ptsd Ptsd Axis Question

[Jay]

Hello

I was wondering if any one knows what the "X" means as shown in the below GAF scale. I was inpatient for PTSD (Childhood) and this was in the discharge notes. My guess is that this means Childhood PTSD or complex PTSD but I'm probably wrong. Any suggestions? Where can I find the discription for this notation (haven't found it with Google)? Thanks in advance for the assistance.

Axis I: "X" PTSD

Bipolar nos

Axis II Deferred

Continues .......

[Papa]

This is JMHO, but I really have a problem with childhood PTSD. To me, the VA would use this against the Veteran. I would think that it would be very hard to prove that ones childhood PTSD was made worse by military service.

When I went to the Vet Center for treatment, the first thing they was about my childhood. Then, I caught on, and told them that I would not answer another question about my childhood. That, in 1968, the military did not ask or care about my childhood. Why should I have to answer these questions now. Yes, I had a terrible childhood. But, I do not want to give the VA a reason to hurt my claims and appeals.

Papa

[Jaina Bledsoe]

From personal experience DON'T bring up childhood anything. Not abuse, school problems, minor run-ins with the law, nothing. If you had anything but a "Beaver Cleaver" childhood a C+P examiner (bought by the VA - remember that) is going to latch onto it tenaciously and begin building a denial case from that. Once that ball gets rolling you may find that you need to shell out hundreds or more for an IMO to set the record straight.

A C+P examiner won't care if you readjusted, were resilient, got over it, grew out of it, etc. The VA can simply ignore any supporting evidence you provide to contradict their "pre-existing condition" diagnosis. Borderline Personality disorder is their own personal darling, and they are quite adept at building a case from minor things pre-service and, in my own case, using your PTSD symptoms to support a diagnosis of childhood PTSD (still scratching my head on being diagnosed 30 years later and after 9 years of service).

REMIND them they are there to evaluate PTSD, NOT to weigh your previous experiences in life into the equation. If they try to say it is for a "baseline", that's bullshit. The baseline is your entrance exam into the service and your performance while serving. If you have had subsequent exams (ie flight physicals) make sure the examiner looks at it... tell him there's his baseline. If they note you are evasive...live with it. It is easier to explain why you are evasive about unrelated matters to your trauma rather than to fight an uphill battle because some pencil pusher is looking to keep the VARO within budget.

If your AXIS 1 was PTSD that's not a claim killer. AXIS 1 (correct me if I am wrong) is used to diagnose more transient issues. It is possible to learn to cope with PTSD especially as a child. Children can bounce back better than adults. However, the fact you once had PTSD would have undoubtedly made you more prone to a recurrence if put under enough stress or a similar stress.

Edited March 13, 2012 by Jaina Bledsoe

[carlie]

Hello

I was wondering if any one knows what the "X" means as shown in the below GAF scale. I was inpatient for PTSD (Childhood) and this was in the discharge notes. My guess is that this means Childhood PTSD or complex PTSD but I'm probably wrong. Any suggestions? Where can I find the discription for this notation (haven't found it with Google)? Thanks in advance for the assistance.

Axis I: "X" PTSD

Bipolar nos

Axis II Deferred

Continues .......

Jay,

First off the above has nothing to do with a GAF scale / score.

No GAF is shown in this post.

A GAF has a number - not an X.

I do not think the "X" means anything at all other than the same thing as a check mark.

You posted, "I am currently Service Connected for PTSD", if you are currently in therapy.

I personally, would ask my provider if the "X" has any meaning. JMHO

[Wings]

x

x

x

Considering the fact that this DSM IV (multi-axis) diagnosis of PTSD and Bi-polar was for a childhood in-patient admission, then for all VARO purposes this evidence (if noted for the record) will meet the Existed Prior to Enlistment (EPTE) statute. So, in order to service-connect a current diagnosis of PTSD and/or Bi-polar (if you have one), you will need to do one of two things:

1. Prove that the early childhood diagnosis was wrong (in this case nearly impossible); or

2. Put the onus back on the VA for them to prove that your disabling condition(s) were not aggravated by military service. ~Wings

[Federal Register: May 4, 2005 (Volume 70, Number 85)]

[Rules and Regulations]

[Page 23027-23029]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr04my05-3]

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 3

RIN 2900-AL90

Presumption of Sound Condition: Aggravation of a Disability by Active Service

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

SUMMARY: This document amends the Department of Veterans Affairs (VA) adjudication regulations regarding the presumption of soundness of a veteran by adding a requirement that, in order to rebut the presumption of soundness of a veteran on entrance into active service, VA must prove not only that the condition existed prior to entrance into active service, but also that it was not aggravated by the veteran's active service. This amendment reflects a change in VA's interpretation of the statute governing the presumption of sound condition, and is based on a recent opinion of VA's General Counsel as well as a recent decision of the United States Court of Appeals for the Federal Circuit. The intended effect of this amendment is to require that VA, not the claimant, prove that the disability preexisted entrance into military service and that the disability was not aggravated by such service before the presumption of soundness on entrance onto active duty is overcome.

DATES: Effective Date: May 4, 2005.

