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  1. I have been working with a VSO to file my claim. I am currently in the process of gathering information. Only thing, file for MST with PTSD or file PTSD. VSO was hung up on the sexual part of MST. Background: Was in service 1991-2000. In 1995 was involved with a female soldier, who also was involved with another male (married) soldier. After an exercise and the last night sleeping together she asked me to kill his wife. After the second time I went to CID and wore a wire twice. While the Article 32 hearing was going on she was let out of pre-trial and started harassing me, being around me. I was moved from my company to another, and ultimately to the brigade HQ (rear detachment). Brigade HQ was deployed then. Both the female soldier and male soldier were other than honorable discharged, but I was exiled for a year. Not the same after. As I was getting out in 1999 I learned that she had asked other people in the unit to kill me. I was seen at a Vet center into 2000. Same time as the Article 32, my chain of command was trying to discipline me for an Article 15/court martial. The incident was with the female soldier (before she had asked me) and was on a trumped up charge. Even had the 1st sergeant threatened me in his office about "if he could not get me on that charge he would find another". After my time in Brigade HQ I returned to almost a new unit, only 5% knew me. All I wanted was out, but he harassed me every day to change my mind and go to the promotion board. Would not even let anyone drive me to airport to PCS. It took my wife to point out that when I get harassed or witness it at work that I am affected by it. I am currently being seen for it by the Vet center I was seen at before. The vet center had listed me as PTSD and marked as military trauma. Also, I don't have anything from that time as I was not in a good place and as a 26 year old did not want the reminders in my barracks room. So if anyone knows how to get the CID or JAG records I am all ears.
  2. Hello and TYIA for any responses and for reading my long post. BLUF: I would appreciate some insight or just plain ol speculatin on why the VA raters would submit me for a lumbar strain increase (that I didn’t submit for) while working on my current claim? Also, are secondary conditions disqualified in the 60% calculation for SMC Housebound? I know it says the 60% must be separate from the 100% condition, but how does this work if I’m on IU, with secondary conditions? I’m probably overthinking at 4am but why would they submit me for an increase for a condition when I didn’t ask them, and the increase has no bearing on the final rating due to VA math, unless it qualifies me for SMC, or they believe I should be qualified. I’ve never raised the issue of SMC and I’m still learning about it trying to figure out my claim, and I know they are supposed to do due diligence, but that’s not my first hunch since that’s why I’m still in this process. History: I filed a claim in 2015 for PTSD increase and TDIU, was granted increase in 2016 to 70% PTSD, denied TDIU. Combined, 80% with other SC conditions. BBE/VSO said I was denied increase to 100% even though I had a nexus statement from a psychologist saying total social and occupational impairment, at least as likely as not, etc., but they said because I was still employed (I was on long term disability leave but not yet “terminated” and yes they had the relevant evidence through my employer and insurance), and my VA treating provider’s opinion took precedence who didn’t feel my symptoms quite qualified me for total of course, though he‘s a CRNP versus a psychologist and I don’t think he even knows me. I thought they were supposed to take the rating and credentials that favor the Veteran but never mind me. I also survived and was approved for Social Security and life insurance premium waivers during this period without having to appeal, with the same medical information and evidence, with the same VA SC conditions, even coming from VA docs and providers. Of course I appealed the rating and TDIU denial (they can decide) in 2016. I also submitted a new claim for secondaries to PTSD, and in my fog, with that claim an increase for PTSD and TDIU, even though I already had those on appeal. I believe I read or was told somewhere (or maybe my brain made it up) that if I submitted new evidence, the raters could look back at the effective date and could EED to the original claim if the evidence shows and close the appeal. Or, they could approve me from the date of the new claim and the appeal could deal with the stuff before that. But what they did was what they are apparently supposed to do (according to Peggy and the VSOs): defer the appeal related claims to the appeal. DOH. Current Status: Early this month my claim progressed and I was granted an increase to 30% for IBS secondary to my 70% PTSD, and since I had a pre-existing 10% for nerve condition and 20% for lumbar strain, that brought me to 90%. My claim never went to complete and I never got the BBE, ebenefits bounced around from gathering of evidence to pending decision approval within days of my last C&P (I had one for PTSD and one for IBS). I’m not sure why they would give me a C&P for PTSD if they are deferring that part of my claim to appeal as I was told. Maybe they’re just giving me a checkup because my 30 appointments and inpatient stays and shock treatments over the past year weren’t enough medical evidence. I learned of the increase bc I got a small retro and my ebenefits letters and disabilities changed within days, but the claim stayed open. I found out by calling Peggy and VSO that it’s due to an increase for my lumbar strain that someone in the rating chain put in. I do have plenty of evidence in my medical records that show my back is also crap. I got sent to a C&P for my lumbar strain and now I wait in GOE. The C&P examiner, Peggy, VSOs specifically say I was submitted for an increase for my back, not a review. BTW, in ebenefiits in the disabilities section, the PTSD increase is still open, the TDIU disappeared, the IBS is rated, and the lumbar strain doesn’t appear. Yes, I know ebenefits is unreliable and I should find something else to do, but compulsively logging into ebenefits is an activity quite similar to playing a slot machine for me. Every 1 in 10000000 logins I might get a glimmer of hope, and it keeps me going lol. I Wonder: What difference does it make if I’m rated 20% or 30% for my lumbar strain? Why would this be raised since my overall rating won’t change from 90% either way? Trust me, I AM NOT COMPLAINING AND I AM GRATEFUL, anything they do (and they have been getting faster and more Vet-friendly it seems) positive for the Veteran that saves future agony and torture is an appreciated blessing. It would help in the future in qualifying for SMC, but I don’t qualify with the math now. Just wondering if they don’t have enough to do over there, because in the future I’d probably have to get another C&P. Also, I would have to have another condition at 30% for that math to work out, and I pray nothing else worsens enough for that to happen. Does “separate” mean it can’t affect the same body system or it can’t be a secondary condition? Because with secondaries, I could potentially qualify for SMC, and therefore the VA rater would be setting me up for success. Otherwise, it just seems like extra work for them when they could close my case and get their quota numbers and help another Vet...again, not complaining but whoever is on my file seems to be thorough regardless. I know they could be doing anything over there, and I’m glad they’re working on my claim, but just for s&g I’d appreciate any guesses or suggestions, and any help clarifying the SMC Housebound math thing please. Thank you all.
  3. I was never diagnosed in service with OSA. I weigh 220 and I am 6' tall. I am rated at 70% for PTSD and the meds I take add to the OSA. I had my personal Dr. and the Psychiatrist I see both write letters to support that the meds I take add to and cause the OSA. My Dr filled out the DBQ and sent it in as well. I had a failed sleep study results sent in with my claim. I also have documentation I sent it that back up the fact that OSA is tied to PTSD and is aggravated by PTSD. Then sleeping with the prescribed CPAP machine adds to the PTSD. Just curious if anyone has ever won this claim? I am going to appeal but wanted to get any advise here first if someone has any to share.. not sure if there is anyone who has gone this route before and won? thanks!
