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I was dropped from 100 % to 90%. The reason was that they claimed my lung had improved and rated them down from 60% to 10% even though I was having problem breathing.I filed an appeal as they used the wrong reading to score my rating. They should have used the DELCO which was low. I was using the DVA as my representative but I never heard one word from them and never received any callbacks. I continued to pursue my shortness of breath and the finally did a right heart cath that showed I had moderate to high pulmonary hypertension. I believed that should have answered the question on the shortness of breath and settled the appeal. But no, pulmonology said that because they saw a wedge pressure between the left side of the heart and the right, it was cardiologists problem and not theirs. Today I just had a left heart cath and everything is clean. No blockage, only .2 tenths of a rise in pressure on the left side. So this proves it's the lungs and an automatic 100%. So I went in and checked on the status of my appeal this evening and it shows that it was withdrawn and has been closed. I did not withdraw it and have no idea who did. I also checked on the request for my C file and it stated that there was no information and the request was closed. So, what do I do now? Tucker

This is my latest C&P what am I looking at? Can anyone break this down? Neck (Cervical Spine) Conditions Disability Benefits Questionnaire Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No Evidence Comments: BOARD REMAND 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a cervical spine (neck) condition? [X] Yes [ ] No Cervical Spine Common Diagnoses: No diagnosis provided. Diagnosis #1: CERVICO-OCCIPITAL NEURALGIA ICD code: == Date of diagnosis: 9/28/2015 Diagnosis #2: CERVICAL RADICULOPATHY WITH BULGING DISC ICD code: == Date of diagnosis: 2016 Diagnosis #3: MECHANICAL CERVICAL PAIN SYNDROME ICD code: == Date of diagnosis: 4/29/2015 If there are additional diagnoses that pertain to cervical spine (neck) conditions, list using above format: CERVICAL VERTEBRAE(NECK MUSCLE SPASM), DATE OF DIAGNOSIS, 6/25/1996. CERVICAL HERNIATED AND BULGING DISC, MUSCLE SPASM, AND CORD CONTUSION WITH COMPRESSION MYELOMALACIA, 8/14/12 CERVICAL SPONDYLOSIS AND DEGENERATIVE DISC DISEASE, 9/25/2014. On today's C&P examination, 11/21/17, Veteran reports several incidents in 1992-1995 of blunt trauma including carrying 50 caliber machine gun barrels and ammunition. Involved in ground defensive tactic also known as "Bull in the Ring" in which the marine is in full gear and is potentially tackled by several marines. Following this , Veteran incurred concussion-1992 or 1993). Also went to Bethesda for back school(approx. week). Currently, Veteran reports daily neck pain. Denies neck surgery. Denies no recent physical therapy. Uses Flexeril, Ibuprofen, Oxycodone, and Tens unit for pain relief. Last treated by chiropractor in 2016(Tampa Bay, Florida). b. Dominant hand: [ ] Right [ ] Left [X] Ambidextrous c. Does the Veteran report flare-ups of the cervical spine (neck)? [ ] Yes [X] No d. Does the Veteran report having any functional loss or functional impairment of the cervical spine (neck) (regardless of repetitive use)? [X] Yes [ ] No If yes, document the Veteran's description of functional loss or functional impairment in his or her own words: Can't do much of any type of physical activity, that's really limited. Obviously a hindrance, job related stuff. Multiple days off from work(pain, stiffness). Can't do lawn activities. Can't wash dishes. Can't play with your kids like you want to. Sleeping is impossible-Sometimes you have to sleep sitting up in a chair. 3. Range of motion (ROM) and functional limitations --------------------------------------------------- a. Initial range of motion [ ] All Normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Forward Flexion (0-45): 0 to 46 degrees Extension (0-45): 0 to 15 degrees Right Lateral Flexion (0-45): 0 to 23 degrees Left Lateral Flexion (0-45): 0 to 14 degrees Right Lateral Rotation (0-80): 0 to 48 degrees Left Lateral Rotation (0-80): 0 to 44 degrees If abnormal, does the range of motion itself contribute to a functional loss? [X] Yes, (please explain) [ ] No If yes, please explain: Limited bending. Description of pain (select best response): Pain noted on examination and causes functional loss If noted on examination, which ROM exhibited pain (select all that apply)? Forward flexion, Extension, Right lateral flexion, Left lateral flexion, Right lateral rotation, Left lateral rotation Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the cervical spine (neck)? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): Tenderness on palpation of the cervical spine. b. Observed repetitive use Is the Veteran able to perform repetitive use testing with at least three repetitions? [ ] Yes [X] No If no, please provide reason: Unable to perform due to severe pain. c. Repeated use over time Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No If the examination is not being conducted immediately after repetitive use over time: [ ] The examination is medically consistent with the Veteran?s statements describing functional loss with repetitive use over time. [ ] The examination is medically inconsistent with the Veteran?s statements describing functional loss with repetitive use over time. Please explain. [X] The examination is neither medically consistent nor inconsistent with the Veteran?s statements describing functional loss with repetitive use over time. Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: This examiner is unable to opine and would otherwise be speculating to state whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. Therefore this examiner cannot describe any such additional limitation due to pain, weakness, fatigability or incoordination. Furthermore, such opinion is also not feasible to give degrees of additional ROM loss due to "pain on use or during flare-ups" without speculation. d. Flare-ups Not applicable e. Guarding and muscle spasm Does the Veteran have guarding, or muscle spasm of the cervical spine? [X] Yes [ ] No Muscle spasm [X] None [ ] Resulting in abnormal gait or abnormal spinal contour [ ] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: Guarding [ ] None [ ] Resulting in abnormal gait or abnormal spinal contour [X] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: f. Additional factors contributing to disability In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: Less movement than normal due to ankylosis, adhesions, etc. Please describe: Decreased ROM. 4. Muscle strength testing -------------------------- a. Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Elbow flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Elbow extension Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist flexion: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist extension: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Finger Flexion: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Finger Abduction Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 b. Does the Veteran have muscle atrophy? [X] Yes [ ] No If muscle atrophy is present, indicate location: Upper Arm Provide measurements in centimeters of normal side and atrophied side, measured at maximum muscle bulk: Normal side: 37.5 cm. Atrophied side: 36 cm. 5. Reflex exam -------------- Rate deep tendon reflexes (DTRs) according to the following scale: 0 Absent 1+ Hypoactive 2+ Normal 3+ Hyperactive without clonus 4+ Hyperactive with clonus Biceps: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Triceps: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Brachioradialis: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam --------------- Provide results for sensation to light touch (dermatomes) testing: Shoulder area (C5): Right: [ ] Normal [X] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent Inner/outer forearm (C6/T1): Right: [ ] Normal [X] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent Hand/fingers (C6-8): Right: [ ] Normal [X] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent 7. Radiculopathy ----------------- Does the Veteran have radicular pain or any other signs or symptoms due to radiculopathy? [X] Yes [ ] No If yes, complete the following section: a. Indicate location and severity of symptoms (check all that apply): Constant pain (may be excruciating at times) Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Intermittent pain (usually dull) Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Paresthesias and/or dysesthesias Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Numbness Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe b. Does the Veteran have any other signs or symptoms of radiculopathy? [ ] Yes [X] No c. Indicate nerve roots involved: (check all that apply) [X] Involvement of C8/T1 nerve roots (lower radicular group) If checked, indicate: [ ] Right [ ] Left [X] Both d. Indicate severity of radiculopathy and side affected: Right: [ ] Not affected [ ] Mild [X] Moderate [ ] Severe Left: [ ] Not affected [ ] Mild [X] Moderate [ ] Severe 8. Ankylosis ------------ Is there ankylosis of the spine? [ ] Yes [X] No 9. Other neurologic abnormalities --------------------------------- Does the Veteran have any other neurologic abnormalities related to a cervical spine (neck) condition (such as bowel or bladder problems due to cervical myelopathy)? [ ] Yes [X] No 10. Intervertebral disc syndrome (IVDS) and episodes requiring bed rest ----------------------------------------------------------------------- a. Does the Veteran have IVDS of the cervical spine? [X] Yes [ ] No b. If yes to question 10a above, has the Veteran had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months? [ ] Yes [X] No 11. Assistive devices --------------------- a. Does the Veteran use any assistive device(s) as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [ ] Yes [X] No b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided. 12. Remaining effective function of the extremities ---------------------------------------------------- Due to a cervical spine (neck) condition, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc.; functions of the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 13. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No c. Comments, if any: No response provided. 14. Diagnostic testing ---------------------- a. Have imaging studies of the cervical spine been performed and are the results available? [X] Yes [ ] No If yes, is arthritis (degenerative joint disease) documented? [X] Yes [ ] No b. Does the Veteran have a vertebral fracture with loss of 50 percent or more of height? [ ] Yes [X] No c. Are there any other significant diagnostic test findings and/or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): 9/25/2014,MRI Cervical spine:Visibility of the central canal of the cord at the C5 level with diameter of 2mm, not considered to reflect significant syringohydromyelia and not associated with mass or abnormal enhancement. Spondylosis and degenerative disc disease of the cervical spine. Right-sided predominant disc osteophyte complex at C6-7 causes mild right central canal and moderate right neural foraminal stenosis at this level. No other central canal stenosis with milder areas of neural foraminal encroachment detailed above. C2-3:Focal shallow central to right paracentral disc protrusion. No central canal or neural foraminal stenosis. C3-4:Mild generalized disc bulge. Mild right than left neural foraminal stenosis with central canal patent. C6-7:Mild generalized disc bulge with more focal disc osteophyte complex in the right paracentral, right subarticular, and right lateral stations. C7-T1:Negative for disc herniation. 8/14/2012, MRI Cervical spine:Herniated disk C3/4, C5/6, and C6/7 levels. Bulging disk C2/3 and C4/5 levels. Diffuse spondylitic changes. Straightened alignment suggesting muscle spasm. Focal area of cord contusion or compression myelomalacia at C5 level. 15. Functional impact ---------------------- Does the Veteran's cervical spine (neck) condition impact on his or her ability to work? [X] Yes [ ] No If yes, describe the impact of each of the Veteran's cervical spine (neck) conditions, providing one or more examples: Veteran is capable of limited lifting, carrying, and bending. 16. Remarks, if any: -------------------- NOTE:Veteran performed neck flexion repeition which reduced ROM to 32deg. Unable to perform any further repetition for other ROM maneuvers. ************************************************************************* Additional exam request information: For any joint condition, examiners should test the contralateral joint, unless medically contraindicated, and the examiner should address pain on both passive and active motion, and on both weightbearing and non- weightbearing. In addition to the questions on the DBQ, please respond to the following questions: 1. Is there evidence of pain on passive range of motion testing? YES 2. Is there evidence of pain when the joint is used in non-weight bearing? YES **************************************************************************** Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS Evidence Comments: BOARD REMAND MEDICAL OPINION SUMMARY ----------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: (a) Please state all diagnoses as to the Veteran's cervical spine, and address all diagnoses already of record: herniated disk and bulging disk of the cervical spine and spondylitic changes, muscle spasm and contusion/compression, spondylosis and degenerative disc disease of the cervical spine, mechanical cervical pain syndrome and radiculopathy. (b) Please provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed cervical spine disability was caused by or etiologically related to active duty. Please specifically address the back injuries and complaints of back pain noted in the STRs. (c) Please specifically address the Veteran's lay statements that he has suffered cervical spine pain since service, and that in service he suffered injury to his neck while carrying heavy equipment and continuous wear of duty gear. (d) Please address the conflicting evidence of record and offer a clarifying opinion, notably the February 2013 VA examination positing a negative nexus, and the April 2016 private opinion positing a positive nexus. b. Indicate type of exam for which opinion has been requested: NECK TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. c. Rationale: Upon review of all available medical evidence, including eVBMS, virtual VA, and Board Remand, the following pertinent information is obtained and reported in 'Evidence Comments': Prior VA Examination, 6/25/96, reports Mr. served in the Marine Corps. he was inducted in 1990 and received separation with an honorable discharge in 1996. Medical History-In 1992, he had onset of pain in the neck area diagnosed at Quantico. Xrays were negative. Impression was muscle spasm and stress. Enlistment RME/RMH for national guard, 4/13/98, reported no neck problems and normal exam of the spine. Miami VAMC, Outpatient clinic, 5/6/2005:Assessment is chronic neck and low back pain-Will get plain films and MRI, does not want any meds. 2/28/2013, VA examination opines "Unable to find SMR evidence of significant neck injury or complaint in service. No evidence to support chronicity of problem for over 10 years post-discharge." THIS OPINION IS GIVEN LOW WEIGHT BECAUSE IT IS NEITHER SUPPORTED NOR CONSISTENT WITH THE RECORDS IN FILE THAT SHOW COMPLAINTS OF NECK PAIN INDICATING A CHRONIC CONDITION. 4/29/15, DBQ neck was completed providing a diagnosis of mechanical cervical pain syndrome and radiculopathy. As received 4/8/16, VA physician, , states that the Veteran suffers from cervico-occipital neuralgia and cervical radiculopathy with bulging disc "are as likely as not a direct result of blunt trauma received during the patient's military career. His conditions are a severe occupational impairment to the veteran and has been exacerbated by many years of continuous wear of duty gear related to his profession." On today's C&P examination, 11/21/17, Veteran is a credible historian and reports several incidents in 1992-1995 of blunt trauma, involving ground defensive tactic also known as "Bull in the Ring" in which the marine is in full gear and is potentially tackled by several marines. Following this , Veteran incurred concussion-1992 or 1993). Veteran also reported chronic neck pain during service was due to carrying 50 caliber machine gun barrels and ammunition. He also went to Bethesda for back school(approx. week). In summary, the Veteran has been under chronic medical care for neck pain first reported during service(6/25/96) and the condition has progressed from cervical muscle spasm to mechanical cervical pain syndrome and radiculopathy, cervical herniated and bulging disc with muscle spasm, cord contusion/compression myelomalacia, cervical spondylosis and degenerative disc disease, cervico-occipital neuralgia, and cervical radiculopathy with bulging disc. A nexus has been established. Therefore, it is at least as likely as not that the claimed condition has direct service connection.