Applicability Date: This rule applies to claims that were pending on or filed after the effective date of this rule, May 4, 2005. It does not apply to claims that were finally decided prior to the effective date of this rule or to collateral challenges to final decisions rendered prior to the effective date of this rule.

FOR FURTHER INFORMATION CONTACT: David Barrans, Attorney, Office of General Counsel (022), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, telephone (202) 273-6315.

SUPPLEMENTARY INFORMATION: VA is amending its adjudication regulations at 38 CFR 3.304(b) to reflect a change in the interpretation of the statute governing the presumption of sound condition.

Section 1111 of title 38, United States Code, provides that veterans are presumed to have been in sound condition when they were examined, accepted, and enrolled for service, except as to conditions that were noted at the time, or ``where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service.'' Section 1153 of title 38, United States Code, states that ``[a] preexisting disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease.''

VA's regulation implementing the presumption of sound condition, 38 CFR 3.304(b), historically has stated that the presumption may be rebutted by clear and unmistakable evidence that a condition existed prior to service. Although this appears to ignore the last seven words of 38 U.S.C. 1111 (``and was not aggravated by such service''), VA historically has interpreted those seven words to relate to the presumption of aggravation under 38 U.S.C. 1153.

Accordingly, VA's regulation implementing the presumption of aggravation under 38 U.S.C. 1153 also implements the last seven words of section 1111, as VA previously construed those words. That regulation, 38 CFR 3.306(b), states that, when a preexisting disability increased in severity during service, the presumption of aggravation may be rebutted only by clear and unmistakable evidence that the increase was due to the natural progress of the disease. The regulation further states that aggravation will not be conceded when a preexisting disability underwent no increase in severity during service. Under VA's current regulations, if a condition was not noted at entry but is shown by clear and unmistakable evidence to have existed prior to entry, the burden then shift[ed] to the claimant to show that the condition increased in severity during service. Only if the claimant satisfies this burden will VA incur the burden of refuting aggravation by clear and unmistakable evidence.

VA is revising its interpretation of section 1111 to provide that, if a condition is not noted at entry into service, the presumption of sound condition can be rebutted only if clear and unmistakable evidence shows both that the condition existed prior to service and that the condition was not aggravated by service. Under this interpretation, the burden does not shift to the claimant to establish that a preexisting condition increased in severity during service. Rather, VA alone bears the burden of proving both that the condition existed prior to service and that it was not aggravated by service. If the evidence fails to support either of those findings, the presumption of sound condition is not rebutted.

Our revised interpretation of section 1111 is based on the extensive analysis of the history of that statute stated in a precedent opinion of VA's General Counsel, VAOPGCPREC 3-2003, and the Federal Circuit's opinion in Wagner v. Principi, No. 02-7347 (Fed. Cir. June 1, 2004).

As the General Counsel and the Federal Circuit noted, the language of section 1111 literally provides that, if a condition was not noted at entry into service, VA bears the burden of showing both that the condition existed prior to service and that it was not aggravated by service. If VA fails to establish either of those facts, the claimant would be entitled to a presumption that he or she entered service in sound condition.

VA ha[d] previously refrained from adopting a strictly literal interpretation of section 1111, because such a literal reading compels results that have been described as ``illogical'' by the General Counsel, ``self-contradictory'' by the Federal Circuit, and possibly ``absurd'' by the United States Court of Appeals for Veterans Claims. See VAOPGCPREC 3-2003, Wagner, slip op. at 8; Cotant v. Principi, 17 Vet. App. 116, 129 (2003).

Among other things, a literal construction of the statute would require VA to presume that a veteran entered service in sound condition even in cases where clear and unmistakable evidence shows the contrary, merely because VA cannot prove the absence of aggravation in service. It is unclear why the question of whether a preexisting disability was aggravated in service should have any bearing on the logically preliminary question of whether there was a preexisting disability at all. Despite these concerns, VA's General Counsel and the Federal Circuit have concluded that the legislative history of section 1111 strongly suggests that Congress intended what the language of the statute literally requires. The General Counsel also concluded that, although the statute's requirements seemed counterintuitive, they were not so bizarre that Congress could not have intended them.

The rebuttal standard in what is now section 1111 originated in the Act of July 13, 1943, ch. 233, Sec. 9(b), 57 Stat. 554, 556 (Pub. L. 78-144), as an amendment to Veterans' Regulation No. 1(a), part I, para. I(b) (Exec. Ord. No. 6,156) (June 6, 1933). Prior to the amendment, paragraph I(b) stated that the presumption of soundness could be rebutted ``where evidence or medical judgment is such as to warrant a finding that the injury or disease existed prior to acceptance and enrollment.'' In 1943, a bill was introduced in the House to make the presumption of soundness irrebuttable (see H.R. 2703, 78th Cong., 1st Sess. (1943)). That bill apparently was introduced in response to the concern that ``a great many men have been turned out of the service after they had served for a long period of time, some of them probably 2 or 3 years, on the theory that they were disabled before they were ever taken into the service'' (89 Cong. Rec. 7463 (daily ed. July 7, 1943) (statement of Cong. Rankin)). The Administrator of Veterans Affairs recommended that the bill be revised to permit rebuttal of the presumption ``where clear and unmistakable evidence demonstrates that the injury or disease existed prior to acceptance and enrollment'' (S. Rep. No. 403, 78th Cong., 1st Sess. 6 (1943)).