  4. I see now the VA is using ecstasy on Veterans saying it helps cure mental illness. Ecstasy causes some major brain damage. The VA Hospital forcefully did lobotomies on 2000 WW2 Veterans and ruined their lives. Roman Tritz’s memories of the past six decades are blurred by age and delusion. But one thing he remembers clearly is the fight he put up the day the orderlies came for him. “They got the notion they were going to come to give me a lobotomy,” says Mr. Tritz, a World War II bomber pilot. “To hell with them.” The orderlies at the veterans hospital pinned Mr. Tritz to the floor, he recalls. He fought so hard that eventually they gave up. But the orderlies came for him again on Wednesday, July 1, 1953, a few weeks before his 30th birthday. This time, the doctors got their way. The U.S. government lobotomized roughly 2,000 mentally ill veterans—and likely hundreds more—during and after World War II, according to a cache of forgotten memos, letters and government reports unearthed by The Wall Street Journal. Besieged by psychologically damaged troops returning from the battlefields of North Africa, Europe and the Pacific, the Veterans Administration performed the brain-altering operation on former servicemen it diagnosed as depressives, psychotics and schizophrenics, and occasionally on people identified as homosexuals. The VA doctors considered themselves conservative in using lobotomy. Nevertheless, desperate for effective psychiatric treatments, they carried out the surgery at VA hospitals spanning the country, from Oregon to Massachusetts, Alabama to South Dakota. Roman Tritz talks about the scars from his lobotomy. The VA’s practice, described in depth here for the first time, sometimes brought veterans relief from their inner demons. Often, however, the surgery left them little more than overgrown children, unable to care for themselves. Many suffered seizures, amnesia and loss of motor skills. Some died from the operation itself. Mr. Tritz, 90 years old, is one of the few still alive to describe the experience. “It isn’t so good up here,” he says, rubbing the two shallow divots on the sides of his forehead, bracketing wisps of white hair. The VA’s use of lobotomy, in which doctors severed connections between parts of the brain then thought to control emotions, was known in medical circles in the late 1940s and early 1950s, and is occasionally cited in medical texts. But the VA’s practice, never widely publicized, long ago slipped from public view. Even the U.S. Department of Veterans Affairs says it possesses no records of the lobotomies performed by its predecessor agency. Musty files warehoused in the National Archives, however, show VA doctors resorting to brain surgery as they struggled with a vexing question that absorbs America to this day: How best to treat the psychological crises that afflict soldiers returning from combat. Between April 1, 1947, and Sept. 30, 1950, VA doctors lobotomized 1,464 veterans at 50 hospitals authorized to perform the surgery, according to agency documents rediscovered by the Journal. Scores of records from 22 of those hospitals list another 466 lobotomies performed outside that time period, bringing the total documented operations to 1,930. Gaps in the records suggest that hundreds of additional operations likely took place at other VA facilities. The vast majority of the patients were men, although some female veterans underwent VA lobotomies, as well. Lobotomies faded from use after the first antipsychotic drug, Thorazine, hit the market in the mid-1950s, revolutionizing mental-health care. The forgotten lobotomy files, military records and interviews with veterans’ relatives reveal the details of lives gone terribly wrong. There was Joe Brzoza, who was lobotomized four years after surviving artillery barrages on the beaches at Anzio, Italy, and spent his remaining days chain-smoking in VA psychiatric wards. Eugene Kainulainen, whose breakdown during the North African campaign the military attributed partly to a childhood tendency toward “temper tantrums and [being] fussy about food.” Melbert Peters, a bomber crewman given two lobotomies—one most likely performed with an ice pick inserted through his eye sockets. And Mr. Tritz, the son of a Wisconsin dairy farmer who flew a B-17 Flying Fortress on 34 combat missions over Germany and Nazi-occupied Europe. “They just wanted to ruin my head, it seemed to me,” says Mr. Tritz. “Somebody wanted to.” Counting the Patients A memo gives a partial tally of lobotomized veterans and warns of medical complications. A note about documents: Yellow highlighting has been added to some documents. The names of patients not mentioned in these articles have been redacted, along with other identifying details. All other marks are original. The VA documents subvert an article of faith of postwar American mythology: That returning soldiers put down their guns, shed their uniforms and stoically forged ahead into the optimistic 1950s. Mr. Tritz and the mentally ill veterans who shared his fate lived a struggle all but unknown except to the families who still bear lobotomy’s scars. Mr. Tritz is sometimes an unreliable narrator of his life story. For decades he has meandered into delusions and paranoid views about government conspiracies. He speaks lucidly, however, about his wartime service and his lobotomy. And his words broadly match official records and interviews with family members, historians and a fellow airman. It isn’t possible to draw a straight line between Mr. Tritz’s military service and his mental illness. The record, nonetheless, reveals a man who went to war in good health, experienced the unrelenting stress of aerial combat—Messerschmitts and antiaircraft fire—and returned home to the unrelenting din of imaginary voices in his head. During eight years as a patient in the VA hospital in Tomah, Wis., Mr. Tritz underwent 28 rounds of electroshock therapy, a common treatment that sometimes caused convulsions so jarring they broke patients’ bones. Medical records show that Mr. Tritz received another routine VA treatment: insulin-induced temporary comas, which were thought to relieve symptoms. ‘Anxious to Start’ The VA hospital in Tuskegee, Ala., asks permission to perform lobotomies. To stimulate patients’ nerves, hospital staff also commonly sprayed veterans with powerful jets of alternating hot and cold water, the archives show. Mr. Tritz received 66 treatments of high-pressure water sprays called the Scotch Douche and Needle Shower, his medical records say. When all else failed, there was lobotomy. “You couldn’t help but have the feeling that the medical community was impotent at that point,” says Elliot Valenstein, 89, a World War II veteran and psychiatrist who worked at the Topeka, Kan., VA hospital in the early 1950s. He recalls wards full of soldiers haunted by nightmares and flashbacks. The doctors, he says, “were prone to try anything.” https://taskandpurpose.com/fda-just-designated-mdma-breakthrough-therapy-ptsd-treatment/ http://projects.wsj.com/lobotomyfiles/
  5. All, Thanks for reading this. I have been trying to find all the information that I can about getting re-examined. So I thought I would start here and I did my research on here. I am rated at 70% for PTSD with Major Depression Disorder long with a few other claims that rounds out to 80%. Ill mostly be disscussing my mental health award and not the others Since the that is my highest rating. My benefits where awarded in July of 2017 as far what e-benifits shows. that was my backpay date. In my award letter that I got in the mail it states for all my conditions even tinnitus that "since there is a likelihood of improvement, the assigned evaluation is not considered permanent and is subject to a future review examination". First let me state that I am beyond grateful of my award and I do not wish to try to try to increase my ratings or bring any attention to my file or profile with the VA. I am content with where I am at. I go to the VA every two weeks for my 1 on 1 with my Mental Health provider. So I am knocking out two birds with one stone as far as getting my treatment and showing the VA that I am seeking treatment. Now...What are the circumstances of me getting Re-evualutated? Is it the luck of the draw and I might get randomly selected? I know plenty of people with lower ratings that are not TDIU or P&T that have been rated for over 4-5 years with no exams what so ever. Consider me being paranoid but I want to be Pre-emptive. Especially since my award letter clearly states that ALL my conditions "is subject to future review examination". When would the VA see that my condition has improved if it did? Would they get an alert from the VA Hospital that I am doing better? Or would it would it arise if i get selected for a review and they review my medical records? Like I said earlier im contempt at 80% and more than anything I just want to stay out of sight out of mind on the VA's raters radar and continue my treatment in peace.
  6. I am in the process of putting together a claim package for mental health issues related to MST. Try as I might, I cannot find a VSO with experience in my situation. It's taken me years to accept that I need help and that I need to address this once and for all, so when I say that I cannot handle doing this twice (submitting a sub par claim and then doing appeals) I really mean it. From day to day, I vacillate between thinking my problems are actually other people's inability to cope OR feeling like there is no point to me and that I'm a burden.If it weren't for the whole not being able to pay bills and risking alienating my kids for all eternity, I'd be perfectly content letting the world turn while I hang out at home and being maladjusted and mean. In my perfect world, there would be a check list of things to submit for a fully developed claim. On this checklist, there would be a list of key phrases or high points that would help sway the decision makers into awarding adequate compensation. I haven't been able to find anyone that has had success doing this with a case like mine. I have police reports from the MST. I have trauma counseling records and AD medical records that clearly state a d/x for PTSD related to rape on X date. My counseling sessions identified dissociation behaviors, PTSD, and anxiety. One doctor even noted that I was combative and stated that I wished harm on my attackers. Obviously, the Navy handled this clear cut case of rape, with evidence and my complete cooperation, like they do any scandal. They buried it and came after me. That might be a secondary stressor, but I've been warned that claiming a secondary stressor could hose up everything and to keep my mouth shut? kind of amazing that the advice that is meant to help, sounds a lot like the advice that sent me careening out of control all those years ago. Anyhow, I survived, got married, got out, and went in and out of counseling. Over the years, I've been diagnosed with PTSD, Chronic Depression, Chronic Adjustment Disorder, Agoraphobia, Generalized anxiety Disorder, and Dissociation Disorder. I don't trust military medicine or the government, so most of my counseling was done through non-profit organizations and women's shelters. They're so secretive, that I felt it'd be safe to tell them what I went through and my statements wouldn't end up in the Navy's summary of Mishaps... again. So, I don't really have records of those, except for prescriptions that were reported to Tricare. I do have my civilian medical records. It has page after page of doctors complaining that I broke down, was combative, emotional etc, etc. I do have a few sessions with shrinks at MTFs in the last couple years. They were not keen on actual diagnostics, they just gave me the pills I asked for. I'm shopping shrinks to assess me and give diagnosis. I'm not sure I need a nexus letter, but I'm thinking it wouldn't hurt. I have a letter from my ex boss describing how my work performance plummeted over the years and how he made accommodations to keep me on. I also have a letter from me, describing my bad days and my rituals to get through them. My husband and his best friend were witnesses to the fallout of my rape, in terms of the military's response to me. They can verify in statements that I did report it and go into counseling. They can also verify that I'm socially isolated and very codepenedent on them to meet new people or get involved in activities. I don't have a single friend that they didn't make for me, first. I do not know how to people. I don't have friends from work. I don't have "my own" friends from church. I don't even have people who like me well enough, and include me in things, without my husband and his best friend acting as intermediaries. oh, I also have the most recent sentencing transcripts for the ringleader of my attackers. The judge stated that he felt this dude was unrepentant and a monster. He cited his past sex crimes, "both in the record and that didn't make it to trial" and his history of convincing others to help him conceal his crimes. If that's not a shout out from the bench, I don't know what is. Anyhow, I guess my question is, has anyone here done a fully developed MST claim with multiple bullet points for anxiety, phobia, ptsd, and depression, and get 100% or at least, a high enough rating to qualify for unemployability? Without having to go through appeals and lawyers? Was a police report enough, even if the military dropped it? Should I give the C&P my evidence, letters, and my personal statement too? I'm sure I have 1000 more questions, but I'm mostly looking for someone who has done what I'm trying to do.
