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  1. This is my latest C&P what am I looking at? Can anyone break this down? Neck (Cervical Spine) Conditions Disability Benefits Questionnaire Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No Evidence Comments: BOARD REMAND 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a cervical spine (neck) condition? [X] Yes [ ] No Cervical Spine Common Diagnoses: No diagnosis provided. Diagnosis #1: CERVICO-OCCIPITAL NEURALGIA ICD code: == Date of diagnosis: 9/28/2015 Diagnosis #2: CERVICAL RADICULOPATHY WITH BULGING DISC ICD code: == Date of diagnosis: 2016 Diagnosis #3: MECHANICAL CERVICAL PAIN SYNDROME ICD code: == Date of diagnosis: 4/29/2015 If there are additional diagnoses that pertain to cervical spine (neck) conditions, list using above format: CERVICAL VERTEBRAE(NECK MUSCLE SPASM), DATE OF DIAGNOSIS, 6/25/1996. CERVICAL HERNIATED AND BULGING DISC, MUSCLE SPASM, AND CORD CONTUSION WITH COMPRESSION MYELOMALACIA, 8/14/12 CERVICAL SPONDYLOSIS AND DEGENERATIVE DISC DISEASE, 9/25/2014. On today's C&P examination, 11/21/17, Veteran reports several incidents in 1992-1995 of blunt trauma including carrying 50 caliber machine gun barrels and ammunition. Involved in ground defensive tactic also known as "Bull in the Ring" in which the marine is in full gear and is potentially tackled by several marines. Following this , Veteran incurred concussion-1992 or 1993). Also went to Bethesda for back school(approx. week). Currently, Veteran reports daily neck pain. Denies neck surgery. Denies no recent physical therapy. Uses Flexeril, Ibuprofen, Oxycodone, and Tens unit for pain relief. Last treated by chiropractor in 2016(Tampa Bay, Florida). b. Dominant hand: [ ] Right [ ] Left [X] Ambidextrous c. Does the Veteran report flare-ups of the cervical spine (neck)? [ ] Yes [X] No d. Does the Veteran report having any functional loss or functional impairment of the cervical spine (neck) (regardless of repetitive use)? [X] Yes [ ] No If yes, document the Veteran's description of functional loss or functional impairment in his or her own words: Can't do much of any type of physical activity, that's really limited. Obviously a hindrance, job related stuff. Multiple days off from work(pain, stiffness). Can't do lawn activities. Can't wash dishes. Can't play with your kids like you want to. Sleeping is impossible-Sometimes you have to sleep sitting up in a chair. 3. Range of motion (ROM) and functional limitations --------------------------------------------------- a. Initial range of motion [ ] All Normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Forward Flexion (0-45): 0 to 46 degrees Extension (0-45): 0 to 15 degrees Right Lateral Flexion (0-45): 0 to 23 degrees Left Lateral Flexion (0-45): 0 to 14 degrees Right Lateral Rotation (0-80): 0 to 48 degrees Left Lateral Rotation (0-80): 0 to 44 degrees If abnormal, does the range of motion itself contribute to a functional loss? [X] Yes, (please explain) [ ] No If yes, please explain: Limited bending. Description of pain (select best response): Pain noted on examination and causes functional loss If noted on examination, which ROM exhibited pain (select all that apply)? Forward flexion, Extension, Right lateral flexion, Left lateral flexion, Right lateral rotation, Left lateral rotation Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the cervical spine (neck)? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): Tenderness on palpation of the cervical spine. b. Observed repetitive use Is the Veteran able to perform repetitive use testing with at least three repetitions? [ ] Yes [X] No If no, please provide reason: Unable to perform due to severe pain. c. Repeated use over time Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No If the examination is not being conducted immediately after repetitive use over time: [ ] The examination is medically consistent with the Veteran?s statements describing functional loss with repetitive use over time. [ ] The examination is medically inconsistent with the Veteran?s statements describing functional loss with repetitive use over time. Please explain. [X] The examination is neither medically consistent nor inconsistent with the Veteran?s statements describing functional loss with repetitive use over time. Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: This examiner is unable to opine and would otherwise be speculating to state whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. Therefore this examiner cannot describe any such additional limitation due to pain, weakness, fatigability or incoordination. Furthermore, such opinion is also not feasible to give degrees of additional ROM loss due to "pain on use or during flare-ups" without speculation. d. Flare-ups Not applicable e. Guarding and muscle spasm Does the Veteran have guarding, or muscle spasm of the cervical spine? [X] Yes [ ] No Muscle spasm [X] None [ ] Resulting in abnormal gait or abnormal spinal contour [ ] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: Guarding [ ] None [ ] Resulting in abnormal gait or abnormal spinal contour [X] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: f. Additional factors contributing to disability In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: Less movement than normal due to ankylosis, adhesions, etc. Please describe: Decreased ROM. 4. Muscle strength testing -------------------------- a. Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Elbow flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Elbow extension Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist flexion: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist extension: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Finger Flexion: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Finger Abduction Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 b. Does the Veteran have muscle atrophy? [X] Yes [ ] No If muscle atrophy is present, indicate location: Upper Arm Provide measurements in centimeters of normal side and atrophied side, measured at maximum muscle bulk: Normal side: 37.5 cm. Atrophied side: 36 cm. 5. Reflex exam -------------- Rate deep tendon reflexes (DTRs) according to the following scale: 0 Absent 1+ Hypoactive 2+ Normal 3+ Hyperactive without clonus 4+ Hyperactive with clonus Biceps: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Triceps: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Brachioradialis: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam --------------- Provide results for sensation to light touch (dermatomes) testing: Shoulder area (C5): Right: [ ] Normal [X] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent Inner/outer forearm (C6/T1): Right: [ ] Normal [X] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent Hand/fingers (C6-8): Right: [ ] Normal [X] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent 7. Radiculopathy ----------------- Does the Veteran have radicular pain or any other signs or symptoms due to radiculopathy? [X] Yes [ ] No If yes, complete the following section: a. Indicate location and severity of symptoms (check all that apply): Constant pain (may be excruciating at times) Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Intermittent pain (usually dull) Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Paresthesias and/or dysesthesias Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Numbness Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe b. Does the Veteran have any other signs or symptoms of radiculopathy? [ ] Yes [X] No c. Indicate nerve roots involved: (check all that apply) [X] Involvement of C8/T1 nerve roots (lower radicular group) If checked, indicate: [ ] Right [ ] Left [X] Both d. Indicate severity of radiculopathy and side affected: Right: [ ] Not affected [ ] Mild [X] Moderate [ ] Severe Left: [ ] Not affected [ ] Mild [X] Moderate [ ] Severe 8. Ankylosis ------------ Is there ankylosis of the spine? [ ] Yes [X] No 9. Other neurologic abnormalities --------------------------------- Does the Veteran have any other neurologic abnormalities related to a cervical spine (neck) condition (such as bowel or bladder problems due to cervical myelopathy)? [ ] Yes [X] No 10. Intervertebral disc syndrome (IVDS) and episodes requiring bed rest ----------------------------------------------------------------------- a. Does the Veteran have IVDS of the cervical spine? [X] Yes [ ] No b. If yes to question 10a above, has the Veteran had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months? [ ] Yes [X] No 11. Assistive devices --------------------- a. Does the Veteran use any assistive device(s) as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [ ] Yes [X] No b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided. 12. Remaining effective function of the extremities ---------------------------------------------------- Due to a cervical spine (neck) condition, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc.; functions of the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 13. