Mental Health C&p Results, Any Opinions Appreciated.

[jeffs17]

1. Diagnosis

a. Does the veteran now have or has he/she ever been diagnosed with a mental

disorder(s)?

[X] Yes

Diagnosis #1: Major Depressive Disorder, Recurrent, Moderate

Indicate the Axis category:

[X] Axis 1

Diagnosis #2: Generalized Anxiety Disorder

Indicate the Axis category:

[X] Axis 1

b. Axis III - medical diagnosis: Pain (shoulder, wrist, knee)

c. Axis IV- Psychosocial and Environmental Problems:

Financial stress, medical problems

d. Axis V - Current global assessment of functioning (GAF) score: 45

2. Differentiations of symptoms

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

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

[X] Yes

b. Is it possible to differentiate what symptoms(s) is/are attributable to

each diagnosis?

[X] Yes

There is some symptom overlap between depression and anxiety.

3. Occupational and social impairment

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

a. Which of the following best summarizes the Veteran's level of occupational and social impairment in regards to all mental

diagnoses?

[X} Occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking

and/or mood.

The Veteran's functional impairments are believed to be the result of the cumulative effects of both mental health conditions.

Also both conditions developed in response to the physical limitations associated with the Veteran's medical problems(wrist, shoulder

knee injuries.)

For VA rating purposes, check all symptoms that apply to Veteran's diagnosis:

[X} Depressed mood

[X] Anxiety

[X] Suspiciousness

[X] Panic attacks more than once a week

[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

[X] Difficulty in adapting to stressful circumstances, including work or work like setting

[X] Suicidal ideation

5. Competency

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

Is the Veteran capable of managing his or her financial affairs?

[X] Yes

Based on all the evidence available it is my opinion that the Veteran's symptoms are at least likely as not (50% or greater probability)

due to or the result of his service connected right shoulder and multiple left/hand wrist fractures. Specifically, the Veteran's symptoms

are believed to be the direct result of the physical limitations related to his medical conditions. His initial depression and anxiety regarding this fact has progressed over time as his injury is not yet repaired and he has been out of work over a year. It is believed that

both the Major Depressive Disorder and the Generalized Anxiety Disorder are contributing equally to moderate to severe impairments

in the Veteran's social and occupational functioning. Although he is not currently working, it is believed that his depressed mood and

anxiety would make it unlikely that he would be able to work reliably and efficiently in either a physical or sedentary job at this time.

The Veteran began receiving treatment for anxiety and depression in January 2013. With additional treatment he may see symptom reduction and a increase in functioning , however, at this time his symptoms remain moderate to severe and have drastically reduced this Veteran's quality of life.

[jeffs17]

no problem anything I can do to help

[harleyman]

jeffs17- I don't have the PTSD evaluation builder at home, but the examiner opined that your current major depressive disorder, with anxiety" is moderate to severe. I expect you will be rated at 70% with IU or actually rated at 100%.MOre likely at the 79% because the examiner did not say you were totally unable to work.

I do also believe you will have a future exam set up, for you to be re-evaluated. RVSRs have been putting them in the computer for a future date at 5 years. (but it could be 3 years). I don't think you will get P&T yet, but that is a call the RVSR who processes the exam and prepares the rating will make. P&T is not totally out of the question, but the examiner felt your ability to work could improve as your physical disabilities get better/ or are treated.

Edited August 24, 2013 by harleyman

[JoeyAnderson]

I expect you will be rated at 70% with IU or actually rated at 100%.MOre likely at the 79% because the examiner did not say you were totally unable to work.

My understanding is that even if an examiner opines that a veteran suffers from total occupational and social impairment, if he or she does not have any of the signs or symptoms listed in the Rating Formula, that in most cases his or her disability will not be rated at 100%. If I'm wrong about that, please let me know (I endeavor to keep an open mind and promptly admit when I'm wrong! )

Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes 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. [38 CFR § 4.130 - General Rating Formula for Mental Disorders]

~ Joey

[harleyman]

My understanding is that even if an examiner opines that a veteran suffers from total occupational and social impairment, if he or she does not have any of the signs or symptoms listed in the Rating Formula, that in most cases his or her disability will not be rated at 100%. If I'm wrong about that, please let me know (I endeavor to keep an open mind and promptly admit when I'm wrong! )

~ Joey

Diagnosis #1: Major Depressive Disorder, Recurrent, Moderate

Indicate the Axis category:

[X] Axis 1

[X} Occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking

and/or mood.

The Veteran's functional impairments are believed to be the result of the cumulative effects of both mental health conditions.

Also both conditions developed in response to the physical limitations associated with the Veteran's medical problems(wrist, shoulder

knee injuries.)

For VA rating purposes, check all symptoms that apply to Veteran's diagnosis:

[X} Depressed mood

[X] Anxiety

[X] Suspiciousness

[X] Panic attacks more than once a week

[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

[X] Difficulty in adapting to stressful circumstances, including work or work like setting

[X] Suicidal ideation

The above information will be entered into the evaluation builder. I don't have access at home to tell for sure, but the conditions checked by the examiner will equate to a 70% or 100% evaluation, as there is suicidal ideation diagnosed. Also, difficulty in establishing and maintaining effective work and social realationships is checked.

Then once that is entered and a percentage decided, the opinion portion of the exam is what is used to determine if there is IU.

If the schedular is 100%, IU becomes a moot point. If the eval builder shows 70%, then the opinion from the examiner is the deciding factor if the Veteran gets IU.

Based on all the evidence available it is my opinion that the Veteran's symptoms are at least likely as not (50% or greater probability)

due to or the result of his service connected right shoulder and multiple left/hand wrist fractures. Specifically, the Veteran's symptoms

are believed to be the direct result of the physical limitations related to his medical conditions. His initial depression and anxiety regarding this fact has progressed over time as his injury is not yet repaired and he has been out of work over a year. It is believed that

both the Major Depressive Disorder and the Generalized Anxiety Disorder are contributing equally to moderate to severe impairments

in the Veteran's social and occupational functioning. ** Although he is not currently working, it is believed that his depressed mood and

anxiety would make it unlikely that he would be able to work reliably and efficiently in either a physical or sedentary job at this time.

The above opinion as shown here, is enough for IU. The examiner does state however, "his injury has not yet repaired", that is enough for a future exam to be scheduled. So P&T might not be awarded if IU is an issue. If 100% schedular then the rater may make the Vet P&T, that is a call that is decided and made by the rater.

The rater is obligated to go with the evaluation builder and the opinion from the examiner. Simply put, it's data entry for the rating percentage.

Edited September 1, 2013 by harleyman

[jeffs17]

Thank you Harleyman for the insight, have to get my treatment records from my doctors for my shoulder and knee, then it is just waiting for the decision.

[scott2120]

Hey Jeffs17, I was just on the e-benefits site and it said my case was complete sense you had yours before i had mine I was woundering if it said the same thing when you logged in there to check as well? Just curious I guess