Hey I'm new to the forum and really need help trying to understand what my last C&P means for my rating.. I have been waiting on this since 2010 on appeal and finally got a C&P after remand to RO. Can anyone tell me what possible rating I might receive Semper Fi. Neck (Cervical Spine) Conditions Disability Benefits Questionnaire Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No Evidence Comments: BOARD REMAND 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a cervical spine (neck) condition? [X] Yes [ ] No Cervical Spine Common Diagnoses: No diagnosis provided. Diagnosis #1: CERVICO-OCCIPITAL NEURALGIA ICD code: == Date of diagnosis: 9/28/2015 Diagnosis #2: CERVICAL RADICULOPATHY WITH BULGING DISC ICD code: == Date of diagnosis: 2016 Diagnosis #3: MECHANICAL CERVICAL PAIN SYNDROME ICD code: == Date of diagnosis: 4/29/2015 If there are additional diagnoses that pertain to cervical spine (neck) conditions, list using above format: CERVICAL VERTEBRAE(NECK MUSCLE SPASM), DATE OF DIAGNOSIS, 6/25/1996. CERVICAL HERNIATED AND BULGING DISC, MUSCLE SPASM, AND CORD CONTUSION WITH COMPRESSION MYELOMALACIA, 8/14/12 CERVICAL SPONDYLOSIS AND DEGENERATIVE DISC DISEASE, 9/25/2014. On today's C&P examination, 11/21/17, Veteran reports several incidents in 1992-1995 of blunt trauma including carrying 50 caliber machine gun barrels and ammunition. Involved in ground defensive tactic also known as "Bull in the Ring" in which the marine is in full gear and is potentially tackled by several marines. Following this , Veteran incurred concussion-1992 or 1993). Also went to Bethesda for back school(approx. week). Currently, Veteran reports daily neck pain. Denies neck surgery. Denies no recent physical therapy. Uses Flexeril, Ibuprofen, Oxycodone, and Tens unit for pain relief. Last treated by chiropractor in 2016(Tampa Bay, Florida). b. Dominant hand: [ ] Right [ ] Left [X] Ambidextrous c. Does the Veteran report flare-ups of the cervical spine (neck)? [ ] Yes [X] No d. Does the Veteran report having any functional loss or functional impairment of the cervical spine (neck) (regardless of repetitive use)? [X] Yes [ ] No If yes, document the Veteran's description of functional loss or functional impairment in his or her own words: Can't do much of any type of physical activity, that's really limited. Obviously a hindrance, job related stuff. Multiple days off from work(pain, stiffness). Can't do lawn activities. Can't wash dishes. Can't play with your kids like you want to. Sleeping is impossible-Sometimes you have to sleep sitting up in a chair. 3. Range of motion (ROM) and functional limitations --------------------------------------------------- a. Initial range of motion [ ] All Normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Forward Flexion (0-45): 0 to 46 degrees Extension (0-45): 0 to 15 degrees Right Lateral Flexion (0-45): 0 to 23 degrees Left Lateral Flexion (0-45): 0 to 14 degrees Right Lateral Rotation (0-80): 0 to 48 degrees Left Lateral Rotation (0-80): 0 to 44 degrees If abnormal, does the range of motion itself contribute to a functional loss? [X] Yes, (please explain) [ ] No If yes, please explain: Limited bending. Description of pain (select best response): Pain noted on examination and causes functional loss If noted on examination, which ROM exhibited pain (select all that apply)? Forward flexion, Extension, Right lateral flexion, Left lateral flexion, Right lateral rotation, Left lateral rotation Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the cervical spine (neck)? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): Tenderness on palpation of the cervical spine. b. Observed repetitive use Is the Veteran able to perform repetitive use testing with at least three repetitions? [ ] Yes [X] No If no, please provide reason: Unable to perform due to severe pain. c. Repeated use over time Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No If the examination is not being conducted immediately after repetitive use over time: [ ] The examination is medically consistent with the Veteran?s statements describing functional loss with repetitive use over time. [ ] The examination is medically inconsistent with the Veteran?s statements describing functional loss with repetitive use over time. Please explain. [X] The examination is neither medically consistent nor inconsistent with the Veteran?s statements describing functional loss with repetitive use over time. Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: This examiner is unable to opine and would otherwise be speculating to state whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. Therefore this examiner cannot describe any such additional limitation due to pain, weakness, fatigability or incoordination. Furthermore, such opinion is also not feasible to give degrees of additional ROM loss due to "pain on use or during flare-ups" without speculation. d. Flare-ups Not applicable e. Guarding and muscle spasm Does the Veteran have guarding, or muscle spasm of the cervical spine? [X] Yes [ ] No Muscle spasm [X] None [ ] Resulting in abnormal gait or abnormal spinal contour [ ] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: Guarding [ ] None [ ] Resulting in abnormal gait or abnormal spinal contour [X] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: f. Additional factors contributing to disability In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: Less movement than normal due to ankylosis, adhesions, etc. Please describe: Decreased ROM. 4. Muscle strength testing -------------------------- a. Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Elbow flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Elbow extension Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist flexion: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist extension: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Finger Flexion: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Finger Abduction Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 b. Does the Veteran have muscle atrophy? [X] Yes [ ] No If muscle atrophy is present, indicate location: Upper Arm Provide measurements in centimeters of normal side and atrophied side, measured at maximum muscle bulk: Normal side: 37.5 cm. Atrophied side: 36 cm. 5. Reflex exam -------------- Rate deep tendon reflexes (DTRs) according to the following scale: 0 Absent 1+ Hypoactive 2+ Normal 3+ Hyperactive without clonus 4+ Hyperactive with clonus Biceps: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Triceps: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Brachioradialis: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam --------------- Provide results for sensation to light touch (dermatomes) testing: Shoulder area (C5): Right: [ ] Normal [X] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent Inner/outer forearm (C6/T1): Right: [ ] Normal [X] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent Hand/fingers (C6-8): Right: [ ] Normal [X] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent 7. Radiculopathy ----------------- Does the Veteran have radicular pain or any other signs or symptoms due to radiculopathy? [X] Yes [ ] No If yes, complete the following section: a. Indicate location and severity of symptoms (check all that apply): Constant pain (may be excruciating at times) Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Intermittent pain (usually dull) Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Paresthesias and/or dysesthesias Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Numbness Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe b. Does the Veteran have any other signs or symptoms of radiculopathy? [ ] Yes [X] No c. Indicate nerve roots involved: (check all that apply) [X] Involvement of C8/T1 nerve roots (lower radicular group) If checked, indicate: [ ] Right [ ] Left [X] Both d. Indicate severity of radiculopathy and side affected: Right: [ ] Not affected [ ] Mild [X] Moderate [ ] Severe Left: [ ] Not affected [ ] Mild [X] Moderate [ ] Severe 8. Ankylosis ------------ Is there ankylosis of the spine? [ ] Yes [X] No 9. Other neurologic abnormalities --------------------------------- Does the Veteran have any other neurologic abnormalities related to a cervical spine (neck) condition (such as bowel or bladder problems due to cervical myelopathy)? [ ] Yes [X] No 10. Intervertebral disc syndrome (IVDS) and episodes requiring bed rest ----------------------------------------------------------------------- a. Does the Veteran have IVDS of the cervical spine? [X] Yes [ ] No b. If yes to question 10a above, has the Veteran had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months? [ ] Yes [X] No 11. Assistive devices --------------------- a. Does the Veteran use any assistive device(s) as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [ ] Yes [X] No b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided. 12. Remaining effective function of the extremities ---------------------------------------------------- Due to a cervical spine (neck) condition, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc.; functions of the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 13. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No c. Comments, if any: No response provided. 14. Diagnostic testing ---------------------- a. Have imaging studies of the cervical spine been performed and are the results available? [X] Yes [ ] No If yes, is arthritis (degenerative joint disease) documented? [X] Yes [ ] No b. Does the Veteran have a vertebral fracture with loss of 50 percent or more of height? [ ] Yes [X] No c. Are there any other significant diagnostic test findings and/or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): 9/25/2014,MRI Cervical spine:Visibility of the central canal of the cord at the C5 level with diameter of 2mm, not considered to reflect significant syringohydromyelia and not associated with mass or abnormal enhancement. Spondylosis and degenerative disc disease of the cervical spine. Right-sided predominant disc osteophyte complex at C6-7 causes mild right central canal and moderate right neural foraminal stenosis at this level. No other central canal stenosis with milder areas of neural foraminal encroachment detailed above. C2-3:Focal shallow central to right paracentral disc protrusion. No central canal or neural foraminal stenosis. C3-4:Mild generalized disc bulge. Mild right than left neural foraminal stenosis with central canal patent. C6-7:Mild generalized disc bulge with more focal disc osteophyte complex in the right paracentral, right subarticular, and right lateral stations. C7-T1:Negative for disc herniation. 8/14/2012, MRI Cervical spine:Herniated disk C3/4, C5/6, and C6/7 levels. Bulging disk C2/3 and C4/5 levels. Diffuse spondylitic changes. Straightened alignment suggesting muscle spasm. Focal area of cord contusion or compression myelomalacia at C5 level. 15. Functional impact ---------------------- Does the Veteran's cervical spine (neck) condition impact on his or her ability to work? [X] Yes [ ] No If yes, describe the impact of each of the Veteran's cervical spine (neck) conditions, providing one or more examples: Veteran is capable of limited lifting, carrying, and bending. 16. Remarks, if any: -------------------- NOTE:Veteran performed neck flexion repeition which reduced ROM to 32deg. Unable to perform any further repetition for other ROM maneuvers. ************************************************************************* Additional exam request information: For any joint condition, examiners should test the contralateral joint, unless medically contraindicated, and the examiner should address pain on both passive and active motion, and on both weightbearing and non- weightbearing. In addition to the questions on the DBQ, please respond to the following questions: 1. Is there evidence of pain on passive range of motion testing? YES 2. Is there evidence of pain when the joint is used in non-weight bearing? YES **************************************************************************** Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS Evidence Comments: BOARD REMAND MEDICAL OPINION SUMMARY ----------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: (a) Please state all diagnoses as to the Veteran's cervical spine, and address all diagnoses already of record: herniated disk and bulging disk of the cervical spine and spondylitic changes, muscle spasm and contusion/compression, spondylosis and degenerative disc disease of the cervical spine, mechanical cervical pain syndrome and radiculopathy. (b) Please provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed cervical spine disability was caused by or etiologically related to active duty. Please specifically address the back injuries and complaints of back pain noted in the STRs. (c) Please specifically address the Veteran's lay statements that he has suffered cervical spine pain since service, and that in service he suffered injury to his neck while carrying heavy equipment and continuous wear of duty gear. (d) Please address the conflicting evidence of record and offer a clarifying opinion, notably the February 2013 VA examination positing a negative nexus, and the April 2016 private opinion positing a positive nexus. b. Indicate type of exam for which opinion has been requested: NECK TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. c. Rationale: Upon review of all available medical evidence, including eVBMS, virtual VA, and Board Remand, the following pertinent information is obtained and reported in 'Evidence Comments': Prior VA Examination, 6/25/96, reports Mr. served in the Marine Corps. he was inducted in 1990 and received separation with an honorable discharge in 1996. Medical History-In 1992, he had onset of pain in the neck area diagnosed at Quantico. Xrays were negative. Impression was muscle spasm and stress. Enlistment RME/RMH for national guard, 4/13/98, reported no neck problems and normal exam of the spine. Miami VAMC, Outpatient clinic, 5/6/2005:Assessment is chronic neck and low back pain-Will get plain films and MRI, does not want any meds. 2/28/2013, VA examination opines "Unable to find SMR evidence of significant neck injury or complaint in service. No evidence to support chronicity of problem for over 10 years post-discharge." THIS OPINION IS GIVEN LOW WEIGHT BECAUSE IT IS NEITHER SUPPORTED NOR CONSISTENT WITH THE RECORDS IN FILE THAT SHOW COMPLAINTS OF NECK PAIN INDICATING A CHRONIC CONDITION. 4/29/15, DBQ neck was completed providing a diagnosis of mechanical cervical pain syndrome and radiculopathy. As received 4/8/16, VA physician, , states that the Veteran suffers from cervico-occipital neuralgia and cervical radiculopathy with bulging disc "are as likely as not a direct result of blunt trauma received during the patient's military career. His conditions are a severe occupational impairment to the veteran and has been exacerbated by many years of continuous wear of duty gear related to his profession." On today's C&P examination, 11/21/17, Veteran is a credible historian and reports several incidents in 1992-1995 of blunt trauma, involving ground defensive tactic also known as "Bull in the Ring" in which the marine is in full gear and is potentially tackled by several marines. Following this , Veteran incurred concussion-1992 or 1993). Veteran also reported chronic neck pain during service was due to carrying 50 caliber machine gun barrels and ammunition. He also went to Bethesda for back school(approx. week). In summary, the Veteran has been under chronic medical care for neck pain first reported during service(6/25/96) and the condition has progressed from cervical muscle spasm to mechanical cervical pain syndrome and radiculopathy, cervical herniated and bulging disc with muscle spasm, cord contusion/compression myelomalacia, cervical spondylosis and degenerative disc disease, cervico-occipital neuralgia, and cervical radiculopathy with bulging disc. A nexus has been established. Therefore, it is at least as likely as not that the claimed condition has direct service connection.