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No c. Comments, if any: No response provided. 14. Diagnostic testing ---------------------- a. Have imaging studies of the cervical spine been performed and are the results available? [X] Yes [ ] No If yes, is arthritis (degenerative joint disease) documented? [X] Yes [ ] No b. Does the Veteran have a vertebral fracture with loss of 50 percent or more of height? [ ] Yes [X] No c. Are there any other significant diagnostic test findings and/or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): 9/25/2014,MRI Cervical spine:Visibility of the central canal of the cord at the C5 level with diameter of 2mm, not considered to reflect significant syringohydromyelia and not associated with mass or abnormal enhancement. Spondylosis and degenerative disc disease of the cervical spine. Right-sided predominant disc osteophyte complex at C6-7 causes mild right central canal and moderate right neural foraminal stenosis at this level. No other central canal stenosis with milder areas of neural foraminal encroachment detailed above. C2-3:Focal shallow central to right paracentral disc protrusion. No central canal or neural foraminal stenosis. C3-4:Mild generalized disc bulge. Mild right than left neural foraminal stenosis with central canal patent. C6-7:Mild generalized disc bulge with more focal disc osteophyte complex in the right paracentral, right subarticular, and right lateral stations. C7-T1:Negative for disc herniation. 8/14/2012, MRI Cervical spine:Herniated disk C3/4, C5/6, and C6/7 levels. Bulging disk C2/3 and C4/5 levels. Diffuse spondylitic changes. Straightened alignment suggesting muscle spasm. Focal area of cord contusion or compression myelomalacia at C5 level. 15. Functional impact ---------------------- Does the Veteran's cervical spine (neck) condition impact on his or her ability to work? [X] Yes [ ] No If yes, describe the impact of each of the Veteran's cervical spine (neck) conditions, providing one or more examples: Veteran is capable of limited lifting, carrying, and bending. 16. Remarks, if any: -------------------- NOTE:Veteran performed neck flexion repeition which reduced ROM to 32deg. Unable to perform any further repetition for other ROM maneuvers. ************************************************************************* Additional exam request information: For any joint condition, examiners should test the contralateral joint, unless medically contraindicated, and the examiner should address pain on both passive and active motion, and on both weightbearing and non- weightbearing. In addition to the questions on the DBQ, please respond to the following questions: 1. Is there evidence of pain on passive range of motion testing? YES 2. Is there evidence of pain when the joint is used in non-weight bearing? YES **************************************************************************** Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS Evidence Comments: BOARD REMAND MEDICAL OPINION SUMMARY ----------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: (a) Please state all diagnoses as to the Veteran's cervical spine, and address all diagnoses already of record: herniated disk and bulging disk of the cervical spine and spondylitic changes, muscle spasm and contusion/compression, spondylosis and degenerative disc disease of the cervical spine, mechanical cervical pain syndrome and radiculopathy. (b) Please provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed cervical spine disability was caused by or etiologically related to active duty. Please specifically address the back injuries and complaints of back pain noted in the STRs. (c) Please specifically address the Veteran's lay statements that he has suffered cervical spine pain since service, and that in service he suffered injury to his neck while carrying heavy equipment and continuous wear of duty gear. (d) Please address the conflicting evidence of record and offer a clarifying opinion, notably the February 2013 VA examination positing a negative nexus, and the April 2016 private opinion positing a positive nexus. b. Indicate type of exam for which opinion has been requested: NECK 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: Upon review of all available medical evidence, including eVBMS, virtual VA, and Board Remand, the following pertinent information is obtained and reported in 'Evidence Comments': Prior VA Examination, 6/25/96, reports Mr. served in the Marine Corps. he was inducted in 1990 and received separation with an honorable discharge in 1996. Medical History-In 1992, he had onset of pain in the neck area diagnosed at Quantico. Xrays were negative. Impression was muscle spasm and stress. Enlistment RME/RMH for national guard, 4/13/98, reported no neck problems and normal exam of the spine. Miami VAMC, Outpatient clinic, 5/6/2005:Assessment is chronic neck and low back pain-Will get plain films and MRI, does not want any meds. 2/28/2013, VA examination opines "Unable to find SMR evidence of significant neck injury or complaint in service. No evidence to support chronicity of problem for over 10 years post-discharge." THIS OPINION IS GIVEN LOW WEIGHT BECAUSE IT IS NEITHER SUPPORTED NOR CONSISTENT WITH THE RECORDS IN FILE THAT SHOW COMPLAINTS OF NECK PAIN INDICATING A CHRONIC CONDITION. 4/29/15, DBQ neck was completed providing a diagnosis of mechanical cervical pain syndrome and radiculopathy. As received 4/8/16, VA physician, , states that the Veteran suffers from cervico-occipital neuralgia and cervical radiculopathy with bulging disc "are as likely as not a direct result of blunt trauma received during the patient's military career. His conditions are a severe occupational impairment to the veteran and has been exacerbated by many years of continuous wear of duty gear related to his profession." On today's C&P examination, 11/21/17, Veteran is a credible historian and reports several incidents in 1992-1995 of blunt trauma, involving ground defensive tactic also known as "Bull in the Ring" in which the marine is in full gear and is potentially tackled by several marines. Following this , Veteran incurred concussion-1992 or 1993). Veteran also reported chronic neck pain during service was due to carrying 50 caliber machine gun barrels and ammunition. He also went to Bethesda for back school(approx. week). In summary, the Veteran has been under chronic medical care for neck pain first reported during service(6/25/96) and the condition has progressed from cervical muscle spasm to mechanical cervical pain syndrome and radiculopathy, cervical herniated and bulging disc with muscle spasm, cord contusion/compression myelomalacia, cervical spondylosis and degenerative disc disease, cervico-occipital neuralgia, and cervical radiculopathy with bulging disc. A nexus has been established. Therefore, it is at least as likely as not that the claimed condition has direct service connection.
