ptsd Question On Ptsd Diagnosis

[vaf]

What does this mean? This is from the psychologist's assessment C & P:

"The PCLM suggested significant PTSD symptoms for criteria B (Re-experiencing) and D (Arousal), but not for criteria C (Avoidance)...The veteran's pituitary brain tumor surgery resulted in a medical discharge and a continuing struggle to find work that he could adequately perform. It is more likely than not that the veteran's military experiences significantly decreased his mental efficiency with a secondary increase of anxiety potentiated by previous military trauma. The prognosis is fair with continued involvement in Alcoholics Anonymous."

I'm trying to figure out if that means he has PTSD or he does not have PTSD for rating purposes. This goes with a previous discussion here regarding PTSD being a separate condition from organic brain syndrome (he has a rating for OBS, but was denied PTSD a few years ago). His most recent GAF (last month) is 55.

Please help me understand this, thank you!

Edited November 12, 2008 by vaf

[rentalguy1]

That is not a diagnosis of PTSD. You can't have PTSD without avoidance. I would assume the diagnosis would be a mood disorder with psychotic features. The statement about AA makes me wonder how far they took the self medication thing. They could have given a diagnosis of a substance induced disorder, which would be bad. If you have the record nearby, loot at Axis I. That is the actual, current diagnosis.

[vaf]

Axis I: Dementia due to pituitary brain tumor. Anxiety Disorder due to a pituitary brain tumor with loss of mental functioning and military trauma.

Axis II: 301.9 Personality Disorder NOS with Histrionic and Antisocial Traits

Axis III: See medical chart

Axis IV: Unemployed, reminder of military combat and medical trauma

Axis V: 55 moderate to serious symptoms

So, he does not have PTSD, and the entire diagnosis is contained in Axis I?

Thanks.

[rentalguy1]

So, he does not have PTSD, and the entire diagnosis is contained in Axis I?

That's correct. It may be very hard to get that sc'd, especially with the PD, NOS given in Axis II. This one will take a very carefully worded IMO from a well-established MD psychiatrist. What does the decision letter state as the reasons and basis for the denial?

[vaf]

I'll scan that part of the decision when I get to work tomorrow and post it then. It's too long to re-type, but "PTSD" is never mentioned. Here's one part of it:

"Psychometric findings suggest a moderate cognitive disorder or mild dementia with impairment of memory, attention, planning, and spatial relations processing. You are shown as competent to handle your financial affairs. Global Assessment Functioning Level is shown as 55 which is considered moderate due to panic, loss of concentraion, irritability, insomnia, social isolation, inability to work, and conflicts with peers. Diagnoses are shown as dementia and anxiety disorder due to pituitary brain tumor."

On another note...

This appeal has been pending since 1994, when we appealed the decision to award a 30% disability rating when we believed the rating should be 50%. After we filed the writ of mandamus request, the Judge got the AMC moving -- finally! So the rating decision contains the rating criteria in effect at the time we filed, as well as when it was changed in November 1996. The AMC says they compared the evidence to both sets of criteria, and neither one supported an increase to 50%. One of the reasons they also cited was that there was no evidence of treatment for organic mental syndrome. I'm considering filing a Section 1151 complaint, since it appears the VA is now telling us that treatment exists for this condition, yet they never suggested, discussed or offered treatment since my husband first started being treated for the related endocrinological problems there in 1993. Plus, he gets all his periodic brain MRI's performed at that VAMC, and none of the psychologists or psychiatrists who performed or evaluated psych C & P's over the years (which never resulted in a rating decision until now) ever told my husband that treatment existed for this. Yet the VA cites lack of evidence of treatment as a reason to deny the claim.

I see so many holes in this thing, I don't know which one to attack first!

[john999]

He had brain surgery in service that resulted in medical discharge. That could probably cause PD. Maybe just pursue consequences of the surgery. You don't even need PTSD diagnosis if doctors will say he is unemployable due to brain surgery. He could have PTSD superimposed on brain injury.

[vaf]

I think your last sentence hits the nail right on the head. But you're saying that Avoidance is a necessary symptom of PTSD, so I guess I'm going down the wrong road thinking my husband as a potential separate claim for PTSD.

He's already 100% schedular, we're seeking an earlier effective date, and he's on SS disability, so the unemployability approach is moot at the present time.

Edited November 13, 2008 by vaf