Hello all. Want to first thank everyone for helping. The information we have received from you all has been incredibly helpful. My dearest husband just received his award letter and the representative forgot to add in two of his disabilities related to his back into the overall rating. He has been recieving these two benefits for several years now and neither of them were mentioned or addressed in his award letter. It simply looks like the VA rep. made a mistake. What should we do and how long does it take to fix a mistake like this? Any ideas?

so during my last c + p exam The Dr. stated that my range of motion has met the criteria for 5251, and 5252, and 5253. now this page says it is lawful to be rated under all these 3 codes. http://www.militarydisabilitymadeeasy.com/hipandthigh.html All three of these codes for limited hip motion CAN be used together. So if the hip is limited in flexion, extension and abduction, then it can be rated three times, once under code 5251, once under code 5252, and once under code 5253. Each code can only be used once, however, so if the hip is limited in abduction and adduction, both are rated under the same code (5253) and so two ratings cannot be given.

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 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: CH PTSD b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): PARKINSON'S, HIGH TRYGLYCERIDE. HEARING LOSS. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [X] No c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [ ] No [X] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes [ ] No [X] No other mental disorder has been diagnosed c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS [X] Other (please identify other evidence reviewed): STRESSOR NOTE. Evidence Comments: TALKED WITH HIS WIFE MELINDA. SHE STATES THAT GRADUALLY HAS BECOME MORE IRRITABLE, LOOSES HIS TEMPER VERY EASILY, SNAPPS AT HIS KIDS, ARGUMENT. AT NIGHT HE IS RESTLESS IN BED, YELLING AND STARTS SWINGING HIS HANDS AND FEW TIME HE HIT HER IN THE SLEEP. WHEN HE IS OFF MEDS, HE IS MORE WITHDRAWN, LESS ACITVE PHYSICALLY AND MORE IRRITABLE. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military) THIS VET ARRIVED HERE FROM SIGNAL MOUNTAIN, TN, DRIVEN HERE BY HIS WIFE.HE WAS BORN IN FRANCE, HIS FATHER WAS IN ARMY. RAISED IN JASPER, TN. HE WAS RAISED BY BOTH PARENTS. HE HAS ONE BROTHER AND ONE SISTER.NO HX OF ANY KIND OF ABUSE.HE IS MARRIED FOR 31 YRS, ONLY MARRAIGE. THEY HAVE 3 CHILDREN. HE JOINED THE AIR FORCE IN 1985 AND DCED IN 2008 WHEN HE WAS DXED WITH PARKINSON'S. HE HAD 6 TO 7 YRS OF ACTIVE AIRFORCE, STATIONED IN KUWAIT AND IRAQ. HE WAS DCED FROM AIRFORCE RESERVE IN 2008. HIS RANK AT DCED WAS MASTER SERGEANT. b. Relevant Occupational and Educational history (pre-military, military, and post-military): COMPLETED HIGH SHCOLL IN JASPER. HAS BACHELOR IN ORGANIZATIONAL MANAGEMENT.HE WORKED FOR TVA IN NUCLEAR PLANT AND DID ROOT COUSE ANALYSIT. HE WORKED LAST SEPTEMBER 2016 BECAUSE OF PARKINSON's. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): HE DID NOT RECEIVE ANY MH CARE BEFORE HE JOINED THE AIRFORCE, NONE WHILE IN AIRFORCE BUT AFTER DCED FROM AIRFORCE, HAD TO SEEK HELP AT CHATTANOOGA CLINIC.HE WAS THEN DEPRESSED, HIS MOTHER PASSED AWAY, COULD NOT HANDLE THE LOSS, HAD TO GIVE UP WORKING AND FELT HOPLESS AND HELPLESS.HE FELT LOW ELF ESTEEM.HE WAS THEN PRESCRIBED AND NOW HE IS STILL FOLLOWED BY PSYCHIATRIST AT CHATTANOOGA CLINIC.HE STILL FEELS DEPRESSED, SOME ARGUMENT WITH HIS WIFE.HE FREQUENTLY CRIES, FEELS HOPLESS AND SOME TIME GOES THROUGH MOOD SWING BUT DENIES ANY MANIC EPISODES.HE KEEP UP WAKING UP AT NIGHT, FIGHTS IN HIS SLEEP, FEW TIME HE HIT HIS WIFE IN SLEEP AND HAS HEPPENDED FREQUENTLY, FEELS GUILTY ABOUT.HIS WIFE TELLS HIM HE CRIES IN HIS SLEEP AND SCEAMING BUT HE DOES NOT REMEMBER DOING THESE. REPORTS THAT HE AVOIDS CROWD, FEELS MORE SAFE AT HOME. IF HE IS IN UNFAMILIAR SITUATION, DOES GET UNCOMFORTABLE.HE GETS FRIGHETEN IF THERE IS LOUD NOISE.VERY LIMITED SOCIAL LIFE, ONLY TIME GOES OUT WHEN HE ATTENDS THE CHURCH. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): NONE e. Relevant Substance abuse history (pre-military, military, and post-military): NONE f. Other, if any: HIS OWN PHSICAL CONDITION AND LEAD TO GIVING UP JOB AND ROLE REVERSAL WHEN HIS WIFE HAS TO WORK AND HE HAS TO STAY HOME. 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: 2001, AT AIRFORCE BASE IN QUATAR, WAS GOING TO DO PURCHASE WITH HIS PRCHASING AGENT, PERSON PULLS UP AT GATE AND PULLS OUT AK 47, START SHOOTING, HE WAS ONLY THIRD CAR FROM GATE., THIS PERSON WAS SHOTTO DEATH 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? [X] Yes [ ] No If yes, please describe the markers that may substantiate the stressor. MIDDLE OF ATTACK. b. Stressor #2: WHEN HE WAS STATIONED IN SAUDI DURING DESERT STORM, THERE WAS GR 1 TORNADO NEAR THE BASE, BRITISH PILOT HAD TO EJECT HIM SELF FROM Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [ ] Yes [X] No Is the stressor related to personal assault, e.g. military sexual trauma? [X] Yes [ ] No If yes, please describe the markers that may substantiate the s tressor. WITNESSING BRITISH PILOT EJECTING FROM AIRPLANE WHEN THERE WAS GR 1 TORNADO AT BASE. 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] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. [X] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Exaggerated startle response. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 [X] Stressor #2 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment[X] Disturbances of motivation and mood [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Inability to establish and maintain effective relationships 6. Behavioral Observations -------------------------- ALERT,ORIENTEDX3,COOPERATIVE, CASUALLY DRESSED, POOR EYE CONTACT, CONSTANTLY MOVING IN THE CHAIR, VERY FIDGITY. AFFECT IS CONSTRICTED, DECREASED INTENSITY, ANXIOUS MOOD. RATE OF SPEECH NORMAL, GOAL DIRECTED. NO AH/VH OR ANY PERCEPTUAL DISTURBANCES. NOT SUICIDAL OR HOMICIDAL. NO COGNITIVE DEFICIT. 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 -------------------------------------------------- THIS VET DID EXPERINECE TRAMATIC STRESSORS AND HAS EXPERIENCED SXS OF PTSD WITH CO MORBID DEPRESSION AND UNDERGOING MH RX AT CHATTANOOGA CLINIC. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. ****************************************************************************

Just got rated at 80% but 70% is for depression and they say it's temporary. The money every month has allowed me to breathe and is making things a lot better for my family but now I'm worried about the temporary part. Guess my question is what do I do now should I make appointments at the va or not? I use to go quite often but not anymore. Figure what is the point all those doctors do is stair at a computer and pump me full of drugs that I honestly I don't want and can't have due to my job. What should I do, do I have to make appointments to see a doctor? Thank you for any help.