  2. An advice anyone can give would be appreciated. I go in for my first C&P exam for my knee issues. I submitted a FDC with my military medical records showing foot issues, shin splints, and issues with bunions. They wanted to operate on the one bunion but I would have had to reenlist. I also submitted my personal medical records that include my recent MRI reports that show various knee issues. (arthritis, patellar maltracking, meniscus tears...) I received a call to set up my C&P exam about a week after submitted my FDC online. I have been looking online, and found out that if I submit any new paperwork my claim will no longer be a FDC. I wanted to submit the medical report they do when you first enlist that shows everything they document you have wrong with you, and on you. (tattoos, scars, appearance). On this form it shows that I didn't have any bunions when I went in. Then while I was in they got bad enough to see the podiatrist while I was in. I am afraid that connection with my knees will not be there, and cause a denial. Do I bring this medical record with me to the C&P exam in case the doctor ask anything, or even bother showing it to him? Do I wait for the possible denial, and then submit this when I appeal? Should I go ahead and submit this form online, and risk my claim to no longer be a FDC? After submitting my claim, and doing more research online I learned that I shouldn't assume that the reviewers will be able to recognize any secondary conditions. Thanks in advance for any help or advice.
  3. 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. 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
  4. Hello everyone, It has been a while but I finally received my C&P examination for mental health. Currently am 50% for Major Depression, seeking 70%. I went to my examination in stained sweats, faded shirt, flip flops, unshaven, and hair frizzy and not brushed. For some reason, I believe my C&P examiner was wishing I did not come so she could go to lunch early based on her reaction to my arrival and her BSing with the receptionist prior. Anyway, I feel angry after reading her assessment and would like to know what you all think. I think she checked the box for 30% which is a decrease but all the symptoms are 70% looking. It feels really bad she is trying to make me out to be a liar when she doesn't know how I really feel. I have been suicidal, I have made attempts, I have researched the best methods, made plans, etc. The closest I have come is purchasing roper, tying it in a noose, and testing out a bar at work to see if it could support me in hanging myself. But I have really been feeling like crap and feel I have to fight really hard to not let my thoughts become the truth. All things she did not ask. What do you think will happen based on the below exam results? I thank you for your time and responses. CaliBay Mental Disorders (other than PTSD and Eating Disorders) Disability Benefits Questionnaire Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No SECTION I: - - - - - - - - - - 1. Diagnosis - - - - - - - - - - - - a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder? [X] Yes [ ] No ICD code: F33.2 If the Veteran currently has one or more mental disorders that conform to DSM-5 criteria, provide all diagnoses: Mental Disorder Diagnosis #1: Major Depressive Disorder, severe, recurrent ICD code: F33.2 Mental Disorder Diagnosis #2: Generalized Anxiety Disorder, with panic attacks ICD code: F41.1 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): severe sleep apnea 2. Differentiation of symptoms - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [X] Yes [ ] No [ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses Depression - depressed mood, not feeling pain, poor motivation, nightmares, few friends, feel worthless and helpless. Anxiety: doesn't like to leave his house, uncomfortable in crowds, some paranoia shakes c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 3. Occupational and social impairment - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [X] No [ ] No other mental disorder has been diagnosed If no, provide a reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: symptoms of GAD and MDD overlap and it is nearly impossible to differentiate between disorders. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: - - - - - - - - - - - Clinical Findings: - - - - - - - - - - - - - - - - - - 1. Evidence Review - - - - - - - - - - - - - - - - - - Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 2. History - - - - - - - - - - a. Relevant Social/Marital/Family history (pre-military, military, and post-military): The veteran has been married for 25 years, and they have 4 children ages 17, 12, and 7. His father lives at their home, but he is self-sufficient and assists caring for the children. His spouse works at Kohls. b. Relevant Occupational and Educational history (pre-military, military, and post-military): He works for the Federal Government as Transportation Specialist at the GS-11 pay grade. He stated that his supervisor has made a verbal accommodation for his mental disabilities to let him come and go as he pleases including arriving late and leaving early for work for appointments. He states he does not know exactly what he does at work but feels like a government worker that is unqualified for his position and got lucky to obtain his current job. He states he answers email correspondence all day and surfs the Internet. He stated that his duties are not really defined and much of his job requires little effort mentally or physically. He creates spreadsheets in Excel and analyzes financial data for travel. He works from 8:00 am to 5:00 pm. He stated that he has used his all of his vacation and sick time because of his disability. He was out of work on FMLA for three months to receive mental health care and has returned in May 2017 with difficulty adjusting. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): He stated that he was feeling better during for two months in a 12-month period. Since he returned to work, his depression has increased and has frequent panic on a daily basis. He stated that he feels paranoid that someone is out to get him. He feels like he is worthless at work even though his managers have never told him his performance is poor. He does not recall periods of remission and stated that he only remembers all the bad things that have happened to him. He uses a CPAP machine but states he rips it off his face every night due to nightmares. He has always had nightmares of when his daughter passed away and escorting human remains off of military cargo planes. He estimates waking up every hour to check on his children to see if they are still alive. He self-admitted to a Mental Health Hospital for 3 months. He was suicidal and very depressed. He has not seen a Therapist but he has spoken to his Psychiatrist. Nightmares: never decreased, nightly or every other night. His nightmares are of the same theme. No exercise Medical records review: DBQ from private provider Statement from veteran Treatment records from Private Hospital Treatment records from Mental Hospital These records are consistent with a diagnosis of Major Depressive Disorder, and Generalized Anxiety Disorder. Many medications have been tried. He is at low risk of suicide at this point. Current Medication: Wellbutrin Abilify Prozac d. Relevant Legal and Behavioral history (pre-military, military, and post-military): None e. Relevant Substance abuse history (pre-military, military, and post-military): He drinks occasionally and states he is a “light weight” in consuming alcoholic beverages. Sometimes he inhales CO2 from whip cream to get a temporary high. f. Other, if any: No response provided. 3. Symptoms - - - - - - - - - - - For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Chronic sleep impairment [X] Flattened affect [X] Disturbances of motivation and mood [X] Suicidal ideation 4. Behavioral observations - - - - - - - - - - - - - - - - - - - - - - - - - - No response provided. 5. Other symptoms - - - - - - - - - - - - - - - - - Does the Veteran have any other symptoms attributable to mental disorders that are not listed above? [ ] Yes [X] No 6. Competency - - - - - - - - - - - - - Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 7. Remarks (including any testing results), if any: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - This 45-year-old veteran still struggles with depression and anxiety. I cannot diagnose him with PTSD because it appears to be secondary to MDD. He has not seeked therapy other than admitting himself to a Mental Health Facility. The veteran has been advised to get help for his symptoms and he has not complied. There doesn't appear to be any changes in his mental health status. The fact that this veteran continues to work without incident suggests that he may be functioning better than what he is showing. I recommend that this veteran receives intensive therapy and be re-evaluated after a year of consistent treatment.
