ptsd Ptsd And Bipolar

[porg]

I am SC 50% for PTSD and am going to another C&P for a rating increase. I am diagnosed bipolar. Should I bring this up in the C&P or just answer the questions asked? I found the first C&P, two years ago, very stressful. Reliving, emotional and telling someone who seemed entirely clinical. I am sure he is a nice person but the process was less than empathetic. Afterwards I sat on the sidewalk outside the phychologist office just watching people go about their normal life while I felt completely abnormal.

I want to be forthcoming with this C&P but I also want to protect myself. I'm just getting this off my chest. If anyone has feedback about disclosing my bipolar I would appreciate it.

Thanks

[Navy4life]

Do you have the qualifications to go from your current 70% S/C for PTSD to 100% PTSD???

You are currently rated under the 70%:

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships ...................................... 70%

Do you have the evidence to support the 100%:

Total occupational and social impairment, due to such symptoms as: gross impairment in thought process or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name …………………..100%

If the answer is yes than you should have no issues with the increase. I would go to the exam with any and all documentation you have that will support your increase.

If you are not currently rated under MH for Bipolar I would submit a new claim for the MH (Bipolar)

[porg]

Thanks so much for the great information.

John

[philusmc]

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: 309.28

2. Current Diagnoses

--------------------

a. Mental Disorder Diagnosis #1: PTSD

Mental Disorder Diagnosis #2: ALCOHOL USE DISORDER

Comments, if any:

moderate

Mental Disorder Diagnosis #3: MOOD DISORDER, NOS

b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): SEE CPRS

3. Differentiation of symptoms

------------------------------

a. Does the Veteran have more than one mental disorder diagnosed?

[X] Yes [ ] No

b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis?

[ ] Yes [X] No [ ] Not applicable (N/A)

If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses:

SYMPTOMS OVERLAP

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:

SYMPTOMS OVERLAP

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?

[X] Yes [ ] No

If yes, list any records that were reviewed but were not included in the Veteran's VA claims file:

ALL RELEVANT RECORDS REVIEWED

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

f. Other, if any:

MILITARY HISTORY

Service Discharge Type (Last): HONORABLE

Service Branch (Last): MARINE CORPS

1967- 69, 69-79

Service Discharge Type (NTL): HONORABLE

Service Branch (NTL): MARINE CORPS

Service Entry Date (NTL):

Did the veteran have combat experience: YES

Combat service location:

Vietnam 1968-69

Duties:

Were combat wounds sustained: no

Any mental health tx: NONE

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: SEE MILTARY HISTORY

Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)?

[X] Yes [ ] No

Is the stressor related to the Veteran's fear of hostile military or terrorist activity?

[X] Yes [ ] No

Is the stressor related to personal assault, e.g. military sexual

trauma?

[ ] Yes [X] No

4. PTSD Diagnostic Criteria

---------------------------

Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the 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] 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] 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 negative emotional state (e.g., fear, horror, anger,guilt, or shame).

[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] 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] Chronic sleep impairment

[X] Mild memory loss, such as forgetting names, directions or recent events

[X] Disturbances of motivation and mood

[X] Difficulty in establishing and maintaining effective work and social relationships

6. Behavioral Observations

--------------------------

OTHER PSYCHIATRIC SYMPTOMS

Today the veteran reports "I'm very agitated, didn't sleep well. Nerves

raw"

Current stressors: health

The veteran described/endorsed the following symptoms associated with

depression:

Withdrawn, isolation, anhedonia, depressed mood, low energy, poor sleep,

poor

attention and concentration, forgetfulness, change in appetite, crying

spells, guilt, helpless, hopeless, and worthless.

Frequency of Symptoms: 4-5 days a week

Duration of Symptoms: hours

Onset of Symptoms: years

Severity of Symptoms: mild to moderate

The veteran described/endorsed the following symptoms associated with

anxiety: restlessness or feeling keyed up or on edge, easily fatigued,

difficulty concentrating or mind going blank, irritability, muscle tension,

sleep disturbance, excessive worrying, second guesses, what if?,

difficulties

with decisions

Frequency of Symptoms: frequently

Duration of Symptoms: minutes

Onset of Symptoms: years

Severity of Symptoms: mild to moderate

The veteran described/endorsed the following symptoms associated with Mania:

inflated self esteem, decreased need for sleep, pressured speech, FOI,

distractibility, increased goal-directed activities, reckless behaviors

Frequency of Symptoms: no recent manic episdoes, often has bouts of

depression

Duration of Symptoms: hours

Onset of Symptoms:years

Severity of Symptoms:mild to moderate

Denies psychosis

MENTAL STATUS EXAM:

Appearance: clean, neatly groomed, casually dressed

Orientation: AOX4

Mood: subdued, mildly agitated

Affect: constricted

Attitude: cooperative

Speech rate and tone: Unremarkable

Language: Good

Thought content and progression: Unimpaired

Tangentiality: none

Circumstantiality: none

Loose associations: none

Flight of ideas: none

Delusional: none

Difficulty in understanding complex commands: none

Gross impairment in thought processes or communication: none

Hallucinations: not present

Delusions: not present

Grossly inappropriate behavior: none

Memory:

Mild memory loss, such as forgetting names, directions or recent events

Attention and concentration: "its shot"

Fund of knowledge: Good

Intelligence: average

Insight and judgment: fair

Abstract Reasoning: wnl and a function of intelligence not reduced by mood

Obsessive-compulsive: used to be organized , now less so.

