Need Advice On My Ptsd C & P Exam

[blexican]

Hello everyone been reading the forums for awhile but this is my first time posting in here. Brief bio of me Im a 14 year marine veteran SSG who served on many west-pac and was stationed in many theaters throughout the world from the first gulf war to Somalia to bangladish to OIF and everything inbetween served with 3/9 from 1989 till 1994 got out for 18 months came back in then got out once in again in 2004. I noticed when I got out I was experencing some personal issues that I wont go into detail on this forum about. I was hoping that you guys can give me a little heads up as to what you think I will be rated. I did my C& P exam on May 17 2012 at the Columbia Missouri VA the results are as follows

Does the Veteran have a diagnosis of PTSD that conforms to DSM-IV criteria-yes

axis I- PTSD With panic and depression-

axis II-none

Axis III-medical diagnoses (to include TBI): hearing loss, hyperlipidemia

Axis IV-Psychosocial and Environmental Problems (describe if any): Unemployed, social environment, martial conflict

Axis V-Current global Assesment of functioning score (GAF): 40

Comments, if any: GAF is assigned due to the presence of major impairment across multiple areas of functioning including irritability and anger outburst, unemployment, martial conflict, avoiding family members, and severe avoidence behaviors.

Does the veteran have more than one mental disorder? no

Occupational and social impairment-

A)Which of the following best summarizes the Veteran's level of occuption and social impairment with regards to all mental diaggnosis?-Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, 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- no other disorder has been diagnosed

C)If diagnosis of TBI exsist, is it possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis:yes

5/17/2012 Veteran was assesed and determined to have had "two mild" TBI's as a result of truma he recieved while on duty in the marines. He was determined to have no risiduals from this TBI. The other mild TBI is from the concussive forces of a blast. This eposide is associated with residuals of headaches. Thus, the psychiatric symptoms described in today's examination are most likely due to PTSD.

Records reviewed-yes

Was pertinent information from collateral sources reviewed? yes

History

a. Relevent Social/Marital/Family history (premilitary, military, and post military):

Veteran was raised in an intact home with one older brother. denied any abuse. Stated childhood and adoescene was a good time for him. Hehad many friends and enjoyed playing baseball.

Veteran has been married twice. He was married while in the Marines and devorced about a year after his first discarge. He stated this was due to his anger. He has been married again since 2002. He reported his anger continues to be a problem.

Veteran has 7 childeren all still living at home. His wife works. He stated his parenting skills are poor and he tends to isolate in his bedroom. Stated he finds the childeren stressfull.

Veteran reported he has no friends except his brother.

Stated he use to like watching boxing; however no longer can tolorate this.

Here was the military incident I choose to leave out due to the fact it happened in Somilia and its very personal and very emotional part of my life hope everyone understands this.

Occupational history:

a)Veteran is unemployed. His last job was for 5 months at a grocery store. Stated he quit because he could not tolorate being around people, even though it was the night shift. Stated he had trouble forcing himself to leave the house to go to work due to fear. Stated his longest period of employment since discharge was 6 months. He has had about 10 jobs since 2004. Stated he has been fired and has had problems with yelling at coworkers.

Relevent Mental Health (pre-military, military, and post military): Veteran is currently treated at the Columbia VA for PTSD. He recently had to be switched from an intern to a licened psychologist as he could not tolorate the changes when interns left. Treatment records corroborate significant symptoms and functional impairment.

b)Relevent legal and behavioral history:

Stated he has been in many fights since discharge and has been arrested a couple of times for fighting.

No substence abuse

No sentinal Events

Here once again it explains the stressors that I wish to leave out

Stressor #1 does the stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? yes

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

Stressor #2 does the stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? yes

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

Stressor #3 does the stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? yes

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

Criterion A: The Veteran has been exposed to a tramatic event where both of the following were present:

The Veteran experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical intergity of self or others.

The Veterans response involved intense fear, helpnessness or horror.

Criterion B: The traumatic even is persistently reexperinced in 1 or more of the following ways:

Recurrent and distressing recollections of the event, including images, thoughts or perceptions.

recurrent distressing dreams of the event

Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Physiological reactivity on exposure to internal or external cues that symbolizeor resemble an aspect of the tramutic event.