  5. 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?
  6. This is EXTREMELY humiliating but I don't know where else to go for anonymous help. Please be gentle, I'm not proud of my past. I had posted in the PTSD forum, but I can be more specific here since my issues stem from MST. I have some issues from my childhood, I do have a psych history including suicide attempt at age 9 (which I didn't even remember until after I was at my first duty station), verbally and possibly physically abusive step fathers (5 total), my mother walked out several times when I was a child and told my dad she didn't want me and wouldn't call me for months, my step-brother sexually abused me when we were around 7 years old, I was in a rehab center for teens for cutting myself when I was 12...I lost my virginity to alcohol induced rape at 17 and joined the marines about a year and a half later to make something of myself. I was involved in a party after boot camp when I was in my MOS school and a group of army guys passed myself and my drunk friend around at a party and had their way with us. I started having a lot of problems after that and became a heavy alcohol user and extremely promiscuous the next 4 years of my enlistment. Most of my encounters happened when I was too drunk to remember or even walk for that matter. I had been diagnosed with Borderline Personality Disorder about 4 months into my first duty station and I never reported to my psych doctors that I was drinking like I was...most of the time I denied I drank at all. I told them about what happened as a child but would never bring up things that were happening in service out of humiliation, guilt, pain, fear that it would get back to my command and I would be reprimanded or mocked or looked down on more than I already was. I was the 'barracks whore'. I was hospitalized several times in service and often had counseling from my command, got very overweight, caught chlamydia once and begged for hysterectomy and tubal procedures which were all denied. I had a restraining order from my gysgt for homicidal thoughts towards him and got married to a man i knew for a month to get off base. After I got a medical separation for my back I ended up homeless in Denver, on acid (which I won't tell my councilors now in fear that it will hinder me getting compensation for the PTSD from MST), divorced and remarried, hospitalized a few more times, and now I am involved with CPS because we just had our first child and I am scared to be alone with him because I get so angry. I am petrified of being around men, my sex life with my husband doesn't exist, my emotional problems cause a huge disconnect in our marriage that we are fighting to keep... My C&P exam states that I have BPD not PTSD and that what I said at the exam (which wasn't much at all) was inconsistent with what was reported over the years. I feel like the 'doctor' conducting the exam did the 'Develop to Deny' trick, he was contradictory in his report, made some false statements, and denied me. I told him about the first incident in MOS school, but apparently that wasn't enough for him to think that I was affected at all. I have around 10 buddy statements ranging from family and friends that knew me prior to service to buddies that I actually served with that were BRUTALLY honest in their reports. My therapist says I definitely have PTSD, but she can't differentiate what is from childhood and what is from MST. I don't know what to do, I'm afraid anything I say will be misconstrued and that I'm ever going to get my PTSD rating. Also, for the test portion my report says, "MMPI2RF-Invalid profile (F z=1.53, Fp z=2.15, Dsrf z=1.94); clinical scales cannot be interpreted." --what the heck do those codes mean?
  7. 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
  8. I have a C&P on March 14, and wanted to know can i bring additional information to submit to the examiner to help with my claim? And If so do they suppose to take that into consideration?
  9. I visited my local DAV ( which was a f*%&#ng joke ) for assistance with filing a claim. He was so distracted with other things like talking on the phone and playing on the computer. Anyways, when he filed my claim he did not submit all of the dr"s notes that I had and he filed a FDC. My question is how can i submit the other information without making it a regular claim or can I wait and just bring it to the c&p exam. Thanks in advance.