  7. HI, New here. Found the community through google. I'm still learning to navigate the site, so please bear with me. Searching got me in the right direction but not close enough. I was recently diagnosed with Service connected PTSD through the VA. I have not done a C&P exam yet. On the same day I was diagnosed with obstructive sleep apnea through a VA sleep study. I've read that there is a slim chance to connect my sleep apnea as a secondary to my PTSD. My VA psych Dr said they aggrevate each other, but a pulmonologist opinion would have more power than his. I've seen some advice from other members talking about letter templates, DBQs and supporting articles. However, I haven't been able to find them here. I've scheduled a civilian Dr. appointment with a pulmonologist in about 2 week and would like to come prepared with any information I can. Any help would be greatly appreciated. Thanks, Nova
  8. I'm reading this VA Citation :NR 1231506 and the VA is saying that because a Veteran with PTSD is getting improvement from his psychiatric medication, that he's showing less symptoms because of it, that he is having his rating reduced from 70% to 30% for PTSD. The VA did reverse the reduction at the BVA. Is this still something to worry about? At a C&P exam does the Veteran have to make it clear that the medication is the reason for improvements and needed to sustain them? Citation NR: " An October 2009 VA medical record reflects that the Veteran reported that the medication he had been prescribed helped with ability to be out in public and that, while leery about being around people, he could go out in public much more easily. His mood overall was good, and he indicated that he continued to enjoy dining out with his wife and stopping by the VFW to socialize with friends. The examiner assigned a GAF score of 76-80". Over at Veteran's Law Blog it says "As an example, say a Veteran has been able to service-connect Irritable Bowel Syndrome (DC 7319). Undiagnosed, the symptoms of IBS might be a component of Gulf War Illness With prescribed medication, our hypothetical Veteran’s condition moderates from a severe form of the disease to a milder form. The severe form of IBS is rated at 30% and the moderate form of IBS is rated by the VA at 10%. Let’s say the VA gives the Vet a rating of 10%, claiming that the Veteran’s medication limits her symptoms. Is that 10% rating correct? No . The Diagnostic Criteria in the VA Rating Schedule for Irritable Bowel Syndrome does not specifically list the effects of medication. Therefore, the VA is not allowed to consider the relief it provides when determining the degree of disability. Has this happened to you? When have you seen the VA use “improvement due to medication” as an excuse to give a lower rating"? https://www.veteranslawblog.org/va-disability-claim-medication-reduce-va-ratings/ https://www.va.gov/vetapp12/files5/1231506.txt
  9. I filed a claim for PTSD back in 2014 and then had my C&P. At the C&P the outside VA examiner asked multiple questions and focused on my upbringing (which was good) and my Father almost insinuating that my MST really is from my Father. When I left there I was completed traumatized because of the line of questioning and that he didn't even ask about my military time and shortly after I was denied. At the same time I had already been diagnosed by my VA Mental health Dr and through a MST coordinator. I got the denial shortly after and because I was so upset just did nothing since I didn't want to go through it again. I still went to the VA for treatment and then 2017 I requested an increase for my TBI. They scheduled a C&P and I went and the VA this time and within 4 weeks I was went from 10% TBI to 70% for TBI/PTSD making my overall rating 100%. A few days ago, I received my narrative and I immediately requested my original claim of PTSD reopened requesting an effective date change to my original claim that was denied . My question is that because I did nothing from 2014-2017 will they deny or is there anything I can do to have my effective date changed since the first C&P went so wrong.
  10. I separated from active duty service in the Air Force with in 2010 and had undiagnosed non-combat military connected PTSD with alcohol use in remission (According to my VA disability paperwork which puts me at 50% for ptsd.) This was granted the beginning of last year. I recently put in to have my discharge upgraded to honorable from general and have yet to hear back from them. (E-benefits say maybe I'll hear about it early February 2018.) There were a few selfmedicated incidents with alcohol that happened while I was active duty that resulted in going into a civilian rehabilitation facility, a perscription to an antidepressant, and a lot of suicidal ideation I recently admitted in my paperwork to the review board that I was afraid to admit to my command because they would do things like write someone up for a sunburn (destruction of government property), or purposefully keep spouses apart by writing one up for something they didn't do and keep them from going during their significant others' PCS (because someone else did it to them for five years and "they turned out fine"(There was no way to prove otherwise.)). I was recently reading about medical retirement from the military. It's a little confusing. I was wondering if there was a way to submit for reconsideration and medically retire from the military after separation?
  11. Hello all, Q: Is there somewhere besides the JSRRC that would keep Marine Corps helicopter accident records. I was diagnosed (by the VA) with PTSD related to a helicopter accident that I was in in the late 80's. I prepared and submitted a PTSD claim that includes details of the accident as well as a buddy statement from someone involved in the investigation of the accident. In my claim I requested assistance from the VA in checking the JSRRC for the related records to prove the accident and my involvement as I did not have the date of the incident. I requested that the VA (and JSRRC) look in 60 day increments during the 1986-1987 years. They denied my claim because they stated they could not locate the incident. Thanks for any and all assistance. Mike
  12. I've been having issues for years but didn't even realize for a long time they were related to my time in service (88-92). I just pushed the feelings down deep inside and avoided thinking about it. When I finally went to a civilian Dr for my depression back in 2003/2004 I was put on every drug available but nothing worked for long. When I lost my job and went back to school to get an associates degree I had to find a way to continue treatment so i started going to the VA. Problem is while I would sometimes be honest with my Dr about how I was feeling, other times I would deny currently suffering. I didn't want to appear weak, especially if it was a woman treating me. I know that my fault, partly because of how I was raised and partly due to my time in the Marines. Depending on who saw me, their DX differed. My primary care Dr and a social worker suspected PTSD, but the Psychiatrists DX was MDD and SAD. Finally after I graduated college and started a new job I lost the ability to cope and had trouble concentrating and handling the stress. I was let go and spiraled out of control. For the past 3 years now I havn't worked and I only leave my house every couple weeks to buy groceries late at night or to visit my Dr at the VA (if I don't end up canceling or missing my appt due to feeling sick at the thought of leaving the house). I finally decided to apply for compensation as my family who has been supporting me has reached their financial limit. I hoped for the best as I now know I really have a horrible problem and need help to survive and not end up under a bridge somewhere. I will post the C & P examiners exam results now and hope someone can find something to help me with my next step. Also he references several other mental health evaluations. I will post those as replys to myself as this is going to be a LONG post. I will only be editing out my and the examiners name, everything else I will leave in. I know now I can't get help if I leave out information. Thank you for any advice in advance. Semper Fi Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [ ] Yes [X] No If no diagnosis of PTSD, check all that apply: [X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria [X] Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire: 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Major Depressive Disorder ICD code: F33.1 Comments, if any: Less likely than not due to, caused by, or incurred during military service. Military records indicate no treatment for this condition and discharge physical exam indicated no mental health problems. The veteran did not have any mental health treatment until many years after military service. Mental Disorder Diagnosis #2: Social Anxiety Disorder ICD code: F40.10 Comments, if any: Less likely than not due to, caused by, or incurred during military service. Military records indicate no treatment for this condition and discharge physical exam indicated no mental health problems. The veteran did not have any mental health treatment until many years after military service. Mental Disorder Diagnosis #3: Attention Deficit/Hyperactivity Disorder (ADHD) ICD code: F90.0 Comments, if any: Less likely than not due to, caused by, or incurred during military service. Military records indicate no treatment for this condition and discharge physical exam indicated no mental health problems. The veteran did not have any mental health treatment until many years after military service. Furthermore, ADHD, by its very definition and nature, begins in childhood, and his not caused by any external events. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): GERD, history of headaches, history of neck pain 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: Due to symptom overlap and multidirectional interactions among the disorders. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [X] No [ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: Due to symptom overlap and multidirectional interactions among the disorders. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS [X] Other (please identify other evidence reviewed): The vet brought a copy of his recent Statement in support of claim which was on his smart phone screen. This examiner reviewed that. It had not been submitted yet to the Regional office. The veteran also brought in a wooden plaque with a Marine Corps Meritorious Mast award on it dated 12/14/1989 indicating that he was involved in capturing an intruder on their base in the Philippines as part of their patrol. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): This veteran has had a number of past mental health evaluations here at the VA. Please see the 12/16/2011 psychology evaluation, the 4/272012 psychiatry intake, and the 10/17/2016 psychology mental health treatment plan for details of his history. The veteran is 47 and is divorced since 2001 (past records noted above suggest this seems to have had little to do with his mental health issues). His last relationship ended in 2012 he reported today that she apparently had another man already lined up, as she was dating him just a couple days after they broke up. He reported no current/recent relationship. He reported he really has not been getting out much at all - says he does not like himself and reported he worries others will judge and talk about him. He says he is watchful and on guard for others' negative evaluations. He resides alone, with his small dog. Mother and brother are 2 hours away in XXXXXXX. He has little contact, avoiding her alot and her possible questions about his job hunt. He used to play some online gaming and still does, but only occasionally. No groups, clubs, organizations or church. No close individual friends. He reported no other recreation/leisure. He says he sleeps on the couch since his relationship breakup about 5 years ago, as the bed reminds him of her. He says his sleep schedule is widely varied and he will do alot of daytime sleeping, watches some TV. He only rarely goes to the store and does so late at night so as to avoid other people and their perceived judgement. He reports he has had little motivation to attend to household tasks and becomes easily overwhelmed and thus avoids or procrastinates. As a result, he reports there are many empty grocery bags laying around, and he simply piles the mail on the kitchen table. Part of that may also be due to avoiding what might be in the mail. He reports he keeps phone ringer off so as to avoid contact from the bill collectors. He says he owes $50,000 in school loans and years ago put $20,000 of his girlfriend's school loans on his credit card and cannot pay fully. It seems his attempt at coping is through avoidance, which then adds to the problems he has. MILITARY: The veteran enlisted into the Marine Corps and served August 1988 to August 1992. He rose to an E4 rank and had an honorable discharge. He served time both in the Philippines and in the Persian Gulf during the Desert storm/desert shield.. His MOS was mortars. His statement in support of claim seen on his cell phone screen today listed two events, one of which he reported occurred in the Philippines in May 1990. He says he and his girlfriend at the time work in the marketplace and then went to a bar down the street. Not too long afterwards, he and others in the bar found out that two airman had been shot in the market area where he had been not long before. This examiner notes that while this could be an upsetting or shocking bit of information to find out, the veteran did not experience any actual trauma. He did not witness the shooting and was not even aware of it until being told shortly after it occurred. The second incident he reported was from February 1991 in Kuwait and reported that they took small arms fire at one point and also took enemy mortar fire and they were in a mortar battle. He felt the enemy mortars were getting closer, as close as 50 yards away, until the enemy position was neutralized. This event would meet DSM?five trauma criteria for PTSD. Other VA notes also refer to the veteran being next to a man who almost committed suicide, but a sergeant apparently prevented it. This would also not meet trauma criteria as nothing actually happened. There was no trauma witnessed, and the veteran himself was not in significant threat. The veteran today said he really wanted to have a career in the USMC, but also noted that the reason he actually got out was due to a Reduction In Force at that time. b. Relevant Occupational and Educational history (pre-military, military, and post-military): This veteran has had a number of past mental health evaluations here at the VA. Please see the 12/16/2011 psychology evaluation, the 4/272012 psychiatry intake, and the 10/17/2016 psychology mental health treatment plan for details of his history. Vet reported today that he has had mental health treatment in the private sector starting about 2003/2004 regarding ADHD and was placed on Adderal as well as a number of antidepressants. He started here at the VAMC in 2011, dealing with issues of ADHD, Depression and Anxiety (particularly Social Anxiety). He has seen psychiatry, psychology and social work at various times since then, up until the preseent. He also had Neuropsychological testing on 10/14/2011 regarding an ADHD eval. Psychiatry records indicate medication has not been all that effective regarding his depression and social anxiety. He currently is treated with Adderal for ADHD and recently was (re)started on escitalopram. He has also been in and out of psychotherapy for the above conditions. This examiner notes that the previous evaluations noted above assessed for PTSD but indicated he did not meet criteria. Those evaluations also indicated that the veteran's depression condition really worsened in recent years following the breakup of his long-term relationship about five or six years ago, though a little bit before that there was some increased depression. Furthermore, those evaluations also indicate the veteran has felt that he always has tended to be rather anxious and depressed with low self-esteem. The records indicate a history of a very strict and harsh, verbally abusive, father as well as a history of being bullied in school, though did not get any mental health services. Curiously, VA social work notes from more recent times such as 5/18/2017, seem to describe the social anxiety as being caused by or started in the military, related to harsh treatment by a corporal. This is not likely accurate given the previous treatment notes described in the first paragraph above that indicate a long history of this type of feeling even in his youth, as well as more recent onset/worsening of symptoms just a few years ago following the relationship breakup. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): This veteran has had a number of past mental health evaluations here at the VA. Please see the 12/16/2011 psychology evaluation, the 4/272012 psychiatry intake, and the 10/17/2016 psychology mental health treatment plan for details of his history. None e. Relevant Substance abuse history (pre-military, military, and post-military): This veteran has had a number of past mental health evaluations here at the VA. Please see the 12/16/2011 psychology evaluation, the 4/272012 psychiatry intake, and the 10/17/2016 psychology mental health treatment plan for details of his history. None. f. Other, if any: n/a 3. Stressors ------------ Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: Small arms fire and mortar battle in Gulf War Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criterion A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] Witnessing, in person, the traumatic event(s) as they occurred to others Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] No criterion in this section met. Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] No criterion in this section met. Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] No criterion in this section met. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] No criterion in this section met. Criterion F: [X] No criterion in this section met. Criterion G: [X] No criterion in this section met. Criterion H: [X] No criterion in this section met. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: No response provided. 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting 6. Behavioral Observations -------------------------- The veteran's affect was broad, though mood appeared dysphoric and anxious. He was quite talkative and animated at times. He was polite and cooperative. Eye contact and behavior were normal. 7. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [X] Yes [ ] No If yes, describe: The veteran has a history of attention deficit/hyperactivity disorder (ADHD), inattentive type. Please see the DSM?five as well as the neuropsychological testing from 10/14/2011 for details of such symptoms. 8. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any -------------------------------------------------- The exam request form states/asks: "Exams on this request: DBQ INITIAL PTSD ** Status of request: Pending, reported to MAS -------------------------------------------------------------------------- ------ DBQ PSYCH PTSD Initial _________________________________________________________________________ The following contentions need to be examined: PTSD Active duty service dates: Branch: Marine Corps EOD: 08/02/1988 RAD: 08/01/1992 DBQ PSYCH PTSD Initial: Please review the Veteran's electronic folder in VBMS and state that it was reviewed in your report. MEDICAL OPINION REQUEST TYPE OF MEDICAL OPINION REQUESTED: Direct service connection OPINION: Direct service connection Does the Veteran have a diagnosis of (a) PTSD that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) Combat Action Ribbon during service? Rationale must be provided in the appropriate section. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion. POTENTIALLY RELEVANT EVIDENCE: NOTE: Your (examiner) review of the record is NOT restricted to the evidence listed below. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. Tab A (DD Form 214 in VBMS): TAB A- CAR COMBAT ACTION RIBBON IN DESERT STORM AND DESERT SHIELD dated 06/27/2017 If more than one mental disorder is diagnosed please comment on their relationship to one another and, if possible, please state which symptoms are attributed to each disorder. If your examination determines that the Veteran does not have diagnosis of PTSD and you diagnose another mental disorder, please provide an opinion as to whether it is at least as likely as not that the Veteran's diagnosed mental disorder is a result of an in-service stressor related event." ------????????? As noted above, this veteran does not appear to meet criteria for PTSD, lacking sufficient number, frequency, and severity of symptoms to warrant such a diagnosis. The veteran does have depression and anxiety (mainly social anxiety) and ADHD conditions described above, though it is this examiner's opinion that they are less likely due to, caused by, or incurred during military service for the reasons noted above. Today, the veteran denied any delusions or hallucinations. There are no panic attacks and no OCD. He denied any suicidal or homicidal ideation. He says that he knows if he were ever to kill himself, it would hurt his mother significantly and he would did not want to do that. He does report frequently being in a low, sad and depressed mood. He reported crying spells, decreased hope, low self-esteem, feeling easily overwhelmed, feeling "stuck" and self critical. He described feeling depressed over various regrets he has in his life. He also reported a lot of anxiety. Some of this is regarding his current life situation including financial difficulties, though a lot also appears to be related to socially related anxiety feelings. He feels others judge and evaluate him in a negative manner. He feels he just does not measure up and worries when others are looking at him, that they are thinking negative thoughts or critical thoughts about him. This also creates not only emotional anxiety, but also physical symptoms such as nausea. Regarding PTSD issues, the veteran says he has sometimes dreamt that he is in the US Marine Corps but is out of shape. He reported no recent issues with any actual trauma related nightmares. He also says he has negatively dreamed recently about his most recent ex-girlfriend (from five years ago). The veteran did not describe upsetting intrusive trauma memories nor severe distress at any particular cues. The veteran does not appear to actually meet criteria for HYPERvigilance. He seemed to deny his issues with anxiety around people have to do with actual fear for his physical safety. This avoidance of people and public has to do more with worrying about their judging him. He reports when driving he is aware of other cars and where people are around him, though this does not appear to be related to trauma or represent any PTSD. The veteran seems to describe having no real set sleep schedule and he will go to sleep at widely varying times. He says he has some difficulty falling asleep but once he is asleep, he will sleep for as long as 12-16 hours. This may be related to his nonservice related anxiety/depression condition and his negative coping strategy of avoidance. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. XXXXXXXXX XXXXXX, PhD Clinical Psychologist
  13. 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
