if the military event had not occurred it is likely that the resulting pattern of substance use would have been present. Moreover, while there is some equivalence in the literature about the direction of causality when both mental disorder and substance use are present, DSM 5 does not acknowledge any substance use disorder as "due to mental illness," yet there are numerous "substance-induced" mental disorders. INDIVIDUAL UNEMPLOYABILITY The veteran retains considerable residual mental function (physical limitations, if any, are not assessed nor considered here). The veteran can perform personal care independently. He has a driver's license and drives independently. The veteran can use a calendar, clock, calculator, telephone, and computer. He can manage money, appointments, and medications, as well as pay bills. There is no mental disorder that prevents him from attending to, learning, and persisting to complete simple and complex tasks. There is no cognitive dysfunction that would prevent same. His performance on mental status in attention, concentration, memory, abstraction, and thought processes were within expectations for age. The veteran reported limited socialization. Yet, he dated, married, and maintains a current relationship (after divorcing). He maintains some contact with family. Moreover, the veteran was a quite bright, capable, pleasant, cooperative gentleman on exam, and his social skills here were excellent. He reported isolating at home, not liking to be around people, and having difficult relationships through time. The veteran is not a member of any clubs/organizations. Indeed, personality disorder is predictive of contentious interpersonal relationships and the affective instability and impulsive decisionmaking/behavior of the personality disorder may interfere with motivation and concentration.
  17. Been quite awhile since I posted anything... (Last post was this Been in that hurry up and wait limbo status that everyone hates, but after 630 on appeal via DRO process (average time was somewhere between 311 and 400 days I think) I finally receive a letter informing me that I have a disability examination. Since this is my first time through this part of the process I would like some simplified translation of what all of this means. At face value it looks as if it means they are going to look at my records and do an exam. But I also, understand that some of these individuals aren't really working in the best interest of the vet. This fact pretty much is giving me an anxiety attack worrying about it. I know this is irrational, but, with hearing all of the horror stories it isn't surprising to feel this way. I want to be fair and honest going into this exam, but I also know, that by being too "helpful" can actually be detrimental to a claim and getting subsequent medical services (my knees and back are shot). Like with my back, flex, I can only bend about 12 Degrees before I have to bend at the waste. This was measured during therapy I was receiving through private insurance with a galvanometer. I know this doesn't mean a hill of beans when it comes to a VA disability examination. So any tidbits of sage advice would be greatly appreciated (as long as it doesn't mean committing fraud.) I don't know if this will be used as the C&P examination or if this just means a very small step in a "direction" (not necessarily favorable). Thanks for the advice and encouragement Joe
  18. I tried to find the DBQ for TBI from the download list. It is missing in action. Is this because of the revision in process of 38 CFR? I need it to get an neuropsychological assessment done by protocol by a local source. The VA is insisting they cannot use a local contractor and that I must travel to Denver, 3.5 hours away for the assessment. The remand didn't specify it be done by a VA qualified psychologist. Only that it be done in protocol which the last one wasn't. Looks like I'll have to go to the CAVC with this.
  19. After going over my progress notes from c&p I noticed some answers to questions that had different answers that I gave. For instance he said i have tingling down my left leg and not my right leg. After seeing my medical records and knowing how both my legs feel I'm wondering why he said one leg and not both. I know i told him both legs experience about the same amount of pain. I was awarded 10% for my left leg and nothing for my right leg. How shall I confront this issue?
  20. Are there any suggestions or preferred methods on how to approach an independent doctor to perform a VA evaluation for your conditions, service connect an event during service, and fill out a DBQ?
  21. I recently completed my C&P exam on 3/14/17. Can anyone give me some insight on this. Some information I relayed to the Dr. apparently went in one ear and out the other. Any information is helpful. ThanksDBQ ( back ).pdf
  22. I am 70% with ptsd and lumbar strain. I have sinced been diagnosed with DMII, Hypertention and sleep apnea with a cpap machine. How or can I SC any of my diagnoses. Any advice is greatly appreciated.
  23. Hello all, I'm having a hard time finding a Dr willing to fill out VA DBQ forms. Va docs will not fill out I've seen two private orthopedic Dr's. They are to busy to fill out they say. I'm rated 10% each R/L hip bilateral coxa vara, 10% osteoarthritis right knee, 10% osteoarthritis of lumbar spine. My conditions have worsened docs recommend PT, I do twice a week have received shots for pain no relief. My other question the coxa vara was documented prior to enlistment, fit for duty, aggrevated and documented throughout enlistment also at ETS physical. According to AR 40-501 coxa vara is a condition listed. I've been asked by VA Dr how I was even able to join the ARMY. Waiver I suppose. Also the two private docs looked at Mri done 6 yrs ago at Va and noticed torn meniscus, patella something, on knee, scoliosis, herniated discs, alot more things with my back can't remember right now. My hips are uneven causing the domino effect. I'd like to get the increase in what I have now before I submit other secondary claim.Getting frustrated with everyday pain.
  24. HI everyone, I am helping my dad with his recently submitted claim. He requested an increase to his 30% rating from 2003, among other things. On ebennies it has DBQ PTSD Review recommended under "evidence needed." I sent quite a bit of evidence showing worsening conditions since 2003 when I submitted the FDC in December. Will not providing one hold up the process? Does he need to submit this DBQ? If he does, will it take him out of the Fully Developed Claims for submitting new evidence? Thanks for the help as usual.
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