OK, so here's my story. I was in Iraq in 2008-09, and started having chest pain. It was dismissed by the army doctors as probably just a strained muscle. Fast forward a few years, and I was diagnosed with pulmonary hypertension and stage one heart failure, both of which are ultimately fatal. I submitted a claim for these conditions, which was denied. I appealed this denied to the DRO in St. Louis, MO. The contention for pulmonary hypertension has a pending rating decision in the system according to my VSO. Here's my issue. I am diagnosed with Pulmonary Hypertension, as well as other diseases. The doctor who did my C&P exam clearly stated that he believed that my PH was service connected. The pending rating states that I am granted service connection for PH. However, in the section that details the rating, it is rated at 30% as "Symptomatic, following resolution of acute pulmonary embolism." In the CFR 38 section 4.97, diagnosis code 6817, Non-tuberculosis diseases of the respiratory system, Pulmonary Hypertension is clearly listed as a 100% condition. I called the 1800 number to check on the rating decision, and I was informed that it was sent to the authorizer, who then sent it back to the rater, and it is now just waiting to be authorized again. Is it possible that the authorizer saw this, and felt that the " Symptomatic, following resolution of acute pulmonary embolism" was not an accurate representation of my diagnosis, and asked for it to be updated?

Under Explanation his letter informs me of a reduction in my PTSD disability rating from 50% to 30%. It lists the reasoning for this decision. They noted all these items as reasons for the reduction but never explained how they arrived at their decision other than "the overall evidentiary record shows":... No where do any of these terms show up in any evaluation in my medical records. I've appealed it. How do they get away with manufacturing this type of evidence? Of course they did not give me due process, I had no predetermination hearing. In my NOD I stated, "To date I have not received this predetermination hearing. I believe this may have been offered in correspondence somewhere, but the confusion of proposed vs. an actual reduction may have clouded the issue. In any event, if I am entitled to a hearing, I request one be scheduled." Do you think I have a case?

First of all wanted to start this out by saying thank you to all the members on this site. I have been doing all my own research and very often arrived here. Today I decided it might be better to get direct contact instead of lurking in the shadows. The short version is that I have not been able to find work after separating, I'm currently on unemployment to keep myself out of debt while I figure this all out. I was in school for a few months and while I was struggling a bit I did my best to push through which was kind of working out for awhile. Eventually I started getting to the point where I could only manage to push myself to get to class and landed right back in bed afterwards. This effect snowballed and now I have just been medically withdrawn from university after missing 2 weeks of class. Those two weeks I could not get out of bed almost the entire time, I have been taking my meds and everything but sometimes depression just decides its going to mess your life up and you don't have the will or energy strong enough to overcome and keep going. But back to the point, the VA awarded me 30% for depression, anxiety and insomnia combined into one rating. Trying to figure out how I am going to get by and what I can do to survive brought me to the vets group on campus where one of the other guys after hearing what was going on suggested trying to get my rating increased and possibly seeing if I am eligible for individual unemployability. After reading how the VA scores depression I believe I might be in the 70% range but I'm not sure how to go about this. I've got the NOD paperwork but didn't want to fire off half cocked. I look to you all for some help with this as time and again I've seen this community help each other navigate the labyrinth that is the VA. My question here is multifaceted, which I will break down for easier reading and responding. 1. When filing a NOD should I go for DRO or traditional? 2. What evidence should I include with this to increase the likelihood of conveying my situation properly? 3. Should I talk to my doctor about trying to raise my percentage or keep the two separate? 4. Should I focus on the depression or give information on insomnia and anxiety as well/ would they all go together? 5. Lastly What sort of timeframe should I expect, I've seen people saying a few months and others waiting years later. Thank you all for any help you can provide and if you need any more information or clarification I will gladly supply it. (There are other things in my disability claim but they are much minor to the mental health issues and I believe the ratings I received for the others were fair or fair enough.)

WARNING, LONG POST I'll go ahead and clear the air here; I know this is going to upset a lot of Veterans that have been seeking a strong rating and have been denied. My apologies, I'm not trying to sound ungrateful here. Here's the situation: I am a full-time educator who has been working for several months (successfully). I was at a 50% PTSD rating for the the past four years, but recently went in for my re-evaluation. Terrified of the outcome and possible reduction, I went in prepared; I had my list of symptoms, I wrote down the worst days I've had recently, and I was open and honest with the evaluator. Today, I received notice that my rating for PTSD and depression has been raised to 100%. The money would be nice. I have a family and am expecting another child soon, but I still don't want this rating. I need to work. Structure and implied hierarchies rule my life. I have a routine that I daily and any deviation from this ruins the entire day. If they took my job away, I would genuinely lose it. . . Here are the reasons I want to lose this rating: 1. I'm terrified of losing my routine and know full well that a new one wouldn't be good for me. The paycheck from the VA would be more than I could make at my job (teachers have a salary ladder) until about five years from now. If I have this much money coming in, I'll get stuck in a rut that I will never break free from. 2. I'm terrified about coming to grips with my condition. Yes, I have some problems. No, I don't think they are severe enough to warrant this decision. I'm able to work. I need to work. If I don't contribute something to the world then I'm lost. I know Vets who cannot function in daily society, and I'm not one of them. I don't want to take away from the people who really need this benefit. 3. I'm worried what others think. Yes, I know it's shallow, but I spend the majority of my time analyzing others. One of my conditions is that I've lost the ability to respond well socially; I'm emotionally numb unless I'm chemically altered. With a 50% rating, my friends, family (and possibly employers) think I've got a "little baggage." With 100%, I doubt they could ever look at me the same. Those that love me will question whether I'm going to do something drastic, and those who don't will judge me and may think I'm faking. I'm grateful that the VA took the time and genuinely listened to me, but I think they're overdone it. Can anyone tell me how to rectify this situation? I don't want benefits I don't believe I'm entitled to. I don't want the VA to think I inflated my condition for profit, and I don't want to lose the one thing that keeps me from crawling into a hole (job). How long can i continue to work before they come after me? I'd at least like to finish up the school year. If I break contract (even though it would be for good reason) I would really destroy my chances of ever teaching again. It's a small town, who would hire me after that? Thanks for all the help.

He takes his glasses off, looks at me and says "son, you're rated at 90%, you could have been rehabbing your knees for the past 4 years free of charge. Some of those DAV guys are good, but some of them are idiots" At this point, I was extremely frustrated and may have slipped out a few expletives at a louder than normal tone. He told me "son, talk to your primary physician about getting seen by a specialist and ask to get an MRI because you're knee looks somewhat okay, but I imagine an MRI might reveal something else that will explain the pain. Regardless of what happened, we'll take care of you, I know it's been a long journey, but hang in there and have faith. Also, how's your migraines? I see you're rated at 30%, but if they've gotten worse, you should file for an increase. Anyways, hang in there son and I'll make sure I put the info gathered from the exam in today" He was extremely caring and pro active, which is something that I am NOT used to with the VA. I don't have as many complaints as some you guys out there, but still, it hasn't been easy. I just wanted to share this story and hopefully I'll get the rating I deserve - since it's a bilateral diagnose, wouldn't I get a rating for each + 10%? Lord willing, if that happens, I should be pushed to 100% according to Hutsky's excel spreadsheet. That will help my family and I out so much! I am glad I am not in this fight alone and if it wasn't for a bunch of you, I would be in a darker place. Thanks - you guys don't know how much you've done for me. Brothers in arms!

Hi, I am hoping someone with a lot more knowledge than me can figure out if I am misinterpreting the rating descriptions or if someone made an error. I will copy and post from what I read at the end of this. I will omit just one section that is irrelevant.(actually I will include it, just in a small font. I have highlighted the areas I feel are important. I have cystitis with recurrent UTI's causing constant (pain, discomfort, urgency) I also have incontinence (aka voiding dysfunction) My claim I stated bladder urinary problem. I wasn't sure how to state it. Clear medical evidence and documents provided to be approved service connection at 40%. My question is that I felt it should be 2 separate ratings. #1 Chronic Cystitis causing frequency meeting 40% AND #2 Voiding Dysfunction meeting requirements for 60% (Or at minimum 1 rating at the higher of the 2 at 60%. I'm curious as to your take on my rating for the "Urinary System" Facts: I have a diagnosis of Cystitis 7512(Interstitial Cystitis) which causes pain, frequent urination, urgency, etc. also I have recurring and frequent UTI's I also have Urinary incontinence 7542(which is not technically a symptom of cystitis, I suppose unless due to urgency, which is different than mine.) On my claim I claimed "Bladder Condition" Note I was rated at 40% My question is looking at this couldn't I have two ratings? One for the Cystitis at 40% under frequency and also one for Voiding dysfunction at 60%. If not at least rating at the higher 60%????? What do you think? Please let me know if I'm mistaken or if I should submit in hopes of correcting and by what method. Thank You Urinary Rating Systems There are three different urinary rating systems. Urinary Frequency: A condition is rated under this system if it causes the body to urinate more often than normal. If you have to urinate 5 or more times during the night, or if you have to urinate more than every hour during the day, it is rated 40%. If you have to urinate 3 or 4 times during the night, or if you have to urinate every 1 to 2 hours during the day, it is rated 20%. If you have to urinate 2 times during the night, or if you have to urinate every 2 to 3 hours during the day, it is rated 10%. Obstructed Voiding: A condition is rated under this system if there is something in the way that makes it hard to urinate, like a kidney stone. If the condition makes it so you cannot urinate at all and must always use a catheter, then it is rated 30%. If there are obvious symptoms (slow or weak stream, hesitancy to start urinating, etc.) and if there is one or more of the following: 1) more than 150 cc (cubic centimeters) of urine left over in your bladder after you urinate, 2) less than 10 cc of urine per second are passed through the ureter, 3) there are regular urinary tract infections because of the obstruction, or 4) the urethra becomes narrow because of an infection and requires regular dilatation (stretching) treatments every 2 to 3 months—then it is rated 10%. If there are only obvious symptoms (slow or weak stream, hesitancy to start urinating, etc.) but none of the other 4 conditions listed above, then it is rated 0%. This 0% rating is still given even if there is narrowing of the urethra that requires regular dilatation (stretching) treatments only once or twice a year. Voiding Dysfunction: All urinary conditions that cannot be rated as urinary frequency or obstructed voiding are rated by this system. If the condition requires the use of a catheter to remove urine from the bladder, or if the condition requires the use of absorbent materials (like pads or Depends) that must be changed more than 4 times a day, then it is rated 60%. If it requires absorbent materials that must be changed 2 to 4 times a day, then it is rated 40%. If it requires absorbent materials that must be changed only once a day, then it is rated 20% Code 7512: Chronic Cystitis is the swelling of the bladder most often due to infections, but it can be caused by other things as well. If it is caused by a urinary tract infection, then it is rated as described for that condition. All other causes of this condition are rated under this code. Code 7542:A Neurogenic Bladder occurs when a person looses control over urination because of damage to the nerves or the brain.