  10. so my claim was submitted on 12/12/2016. I submitted for bipolar/depression (reopen) and tinnitus (new). I sent it in as an FDC with all my evidence. I checked ebenefits on 12/21/2016 and the status is already showing preparation for decision. Is this normal? I haven't even gone to a c&p exam, I haven't recieved any correspondences or anything. For the bipolar depression it is a reopen because when i first filed in 2011, I missed my appointment. After I missed my appointment, the VA sent me papers (back in 2011) saying that they see that i was treated for depression during active duty. but since i failed to show up to the appointment, it was denied. So now i've sent a ton of new evidence that supports my claim and they've reopened the case. But does the speed with which this is progressing means that i am being denied? As noted below, ebennies is showing that the va rep has already made a decision, in less than two weeks. With no exams or anything... What does this mean... Is this normal? have i been denied? Is there a phone number i can call?? im freaking out. Here's what ebenefits show: Estimated Completion: 01/24/2017 - 03/04/2017 STATUS: Preparation For Decision The Veterans Service Representative has recommended a decision, and is preparing required documents detailing that decision. If more evidence is required, the claim will be sent back in the process for more information or evidence
  11. I am currently rated at 50% for PTSD and just had my C&P exam for an increase. Below is my current C&P results. Any input would be appreciated on to what my outcome may be. Thank you SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes[ ] No 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD, moderate to severe, chronic Comments, if any: The trauamtic event was learning that a close friend of his killed two older female civilians. PTSD also causes secondary panic attacks 2-3 times per week. 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 ------------------ 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 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) [X] 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? [X] Yes[ ] No If yes, describe: On 11/25/2014, Dr. XXX conducted a C&P Initial Evaluation for PTSD and diagnosed the veteran with PTSD with panic attacks. 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: Mr. XX is currently married to his wife of 10 years. He describes the quality of his current marriage as, "loving - but my wife puts up with me." He reports his irritability and anger can stress his wife. He adopted his wife's 14 year old daughter. He reports he has no friends of his own, but he reports he is friendly with many of his wife's friends. He tends to avoid crowds and group social activities. He is quite close with his parents. His main hobby is drumming and working on computers. Overall his social support is limited. He reports that the primary effect of his psychiatric symptoms on his social relationships are tension and distance caused by irritability, rage (including yelling, swearing, and very occasional violence towards inanimate objects - like punching a hole in the door), withdrawal, and emotional numbing. b. Relevant Occupational and Educational history: Mr. XXX highest level of education is some college. He served in the Airforce. He is currently employed as a cyber security analyst at XXX a telecommunications company called XXX. He has worked at XXX since 2011. In 2012, he was written up for "going off on a customer." He reports he works from home or calls in sick 4-5 days a month due to feeling stressed. He reports during times of stress he impulsively loses his temper when talking with customers or makes careless mistakes. He is a lead, and he has five other analysists who report to him. c. Relevant Mental Health history, to include prescribed medications and family mental health: Mr. XXX denied history of psychiatric hospitalization, receiving out-patient therapy, receiving any type of psychopharmacological treatment, or prior suicide attempts. He has been referred to a psychiatrist by his PCP but he is not currently engaged in therapy. He receives medication management from his private PCP, and he is currently maintained on a regimen of Zoloft, hydroxyzine, prazosin and diazepam. d. Relevant Legal and Behavioral history: No arrests. Received an article 15 in the military after he learned of the murders. e. Relevant Substance abuse history: No response provided. f. Other, if any: No response provided. 3. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threatening situations (non-combat related stressors.) Do NOT mark symptoms below that are clearly not attributable to the Criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in one or more of the following ways: [X] Witnessing, in person, the traumatic event(s) as they occurred to others [X] Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] 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. [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] 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] 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 5. Behavioral Observations: --------------------------- Mr. XXX was casually dressed, and was cooperative throughout the examination. His speech was fluent. His psychomotor behavior was appropriate. His affect was constricted and his mood was anxious. His insight was intact. Thought process was linear, goal directed, and future oriented. No reported hallucinations or delusions. No reported homicidal or suicidal ideation. 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: --------------------------------------------------- Veteran's PTSD and panic attacks currently cause moderate socio-occupational impairment.
  12. I am currently rated at 50% for PTSD and just had my C&P exam for an increase. Below is my current C&P results. Any input would be appreciated on to what my outcome may be. Thank you SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes[ ] No 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD, moderate to severe, chronic Comments, if any: The trauamtic event was learning that a close friend of his killed two older female civilians. PTSD also causes secondary panic attacks 2-3 times per week. 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 ------------------ 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 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) [X] 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? [X] Yes[ ] No If yes, describe: On 11/25/2014, Dr. XXX conducted a C&P Initial Evaluation for PTSD and diagnosed the veteran with PTSD with panic attacks. 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: Mr. XX is currently married to his wife of 10 years. He describes the quality of his current marriage as, "loving - but my wife puts up with me." He reports his irritability and anger can stress his wife. He adopted his wife's 14 year old daughter. He reports he has no friends of his own, but he reports he is friendly with many of his wife's friends. He tends to avoid crowds and group social activities. He is quite close with his parents. His main hobby is drumming and working on computers. Overall his social support is limited. He reports that the primary effect of his psychiatric symptoms on his social relationships are tension and distance caused by irritability, rage (including yelling, swearing, and very occasional violence towards inanimate objects - like punching a hole in the door), withdrawal, and emotional numbing. b. Relevant Occupational and Educational history: Mr. XXX highest level of education is some college. He served in the Airforce. He is currently employed as a cyber security analyst at XXX a telecommunications company called XXX. He has worked at XXX since 2011. In 2012, he was written up for "going off on a customer." He reports he works from home or calls in sick 4-5 days a month due to feeling stressed. He reports during times of stress he impulsively loses his temper when talking with customers or makes careless mistakes. He is a lead, and he has five other analysists who report to him. c. Relevant Mental Health history, to include prescribed medications and family mental health: Mr. XXX denied history of psychiatric hospitalization, receiving out-patient therapy, receiving any type of psychopharmacological treatment, or prior suicide attempts. He has been referred to a psychiatrist by his PCP but he is not currently engaged in therapy. He receives medication management from his private PCP, and he is currently maintained on a regimen of Zoloft, hydroxyzine, prazosin and diazepam. d. Relevant Legal and Behavioral history: No arrests. Received an article 15 in the military after he learned of the murders. e. Relevant Substance abuse history: No response provided. f. Other, if any: No response provided. 3. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threatening situations (non-combat related stressors.) Do NOT mark symptoms below that are clearly not attributable to the Criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in one or more of the following ways: [X] Witnessing, in person, the traumatic event(s) as they occurred to others [X] Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] 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. [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] 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] 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 5. Behavioral Observations: --------------------------- Mr. XXX was casually dressed, and was cooperative throughout the examination. His speech was fluent. His psychomotor behavior was appropriate. His affect was constricted and his mood was anxious. His insight was intact. Thought process was linear, goal directed, and future oriented. No reported hallucinations or delusions. No reported homicidal or suicidal ideation. 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: --------------------------------------------------- Veteran's PTSD and panic attacks currently cause moderate socio-occupational impairment.