  14. I have some questions and wondering what some of your observations are. I had a c and p exam recently and got ahold of the DBQ. All the boxes the doctor checked were good for me. She checked all the right boxes and checked that I had PTSD and all the symptoms they went with it but in some of the comments she made, they seem really bad. So I'm wondering what matters more, the doctors observations or the boxes she checked? I'm rated at 60% currently with anxiety NOS and Tinnitus. I did not initiate the exam for an increase. It was one of the random c&p to see how things are going. This is from the PTSD initial DBQ that she filled out 1) yes 2) PTSD, paranoid personality disorder with avoidant features, other specified anxiety disorder with depressive symptoms 3) a. Yes. B.no 4.) A.Occupational and social impairment with deficiencies In most areas work, school , family relations...etc B. Yes--most impairment is attributed to PTSD and anxiety disorder with paranoia secondary. Under PTSD criteria she checked 2 in A, 3 in b, 2 in c, 6 in D and 4 in E . 6) Argumentative and irritable veteran who is hiding behind his wife and looks at her instead of the examiner; has poor eye contact; unable to tolerate questions without interrogating examiner about "meaning" of question; makes people want to avoid him due to his paranoid arguing. Hopeless attitude; does not accept hopeful comments; arrogant and appears to think he knows more than others; thinking was designed to perceived threat, not to answer questions; emotional overactivity; exaggerated affect; affect constricted; everything annoys him; meds do not touch symptoms and he does not sleep; problems with lack of trust. 7) " he may be playing this up out of a desire to avoid working at jobs that are low pay---he has no job skills and comes from a highly educated family --father is lawyer, sister a geophysicist; he may prefer the sick role, rather than go back to school and stretch himself; there is an element of malingering and playing to an audience." I found this highly offensive because I've been going to the VA for at least 5 years. I didn't initiate the exam so I'm not trying to get more money. However, I wasn't honest in my first c&p in 2011 because I was ashamed and held back a lot of the really bad things I experienced. This time around I made sure that I was brutally honest. I know that I'm supposed to tell them about my "worst" day and how bad it really is and I did. And now my sincerity is questioned? The lady was incredulous that my wife married me even though I didn't have a job and still don't. I said that I don't believe I can work which I don't think that I can because I barely can stand to leave the house and that I hate being around people because I'm constantly thinking in my head that I'm going to be attacked or have to attack someone else. I also don't sleep, I have diagnosed insomnia from the VA. Because of all this I don't think I'd be able to hold down a serious job. Is that crazy? I haven't worked in a long time. I stay at home and take care of our kids. I said something like at least I can feel useful like that. The woman seemed stunned by this. I'll admit I was extremely uncomfortable during the exam because I hate talking about this stuff and prefer to not think about it. And she interpreted it in the way above. Her comments seem contradictory to all of the boxes she checked. If I'm "malingering and playing to an audience" why did she check all of the other boxes? It's driving me crazy. This feels really bad for me. I'm having anxiety attacks almost daily thinking about this. Am I crazy to worry about how this will turn out for me? This woman was in her late 70s or early 80s. The exam was through VES and was done at her in home practice
  15. Thank You in advance! (First question after reviewing this book I wrote here should probably be, do i need to separate all of these questions into the different subject forums or is this OK ?) I've been procrastinating now for almost 10 years (mainly because of denial, I volunteered, tough guy, I know guys that seen/did worse and horror stories with the VA) and have just this year decided to attack this VA Claims Process. Putting it off for too long and ready to get the information needed to hopefully (fingers crossed) have a smooth process. I have not filed for anything, have no medical records or injuries documented while active or since (I have just requested my military records from the right place after all these years, because I assumed the VA would have them and keep them safe, so I didn't need a copy. MISTAKE #1, Naive I know) and have not been to see a private doctor for anything. I medicate with over the counter and always have, but have never been officially diagnosed with anything. Just last month I made an appointment with advice from an amazing local veteran group with a psychologist outside of the VA and she diagnosed me with PTSD. It was extremely hard to even talk to her, I've never talked to anyone about it just denied it or pushed it back. (I know I'll still need a VA exam). I was also seen by an outside, but VA referred hearing specialist and was diagnosed with tinnitus in the 3k range and hearing loss. 6 months after release from active duty in 2007 I was seen at the local VA for hemorrhoids and treated. I have had issues with roids, constipation, diarrhea etc ever since. This is also the only thing I have ever been seen for at the VA. My wife has also complained for years about sleep apnea and me startling her in the middle of the night when I sleep, should I get an evaluation for sleep apnea. She doesn't remember ifI did it when active or not, but does that matter for service connection ? I have already made the intent to file as of last month and am wondering how I should proceed from the above mentioned. I have not been seen for IBS, by any professional but it reads like that is a high possibility, so do I need a diagnosis from outside of the VA or should I get one prior to filing? Should I file IBS, if diagnosed under "presumptive illness" (BALAD IRAQ 2005-2006) ? Should I get on the Burn Pit or Gulf War Registry (Is there anything I should know prior to going to these registry appts) ? Should I file for PTSD with just an outside evaluation (How are stressors confirmed, all mine are personal accounts and encounters) ? Should I file for hearing loss or tinnitus or both I served as a firefighter and have read that as being on some list hearing related jobs ? And finally, Should I file for all of these now at one time or should I wait and do them individually ? My main concern is going into this and not being fully prepared, if there is anything you believe would aid in the above filings please let me know. I know there is a long road ahead, but I don't see any point in going alone and appreciate you all. Thanks again!
  16. This appears to be a favorable exam but I am confused. I was previously denied for PTSD so I submitted new evidence and also claimed Depressive disorder. I just went to my exam last week and this was the results. The doctor checked the box that would warrant a 30% rating but I definitely feel this is a low ball. My life has not been the same and just keeps declining. He noted in here my suicide attempt and the ideation that still occurs so would that help in the ratings game? I honestly just think that working isnt going to happen much longer. I think IU is in my future but if you could help me understand what the rater may choose I would appreciate it. LOCAL TITLE: C&P MENTAL DISORDER STANDARD TITLE: MENTAL HEALTH C & P EXAMINATION CONSULT DATE OF NOTE: SEP 20, 2017@10:00 ENTRY DATE: SEP 20, 2017@16:45:06 AUTHOR: RAY,CHRISTOPHER L EXP COSIGNER: URGENCY: STATUS: COMPLETED *** C&P MENTAL DISORDER Has ADDENDA *** Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [X] Yes [ ] No ICD code: F43.10 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Posttraumatic Stress Disorder ICD code: F43.10 Mental Disorder Diagnosis #2: Other Specified Depressive Disorder ICD code: F32.89 Mental Disorder Diagnosis #3: Unspecified Attention-Deficit/Hyperactivity Disorder ICD code: F90.9 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Knee pain, sleep apnea, diabetes. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: Some symptoms, such as his insomnia, irritability, trouble concentrating,and social withdrawal characterize both PTSD and Other Specified Depressive Disorder. His concentration deficits also characterize ADHD. It is difficult to differentiate what portion of each symptom is attributable to each diagnosis without resorting to speculation. 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 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 reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: It is difficult to determine to what extent his three conditions are impacting his social and occupational functioning. This is because of shared symptoms. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS Evidence Comments: The veteran was referred for a compensation and pension examination. The veteran was informed of the nature and purpose of the examination and confidentiality limits. He was also informed of the risks and benefits of the current examination. He was provided with a chance to ask questions about the evaluation procedures. He voiced an adequate understanding of the evaluation procedures. He was informed that this examiner is not his treating clinician or the legal determiner of compensation or pension. Instead, he was informed that this examiner is an independent provider of clinical information and expertise to assist those who review and make legal compensation and pension claim decisions and would not be participating in his healthcare. The veteran indicated understanding of these terms and explicitly and freely consented to the evaluation. He was also notified that judgments of symptoms and opinions in this evaluation report are offered to a reasonable degree of professional certainty and are only based upon the information available at the time of the evaluation. He was notified that a copy of the C&P mental disorder evaluation report would be provided to the Veterans Benefits Administration (VBA) and that a copy can be requested through VBA or through the Release of Information Department at the Columbus VA. The psychological evaluation consisted of a review of the veteran's CPRS records, a review of his VBMS/Virtual VA records, JLV records, a clinical interview, and the veteran's assessment results. On 6/1/17 the veteran had an initial evaluation of residuals of TBI with Dr. Lin. Although the veteran had difficulty with concentration, memory, and comprehension, these issues were not due to a TBI but attributable to other causes. Multiple records showed no evidence of TBI. The veteran's CPRS records indicate that he has received mental health treatment at the Columbus VA since 12/6/10. The veteran's most recent meeting with Dr. Haraburda, a VA psychologist, was on 10/28/16. The veteran was upset about a C&P exam when he was not diagnosed with PTSD due to overreporting. The veteran said he was interested in couples counseling. The veteran was diagnosed PTSD and Alcohol Abuse. The veteran's most recent psychiatric appointment was with Dr. Churchill, a VA psychiatrist, on 8/17/17. The veteran was diagnosed with ADHD, Combined Type, PTSD, Chronic and Major Depressive Disorder, Recurrent. The veteran indicated that his mood was low and his anxiety was always high. He was psychiatrically hospitalized at the VA in 2012 for 3 days and received substance abuse treatment as well as vocational rehabilitation. Theveteran indicated having problems with depression after returning from Iraq inlate 2010. He said he had been on multiple medications and once made a suicide attempt in January 2012. On 9/1/17 the veteran met with Dr. Nigl, a VA neuropsychologist. Dr. Nigl had previously assessed the veteran in 2011 at which time no significant primary cerebral dysfunction was detected although some ADHD symptoms were endorsed consistent with the veteran's developmental history. Dr. Nigl indicated that even though there was no evidence of primary brain dysfunction, ADHD was not ruled out. Dr. Nigl told the veteran that one or 2 concussions in years past would not be anticipated to lead to permanent brain damage. The veteran was glad to learn that his current concerns were not TBI-related. The veteran stated that his cognitive concerns included forgetting details of conversations, misplacing things, zoning out and needing to write much more down. The veteran was informed that chronic ADHD symptoms are likely being exacerbated by increased depression, PTSD, pain, and sleep that was not optimally controlled by OSA. The veteran's cognitive concerns were more likely than not due to problems with attention and/or encoding. The veteran was diagnosed with PTSD, Depression and ADHD. A statement written by the veteran's wife was reviewed. She indicated that their relationship had been "rocky." Wife noted that the veteran tends to be very jumpy and has trouble going places because he does not want to be around groups of people. She noted that he has not been the same since he went to Iraq. She referenced how he attempted suicide in January 2012 and was psychiatrically hospitalized at the Chillicothe VA. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): The veteran stated that he was born and raised in Columbus, Ohio. He indicated he grew up with his parents, who divorced "when I was 10 or 11. I lived with mom and we moved to Newark. My dad stayed on the East side of Columbus." The veteran added, "Both of my parents remarried. My mom and stepdad moved to South Carolina and I stayed 6 months but didn't like it and came back to Ohio to live with my father and stepfmother." The veteran said he has one stepbrother. The veteran did not report being abused or neglected. When asked about his relationship history, the veteran reported,"I married the same woman twice. I got hurt in Iraq and things went downhill. I drank a lot." The veteran stated that he and his wife were married the first time for 2 years, and they have been married the second time for 4 years. According to the veteran, "Ourrelationship is not the greatest. We dated after the divorce and found out we're having our first son. She's left a few times and we argue quite a bit. We have ups and downs." The veteran said he has two children ages 1 and 4. Regarding his social support system, the veteran stated, "My wife is a nurse and says she is supportive of my mental health issues, but she has said I don't have as bad of a case of PTSD as I make it out to be." The veteran added, "I don't really talk to my mom or dad about things." The veteran noted that he keeps up "with some people I went to basic training with on Facebook." When asked about his interests or hobbies, the veteran reported."I used to love to do a lot but don't really do much anymore. I kind of go to school, work, and then go home." b. Relevant Occupational and Educational history (pre-military, military, and post-military): The veteran stated that he graduated from high school. He said that he had a 3.4 GPA. The veteran reported that he did not have any learning disabilities and was never enrolled in special education classes. He said he took Adderall "for about a year. My mom thought I had ADHD (Attention-Deficit/Hyperactivity Disorder) but I stopped taking the medicine on my own and didn't notice a difference." The veteran reported that he attends Park University. He noted, "I seem to have a hard time now understanding and remembering material." He noted, "I failed quite a few classes. I have pretty good grades in some classes. I'm in Voc Rehab right now." Before the military, the veteran stated, "I worked at Golden Corral in Whitehall." The veteran reported that he served in the U.S. Army from January 2008 until January 2014. He stated that his highest rank was E-5. The veteran indicated that his MOS was military police. The veteran reported that he was deployed to Iraq from August 2009-August 2010. He noted that he received the Combat Action Badge among other medals. The veteran's DD-214 contained in his VBMS records indicates that he was awarded the Army Commendation Medal, National Defense Service Medal, Global War on Terrorism Service Medal, Iraq Campaign Medal with Campaign Star, Army Service Ribbon, Overseas Service Ribbon, Armed Forces Reserve Medal with M Device. Notably, there was no mention of the Combat Action Badge. The veteran reported that he had an honorable discharge, which is consistent with his DD-214. Since the veteran left the military, he stated, "I was a police officer from December 2013 until February 2017. Now I work as a criminal investigator. I left the police officer job since I had anxiety and I didn't trust myself carrying a side arm.I have a letter from my old patrol supervisor. She noticed that I had a lot of anxiety and panic attacks." The veteran indicated that his job performance at his current job "is ok but my big problem is my memory. There are things I've left out and forgot in my cases. I have good days and bad days." c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The veteran denied receiving mental health treatment before the military. The veteran reported that while in the military "after my deployment to Iraq I started coming to the VA. I saw Dr. H, and had a break while I was going to the Chillicothe VA. I did the domiciliary and vocational rehab then came back up here. I reconnected with Dr. H up here." The veteran added that he receives psychiatric care with Dr. C. According to the veteran, he is prescribed venlafaxine and nortriptyline hcl. The veteran indicated that his medications are partially helpful in alleviating his mental health symptoms. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): The veteran denied any legal problems before the military. The veteran did not report receiving any Article 15s, non-judicial punishments, infractions or arrests while in the military. The veteran denied receiving any criminal charges since leaving the military. e. Relevant Substance abuse history (pre-military, military, and post-military): Before the military the veteran stated that he tried "pot (marijuana) a few times but that was it." While in the military the veteran did not report consuming illegal drugs. He acknowledged that while in the military he drank alcohol "especially after Iraq. That's when I abused pain meds (Vicodin and Percocet)." After the military the veteran said his use of alcohol has "waxed and waned. I don't know that I've been addicted." The veteran stated, "I have not had a beer in a few weeks." In the past the veteran noted that he has had cravings for alcohol but not recently. The veteran denied any recent negative impact on jobs or relationships. The veteran reported that he has not used opioids since January 2012. f. Other, if any: The veteran reported that he is service connected "for both knees. It shoots into my hips. I also have sleep apnea, diabetes, and high blood pressure." His CPRS records show the following active problems: Code Description 719.46 Knee: arthralgia (ICD-9-CM 719.46) 305.1 Nicotine Dependence (ICD-9-CM 305.1) 836.0 Meniscus Tear, Med (Current) (ICD-9-CM 836.0) V71.09 No Diagnosis or Condition on Axis I (ICD-9-CM V71.09) R52. Pain (SCT 22253000) 110.9 Tinea (ICD-9-CM 110.9) 692.6 Contact dermatitis and other eczema due to plants (except food) (ICD-9-CM 692.6) 309.24 WITH ANXIETY (ICD-9-CM 309.24) Z63.0 Partner relationship problem (SCT 1041000119100) R03.0 Essential hypertension (SCT 59621000) F33.8 Chronic depression (SCT 192080009) F10.10 Alcohol abuse (SCT 15167005) 305.50 Opioid abuse (ICD-9-CM 305.50) F43.12 Chronic post-traumatic stress disorder following military combat (SCT 699241002) His CPRS records show the following active medications: 3. Stressors ------------ Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: Removed for privacy Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No b. Stressor #2: Removed for privacy Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No c. Stressor #3: Removed for privacy Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criterion A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] 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). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Problems with concentration. Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 [X] Stressor #2 [X] Stressor #3 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events 6. Behavioral Observations -------------------------- The veteran was alert and oriented to person, place, the date, time, and situation. The veteran's clothing was appropriate to the situation and weather. He maintained appropriate eye contact. The veteran exhibited acceptable hygiene. His speech was within normal limits with regard to rate, rhythm and volume. He walked with a normal gait. The veteran was cooperative and actively participated in the evaluation procedures. His affect was appropriate to discussion and well-modulated. The veteran described his mood as "down." The veteran endorsed symptoms of depression including sadness, low energy, sleep disturbance, concentration deficits, loss of pleasure, agitation, indecisiveness, and hopelessness. The veteran reported suicidal thinking (without current intent or plan). He noted one past attempt "when I drank a lot and took a lot of Ativan. That was in January 2012." He denied thoughts of harming others. The veteran did not report nor were there clear indications of obsessions, compulsions, or manic symptoms. Regarding the veteran's mental content, his thought processes were linear. The veteran's associations were goal-directed. There were no indications of delusions or hallucinations. Regarding ADLs, he reported that he keeps up with his personal hygiene. The veteran stated that he is able to cook, clean, and complete other basic household chores. The veteran reported that he has a bank account and driver's license. The veteran's judgment in hypothetical situations is intact. The veteran exhibits adequate abstract reasoning and comprehension. The veteran was able to remember events from the past indicating no significant long term memory issues. On a forward digit span task the veteran correctly repeated back 6 digits. The veteran accurately recalled 3 of 3 words after 5 minutes on a brief word learning task. He accurately recalled the months in reverse order. He correctly spelled the word WORLD forwards and backwards. The veteran responded accurately to four basic calculation tasks. Overall there is no obvious evidence of possible short-term memory and/or concentration deficits. The veteran's intellectual functioning appears to be in the average range based upon his educational attainment and vocabulary. DSM-5 ASSESSMENT OF PTSD: I REMOVED THIS PORTION FOR PRIVACY BUT NOTE THAT THE DOCTOR INDICATED THAT I MET ALL CRITERIA NEEDED 7. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 8. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any -------------------------------------------------- Assessment Results: The MMPI-2-RF was administered to measure symptom patterns associated with particular classes of psychopathology. The test includes validity scales to identify unusual test-taking attitudes, including the detection of possible feigning or denial of symptoms. Possible underreporting is indicated in that the veteran presented himself in a positive light by denying some minor faults and shortcomings that most people acknowledge. Inconsistent responding was ruled out. Any absence of elevations on the substantive scales were interpreted with caution as they may underestimate the problems assessed by those scales. The veteran's test scores indicate preoccupation with suicide and death. His test scores suggest that he may have recently attempted suicide. These test results also indicate the presence of helplessness and hopelessness. According to the veteran's test results, he reported feeling anxious. This testing profile suggests the presence of intrusive ideation, anxiety and anxiety-related problems, sleep difficulties, including nightmares and posttraumatic distress. According to the veteran's test results, he reported not enjoying social events and avoiding social situations, including parties and other events where crowds are likely to gather. His test results suggest that the veteran is introverted, has difficulty forming close relationships, and is emotionally restricted. Opinion & Rationale: It is my opinion, with reasonable professional certainty, that it as likely as not (a 50% probability) that his Posttraumatic Stress Disorder resulted from his Iraq trauma stressors. My opinion is based upon my clinical experience and expertise, a review of the veteran's CPRS records, a review of his VBMS/Virtual VA records, the results of a clinical interview, and the veteran's assessment results. The veteran showed no signs of significant exaggeration or feigning of mental disorder symptoms on objective testing. Remote records reviewed by Chillicothe VA staff, however, suggest that the veteran's commanding officer had confronted the veteran because his reported military experiences either did not occur or did not occur to the veteran. Also, during the clinical interview the veteran said he had a Combat Action Badge, which was not located on his DD-214. On the other hand, his VBMS records contain a statement written by battle buddy, who provided information consistent with the veteran's statements about his trauma stressors. Overall, it is beyond the scope of the current evaluation procedures to determine if the veteran's statements concerning his trauma stressors are accurate. Assuming that the veteran's statements about his trauma stressors are true, there appears to be a direct link between his PTSD symptoms and his trauma stressors experienced in Iraq. The veteran's CPRS records suggest that a number of treatment providers have diagnosed him with PTSD. It is my opinion that it is less likely as not (less than a 50% probability) that the veteran's Other Specified Depressive Disorder is proximately due to his physical pain associated with his knees. Although his physical pain likely contributes to some degree to his feelings of depression, there are multiple factors that explain his chronic feelings of sadness. Some of these include his relationship problems with his wife and military trauma stressors. In the past his excessive use of alcohol and drugs have also exacerbated his depressive symptoms. Of note is that the diagnosis of Other Specified Depressive Disorder was chosen because the veteran was vague about the frequency of his depressive symptoms. Concentration deficits were endorsed because even though his mental status did not specifically show concentration issues, information from Dr. N suggests that the veteran's concentration deficits likely are associated with the veteran's mental health concerns, pain, and sleep problems due to obstructive sleep apnea. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. /es/ CHRISTOPHER RAY PHD ABPP Psychologist, C&P Signed: 09/20/2017 16:45 09/20/2017 ADDENDUM STATUS: COMPLETED The veteran's C&P exam was completed in CAPRI. /es/ CHRISTOPHER RAY PHD ABPP Psychologist, C&P Signed: 09/20/2017 16:46
  17. All, I competed my C & P exam for TDIU claim for PTSD and Lumbar DDD. I am uploading the notes from my C & P exam for PTSD. The examiner stated I do not know why you are here because your last C & P was in March. If anyone has experience with interpreting the notes I would appreciate your help. I did delete her extensive notes about what I said about my family and events.... My previous C & P exam was 70% for PTSD and total rating of 90% 40 lumbar ddd and radiculopathy, 10% for each knee, 10% for tinnitus. Also I was just diagnosed with Moderate to severe Sleep apnea.... but I have not filed for disability. I would have to get a nexus letter from doc stating secondary to PTSD. If I am denied TDIU I will start that process.... I would like any advice on the results below and also what should I do with sleep apnea claim... I also have High BP... not sure if I should submit Sleep apnea claim and try to go for SC 100% Thanks in advance for your "time and your help" Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No SECTION I: ------------- 1. Diagnostic Summary ------------------------------ Does the Veteran now have or has he/she ever had a diagnosis of PTSD? [X] Yes [ ] No 2. Current Diagnoses ------------------------------ If the Veteran currently has one or more mental disorders that conform to DSM-5 criteria, provide all diagnoses: a. Mental Disorder Diagnosis #1: Posttraumatic Stress Disorder ICD Code: F43.10 Mental Disorder Diagnosis #2: Major Depressive Disorder ICD Code: F33.9 b. Medical problems relevant to the understanding or management of the mental health disorder(s): Physical health problems that he described as affecting his day-to-day functioning or requiring the use of daily medication or medical devices include back pain and sleep apnea. Just got a CPAP yesterday. Please see his medical records for additional information about his physical health conditions. 3. Differentiation of Symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: These conditions can co-occur, and there is some overlap in their symptoms and associated features, which precludes attribution of certain specific difficulties to JOHN DOECONFIDENTIAL Page 22 of 68 one condition or another without resorting to speculation. Consequently, these conditions cannot be fully differentiated from each other. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed Comments: Not applicable. d. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [ ] No [X] Not applicable (N/A) 4. Occupational and Social Impairment ------------------------------ a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: As these conditions cannot be fully differentiated from each other, their associated functional impairments cannot be differentiated without resorting to speculation. 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 and Virtual VA) [X] CPRS [X] Other (please identify other evidence reviewed): VistaWeb or JLV JOHN DOECONFIDENTIAL Page 23 of 68 2. History ------------------------------ Relevant Family and Social History: Relevant Mental Health History: EVALUATION AND TREATMENT HISTORY EMOTIONAL AND BEHAVIORAL PROBLEMS: SUICIDAL OR SELF-INJURIOUS IDEATION OR BEHAVIOR: Other Relevant History: None reported. 3. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criterion A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) JOHN DOECONFIDENTIAL Page 26 of 68 sexual violence, 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] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined"). [X] Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). JOHN DOECONFIDENTIAL Page 27 of 68 [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the symptoms described above in Criteria B, C, D, and E is more than 1 month. Criterion G: [X] The symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms --------------------------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks more than once a week [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks [X] Flattened affect [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships CONFIDENTIAL Page 28 of 68 [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting 5. Behavioral Observations --------------------------- The Veteran arrived on time for the appointment. His appearance was unremarkable, and his grooming and hygiene were appropriate. He was alert and oriented to person, place, time, and situation. The nature and purpose of the evaluation, the examiner's role in the disability claims adjudication process, and the limits of confidentiality were discussed with him. He verbalized understanding and consented to participate. He engaged well with the examiner, and his responses to inquiries were appropriate in content and level of detail. While no formal evaluation of his mental status was conducted, his cognitive functioning appeared to be adequately intact for the purpose of the present interview. His thoughts were logical, coherent, and goal-directed. His speech was clear and intelligible, and of normal rate, volume, and prosody. There was no evidence of significant expressive or receptive language impairments. There was no overt evidence of perceptual disturbances, delusional beliefs, or perseverative thoughts. His attention, concentration, and motor activity were unremarkable. His mood and affect were appropriate in nature, range, and intensity to the situation and to the topic of conversation. He was tearful throughout much of the interview. He denied current suicidal or homicidal ideation, intent, or plan. He appeared to be a reliable historian and credible informant, and there were no overt indications of malingering or of symptom overreporting or underreporting. 6. Other Symptoms --------------------------- Does the Veteran have any other symptoms attributable to PTSD and other mental disorders that are not listed above? [X] Yes [ ] No If yes, describe: [X] Irritable or angry mood [X] Loss of interest or pleasure in activities [X] Appetite disturbance [X] Weight disturbance [X] Fatigue or loss of energy [X] Difficulty thinking, concentrating, or making decisions [X] Feelings of worthlessness or guilt CONFIDENTIAL Page 29 of 68 [X] Emotional numbing and detachment 7. Competency --------------------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No If no, explain: Not applicable. 8. Remarks, (including any testing results) if any: -------------------------------------------------- JOHN DOE: is a 45-year-old male who was in the Army, and who had a deployment to Iraq in xxxxxxx. He has a service connection for PTSD, with a current rating of 70%. This examination was focused on his functioning since the previous examination on 3/15/2017, although information regarding prior history was reviewed and obtained where relevant to the issues in question. Please see the report of the previous examination for relevant prior history. The present examination was based on a face-to-face interview with the Veteran and review of records as indicated above. Except where otherwise indicated, historical information presented above is taken from the interview. Results of the examination indicate that the Veteran's difficulties are consistent with current diagnostic criteria for PTSD. They also indicate that he experiences symptoms supporting a diagnosis of Major Depressive Disorder (MDD) at this time. These are considered to be separate, comorbid conditions which share some symptoms and a common etiology. Due to the overlap in symptoms and associated features of these disorders, it can at times be difficult to determine--and clinicians may reasonably differ regarding--whether the clinical picture might be better accounted for by a single diagnosis or by multiple diagnoses. Results of the examination indicate that as a result of his mental health conditions, he is experiencing significant impairments in a number of domains, including occupational functioning. As he is no longer working, his occupational functioning is inferred from his past work history, from his current social functioning, and from the nature and severity of his current symptomatology. He has not held paid employment since February 2016, when he lost his job due to irritability and angry outbursts. He indicated a previous history of work-related difficulties due to anxiety and panic. Taken together with fatigue, problems with attention and concentration, forgetfulness, intrusive thoughts, hypervigilance, discomfort in interpersonal interactions, and a propensity for social withdrawal and avoidance as a means of coping with stress, these difficulties would significantly limit his ability to secure and maintain gainful employment. He would likely experience challenges in adjusting successfully to a work environment due to difficulty establishing and maintaining effective work relationships, as well as to reduced reliability, productivity, efficiency, accuracy, and timeliness in JOHN DOECONFIDENTIAL Page 30 of 68 attending work and fulfilling job responsibilities. ***This DBQ was completed solely for the purpose of a disability evaluation, and does not represent the results of a comprehensive clinical or forensic evaluation of this Veteran. It represents the information and impressions which could be gathered and reported within the constraints of the time allotted for interview, review of records, and documentation, and within the constraints of this mandated format. DBQs are completed in highly specialized ways that conform to the requirements of the disability claims adjudication and appeals processes. Some items may be left blank or diagnoses may be omitted where the symptoms or disorders might actually be present but, for example, cannot be attributed to a specific cause or etiology, cannot be attributed to the specific condition for which the C&P examination was requested, or cannot be linked to the Veteran's military service on the basis of evidence that conforms to the required standards. The conclusions and opinions documented on this form were based upon the information available to the examiner at the time the evaluation was completed, and may differ from those of professionals who have evaluated the Veteran in a clinical setting and/or from the findings of any previous C&P examinations. New or additional information might result in changes to the examiner's interpretations, conclusions, or opinions as documented on this form.*** NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application.