I apologize for the long post but I need help as the VA has made a complete disaster of my claim. My original decision from predischarge exam I was rated 10% for shin splints of the right and left leg along with 10% for each of STATUS POST LEFT KNEE MENISCECTOMY WITH DEBRIDEMENT and PATELLOFEMORAL SYNDROME OF THE RIGHT KNEE. The shin splints were rated analogously as 5262-5022 but MY condition never actually included a knee disability any where in my records as was noted in the rating decision here from October 2004 here: We have granted service connection· for your bilateral shin splints. The available service medical records submitted for review show you were initially treated on August 13, 1999 for bilateral shin pain after running. You were diagnosed with shin splints, provided with Naprosyn for discomfort, and placed on thirty days limited duty. Your records also show six additional, periodic medical reports through September 2003 to obtain medication for shin pain, and placement on another twenty-one days limited duty. You experience .symptoms of constant tightness in the shin muscles that easily become inflamed after long periods of standing, running, walking, and climbing up stairs. Treatment was limited duty, Motrin, and ice. Functional impairment is an inability to run or stand for long periods of time however you denied any time lost from work due to this condition. We have assigned a separate 10 percent disability evaluation for shin splints of each leg. Physical examination revealed tenderness to palpation of the anterior tibia bilaterally of both tibia/fibula performed on the day of examination were considered normal bilaterally. A review of all findings which includes treatment in service, VA examination, and your subjective complaint of bilateral shin pain falls in-between the criteria for a 0 percent .evaluation and a 10 percent evaluation, Where there is a question which of two evaluations shall be applied, the higher evaluation will be assigned if disability picture more nearly approximates the criteria required for that rating. wise, the lower rating will be assigned. Resolving all benefit of the doubt in your the 10 percent evaluation is assigned. A higher evaluation of 20 percent is not warranted unless evidence demonstrates leg flexion which is limited to 30 degrees. Since this condition is not specifically shown in the VA regulations, it has been rated on a similar condition in which the anatomical location and symptoms are closely rated. Additionally disabilities such as limitation of motion, restriction of activity, and additional functional impairment caused by pain have also been considered; even though they not have been specifically noted during VA examination. ----------------------------------------------- The VA Sent a CUE with my MARCH 2015 trying to lower my rating for spin splints from my predischarge exam with my 03/03/2015 rating decision that says: "I hereby certify that the claims record of this veteran has been reviewed and that the following clear and unmistakable error has been identified: The rating decision of October 18, 2004 incorrectly provided separate compensable evaluations of 10 percent each for left leg shin splints and right leg shin splints along with compensable evaluations for the left and right knees. However, a more complete review of the evidence shows that the separate compensable evaluations for bilateral shin splints was a clear and unmistakable error due to pyramiding. This Rating Decision constitutes a proposal to reduce the evaluations of shin splints to 0 percent each, which results in a reduction of the overall evaluation to 70%. (38 CFR 4.00 (k, 3.105, 4.14, 4.71a (5262))" The problem is my shin splints are strictly a leg condition that were rated analogously , as was initially found and have never been tied to my knees or ankles anywhere in my SMRs. I just got my C-file and was treated numerous times for for shin pain, did 51 days limited duty because of it and had no treatment for the knee condition and shin splints at the same time in service. Shin splints it is still listed as an active condition in my VA medical records along with the knee conditions as of May 2015 and no where in my VA records is it tied to a knee disability. My wife had a bad interaction with a butthole rater at a local event the VBA did two months before this was sent about the reason my claim for increase in my knee conditions so we protested the condition based on retaliation to the Veteran Service Manger who remembered us from the event and agreed it was suspect and ordered an administrative review. We got a rating decision stating the following two weeks later: "Rating decision dated March 3, 2015 proposed to reduce your right and left knee condition rated as shin splints from 10 percent to 0 percent. Although that decision was a correct decision based on the diagnostic code that was assigned and the medical evidence of record for that diagnostic code. A review of your case was requested and what we found was the medical evidence from the VAMC in Fayetteville and from your private provider shows you have bilateral limitation in flexion and extension at a compensable rate of 10 percent. Therefore, we have changed the code sheet to reflect this decision and continued your overall evaluation of 80 percent." They changed the code from 5262-5022 which was analogous so never actually included a knee disability to 5262 for limitation of extension of the knee(I never claimed that). The problem the rating decision I received on 12/10/15 when I put in an increase for shin splints which is lower leg pain they examined me for the limitation of extension of knee and are now proposing to lower it again because i didn't have a limitation of extension of knee and the C&P exam said I have no history of shin splints. I'm trying to figure out the best way to straighten this mess out. Any advice?

In 1972, while serving in USN, I landed on my head from a motorcycle accident and woke up in the Naval Hospital. LOC ~45min but at time diagnosed as "mild concussion", held 24hr, dismissed after being told I would be fine and sent back to ship to be deployed to Vietnam. Flash forward ~40yr. When my perpetual depression eventually went off the deep end I asked the VA for help. Started taking meds and asking questions about my life. Finally got directed to Poly-Trauma for full neuro-pysh and MRI. FWIW, I was wondering why I always had trouble remaining employed longer than ~2yr at-a-time over the past ~40yr. I earned three degrees including a PhD, plus three other professional certs, but just could NOT keep a job. MRI results showed past indications of "stroke" (ischemic insults in white matter where parts of brain died), but being UNRATED for TBI, the current doctors atributed this to current diabetes and age. At this point I filed for disability and 14 months later got my 50% rating for TBI. THAT is when I finaly realized my TBI was real AND just how bad I am disabled by it. The detailed list of symptoms/manifestations that the VA examiner provided read like a laundry list of my life's challenges, that until then I had never put together in conscious thought. I have my intelligence but what I lack are the higher level executive functions that would let me put my education to use. In other words, I can't play well with others at work or at home. I could p***-off the Pope given enough time together. I have no friends at this point, but do have ONE person I taught school with (a retired LTC) that seems to understand and gives me advice from across the country. My military performance records are bad, real bad... as in I do not understand why I wasn't kicked out, jailed, etc. They show manifestations of deprived sleep, anxiety, irratibility, lack of motivation, etc. My post-military civilian employment performance records show the SAME manifestations over a roughly ~27yr of the 40yr since TBI. I only kept THOSE records because I thought "they" were picking on me. But they are detailed records, and they seem to show that "they" were correct, and NOT me. This took me months to come to terms with, and only by viewing these things using a 3rd person analysis. Personally, I get too upset reading/thinking about them. My Depression Rating was denied, though the VA final rulling about depression being "secondary service connected" came through within a week of my TBI rating, so THAT will be reassessed in the appeal. I recieved a C-PAP for my sleep apnea, that was just diagnosed in 2013. I have a 1973 diagnosis for vaso-motor rhinitus, that also states/records such things a "trouble sleeping, mouth breathing, snoring, 30lb weight gain(BMI-31 = obese), anxiety, BP of 140/100/90, non-reactivity to know allergens, etc. Sleep apnea denied due to lack of nexus. BOTTOM LINE is that the military FAILED to do adequate testing in 1972-73 on my TBI, depression, sleep disordered breathing, etc. What is NOW considered as standard protocol following a TBI, was not even known in 1972-73. Shoot the C-PAP machine wasn't even invented until 1985, so the military would not even know what to look for. QUESTION: Isn't THIS where the VA's "benefit of the doubt" rule should kick in? After all they finally rated my TBI (lower rating than I have records to show degree of disability) going retro-active ~41yr. (i.e. Schrödinger's cat) CURRENT STATUS: My TBI/Depression appeal has been filed. My Sleep Apnea appeal is being developed AND THIS IS WHERE I COULD USE SOME HELP. I am focusing on the military's failure test me for sleep disorders when it was/is obvious that I had manifestations of sleep disordered behavior in my elisted performance records as well as in my vaso-motor rhinitus diagnosis in 1973. Any help/advice would be appreciated.

Hello, I'm new here. I'm in a 6 year wait to receive compensation. Received letter from BVA dated November 4th, granting service connection for left knee disability, manifested by arthritis, and residuals of a bilateral foot injury, manifested by neuropathy as due to cold weather exposure. No further instruction were included as to rating and/or benefit info. Ebenefits was updated 11/26, indicating a combined disability rating of 30%, 10% for knee and each foot. I'm puzzled as to how RO has concluded rating on knee, due to the fact in 2013 I had a total knee replacement. I was expecting knee alone to be 30%, at bare minimum. This 12 page letter from BVA VLJ includes discussion of my total knee replacement and also three scopes done on knee prior to TKR. It's there in black and white! Is it likely RO has overlooked something so obvious?! Or is it possible they are still working on rating and just entered bare minimum rating on each to get me in system?? Just recently, as of 11/26 was I able to add dependents. Before then I couldn't update any info such as banking info and spouse and children without 30% rating. I have yet to receive any letter/paperwork from RO, though I'm anxiously awaiting to better understand their conclusions. I'd appreciate any advice and opinions. Thank you in advance!

Well, some weirdness happened on eBenefits the past couple of days. Two days ago, all of my conditions under appeal on a NOD DRO review disappeared completely on my "Pending Disabilities" list on my eBenefits "Dashboard". They were replaced by one "new" claim of "back pain condition" with a filed date of 09/09/2015, and it showed "Pending Decision Notification". It sat like that until today when it also was gone, and eBenefits gave an error message that it was unable to retrieve my information on pending disabilities. The interesting thing was that it shows that I got a bump up to a total of 20% (was sitting at 10% for tinnitus and 0% for hearing loss, left ear). The condition awarded at the additional 10% was for degenerative arthritis in my back, with an EED of 06/10/2010, which is good because that is when I filed the initial claim. I checked my AB8 and yep, shows 20%, then called "Peggy" on the VA's 1-800 lie line just to extra-super-duper-confirm, and after a 30 minute wait, I confirmed the award. I quizzed the guy about my remaining multiple conditions still under NOD, and he said that it looked to him like they were still pending, then he said something interesting. He said that it looked to him that the VA decided this one outside the others because it looked easily ratable. I pressed a little more on things, and he of course became nervous, and then said that he couldn't give me additional information until I received my letter on that rated condition. What this one was a new claim that I filed in 2014 based on military medical records that I received from the NPRC. I had filed for back pain in 2010, and had simply assumed that the VA had my military records. I was wrong. After they denied me, I did a couple of requests for NPRC records (I know I've mentioned this time and time again.), and after receiving the magic records and noting that they were not in my C-File, I shot them off as part of a new claim, which the VA then "consolidated" into my pending NOD claim. Crazy, huh? So I have moved the football another 10 yards, thanks to a couple of free NPRC records requests, and retroed back to June 10, 2010 on that increased rating amount. I don't have retro yet, but Peggy (before he turned back into a VA phone drone) told me I should be seeing the retro hit my account soon, and that I'll be getting my SOC in the mail soon as well on this condition. Lord only knows that eBenefits and Peggy may lie, or just not know what is what, so we'll see when I get a paper document or a deposit. Just an update. Thanks again for all of you and the help you have provided me. I could not have gone even this far without your help, knowledge and support....and AskNod's book. Now the mission continues on the conditions still on appeal. Just don't forget: Check the NPRC for records too.....you never know what treasure may be hiding in one of their envelopes. My gold nugget in one of their envelopes helped greatly on this one particular condition. Half a league onward! Mark