The Senate thereafter approved an amendment to the bill adopting the Administrator's suggested language, but adding to it the phrase ``and was not aggravated by such active military or naval service.'' That language was approved by the House and was included in the legislation enacted as Public Law 78-144. The provisions of Veterans' Regulation No. 1(a), part I, para. I(b), as amended, were subsequently codified without material change at 38 U.S.C. 311, later renumbered as section 1111.

A Senate Committee Report concerning the 1943 statute stated that ``[t]he language added by the committee, `and was not aggravated by such active military or naval service' is to make clear the intention to preserve the right in aggravation cases as was done in Public [Law] No. [73] 141.'' S. Rep. No. 403, at 2. Public Law 73-141, referenced as the model for the Senate amendment, provided for restoration of service-connected disability awards that had been severed under depression-era statutes, and provided that:

The provisions of this section shall not apply * * * to persons as to whom clear and unmistakable evidence discloses that the disease, injury, or disability had inception before or after the period of active military or naval service, unless such disease, injury, or disability is shown to have been aggravated during service * * * and as to all such cases enumerated in this proviso, all reasonable doubts shall be resolved in favor of the veteran, the burden of proof being on the Government. Act of March 27, 1943, ch. 100, Sec. 27, 48 Stat. 508, 524. This statute appears to have placed the burden on the government to show by clear and unmistakable evidence both that the disability existed prior to service and that it was not aggravated by service. It is thus consistent with the view that the presumption of soundness enacted in 1943 was intended to place the burden of proof on VA with respect to both issues. That purpose is also reflected in other statements made during the debate on the 1943 legislation. See 89 Cong. Rec. 7463 (daily ed. July 7, 1943) (statement of Rep. Rankin) (``It places the burden of proof on the Veterans' Administration to show by unmistakable

evidence that the injury or disease existed prior to acceptance and enrollment and was not aggravated by such active military or naval service.'')

Based on the foregoing authorities, VA is revising its regulations at 38 CFR 3.304(b) to provide that, in order to rebut the presumption of sound condition, VA must establish by clear and convincing evidence both that the disability existed prior to service and that it was not aggravated by service. To accomplish this, VA is amending Sec. 3.304(b) by adding, at the end of the first sentence, ``and was not aggravated by such service.''

The effect of this new interpretation is to establish different standards to govern for disabilities that were noted at entry into service and those that were not. If a disability was not noted at entry into service, VA will apply the presumption of sound condition under 38 U.S.C. 1111. If VA fails to establish either that the disability existed prior to service or that it was not aggravated by service, the presumption of sound condition will govern and the disability will be considered to have been incurred in service if all other requirements for service connection are established. In such cases, the presumption of aggravation in 38 U.S.C. 1153 will not apply because VA will presume that the veteran entered service in sound condition. On the other hand, if a condition was noted at entry into service, VA will consider the claim with respect to the presumption of aggravation in section 1153.

This final rule is an interpretative rule explaining how VA construes 38 U.S.C. 1111, and it merely reflects the holding in the Federal Circuit's decision in Wagner. Accordingly, there is a basis for dispensing with prior notice and comment and delayed effective date provisions of 5 U.S.C. 552 and 553.

List of Subjects in 38 CFR Part 3

Administrative practice and procedure, Claims, Health care,

Individuals with disabilities, Pensions, Veterans.

Approved: April 4, 2005.

Gordon H. Mansfield,

Deputy Secretary of Veterans Affairs.

For the reasons set forth in the preamble, 38 CFR part 3 is amended as follows:

PART 3--ADJUDICATION

Subpart A--Pension, Compensation, and Dependency and Indemnity Compensation

1. The authority citation for part 3, subpart A continues to read as follows:

Authority: 38 U.S.C. 501(a), unless otherwise noted.

Sec. 3.304 [Amended]

2. In Sec. 3.304, paragraph (b) introductory text, remove ``thereto.'' and add, in its place, ``thereto and was not aggravated by such service.''

[FR Doc. 05-8899 Filed 5-3-05; 8:45 am]

[11cvolley]

I been out of the Army since 06 with no diagnoses of PTSD. I got rated last year. I told them the truth about my childhood. Not paying attention in school, skipping school, bad grades, troublemaker in school, and how my parents really didn't care what I did. I still got SCed for PTSD. I know the VA/RO are a bunch of sloths but you should always tell the truth. Proper care comes from the truth. No one can fully help you if you lie. You got credible evidence supporting SC for PTSD. Don't hinder your treatment with lies.

[Papa]

11 good grief you were normal; try broken home, drinking and smoking mj by 12, did not go to schhol half the time, fighting, expelled from school numberous times. I could go on and on, but that is in the past, none of this is any of the VA's business. We all have a history, and some of us have a bad one.

Papa