Sleep impairment: chronic difficulties with delayed onset, has sleep apnea ADLs: no impact from mental disorder

Suicidal ideation: in past

Homicidal ideation: none

Persistent danger of hurting self or others: none

Relationships: limited to partner (see social history for details)

Has difficulty with people, easily irritated in dealing with others.

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

--------------------------------------------------

MMPI2 RF- profile of questionable validity with some validity scales elevated to the extent that profile interpretation is of limited utility.

Veteran endorsed many psychological symptoms on a variety of clinical scales, often reporting moderate to severe levels of intensity.

Overall this response pattern may indicate a sense of feeling overwhelmed, though exaggeration of psychological distress cannot be ruled out.

NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application.

=========================================================================

I have PTSD and diagnosed as bi-polar too. Personally, I think the bi-polar is not correct but, hey, I'm not a doctor. I missed my C&P exam in Houston TX in Oct 2011 (I moved back to Florida in August 2011 and did not get the notice). ANyway, I got notice in Dec 2011 that my claim for PTSD had been denied because I missed the exam. I went to my county VA office and the "&D&&" filed to wrong request -- he filed an appeal instead of requesting my case be reopened and requesting a new C&P date. Fast forward 3 years and here I am. I had my C&P exam this last Wednesday and personally don't know how it went. The doc was very straight laced with no personality (I think that's the way they're supposed to be). Hadn't slept well in about two-three days and only got about 1 hour on Tuesday night before the exam at 8:00am. I muddled through with the doc -- lasted about 45 min. and the took the mmpi2. The mmpi test results were "questionable validity with some validity scales elevated to the extent that profile interpretation is of limited utility". " Veteran endorsed many psychological symptons on a variety of clinical scales, often reporting moderate to severe levels of intensity. Overall this response pattern may indicate a sense of feeling overwhelmed, though exaggeration of psychological distress cannot be ruled out."

Here's the summary of my C&P exam and I'd appreciate any feedback. Semper Fi.

[john999]

Give that exam doctor a kick in the yarbells for hinting you may be faking the severity of your symptoms. I have had the say much worse things about me as in "Vet is faking his symptoms because he has a degree in psychology".. Is that stupid or what.

John

[porg]

Any update on your TDIU C&P? Have you received a decision? I wish you the best.

I am going for my TDIU C&P on July 23rd in Gainesville, Florida. I am rated 70% PTSD and not working. I am very, very nervous about this exam. I have had two C&P's for PTSD, one the guy was so detached I felt completely alone and discarded, the other the woman was empathetic. I will arrive with my armor on.

[Matthew Hill]

Porg;

I'm not going to sugar coat this-- Gainesville C&P is the worst PTSD C&P center in the nation. To be sure, there are individual examiners nationwide who believe that it is their job to go after veterans who have PTSD. But I have had 100s of vets go through Gainesville and not one of them has had a positive C&P because all three doctors go out of their way to discredit veterans. There are three main examiners-- Dr. Billy Warren, Dr. Todd Davis and the name of the other escapes me-- and they all are equally as bad. I recently had a DRO tell me to get an IME because he knew that the C&P services in Gainesville were awful when it came to PTSD.

So here is what I would do. It is vital that someone with knowledge of the severity of your PTSD go with you. You will ask the examiner for the witness to be able to go in the room with you because he has knowledge of your claim. If the doctor does allow the person in then he needs to give examples of how severe your anger and isolation are. If the doc does not let the person in-- for the record, I have never seen a doc let someone in to a PTSD C&P-- then that person needs to mark the exact times that you went back to the exam and when you came out. Then that person writes a buddy statement about the facts-- what he observed about the doctor and the time that you were back with him. Also, he will write about why he came and the observations he has about your PTSD on a daily basis.

When you are back with the doctor you need to tell him straight how the PTSD affects you. Before the exam, you need to think about your worst symptoms and discuss with you loved ones what they believe your worst symptoms are. You need to tell these to the doctor when you get a chance. If the doc does not give you a chance then you need to state this in a statement to RO.

If the exam comes out saying that your PTSD is not worse or that you were malignering (faking) then you appeal and submit the statement of your friend, your statement about the exam and any other statements from friends or relatives. You also get an IME. The statements from you and your witnesses are the foundation of the IME because that is important evidence that the examiner did not bother reviewing. This is how your doctor will differentiate his evaluation from the C&P. The doctors in Gainesville are mean but they also are sloppy. They do not consider all the evidence of the severity of the problem like they are supposed to do. As a result, your doc's IME should be a lot stronger.

Hopefully, I am wrong about how the exam turns out. But if I'm not, know that it is not you but that the examiners that are in the wrong. You must push forward and appeal.