Hello all. I would like to thank all of you for your work on this site. I am a long time lurker, first time poster. I received my C&P Results back and would appreciate any feedback. I understand that there is no way to be fully accurate when trying to guess a rating based off of this information. I am just under immense stress lately as I have watched my life fall apart piece by piece over the last few years. I had good rapport with the interviewer but don't know what to make of some of the things he wrote. Thanks in advance for your insights you all do great work here. SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [X] Yes [ ] No ICD code: 309.81 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD ICD code: 309.81 Mental Disorder Diagnosis #2: Alcohol Abuse, in Remission ICD code: 305.03 Mental Disorder Diagnosis #3: No response provided. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [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: Currently, no symptoms are attributed to alcohol abuse, because alcohol abuse is in remission. All symptoms are attributable to PTSD. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with reduced reliability and productivity b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [X] Yes [ ] No [ ] No other mental disorder has been diagnosed If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: Currently, no occupational or social impairment is attributed to alcohol abuse, because alcohol abuse is in remission. All occupational and social impairment is attributable to PTSD. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence review ------------------ In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: ------------------------- Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes [ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [ ] Yes [X] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: If no, check all records reviewed: [X] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [X] Department of Defense Form 214 Separation Documents [X] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [X] Other: MTR - govt and nongovt, VA documents and forms, b. Was pertinent information from collateral sources reviewed? [X] Yes [ ] No If yes, describe: Buddy or lay statement from who was Veteran's ex-girlfriend, 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): Relevant social history, birthplace, (mostly) happy childhood memories, (-) homeless currently, (-) rent currently, (+) own currently, (#0) of household occupants in addition to Veteran, (-) close friends, Veteran states that he feels estangement from others, he reached out to one of his military friends two weeks ago, this was the first tome to do that for one year, Veteran used to be active on Facebook, but he is no longer active on facebook, he began experiencing the idea that his thoughts were being communicated in a certain way by others, (-) attend social activities, (+) hobbies or interests, Video games, all kinds, grand theft auto, mad and football, wrestling, Veteran used to be an avid sports fan, he used to know the lines of college and professional football teams, he does not do that anymore, Relevant marital history, (S) civil status, he used to have a girlfriend, they were together for 3 years, he used to yell and scream at her, he states that it took everything within him to keep from hitting her, but he never hit her, she left and she did not come back; Veteran states he never assaulted his ex-girlfriend prior to their breakup; alternatively, he states that he choked his girlfriend in the heat of the moment 2 times, but she did not pass out, (#0) number of marriages, (#0) number of divorces, (#1) number of childrren y/o son, Veteran's son's mother does not allow Veteran's son to have unsupervised visits with Veteran, Relevant family history, (-) emotional or mental problems, (+) heart disease, PGF has CAD and h/o CABG, (+) both parents living, (-) close to them, he rarely talks with them, (#1) siblings living, 1 sister, (-) close to her, they have not spoken for 2 years Pre-military, Veteran states he killed his first animal at 10 y/o, which was a deer, and he gutted and cleaned it at that age. Post-military, Veteran states that he carries a gun wherever he goes. He was closer to his family and other people pre-military and military. Post-military, he has become distant with family and friends. His parents live inand have a home there . Post-military, after finishing his contract work in which he mostly worked on military instillations for the federal government, he lived with his parents for 2 months in He moved f to to go to College in 2012. He did not start having problems from symptoms of PTSD until after he finished his contract work, which was more like being in, rather than out of, the military, and began living more as a civilian. b. Relevant Occupational and Educational history (pre-military, military, and post-military): Relevant occupational history, (-) currently working outside the home, (2012) year last worked outside the home, (F) P = part time, F = fulltime, (security) type of work, (nothing) current source of income, Veteran indicates that he has used up his savings and now he is behind on many of his bills, (+) emotional or mental symptoms associated with occupational problems, Veteran was fired from his last two jobs, Relevant educational history, (+) learning difficulties, (-) learning disabilities, (he has two years of college) level of education, (+) emotional or mental symptoms associated with educational problems, difficulty concentrating, Veteran graduated from HS at 18 y/o. He went to college for one year. He worked seasonal work, restaurant work, cabinet factory, met a woman, had a son, was in and out of legal troubles, and entered the USA at 23 y/o. He was discharged from the USA at 27 y/o. He worked for as a regional supervisor for 5 years. . ; Veteran states he was a distinguished soldier during basic training. He became the best mechanic while in stationed in Germanny. He was a leader and NCO in the Ranger battalion. He did not get DUIs and he did not get into fights. Veteran states that he laughed at the PTSD symptoms checklist when he first came back from his deployment to Iraq. but now he cannot get a job due to such symptoms. He has not been able to hold down a job for the past 3 years. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Relevant mental health history, (-) mental health care before military service, (-) mental health care during military service, (+) mental health care after military service, (#0) previous suicide attempt(s), (#0) previous hospitalization on psychiatric ward(s), (#0) previous court orders for involuntary treatment, (+) currently seeing a provider for the purpose of medication management, (-) currently attending individual psychotherapy and/or group therapy, he used to go to groups, he lost his driver's license, therefore he has not been going, because it is difficult getting there, (+) h/o severe emotional trauma, (-) h/o head trauma, (-) h/o evaluation for TBI, (+) current emotional or mental problems, (+) mood often blue or sad, (+) anger, (+) h/o ever experiencing seven or more days of manic excitement (i.e., abnormally, discretely, and persistently elevated, expansive, or irritable mood), decreased need for sleep, racing thoughts, or pressured speech, Veteran states that he has gone for many days without sleeping, he would keep busy because he was unable to sleep, he used to self-medicate insomnia by drinking alcohol to the point of blacking out, he has h/o anxiety and paranoia, racing thoughts, increased goal directed behavior (in terms of playing a video game), agitation (in terms of pacing around the apartment), he was not talking faster or more than usual, no significant change in self-esteem or grandiosity, no significant distractability, (+) behavior for the purpose of pleasure with potentially painful consequences (alcohol problem), (+) h/o of hallucinations, he used to have these when he was drinking alcohol, he used to have alcohol hallucinosis, he has been sober since June 2015, (+) h/o delusions, he has h/o delusions of reference, Prescribed medications, List, propranolol, sertraline, and trazodone; he was remotely taking aripiprazole and valproate, he was taking quetiapine when going through inpatient treatment for alcohol abuse, he has h/o risperidone and risperidone-associated akathisia, (+) adverse events with one or more of these, his sleep is too deep with trazodone, then he has disturbing dreams, then he cannot wake up out of these disturbing dreams, because his sleep is too deep, (-) beneficial effects with each of these, propranolol was previously helpful while he was on risperidone to decrease the akathisia associated with risperidone, sertraline is not yet producing a beneficial effect, Family mental health, Please see above under "relevant family history." d. Relevant Legal and Behavioral history (pre-military, military, and post-military): Relevant legal history, (+) symptoms associated with legal problems, (+) h/o arrests for assault, battery, or violence, (+) h/o arrests, convictions, or sentencing (to jail or prison), (-) currently on parole or probation, (-) current conservator or guardian, (+) h/o DUI, #1, Relevant behavioral history, (+) symptoms associated with behavioral problems, Veteran states that he does not talk with anyone, he does not do anything, he enrolled in school, he cannot deal with that anymore, he dropped out of College, he cannot deal with the people there, he believes he is viewed by others as a time bomb, after he was arrested for eluding an officer. (yesterday) last time to be in a heated argument with another person, (June, 2015) last time that to be in a physical altercation with another person, (poor) quality of sleep generally, Pre-military: Veteran had reckless driving charges and assault with a deadly weapon charges prior to USA service. He was charged with reckless driving. He ended up doi of house arrest for reckless driving. He took assault with a deadly weapon to a jury who did not find him guilty as charged. It was determined that he was defending himself, and he was absolved of any wrong doing. Military: Veteran has one negative counseling statement for missing formation one morning due to oversleeping when they had a power outage, when his roommate was on leave, but other than that he did not have any other LOCs, no LORs, no Article 15s, and no other non-judicial or judicial punishments. Postmilitary: Veteran was arrested in 2013, and he was placed in a mental health safe cell while in jail, because he drove off from a traffic stop away from an officer. He was initially written up for felony eluding, but the charges were plea bargained down to a misdemeanor. Veteran has pending charges. He has a warrant out for his arrest. This is for criminal speeding (99 mph in a 45 mph zone). e. Relevant Substance abuse history (pre-military, military, and post-military): (+) tobacco during past 30 days, (today) when last used, (-) alcohol during past 30 days, (July 2015) when last used, he got out of treatment June 8th, he relapsed in July, for 2 days, (+) h/o alcohol problem or alcohol abuse, (-) illicit drugs during past 30 days, (prior to March, 2014) when last used, he has not used spice (synthetic MJ since prior to his first inpatient treatment program, (+) h/o inpatient or outpatient treatment for alcohol or illicit substances, 2 times, (+) currently attending AA, NA, or other support groups, Veteran does not believe that he suffers from alcoholism, Veteran smoked a joint of MJ when he graduated from HS, he did not smoke MJ during the military, and he smoked MJ less than 6 times after the military. He drank alcohol 2 times during HS, he was a social drinker during college and the military, while in Germany, and he became an alcoholic after the military. He was drinking a lot with his friends, at the time of his deployment to Gerrmany, from dusk until dawn. Other times, he could drink until 2 AM, go to sleep, wake up at 5 AM, go to PT, and be fine, while in the regular Army battalion, but he was not able to keep that lifestyle while in the Ranger battalion, because they put him through too much. Veteran does not like talking with anyone about anything, even the weather. Veteran feels uncomfortable when in large groups of people. This triggers intense urges for drinking alcohol. Living with his emotions and feelings is more difficult without alcohol than with alcohol. f. Other, if any: No response provided. 3. Stressors ------------ Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: 1. Military Combat Trauma (Veteran observed traumatic events as experienced by others, including seeing a person get his face shot off, seeing people with their heads cut off, and seeing a dead body, he claims he saw a US missile hit a minivan carrying an entire family,) 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 b. Stressor #2: No response provided. 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criteria A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in one or more of the following ways: [X] Witnessing, in person, the traumatic event(s) as they occurred to others Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid 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 to the individual to blame himself/herself or others. [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. [X] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Reckless or self-destructive behavior. [X] Hypervigilance. [X] Exaggerated startle response. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks that occur weekly or less often [X] Chronic sleep impairment [X] Difficulty in establishing and maintaining effective work and social relationships [X] Inability to establish and maintain effective relationships 6. Behavioral Observations -------------------------- Appearance - attire is summertime casual, grooming is average, and presently, the veteran does not appear to intermittently be in distress as he intermittently discusses his taaumas. Behavior - eye contact is intermittent, and speech is of unremarkable rate, rhythm, volume, prosody, and articulation. Speech contains profanity in many sentences. Comportment suggests that the veteran gets along adequately with this writer. Affect is neutral. Thought processes are logical, linear, and goal-oriented. Presently, the veteran does not have a formal thought disorder. Thought content is without homicidal ideation or suicidal ideation. Perceptions - the veteran presently does not appear to be responding to internal stimuli. Insight is fair. Judgment is fair. Psychomotor activity - Veteran becomes agitated when talking about his experiences in Iraq. Muscular observation shows absence of focal motor deficits. Cognitions are grossly intact. Abstractions demonstrate at least average capacity for logical reasoning and systematic thought. 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 -------------------------------------------------- REQUESTS AND FINDINGS A. CLAIM TYPE - ORIGINAL, DBQ PSYCH PTSD Initial, the following contentions need to be examined - PTSD, The VARO has verified the veteran's combat service and the veteran has the following combat medals Combat Action Badge, Veteran is a y/o divorced, unemployed EA who served in a Ranger battalion while serving in the USA and experienced military combat while serving in Iraq. Veteran served in the USA from 2003 to 2007. He was in the motor pool division of the Ranger battalion. He observed traumatic events as experienced by others, including seeing a person get his face shot off, seeing people with their heads cut off, and seeing a dead body. He claims he saw a US missile hit a minivan carrying an entire family, because the US forces wanted to kill one enemy combatant inside the minivan. Veteran saw a VAMC on 10/01/2014, who diagnosed him with and treated him for PTSD. Veteran experienced military combat stressors. Currently, at night he has dreams, in which he cannot get his gun to shoot, because it will not fire. During the day, he has uncontrollable thoughts. He visions someone getting shot. Either he is shooting at the person getting shot or groups of people are shooting at the person getting shot. He hears someone getting shot. He states that it makes a very distinct sound. Thunderstorms, trigger he to "lose it," whereby he becomes diaphoretic, comes to, and finds himself on the floor in the prone position, after he has pulled his ex-girlfriend to the floor with him. He has trouble sleeping for one week following such events. Firecrackers on the 4th of July trigger he to "lose it," whereby he finds he has pulled his son to the ground with him, causing abrasions to his son's B/L knees. Veteran states that he avoids people, because when they find out that he is an Iraq War veteran, then they have a tendency to talk with him and ask him questions about his experiences. He states that he hates it when they state that they understand, and he states that they do not understand, because they were not there. Veteran voices his suspiciousness and states that as soon as groups of people at AZU, where he was in school, and groups of people where he has been employed find out that he has issues, then people talk about him and he is talked about. Veteran states that people make jokes as to when would he be going postal and start shooting up the office. He states that he knows that others are talking about him, because when he goes into a room, then everyone stops talking. Veteran states that once people become uncomfortable with someone, then they plot and scheme. Veteran used to be a baseball player, where he learned that being calm and controlled worked to his advantage, but he states that he has lost the ability of being calm and controlled in order to work to his advantage. He recognizes that he has a "short fuse" and can suddenly go from neutral to angry, agitated, and combative with the right cue, as in someone older bossing him around and telling him what to do. He states "[he] wants to punch out a window over nothing." Veteran states that if he applies for a supervisor position, then he is offered an entry level position instead. He states in the past he was able to deal with supervisors, but now he cannot deal with supervisors. One of his supervisors was talking to him as though he was a child, then Veteran took his left hand, placed it across his supervisors neck, and pushed him against the wall. His supervisor "flipped out," talked about suing him, and talked about pressing charges. Then Veteran was immediately let go. He was told that they were going to consider it as though he was never hired. Veteran admits to being high strung and states that he used to be able to filter out supervisors telling him what to do kinds of stressors, but he is no longer able to do that. He states that yesterday when he took a urine drug test for a job that he would like to get, after waiting for 20 minutes and watching the receptionist doing one thing or another on the computer, he became irate and confrontational. Veteran denies suicidal ideation. He states his father's sister's husband killed himself. Veteran states that he would never do that. He would not do it on account of his mother and his son. Work impairments include being up for 3 nights at a time without sleeping, then he falls asleep while he is doing something routine, such as tying his shoes. He states that he has missed a few jobs on account of this problem. Veteran meets the following DSM 5 criteria for PTSD. 1.) Trauma, (+) Directly experiencing the events, (+) Witnessing the events as they occurred to others, (-) Learning that the traumatic events occurred to someone close, 2.) re-experiencing, (+) dreams or nightmares, (+) flashbacks, (-) illusions or hallucinations, (+) images, perceptions, or thoughts, (+) triggers cause emotional and mental distress, 3.) avoidance, (-) activities, he enjoyed American Sniper immensely, but he states that this stirred up emotions and feelings, (+) conversations, he avoids conversations with his Ranger friends, (-) feelings, (+) people, he avoids seeing his Ranger friends, (+) places, he states he does not like the VA, people came back without eyes and limbs, he came back with emotional and mental symptoms, (-) thoughts, 4. negative feelings or thoughts, (+) anhedonia, (+) decreased interest or participation in activities, (+) distorted cognitions about the cause or consequences of the events, he states that the entire Gulf War was "&$," (+) feeling detached and estranged, (-) forgetting details about the events, (+) negative beliefs about himself, others, or the world, he states that the US federal government is "&$," (+) negative emotions, 5.) Altered arousal and reactivity (+) angry outbursts, (+) irritable behavior, (+) hypervigilance, (+) exaggerated startle, (+) recklessness, (+) self-destructiveness, (-) concentration problem, if interested, then he can concentrate really well, if not interested, then he cannot concentrate very well, (+) sleep disturbance, 6.) (+) long-term duration, 7.) (+) dysfunction, 8.) (+) not due to a medical illness or substance, Veteran has decreased productivity at work, because he has emotional and mental symptoms affecting his ability to work, interpersonal problems affecting his ability to get along well with others, and authority and submission problems affecting his ability to get along well with supervisors. These problems are secondary to symptoms of PTDS. They occasionally, but not continuously, affect reliability. Otherwise, his ability to adapt to change, maintain a regular work schedule, pay attention, concentrate, and reason, show up for the job, maintain himself on the job, and complete the job are not impaired. Alcohol abuse is in remission. Functional limitations include working under a less than supportive supervisor, working around any more than 2 or 3 other people, and working indoors. B. ELECTRONIC CLAIMS FOLDER AVAILABLE, review Veteran's electronic folder in VBMS and state that it was reviewed. Veteran's electronic folder in VBMS and was reviewed. C. If more than one mental disorder is diagnosed, comment on their relationship to one another. Alcohol abuse is secondary to insomnia, which is secondary to PTSD. Alcohol abuse is in remission. D. If more than one mental disorder is diagnosed, state which symptoms are attributed to each disorder. Currently, no symptoms are attributed to alcohol abuse, because alcohol abuse is in remission. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application.