  13. Hi, I am currently rated at 20% for my shoulder. I went in for a CP exam recently and these were the results. This is a remand exam from the BVA. Am I looking at a decrease to 10 or even zero? I am not bending my shoulder so it may dislocate for any of these people or any examination and I think it may have hurt me. If you could take a look I'd appreciate it. Thanks for your time! Shoulder and Arm Conditions 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 ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 1. Diagnosis ------------ a. List the claimed condition(s) that pertain to this DBQ: Strain with radicular sx b. Select diagnoses associated with the claimed condition(s) (check all that apply): [X] Shoulder strain Side affected: [ ] Right [X] Left [ ] Both ICD Code: S46.019A Date of diagnosis: Left UNK- S/C c. Comments, if any: No response provided d. Was an opinion requested about this condition? [ ] Yes [X] No [ ] N/A 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's shoulder or arm condition (brief summary): *** Note - Veteran was notified that this evaluation is for Compensation and Pension purposes only and he/she is to return to his/her treating clinician for regular medical care =========================================================================== ===== Veteran served in the US Army as a Cav Scout E-5 from 1988-1996 - reports that he is s/c for L shoulder strain with radicular sx. Reports current condition includes the following sx- L shoulder Pain- intermittent Daily lasting 10 minutes to hours 3-7/10 dull to sharp depending on activity Dislocations - Last occurred was 3 years ago - has popping and clicking, sensation of weakness Reports constant L lateral 1st metatcarpal numbness Has additional numbness from axillary region to the Lateral aspect of the L 1st metacarpal- occurs 3-5 x weekly lasting 10 minutes to 2 hours Condition impacts Occupation/Recreation/Daily activities- Limits carrying, lifting, pushing, pulling and overhead work Current Tx Type Duration Response to Medications 1. Medications OTC ASA, Tylenol, Advil as directed PRN- fair results 2. Denies Physical therapy Occupation since discharge- HVAC mechanic now on SSDI since 2013 2. DOMINANT HAND: right 3. POSTURE & GAIT: straight; gait stable, smooth, symmetric b. Dominant hand: [X] Right [ ] Left [ ] Ambidextrous c. Does the Veteran report flare-ups of the shoulder or arm? [X] Yes [ ] No If yes, document the Veteran's description of the flare-ups in his or her own words: L shoulder Pain- intermittent Daily lasting 10 minutes to hours 3-7/10 dull to sharp depending on activity Dislocations - Last occurred was 3 years ago - has popping and clicking, sensation of weakness Reports constant L lateral 1st metatcarpal numbness Has additional numbness from axillary region to the Lateral aspect of the L 1st metacarpal- occurs 3-5 x weekly lasting 10 minutes to 2 hours Condition impacts Occupation/Recreation/Daily activities- Limits carrying, lifting, pushing, pulling and overhead work Pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. Veteran would have additional limitations in ROM but unable to quantify the degree of ROM loss as it would vary due to severity of pain , weakness, fatigability and overuse. d. Does the Veteran report having any functional loss or functional impairment of the joint or extremity being evaluated on this DBQ (regardless of repetitive use)? [X] Yes [ ] No If yes, document the Veteran's description of functional loss or functional impairment in his or her own words: L shoulder Pain- intermittent Daily lasting 10 minutes to hours 3-7/10 dull to sharp depending on activity Dislocations - Last occurred was 3 years ago - has popping and clicking, sensation of weakness Reports constant L lateral 1st metatcarpal numbness Has additional numbness from axillary region to the Lateral aspect of the L 1st metacarpal- occurs 3-5 x weekly lasting 10 minutes to 2 hours Condition impacts Occupation/Recreation/Daily activities- Limits carrying, lifting, pushing, pulling and overhead work Pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. Veteran would have additional limitations in ROM but unable to quantify the degree of ROM loss as it would vary due to severity of pain , weakness, fatigability and overuse. 3. Range of motion (ROM) and functional limitation -------------------------------------------------- a. Initial range of motion Left Shoulder ------------- [ ] All Normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0 to 180): 0 to 130 degrees Abduction (0 to 180): 0 to 150 degrees External rotation (0 to 90): 0 to 90 degrees Internal rotation (0 to 90): 0 to 90 degrees If ROM is outside of normal range, but is normal for the Veteran (for reasons other than a shoulder condition, such as age, body habitus, neurologic disease), please describe: Veteran refuses to move L shoulder beyond stated range due to fear of pain and dislocation- poor effort If abnormal, does the range of motion itself contribute to functional loss? [X] Yes (please explain) [ ] No If yes, please explain: limits ROM Description of pain (select best response): Pain noted on exam and causes functional loss If noted on exam, which ROM exhibited pain (select all that apply)? Flexion, Abduction Is there evidence of pain with weight bearing? [ ] Yes [X] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [ ] Yes [X] No Is there objective evidence of crepitus? [ ] Yes [X] No b. Observed repetitive use Left Shoulder ------ ------- Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional functional loss or range of motion after three repetitions? [ ] Yes [X] No c. Repeated use over time Left Shoulder ------------- Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. Veteran would have additional limitations in ROM but unable to quantify the degree of ROM loss as it would vary due to severity of pain , weakness, fatigability and overuse. d. Flare-ups Left Shoulder ------------- Is the exam being conducted during a flare-up? [ ] Yes [X] No If the examination is not being conducted during a flare-up: [ ] The examination is medically consistent with the Veteran's statements describing functional loss during flare-ups. [ ] The examination is medically inconsistent with the Veteran's statements describing functional loss during flare-ups. Please explain. [X] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups. Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. Veteran would have additional limitations in ROM but unable to quantify the degree of ROM loss as it would vary due to severity of pain , weakness, fatigability and overuse. e. Additional factors contributing to disability Left Shoulder ------------- In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: Less movement than normal due to ankylosis, adhesions, etc., Other (please describe) Please describe additional contributing factors of disability: Condition impacts Occupation/Recreation/Daily activities- Limits carrying, lifting, pushing, pulling and overhead work 4. Muscle strength testing -------------------------- a. Muscle strength - Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Right Shoulder: Rate Strength: Forward flexion: 5/5 Abduction: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No Left Shoulder: Rate Strength: Forward flexion: 5/5 Abduction: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No b. Does the Veteran have muscle atrophy? [ ] Yes [X] No c. Comments, if any: No response provided 5. Ankylosis ------------ Complete this section