  18. What weight would a private psychologist have on my claim for PTSD. The VA keeps ducking saying it was due to childhood trauma. I am trying to get them to admit it exasperated any preexisting condition. I had a Top Secret Clearance from 92 to 96 and would (back n those days) NEVER received it with any hint of mental issues. I feel if I can get a professional to say this into my medical record I might have a fighting chance. I have been denied twice I think. Link for so many of us it has been a long journey... Thoughts? Also does anyone know of a Veteran friendly Private Psychologist in South West Florida?
  19. I went online to EBenefits this morning to see if nothing changed after my C&P last month. It said claim closed and Decision letter sent. After checking around I found a 70% rating for PTSD and MDD and a 3/15/17 effective date which was when I filed my claim. I hadn't set up banking info yet so I did that. Some questions: 1. Will they mail a retro pay check since I didn't have banking set earlier? 2. I know I need to wait for the letter but is EBenefits usually accurate with the rating? 3. Is there a certain day of the month VA sends payments (Like social security is always at the start of the month) or is it the claim date each month? 4. Where can I find information on how my VA class will change? I was class 8 before (big copays). 5. I have a very good private therapist I'm paying for myself. Now that I'll have a rating will the VA pay for him or do they only cover their own therapists? Thanks for the help! JW
  20. I received my C&P over the weekend. My exam was nearly three hours and I think the report is accurate and fair and represents how things are. I was as honest as I could be with the examiner and despite being nervous to the point of an anxiety attack about it the day before calmed down a bit and was OK during the visit. The doctor did a good job asking questions and made me feel at ease which is saying something. The report ended up being 18 pages which surprised me. I had PMd the results to a handful of people here on HADIT and a couple recommended I post it for more input. I was hesitant to do so but decided my desire for more information is more important than my paranoia of posting it. I'd really like to get the opinions of some senior HADIT posters like Berta and others. I'm thinking this is a good C&P for my claim but would like a more seasoned opinion than my own completely inexperienced one. I've posted the opinion and rationale below. . Thank you. JW. ___________________________________ 5. Symptoms For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Suicidal ideation REQUESTED OPINION: Based on information from the clinical interview, review of records (C-file and VA medical records), and psychological assessment measures, It is my opinion that the veteran meets DSM-5 diagnostic criteria for (1) Post-Traumatic Stress Disorder (PTSD) due to childhood sexual trauma with delayed onset, and (2) Major Depressive Disorder (MDD), Recurrent, with Mood-Congruent Psychotic Features secondary to PTSD. While his PTSD and MDD were less likely than not to have been caused by an in-service stressor, both conditions were more likely than not incurred in service (i.e., delayed onset with clinically significant symptom presentation beginning while on active duty). PSYCHOLOGICAL ASSESSMENT / OBJECTIVE TESTING: Objective psychological assessment measures administered: -- Personality Assessment Inventory (PAI): valid profile without any evidence to suggest inattention, inconsistency, or negative/positive impression management; primary code type - DEP/ARD (97T/85T) * Summary/interpretation of results: Briefly, the veteran's responses on the PAI were suggestive of significant tension, unhappiness, and pessimism, with various stressors (past and/or present) contributing to low mood and self-esteem. Individuals with similar profiles often see themselves as ineffectual and powerless to change the direction of their lives and feel uncertain about goals, priorities, and what the future may hold. In addition to depression, the veteran endorsed significant distress on measures of suicidal thoughts, traumatic stress, and social discomfort or detachment. His profile was most consistent with major depression, and while some traumatic stress concerns were indicated, he did not endorse the full range of concerns typically seen among individuals with PTSD. RATIONALE FOR OPINION: 1. The veteran's symptoms meet DSM-5 diagnostic criteria for PTSD due to childhood sexual trauma. The veteran's history of childhood sexual abuse is well-documented across multiple sources and during the current evaluation, he endorsed the full range of trauma-related symptoms meeting criteria for a diagnosis of PTSD. He was first diagnosed with PTSD while on active duty in xxxx by a DOD psychiatrist and mental health records (private and VA) dating back to xxxx also show that multiple mental Health providers have diagnosed and treated PTSD. Although the veteran experienced some symptoms immediately following the assault (bed wetting, night terrors), these symptoms largely resolved by the time he was in middle school due to reported "traumatic amnesia." His only residual symptoms throughout the remainder of middle school and high school were associated with a chronic mistrust of others and related social detachment. His enlistment exam was silent for any relevant concerns, as were STRs from the time of his enlistment in xxxx until the first disclosure of the assault and associated symptoms in xxxx and xxxx. Thus, there is no evidence to suggest that the veteran was experiencing clinically significant symptoms of PTSD prior to his enlistment and thus the question of aggravation is moot. Records clearly document onset of symptoms while the veteran was on active duty and indicate chronic trauma-related symptoms and impairments since then. 2. The veteran's current mental health symptoms also meet DSM-5 diagnostic criteria for Major Depressive Disorder (MDD), Recurrent, with Mood-Congruent Psychotic Features, secondary to underlying PTSD. His current depressive symptoms are a continuation of those first diagnosed in service as Dysthymic Disorder, and the veteran has been treated for MDD by multiple mental health providers (private and VA) since at least xxxx. As indicated above (Rationale #1), there is no evidence to suggest Clinically significant symptoms of depression prior to military service, and he was first diagnosed with a depressive disorder while psychiatrically hospitalized in service (xxxx). Subsequent records indicate chronic problems with depression since his discharge from active duty. 3. The veteran's history is suggestive of some underlying Personality features which are likely contributing to some of his on-going concerns (e.g., schizoid and avoidant features). Although he was diagnosed with a personality disorder in service, there is insufficient evidence to warrant a personality disorder diagnosis at present, as some of his on-going symptoms can be attributed to underlying PTSD (e.g., mistrust of others, social/interpersonal detachment, avoidance of intimate relationships). 4. The veteran showed no signs of significant exaggeration/feigning or minimization of mental health symptoms on objective testing, during the interview, or when comparing his self-report to the evidence in the record. As such, information from this evaluation is believed to be an accurate reflection of the veteran's current mental health concerns and relevant background.
  21. After failing a sleep private study and required to sleep with a CPAP machine and meds, my private psychiatrist wrote me a NEXUS letter linking the sleep apnea as secondary to the PTSD. Also I had my Dr fill out a DBQ also linking them together. I have been waiting on them to send me info on when to go to a C&P exam but nothing yet. So I called my Veterans Services Rep and they looked it up and said they see where the information has been sent out for a medical opinion. any idea if this means NO C&P or if they are looking info to see if they will even schedule one? thanks!
  22. 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.
  23. Success at the BCNR

    Hello Hadit members, it has been a while since I posted. I believe that my last post was regarding an Earlier Effective Date NOD that I filed in 2015. I received the SOC last year, submitted my Form 9 this year, returned it and am now waiting to be certified to the BVA. A little background: https://community.hadit.com/topic/63190-70-service-connected/#gsc.tab=0 https://community.hadit.com/topic/63830-what-evidence-is-needed-for-an-eed/?tab=comments#comment-386303&gsc.tab=0 I sent a letter requesting a discharge upgrade in 2015 at the same time that I submitted the NOD. However, I did not file the proper form and never got a response. This year, due to another process that is going on, my General Under Honorable - Personality Disorder discharge came up again. At that moment, I realized that although its seems that I have not been affected by the stigma attached to that reason, when it comes to official business, it does harm veterans. The same day that I submitted the Form 9 for my appeal, I took the initiative to make copies and submit almost identical paperwork to the Board of Naval Corrections to have my discharge upgraded. On June 11th, “in the interest of justice” a decision was made and I am now an honorably discharged veteran (characterization). The narrative is being changed to Secretarial Authority and the reinlistment code was changed to RE-1J (Eligible to reenlist but elected to separate). I did not receive the letter because it was sent to my old address, but after many calls, bad numbers and full mailboxes a wonderful lady took the time to speak to me and personally forwarded me the information last week. I just want to say that I have spent countless hours online here at Hadit and other sites, reading BVA cases, reading WARMS, 38CFR’s, speaking to other veterans and watching Chris Attig and other videos on YouTube to get a good understanding of how the various processes work. I have decided that if I win this EED appeal then I will believe that I am able to help other veterans with their claims. I have done my share of sharing websites, videos and posting information on social media but I do not have the confidence to help on a larger scale. I am afraid that I will mess something up. Will I ever be a VSO? Probably not but at least I will be able to guide someone in the right direction. I just wanted to write this to encourage others to never give up and keep fighting for what’s right. I know that we all have had struggles with the VA but do not give up. It took me over 21 years to get service connected and over 26 years to get up the nerve to apply for the upgrade. Please please do not give up. I have been a member of Hadit for almost 10 years and although I do not post much I am always on or sending others this way for help. Love and hugs, txcooper aka 1994 and counting
  24. I just submitted my first claim for PTSD from MST. When I was overseas, I was on guard duty was an infantryman. When in a guard tower, he exposed his penis and started playing with it. He was looking at me and wanted to me "help" him out. We were locked and loaded so I was fearful on what this man was going to do next. I just froze. I told his SGT and he was detained and sent back to garrison. The rules changed and I was looked at a different way since the incident. There was no touching but this incident has impacted my life and my sense of security. I'm fearful of everything and what's worse is that it's now effecting my children and my marriage and that's why I'm now filing. I haven't talked about it openly with my friends and now I'm expected to talk about it with a stranger for my c&p appointments? Any advice on what to expect and how long the whole process take.
  25. Anybody have any idea or know anything about the part of the PTSD criterion relating to derealization and or dissociation? I experienced them both during my multiple MST events...still do.
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