how does rating protection works. what is it. 5year or 10 year and the va cant lower your rating?

I know I heard somewhere that two 0% rated conditions equate to 10%. Is this true? Also, what about situations where there are even more multiple 0% rated conditions.....like 3 or 4 of them? Just a thought. Mark

Hello there, Currently waiting for a rating. Put in the claim jan 2014 changed to prep for decision begining fot this month. Things are moving pretty fast. What should I expect when I get my claim will it be denied? This is from the C&P DSM 5 PTSD 309.81 DATE 06/23/14 DSM 5 SCHIZOAFFECTTIVE DISOREDER, BIPOLAR TYPE 295.70 DATE 06/23/14 DSM 5 ACHOL DEPENDENCE ICD 305.00 DATE 06/23/14 THE VETERAN MEETS THE FULL DIAGNOSTIC CRITERIA FOR POST TRAUMATIC STRESS DISORDER, SCHIZOAFFECTIVE DISORDER, BIPOLAR TYPE AND ALCHOL DEPENDENCE BASED ON DSM-IV AND IN ADDITION TO DSM 5 DIAGNOSTIC CRITERIA, THE VETERANS ALCHOL DEPENDENCE IS RELATED TO PTSD AS HE BEGAN TO DRINK TO EASE HIS ANXIETY RELATED TO THE TRAUMA AND PTSD SYMPTOMS. THE VETERANS SYMPTOMS OF PTSD ARE DISTINCT FROM HIS DELUSIONS AND AUDITORY HALLUCINATIONS CAUSED BE SCHIZOAFFECTIVE DISORDER VIPOLAR TYPE. HE IS HYPERVIGILANT FROM PTSD. HIS ALCHOL DEPENDENCE IS ALSO DISTINCT EITH PERIOD OF BINGE DRINKING AND BLACKOUTS. X OCCUPATIONAL AND SOCIAL IMPARMENT WITH REDUCED ABILITY AND PRODUCTIVITY. 70% SCHIZOAFFECTIVE DISORDER, BIPOLAR TYPE 20% ALCHOL DEPENDENCE 10% PTSD PTSD DIAGNOSTIC CRITERIA A X DIRECTLY EXPERINCING THE TRAUMATIC EVENTS X WITNESSING IN PERSON, THE TRAUMATIC EVENTS, AS THEY OCCOURED TO OTHERS CRITERIA B X INTENSE OR PROLONGED PSYCHOLOGICAL DISTRESS AT EXPOSURE TO INTERNALOR EXTERNAL CUES THAT SYMBOLIZE OR RESEMBLE AN ASPECT OFTHE TRAUMATIC EVENT CRITERA C X AVOIDENCE 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) CRITERIA D X PERSISTENT AND EXXAGERATED NEGATIVE BELIEFS OR EXPECTATIONS ABOUT ONESELF, OTHERS, OR THE WORLD (EG, "I AM BAD", "NO ONE CAN BE TRUSTED", "THE WORLD IS COMPLETLY DANGEROUS", "MY WHOLE NERVOUS SYSTEM IS PERMANENTLY RUINED") X PRESISTNEGATIVE EMOTIANL STATE (E.G. FEAR, HORROR, ANGER, GUILT, OR SHAME) X FEELINGS OF DETACHMENT OR ESTRANGEDMENT FROM OTHERS. CRITERIA E X HYPERVIGILANCE X PROBLEMS WITH CONCENTRATION CRITERIA F X DURATION FOFTHE DISTURBANCE IS MORE THAN 1 MONTH CRITERIA G X THE DISTURBANCES CAUSES CLINNICALLY SIGNIFIGANT DISTRESS OR IMPARIMENT IN SOCIAL, OCCUPATIONAL, OR OTHR IMPORTANT AREAS OF FUNCTIONING. SYMPTOMS X DEPRESSED MOOD X ANXIETY X SUSPICIOUSNEDD X DEPRESSION AFFECTING THE ABILITY TO FUNCTION INDEPENDENTLY, APPROPRIATLEY, AND EFFECTIVLEY X IMPARMENT OF SHORT- AND LONG TERM MEMORY, FOR EXAMPLE RETENTION OF ONLY HIGHLY LEARNED MATERIAL, WHILE FORGETTING TO COMPLETE TASKS X FLATTEND AFFECT X CIRCUMLOCUTORY SPEECH X STEROTYPED SPEECH X SPEECH INTERMITTENTLY ILLOGICCAL, OBSCURE, OR IRREVANT X IMPARED JUDGMENT X GROSS IMPARMENT IN THOUGHT PROCESSES OR COMMUNICATION X DISTURBANCES OF MOTIVATION AND MOOD X INABILITY TO ESTABLISH AND MAINTAIN EFFECTIVE RELATIONSHIPS X PERSISTENT DELUSIOONS OR HALLUCATIONS X INTERMITTENT INABLITY TO PREFORM ACTIVITIES OF DAILY LIVING, INCLUDING MIANTENANCE OF MINIMAL PERSONAL HYGENE BEHAVIORAL OBSERVATIONS THE VETERAN PRESENTED AS AN AVERAGE GROOMED AFRICAN-AMERICAN MALE WITH NOTICABLE FLAT AFFECT. HE BECAME INCREASINGLY MORE LABILE AS HE BEGAN VERBELIZING HIS DELUSIONAL BELIFS. X THERE IS A DIAGNOSIS OF SUBSTANCE ABUSE. THE DIAGNOSIS IS. ALCHOL DEPENDENCE X SUBSTANCE ABUS IS SECONDARY TO AGGRAVATED BY A PSHCHIATRIC DISORDER RELATED TO MILITARY X THE VETERAN CONTENDS THAT FUNCTIONAL IMPAIRMENT IS DUE TO THE EFFECTS OF A MENTAL DISORDER. THE VETERAN PRESENTS AS ACTIVELY DELUSIONAL. HE IS HIGHLY DISTRACTED BY HIS NEED TO "CURE CANCER" AND OTHER GRANDIOSE BELIEFS. WILL THIS SHOW AS MILTARY RELATED? WILL I GET A RATING? FILED 1/15/2014 PREPARATION FOR DECISION 08/04/2014C&P 0623/2014 ANYBODY HAVE A CLAIM LIKE THIS? WHAT COULD I EXPECT? SHOULD I GET THAT APPEAL STARTED?

