Adjustment Disorder Rating, Dbq, Etc.

[georgiapapa]

I am in the process of filing a formal claim for "Chronic adjustment disorder with anxiety and depression", diagnostic code 9440. I have been in psychotherapy since summer of 2011 with a VA psychologist and a VA psychiatric nurse practitioner. I currently have claims pending for multiple myeloma (agent orange presumptive) and IHD (agent orange presumptive). Both my psychologist and NP have stated in my progress reports that my adjustment disorder is "secondary to my medical conditions-multiple myeloma."

They also both agree my adjustment disorder is aggravated even more by my recent diagnosis of IHD.

My psychologist completed a DBQ for me to submit with my claim. Some of the responses she provided in the DBQ are some of the same symptoms shown in the general rating formula for mental disorders in the 70%, 50%, 30% and 10% criteria so I really have no idea as to the rating I should receive. For example, she responded that I have "obsessional rituals which interfere with routine activities" and "difficulty in adapting to stressful circumstances including work or work like setting" both of which fall in the 70% criteria. She also responded that I have "occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect", "panic attacks more than once a week", "impairment of short and long term memory" which all fall in the 50% criteria. She also responded that I have "depressed mood", "anxiety" and "chronic sleep impairment" which all fall in the 30% criteria. She responded that I have "symptoms controlled by continuous medication" which falls in the 10% criteria.

On the DBQ she indicated my diagnosis was "adjustment disorder with anxiety and depression" ICD code: 309.28 in axis category I. Under Axis III, she listed "multiple myeloma" ICD code 203.00 and under Axis IV she listed "health". Under Axis V, she listed my GAF score as "45".

I am sending the VA copies of all my progress reports from my psychologist and NP. The reports support the responses provided in the DBQ. One difference between the reports of my psychologist and my NP is the GAF scores. My psychologist consistently gave me GAFs of 45 while my NP gave me GAFs in the mid 50s.

Other symptoms constantly mentioned in my mental disorder progress reports include: Hopelessness & helplessness, low frustration tolerance, withdrawn, anticipatory anxiety, sleep disorder (restless & broken), nightmares, insomnia, diminished ability to concentrate, recurrent thoughts of death, memory deficiencies, depressed, irritable, blunted and labile.

I am trying to get an idea as to what rating I should receive for my adjustment disorder so any input from other hadit members would be appreciated, especially input from veterans who have been service connected for mental health disorders..

Thanks...Georgiapapa

[john999]

She did not say you were unemployable due to your chronic adjustment disorder. Do you have any private records for psychiatric treatment? It is just a guessing game to try and figure out what rating the RO will give you on this. The doctor does not make your rating. With your AO claims it may not matter that much about your Adjustment disorder rating. Have you sent in a TDIU claim officially? You should do that I think because I take it you are not able to work. You might want to get an IMO/IME on all your conditions to get evidence that you are completely disabled. Have you applied for SSDI or any other form of disability?

[Commander Bob]

I am in the process of filing a formal claim for "Chronic adjustment disorder with anxiety and depression", diagnostic code 9440. I have been in psychotherapy since summer of 2011 with a VA psychologist and a VA psychiatric nurse practitioner. I currently have claims pending for multiple myeloma (agent orange presumptive) and IHD (agent orange presumptive). Both my psychologist and NP have stated in my progress reports that my adjustment disorder is "secondary to my medical conditions-multiple myeloma."

They also both agree my adjustment disorder is aggravated even more by my recent diagnosis of IHD.

My psychologist completed a DBQ for me to submit with my claim. Some of the responses she provided in the DBQ are some of the same symptoms shown in the general rating formula for mental disorders in the 70%, 50%, 30% and 10% criteria so I really have no idea as to the rating I should receive. For example, she responded that I have "obsessional rituals which interfere with routine activities" and "difficulty in adapting to stressful circumstances including work or work like setting" both of which fall in the 70% criteria. She also responded that I have "occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect", "panic attacks more than once a week", "impairment of short and long term memory" which all fall in the 50% criteria. She also responded that I have "depressed mood", "anxiety" and "chronic sleep impairment" which all fall in the 30% criteria. She responded that I have "symptoms controlled by continuous medication" which falls in the 10% criteria.

On the DBQ she indicated my diagnosis was "adjustment disorder with anxiety and depression" ICD code: 309.28 in axis category I. Under Axis III, she listed "multiple myeloma" ICD code 203.00 and under Axis IV she listed "health". Under Axis V, she listed my GAF score as "45".

I am sending the VA copies of all my progress reports from my psychologist and NP. The reports support the responses provided in the DBQ. One difference between the reports of my psychologist and my NP is the GAF scores. My psychologist consistently gave me GAFs of 45 while my NP gave me GAFs in the mid 50s.

Other symptoms constantly mentioned in my mental disorder progress reports include: Hopelessness & helplessness, low frustration tolerance, withdrawn, anticipatory anxiety, sleep disorder (restless & broken), nightmares, insomnia, diminished ability to concentrate, recurrent thoughts of death, memory deficiencies, depressed, irritable, blunted and labile.