if the Veteran has ankylosis of scapulohumeral (glenohumeral) articulation (shoulder joint) (i.e., the scapula and humerus move as one piece). a. Indicate severity of ankylosis and side affected (check all that apply): Left side: [ ] Ankylosis in abduction up to 60 degrees; can reach mouth and head (Favorable ankylosis) [ ] Ankylosis in abduction between favorable and unfavorable (Intermediate ankylosis) [ ] Ankylosis in abduction at 25 degrees or less from side (Unfavorable ankylosis) [X] No ankylosis b. Comments, if any: No response provided 6. Rotator cuff conditions -------------------------- Is rotator cuff condition suspected? Right Shoulder: [ ] Yes [ ] No Left Shoulder: [X] Yes [ ] No If "Yes" complete the following: Hawkins' Impingement Test (Forward flex the arm to 90 degrees with the elbow bent to 90 degrees. Internally rotate arm. Pain on internal rotation indicates a positive test; may signify rotator cuff tendinopathy or tear.) [ ] Positive [X] Negative [ ] Unable to perform [ ] N/A Empty-can Test (Abduct arm to 90 degrees and forward flex 30 degrees. Patient turns thumbs down and resists downward force applied by the examiner. Weakness indicates a positive test; may indicate rotator cuff pathology, including supraspinatus tendinopathy or tear.) [ ] Positive [X] Negative [ ] Unable to perform [ ] N/A External Rotation/ Infraspinatus Strength Test (Patient holds arms at side with elbow flexed 90 degrees. Patient externally rotates against resistance. Weakness indicates a positive test; may be associated with infraspinatus tendinopathy or tear.) [ ] Positive [X] Negative [ ] Unable to perform [ ] N/A Lift-off Subscapularis Test (Patient internally rotates arm behind lower back, pushes against examiner's hand. Weakness indicates a positive test; may indicate subscapularis tendinopathy or tear.) [X] Positive [ ] Negative [ ] Unable to perform [ ] N/A 7. Shoulder instability, dislocation or labral pathology -------------------------------------------------------- a. Is shoulder instability, dislocation or labral pathology suspected? [X] Yes [ ] No If yes, complete questions 7b - 7d below: b. Is there a history of mechanical symptoms (clicking, catching, etc.)? [X] Yes [ ] No If yes, indicate side affected: [ ] Right [X] Left [ ] Both c. Is there a history of recurrent dislocation (subluxation) of the glenohumeral (scapulohumeral) joint? [X] Yes [ ] No If yes, indicate frequency, severity and side affected (check all that apply): [X] Infrequent episodes [ ] Right [X] Left [ ] Both [X] Guarding of movement only at [ ] Right [X] Left [ ] Both shoulder level d. Crank apprehension and relocation test (with patient supine, abduct patient's arm to 90 degrees and flex elbow 90 degrees. Pain and sense of instability with further external rotation may indicate shoulder instability.) [ ] Positive [X] Negative [ ] Unable to perform [ ] N/A 8. Clavicle, scapula, acromioclavicular (AC) joint and sternoclavicular joint conditions ------------------------------------------------------------------------------ a. Is a clavicle, scapula, acromioclavicular (AC) joint or sternoclavicular joint condition suspected? [X] Yes [ ] No If yes, complete questions 8b, 8d and 8e below: b. Does the Veteran have an AC joint condition or any other impairment of the clavicle or scapula? [ ] Yes [X] No c. Does the clavicle or scapula condition affect range of motion of the shoulder (glenohumeral) joint? No response provided d. Is there tenderness on palpation of the AC joint? [ ] Yes [X] No e. Cross-body adduction test (Passively adduct arm across the patient's body toward the contralateral shoulder. Pain may indicate acromioclavicular joint pathology.) [ ] Positive [X] Negative [ ] Unable to perform [ ] N/A 9. Conditions or impairments of the humerus ------------------------------------------- a. Does the Veteran have loss of head (flail shoulder), nonunion (false flail shoulder), or fibrous union of the humerus? [ ] Yes [X] No b. Does the Veteran have malunion of the humerus with moderate or marked deformity? [ ] Yes [X] No c. Does the humerus condition affect range of motion of the shoulder (glenohumeral) joint? No response provided d. Comments, if any: No response provided 10. Surgical procedures ----------------------- No response provided 11. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ------------------------------------------------------------------------ a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No c. Comments, if any: No response provided 12. Assistive devices --------------------- a. Does the Veteran use any assistive devices? [ ] Yes [X] No b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided 13. Remaining effective function of the extremities --------------------------------------------------- Due to the Veteran's shoulder and/or arm conditions, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc., while functions for the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 14. Diagnostic testing ---------------------- a. Have imaging studies of the shoulder been performed and are the results available? [X] Yes [ ] No If yes, is degenerative or traumatic arthritis documented? [ ] Yes [X] No b. Are there any other significant diagnostic test findings or results? [ ] Yes [X] No c. If any test results are other than normal, indicate relationship of abnormal findings to diagnosed conditions: No response provided 15. Functional impact --------------------- Regardless of the Veteran's current employment status, do the condition(s) listed in the Diagnosis Section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)? [X] Yes [ ] No If yes, describe the impact of each of the Veteran's shoulder conditions providing one or more examples: Condition impacts Occupation/Recreation/Daily activities- Limits carrying, lifting, pushing, pulling and overhead work 16. Remarks, if any: -------------------- Impression- 1. L shoulder strain with residuals of radicular sx as noted- Veteran refused to move L shoulder beyond stated range due to fear of pain and dislocation
  14. I e-mailed my DAV representative yesterday. I have a C&P exam this Friday. I asked him if I should bring in my buddy statements, awards, Release of [medical] Information, my DD Form 2807-1 (which shows I asked the Regimental Medical Officer that I was seeking help/advice for reoccuring nightmares that stemmed from a military operation the pentagon 9/11). The Rep responded, "You do not want to submit anything at this time, getting the exam is a huge step, because if they did not verify your stressor they would not have requested the exam". My Question: So, should I not bring my medical records for proof? In the beginning, It was my understanding that I would want to bring in as much information as possible.
  15. 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!
  16. So here is my predicament. I'm 70% service connected with PTSD and have been for almost four years now. I recently received a phone call from the QTC Corporations asking me if I was available for an appointment. I asked them what it was about. They said the VA is now "outsourcing" their patients and I was on the list. My question is this. If I already have my rating why do I need to go to the QTC? I've got my rating and I go to the VA as much as possible, not as much as they would like me to BUT I do go(think the last time was over a year ago). I'm all anxious about this shit and its causing me stress I do not need. Can the VA be trying to reduce my rating? Is that possible?