Criterion C: Persistence avoidence of stimuli associated with the trauma and numbing of general responiveness ( not present before the trauma) as indicated by three or more of the following:

Efforts to avoid thoughts, feelings or conversations associated with the trauma

Efforts to avoid activities, places or people that arouse recollections of the trauma

Marketedly diminished intrest or participation in significant activities

Feeling of detachment or estrangement from others

Restricted range of affect ( e.g., does not expect to have a career, marriage, childeren or a normal life span)

Criterion D: persistent symptoms of increased arousal, not present before the trauma, as indicated by two or more of the following:

Difficulity falling asleep

irritability or outburst of anger

difficulty concentrating

hypervigilance

exaggerated startle response

Criterion E:

The duration of the symptoms described above in Criteria B, C and D is more than one month

Criterion F: The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Which stressor (s) contributed to the Veterans PTSD diagnosis?:

Stressor #1-yes

Stressor #2-yes

Stressor #3-yes

For VA rating purposes, check all symptoms that apply to the Veterans diagnosis:

Depressed mood

Anxiety

Suspiciousness

Near-continous panic or depression affecting te ability to function independently, appropriately and effectively

Chronic sleep impairment

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

Flattened effect

Impaired judgement

Impaired abstract thinking

Disturbances of motivation and mood

Difficulty in establishing and maintaining effective work and social relationships

Difficulty in adapting to stressfull circumstances, including work orworklife setting

Obsessional rituals which interefer with routine activites

Impaired impule control, such as unprovoked irritability with period of violence

Remarks if any-Mental status/behavioral observations: Alert and oriented. Veteran looked disheveled with holes in his pants. Mood appeared anxious with tense affect. Veteran was hiding outside the waiting area initially. He sat at the farthest distance possible from the interview and did not make eye contact at all. He tended to look at the floor, wring his hands, and rock himself. Thoughts were logical and goal directed. Noevidence of psychosis. Spech was within normal limits

Reported Symptoms:

Re-experinces symptoms: Veterans reported he was not initially bothered by re-experienceing symptoms for about the first year after deployment; however the developed over time and worsened significantly when there was news about Somalia pirates. Currently he has intrusive memories daily about stressors. Reported that he has nightmares about 4 times per week, about being in Somalia, about ~Deleted this part~. He wakes up and cannot return to sleep.

Hyperarousal: Endorsed hypervigilence that occurs constantly. He frequently checks doors and windows are locked. Irritability and anger outburst results in problems at home and at work. He tends to puch walls he sleeps 4-5 hours per night. Stated he is afraid to fall asleep due to nightmares. Endorsed difficulty with concentration such as absorbing what he is reading. stated he tends to forget things.

Avoidence: Veteran tends to avoid talking about stressors and tries not to think about stressors. When he does this is highly distressing. He avoids leaving his home and stays for weeks at a time only coming to the VA appointments. He avoids people in general and his family members. he feels loving towards his family; however stated he has difficulty showing this.

Panic attacks: Endorsed spisodes of hyperventlilating, shaking, feeling paralyzed, heart racing that occur about once per week and when he is alone.

Indicate type of exam for which opinion has been requested-DBQ Intial PTSD

Was the Veteran VA Claims file reviewed-YesChoose the statement that most closely approximates the etiology of all claims condition.

The claimed condition was at least as likely as not (50 percent or greater probability) incured in or caused by the claimed in-service injury, even, or illness. Provide rational in sectionc.

c. Rationale: Data from veteran interview and record review suggests that veteran presents with symptomology that meets the criteria for Posttraumatic Stress Disorder. Moreover, data suggests that reported symptomolgy is associated with moderate to sever levels of impairment across multiple areas of functioning that are addressed throughout the report. Veterans self report and treatment records suggest that these reported symptoms and functional impairment developed after veteran returned from Somalia. Overall, it appears likely that veterans reported symptoms are manifestations of exposure to stressors events while serving for the Marines in Somalia. Rationalfor this is the severity of the described combat experiences; the symptoms and the nature of his avoidence behaviors, such as avoiding crowds which are reminders of his stressors.

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Well that is the entire C & P report if some one can give me an idea as to what the rating may be like and time frame. Luckly im getting great help at the Columbia Missouri VA, they are an amazing group here and they are helping me with my problem mentaly. Its just very difficult for me to work. Presently my wife is the one working so that helps. I know this report is extremely long but I didnt want to leave anything out (except the actual stressors).

[Philip Rogers]

I'd guess somewhere between 50% - 100%. If you haven't already done so, you should apply for TDIU because without an application the VA is unlikely to award TDIU. It appears, to me, the VA is being more lenient when awarding 100% or TDIU, in recent yrs, so they may lean towards a higher percentage award. jmo

pr

[blexican]

Thanks phillip for the quick response I appreciate it.