I am trying to get an idea as to what rating I should receive for my adjustment disorder so any input from other hadit members would be appreciated, especially input from veterans who have been service connected for mental health disorders..

Thanks...Georgiapapa

Greetings, Georgiapapa. My most positive thoughts are with you as you deal with your situation and the VA.

A lot of Vietnam vets were undiagnosed, or misdiagnosed for stress disorders, back then.

May I ask if you experienced any PTSD stressors while in Vietnam? Just being there was a stressor. And many of us were so young. Are you agreeable with the VA diagnostic code 9440?

Best wishes,

C.B.

[Commander Bob]

She did not say you were unemployable due to your chronic adjustment disorder. Do you have any private records for psychiatric treatment? It is just a guessing game to try and figure out what rating the RO will give you on this. The doctor does not make your rating. With your AO claims it may not matter that much about your Adjustment disorder rating. Have you sent in a TDIU claim officially? You should do that I think because I take it you are not able to work. You might want to get an IMO/IME on all your conditions to get evidence that you are completely disabled. Have you applied for SSDI or any other form of disability?

Hi John. Glad to see you in on this. Georgiapapa is most fortunate to have your input.

* (side note), I enjoyed our visit last year , or so, and am looking forward to seeing you some time next year, when I will be in your neck of the woods, again.

Bob

Edited November 27, 2012 by Commander Bob

[stillhere]

After reading your profile I see where you are a retired marshal with over 25 years and retired. I would also like to know if you are ssdi as john asked.

I have 50% PTSD which I am never very proud of but at least I am getting help for and meds. I am also over 300% with different conditions due to my service and all are SC. If I were you I would work more on getting my myeloma SC and go from there.

I am not a shrink but I am pretty sure once the myeloma is SC all the rest will be SC based on residuals of that.

Try and keep a positive attitude while you deal with that. I know it is easier to say than due but would like to see you stay around longer in your golden years!!

Thank you for your service and keep your head of Marine!

[georgiapapa]

Hi guys,

Sorry for taking so long getting back to you but I got side tracked by another trip to the hospital. The day after posting my message, I experienced more chest pains and my cardiologist immediately put me in the hospital, performed another heart cath and put one more stent in my heart for an 80% blockage in my PDA. I now have a total of three stents, two in my LAD and one in my PDA.

Stillhere:

I was with the U.S. Marshals Service from 1978 until 2004. There are a lot of military veterans in federal and local law enforcement. I have not filed a claim for SSDI and I am not sure if I would qualify because of my income and my age. I am 64 years old. I really haven't checked into it that much. Is there an income cap?

Commander Bob:

I do not think I have PTSD but I experienced PTSD stressors in Vietnam. I was in Vietnam in 1967 and 1968 and saw my share of fellow marines who were KIA or WIA, including close friends. Up until my diagnosis of multiple myeloma, I always managed to handle my stress on my own. I never discussed my Vietnam experiences too much because I did not want to do anything to make supervisors or co-workers uncomfortable with me because I do tend to become emotional at times when discussing Vietnam. I did not want to to do anything to jeopardize my career in law enforcement because I had a wife and three kids to support. Law enforcement and the military have many similarities, especially the sense of comradery and belonging to a unit that looked out for each other.

When I first met with my psychologist, she asked me a few questions regarding my experiences in Vietnam and then she said I don't believe you have any PTSD problems. When I went to see her, I was trying to get help coping with my cancer diagnosis and I did not really have any interest in a PTSD claim. She said I had an adjustment disorder due to my multiple myeloma diagnosis and I didn't question her. My primary stress from my health problems is the impact my problems are having on my family. I am coming up on my 43rd wedding aniversary and my goal is to make it to my 50th.

I am not sure I understand your question "are you agreeable with the VA diagnostic code 9440?"

Is there a problem with filing a claim under diagnostic code 9440? I am open to suggestions.

John999:

I really wasn't thinking about filing a TDIU claim at this time. My claim for the adjustment disorder was as secondary to my multiple myeloma and IHD conditions. Don't get me wrong, if I am eligible for TDIU I will defiinitely file a claim. However at the present time, I am only 30% service connected for other conditions and I have no idea what kind of rating I will get for my multiple myeloma, IHD and adjustment disorder. Please give me your thoughts because I am open to suggestions as to when would be the appropriate time to file a TDIU claim.

I have only been treated by a VA psychologist and VA NP. I have never been to a private mental health professional. I am thinking about it now though because my VA psychologist just transferred to the Department of Defense and she told me the VA is not going to replace her so I will have to drive about 120 miles round trip to see another VA psychologist. My private insurance would pay for the private doctor but I would have to pay a small co-pay.

I am just trying to get a rough idea on what kind of rating to expect on the adjustment disorder so I will have an idea if I am being low balled or if the rating is in line with the rating formula.

I appreciate any thoughts or suggestions offered.

Thanks...Georgiapapa

[john999]

I think you should file for TDIU now! That is the date they will use for the TDIU award regardless of your present rating. I filed when I was 30% and that was the date they used when I got it 18 months later on appeal. I had a long fight with these guys. With your AO problems I don't think it will be that long since they are presumptive. You may get 100% anyway.

John