  17. He takes his glasses off, looks at me and says "son, you're rated at 90%, you could have been rehabbing your knees for the past 4 years free of charge. Some of those DAV guys are good, but some of them are idiots" At this point, I was extremely frustrated and may have slipped out a few expletives at a louder than normal tone. He told me "son, talk to your primary physician about getting seen by a specialist and ask to get an MRI because you're knee looks somewhat okay, but I imagine an MRI might reveal something else that will explain the pain. Regardless of what happened, we'll take care of you, I know it's been a long journey, but hang in there and have faith. Also, how's your migraines? I see you're rated at 30%, but if they've gotten worse, you should file for an increase. Anyways, hang in there son and I'll make sure I put the info gathered from the exam in today" He was extremely caring and pro active, which is something that I am NOT used to with the VA. I don't have as many complaints as some you guys out there, but still, it hasn't been easy. I just wanted to share this story and hopefully I'll get the rating I deserve - since it's a bilateral diagnose, wouldn't I get a rating for each + 10%? Lord willing, if that happens, I should be pushed to 100% according to Hutsky's excel spreadsheet. That will help my family and I out so much! I am glad I am not in this fight alone and if it wasn't for a bunch of you, I would be in a darker place. Thanks - you guys don't know how much you've done for me. Brothers in arms!
  18. looking for a little knowledge or an opinion that i dont already have,( make the vet think somethings happening but we are really just screwing him__) so, my claim is currently waiting a BVA judgment ( yes its been in appeal for years and yes ive had the hearing now just waiting on a judgement) so. i handed my increadable IMO to the hearing majistrate so that they could give me a waiver form to sign saying that the RO doesnt need to see first. then i sent The imo to The RO so that i cover all my bases. Now, the RO wants a new C+P exam/ the judge has yet to offer his opinion and all the ro in my opinion is wanting to rebuke the imo before anything comes down the pipe. my question is ,,, should i go to the C+P or as them to wait for the judge decision or do i even havae that option.?
  19. My CPE Exam

    OK - I went to my CPE Exam yesterday (at Iowa VA). First - the examination wasn't conducted by a Physician but a Physician Assistant...whatever. At least he was a 32 year retired Vet! However - I put on this 'gown' and then laid back on the table so that my ankle and two knees could be inspected. As hard as it is to believe and based on the extensive nature of my claim in these three areas, this part of the exam took less than 30 seconds. The guy then said HE would be charged with rating my injuries. Should I be concerned? Next - for some reason - I had the ORIGINAL copies of my separation exam from 1994. It wasn't in my file I guess. I offered them up and the examiner took them although they were a part of the FDC process. These documents support some of my claim anyway. Now for the big issue - the Iowa VA said they have no 'eye examiner' provider at this point so no appointment was scheduled by the regional office. This was frustrating that I drove so far and couldn't get this portion of my exam done. Thoughts? I've read that often-times unless there is some form of traumatic eye injury, this claim my be rated at 0% due to aging. However; I think my case is a bit different in that I had 20/20 vision when entering the military and just a year later, I required glasses and were thus issued in service. Any ratings speculation would be appreciated. Last - my PTSD (like eye exam) wasn't ordered by the Regional Office either. Does PTSD exams take longer to complete or something? Will a rating decision be given without these two exams? Although a bit before my time - I want to say a special thank you to Vietnam Vets for your service! They seem to be the dominate population at the VA Hospital while I was there.
  20. Gw Exam

    Howdy, I've got a GW exam in a few weeks, and was wondering if there's anything I should know before going in? Also, does bringing in pre-filled DBQs help? I know they'll use their own, but I've read on here from multiple posters that the VA often skimps on these and doesn't always accurately document the conditions. By bringing in pre-filled forms I was hoping to just hand them a copy as we went through the questions so that there's no room for miscommunication. Thanks
  21. 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.
  22. Folks: I need advice on a possible service connection or status? I was injured while in the Army with a Tank Main Gun Blast 105mm Accident in 1985 but a Line of Duty was never done or initiated in my case/or for the incident. However, it was reported to the Range Safety Officer who was in charge at the time? I have the SMRs that show I was clearly injured and treated for the injuries for the blast while in service. Consequently, an inexperienced mechanic from the battalion maintenance crew working on my M60 A3 Tank Firing System, caused the accident in the first place. The battalion maintenance crew was supposed to remove the firing pin before they started troubleshooting the secondary firing system that eventually malfunctioned causing the tank to fire unexpectedly? Also if there was an investigation, the Range Safety Officer would most likely have been the one held responsible for the incident? Unfortunately, I ended being in the front of the tank by the front end of the main gun barrel when a hang-fire 105 MM round went off which put me at the wrong place at the right time. I was injured significantly almost 30 years ago by the blast and it also ruptured my right eardrum, damaged my hearing and injured my head, neck and back. Also, it was clearly an accident an no willful intent to do anything wrong by anyone at the time? So, again if there was never a LOD conducted by my chain of command and no investigations, either formal or informal at the time but the accident and the treatment clearly happened with good SMR evidence in my files. So does anyone have experience with seeing this type of thing before being classified as service connected or not in the past ? Today I saw something in the internet from a Legal Firm that supports Vet Claims that said if there was never an LOD and a soldier was clearly injured while in service, that there's a presumption that and incident like this "was in the Line of Duty then? From what I have found, it was not uncommon for LODs to have not ben initiated like this one.
  23. Folks: Does anyone know once the VA orders and exam both regular and an ACE Exam...how long it takes (on average) berfore the Veterans are notified and the exam takes place?
  24. This is my first post and I wanted input on my sons PTSD exam. The examiner said my son had multiple related diagnosis and his service connection was presumptive because of the conditions of his service and time period of diagnosis. He wanted to know why he waited so long to submit a claim after diagnosis. It's been 6 or 7 years since he was diagnosed right after service. He also said we should arrange to get power of attorney over him. He did not let me in at first and then called for me. He said had looked over his records and would look at some more records and then submit it to the regional office. The exam went quick he did not want to go into detail and said it would be not a stressful exam. My son has several hospitalizations, suicide attempts, near a dozen meds, multiple doctors and the exam lasted about 20 minutes. He has a diagnosis from at least 6 VA doctors. My son has flash backs all the time, becomes homicidal in addition to suicide, has lots of memory issues, wanders, has sleeping issues, nightmares and lots of other issues that make it impossible to take care of himself. When released from hospitalizations they always tell us not to leave him alone or let him live alone. Half of my time there was being given advice about his care and power of attorney. So what are your thoughts?
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