Went for a second c&p exam last week and I'm afraid it doesn't look good for me. Currently I'm 50% for PTSD and 10% for tinnitus. My first exam was back in '08 when I originally filed so I guess this exam was just a follow up. I'm an OIF 1 veteran if that makes a difference. Below are my exam notes. Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire SECTION I: 1. Diagnostic Summary Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes[ ] No ICD Code: 309.81 2. Current Diagnoses a. Mental Disorder Diagnosis #1: PTSD ICD Code: 309.81 Comments, if any: Based on DSM-5. VBMS and CPRS records reviewed. Based on today's review examination, the veteran continues to meet DSM diagnsotic criteria for PTSD. The veteran has reported a worsening of PTSD symptoms since his 2008 Initial examination, with additional stressors (highlighted in other sections of this examinaiton report). Veteran is currently prescribed psychotropic medications by his former VA-primary care provider, Dr. Shissler, who has since retired-veteran receives medications by mail. Veteran is not currently seen by VA mental health providers. Mental Disorder Diagnosis #2: Alcohol Intoxication ICD Code: 303.00 Comments, if any: Based on DSM-5. VBMS and CPRS records reviewed. Based on today's examination, the veteran currently meets DSM-5 diagnostic criteria for Alcohol Intoxication. The veteran's current substance-related and addictive disorders diagnosis is based on veteran's report of consuming 5-16oz bottles of beer less than 24hrs prior to this examination. In addition, veteran reported history of alcohol addiction and treatment through the VA-Baton Rouge South SATP with Dr. Reidwald. Veteran's current Alcohol Intoxication/Alcohol Dependence diagnosis is at least as likely as not (50/50chance) due to, or result of his PTSD diagnosis. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Dyslipidemia, deviated nasal septum, chronic maxillary sinusis, tinnitus, bilateral sensori hearing loss, hypertension, Comments, if any: Medical diagnoses taken from CPRS records. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes[ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [X] Yes[ ] No[ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis: Alcohol Intoxication- Recent ingestion of alcohol -Clinically significant/problematic behavioral/psychological changes associated with recent consumption of alcohol -One or more of the following sx onset with consumptions of/shortly after consumptions of alcohol: slurred speech, incoordination, unsteady gait, nystagmus, impaired attention/memory, stupor/coma -Sx are not attributable to another medical condition nor explained by another mental disorder PTSD -recurrent and intrusive memories and thoughts of the event -recurrent and disturbing dreams of the event -psychological reactivity -efforts to avoid conversations, thoughts, feelings, related to trauma -loss of interest or participation in activities -feelings of detachment or estrangement from others -emotional numbing -difficulty falling asleep/staying asleep -irritability/anger -difficulty concentrating -hypervigilence -exaggerated startle response -suicidal ideation -memory problems c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes[ ] No[X] Not shown in records reviewed 4. Occupational and social impairment a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [ ] Yes[X] No[ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: Due to overlap of affective and behavioral 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 In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes[ ] No Was the Veteran's VA claims file reviewed? [X] Yes[ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: CPRS records reviewed. Attention was givent to the Veteran's Initial PTSD examination report, with Dr. Kodur, 8/18/08. Based on his Initial PTSD examination, the veteran met criteria for PTSD, and obtained a GAF score of 49, which suggested serious impairment in the veteran's social and occupational functioning at the time. If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [ ] Yes[X] No If yes, describe: 2. Recent History (since prior exam) a. Relevant Social/Marital/Family history: Veteran reported since his 2008 Initial examination, hw ans his Wife have had two children (ages 5, 2) and their 8yr old dog has died (December 2013). Veteran reported his Wife now works full-time, having weekend and night shift as a Nurse, and veteran provides most of the care and parenting for their children. Veteran reported he enjoys this responsibility, however at times this is stressful. Veteran reported his marriage is currently strained, due to his return to excessive drinking. Veteran reported he has attempted to "quit" several times, and has been successful for short periods of time. Veteran reported when drinking alcohol, he at times becomes argumentive with his Wife, and angry. Veteran reported at times, including within the past 24hrs prior to this appointment, he consumes 5-16oz containers of beer in one sitting, and this irritates his Wife. Veteran reported this is typically how arguments begin. Veteran reported his Wife has stopped communicating with him and gives him the silent treatment when he drinks now. Veteran reported this usually leads to him becoming angrier. Veteran reported last night, his Wife refused to talk to him. Veteran reported they have sought marital counseling in the past, and the counselor challenged him to not drink for 30 days, which he did. Veteran reported he does not feel his drinking is excessive or problematic, although he has been labeled a "functional alcoholic." Veteran expressed concerns for losing his family due to his excessive drinking at this time. Veteran reported alcohol helps him to cope with sx of PTSD including nightmares and unwanted thoughts, and stated these are issues his Wife does not understand. Veteran reported feeling supported by his family/parents, and they too have encouraged him to seek treatment for his excessive drinking, and to resume marital counseling. b. Relevant Occupational and Educational history: Veteran reported he continues to work as and Industrial Contractor along with his father and brother. Vetran reported doing this work since 2007, and denied having problems on the job. Vetran reported when he is stressed on the job, or experiences panic attacks, his family members are "understanding" and they allow him time to relax in his office. Veteran described having a panic attack some years ago on the job, in which his father drove him to the emergency room. Veteran reported feeling as though he were having a heart attack, and later after tests, he was told he suffered a panic attack. c. Relevant Mental Health history, to include prescribed medications and family mental health: Veteran reported he is not currently receiving mental health services. Veteran reported he is prescribed psychotropic medication, Citalopram, which was origianlly prescribed by his former VA primary care provider, Dr. Shissler. Veteran denied being referred to mental health, and stated his medications continue to come to him via mail. Veteran reported he feels the medication helps him to not feel depressed, however, the medication does not prevent panic attacks, nor does it help him to sleep. Veteran reported he was previously seen at the VA-Baton Rouge South clinic in the SATP program by Dr. Reinwald in 2012. Veteran reported he completed the program, although he did not feel he had problems with alcohol at that time. Veteran denied history of inpatient hospitalization since his last examination. Veteran endorsed current sx to include increased tearfulness, sad/depressed mood, chronic sleep impairment, restlessness, increased nervousness, difficulty managing stress, increased memory problems, distractibility, increased panic attacks, difficulty in crowds and amongst people unknown to him, racing heart/pounding heartbeat, and increased use of alcohol and nicotine. Vetran denied thoughts of harming himself or others, however, reported at times he has become verbally aggressive when stressed or after drinking. Veteran reported increased nightmares, and described a mixture of real events along with events that had not occured in his nightmares. Veteran reported current fear of "being sent back to Iraq," at times. CPRS records indicate veteran was last seen at the VA Baton Rouge South Clinic in the SATP program in February 2012. Records indicate veteran was last seen in psychiatry by Ms. Joseph in March 2012 for medication management. Veteran has a diagnostic history to include Alcohol Dependence, PTSD, and Panic Disorder, NOS. d. Relevant Legal and Behavioral history: Veteran denied e. Relevant Substance abuse history: Veteran reported he was previously seen at the VA-Baton Rouge South clinic in the SATP program by Dr. Reinwald in 2012. Veteran reported he completed the program, although he did not feel he had problems with alcohol at that time. Veteran reported his marriage is currently strained, due to his return to excessive drinking. Veteran reported he has attempted to "quit" several times, and has been successful for short periods of time. Veteran reported when drinking alcohol, he at times becomes argumentive with his Wife, and angry. Veteran reported at times, including within the past 24hrs prior to this appointment, he consumes 5-16oz containers of beer in one sitting, and this irritates his Wife. Veteran reported this is typically how arguments begin. Veteran reported his Wife has stopped communicating with him and gives him the silent treatment when he drinks now. Veteran reported this usually leads to him becoming angrier. Veteran reported last night, his Wife refused to talk to him. Veteran reported they have sought marital counseling in the past, and the counselor challenged him to not drink for 30 days, which he did. Veteran reported he does not feel his drinking is excessive or problematic, although he has been labeled a "functional alcoholic." Veteran expressed concerns for losing his family due to his excessive drinking at this time. Veteran has history of Alcohol Dependence diagnosis. Veteran was last seen in the SATP program 2/6/12. f. Other, if any: No response provided. 3. PTSD Diagnostic Criteria Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threatening situations (non-combat related stressors.) Do NOT mark symptoms below that are clearly not attributable to the criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #5 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in on or more of the following ways: [X] Directly experiencing the tramuatic event(s) Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). [X] Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead to the individual to blame himself/herself or others. [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. [X] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Reckless or self-destructive behavior. [X] Hypervigilance. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 4. Symptoms For VA rating purposes, check all symptoms that apply to the Veterans diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks that occur weekly or less often [X] Chronic sleep impairment [X] Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks [X] Impaired judgment [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Impaired impulse control, such as unprovoked irritability with periods of violence 5. Behavioral Observations: MSE: Veteran presented as a neatly and casually dressed 33yr old male with good hygiene and flat affect. Veteran stared at the Examiner, and noted to sit on the edge of the seat in the examination room. Veteran reported consuming 5-16-oz beers last night, and stated this led to problems and silent treatment at home. Vetran then became tearful, and reported fear of losing his family, due to difficulties related to alcohol dependence. Veteran reported consuming alcohol at this time on a daily basis. Veteran reported being able to participate in today's examination, however, and denied problems with comprehension of questions/interview at this time. Veteran denied thoughts of harming himself or others at this time. 6. Other symptoms Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes[X] N 7. Competency Is the Veteran capable of managing his or her financial affairs? [X] Yes[ ] No 8. Remarks, (including any testing results) if any: Based on DSM-5. VBMS and CPRS records reviewed. Based on today's review examination, the veteran continues to meet DSM diagnostic criteria for PTSD. The veteran has reported a worsening of PTSD symptoms since his 2008 Initial examination, with additional stressors (highlighted in other sections of this examination report). Based on today's examination, the veteran also currently meets DSM-5 diagnostic criteria for Alcohol Intoxication. The veteran's current substance-related and addictive disorders diagnosis is based on veteran's report of consuming 5-16oz bottles of beer less than 24hrs prior to this examination. In addition, veteran reported history of alcohol addiction and treatment through the VA-Baton Rouge South SATP with Dr. Reidwald. Veteran's current Alcohol Intoxication/Alcohol Dependence diagnosis is at least as likely as not (50/50chance) due to, or result of his PTSD diagnosis. Veteran is currently prescribed psychotropic medications by his former VA-primary care provider, Dr. Shissler, who has since retired-veteran receives medications by mail. Veteran was seen by NP Ms. Joseph, for medication management (3/2012), however no other appointments with MH since that time. Veteran is not currently seen by VA mental health providers. Sorry if that makes peoples head hurt. It just seems like the examiner wrote more about my drinking problem than a review of my symptoms. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication This is what worries me, in my initial exam it was stated as severe, not mild. Im really worried about my rating being dropped, can someone help me decipher all this? If you need more info. from me about anything just let me know. thanks

Hi everybody My doctor recently filled the DBQ for Parkinson disease. How VA rate certain Parkinson conditions. I have look the scheduled rating for disabilities, but cannot find an answer. Balance impairment = Moderate Bradykinesia or slow motion = Moderate Stooped posture = Mild Does veteran Parkinson impact his or her ability to work? = YES Unable to work due to slowness, tremors and difficulty walking. Thank so much for your help. Currently, I have service connected Parkinson 30% not related to agent orange.

I got my rating today. Basically I submitted a fully developed claim around Aug. Had C&P's done in Nov 6th. They shipped out my claim to Philly to be rated and within a month I get the rating. Just under 4 months total from start to finish, unreal! I ended up with 90%. I searched through tons of information on this website and I am truly grateful to all my veteran/civilian brothers and sister for sharing your experiences with me. I can't tell you how much I appreciate it. I live with some pretty bad stuff that money can't buy but, this helps me and my family out a lot. One questions I had is after the %ratings it stated an exam will be scheduled at a future date to evaluate the severity of my service connected disabilities. What is that even all about? Is this there way to decrease my rating? Just confused if they can taketh what they giveth? Again thanks-you to everyone who helped me along the way, I truly appreciate it.

The CAVC case, Jones vs Shinseki, is instructive. http://www.veteranslawlibrary.com/files/CAVC_cases/2012/Jones_11-2704.pdf This Veteran complained that the Board did not rate him strictly by the criteria. The CAVC stated it plainly: As this Court has made clear, "[t]he Board's consideration of factors which arewhollyoutside the rating criteria provided by the regulations is error as a matter of law." This comes very close to saying that, when the VA rates the Veteran OTHER than by the specified criteria, it is CUE. In this case, the Veteran won a remand, because the VA considered the effects of the meds he was on, when the rating criteria did not specify whether the Veteran should be rated on symptoms with OR without medication. If you have been recently denied, then you might look over the rating criteria, and then re read your decision to see if the VA used non criteria. I know for a fact the VA does just that. They denied my hearing loss ten years ago because it had been a long time since I was in service. The length of time since service is not one of the criteria for rating hearing impairments.