C&p Results

[Tela]

Sorry for the long post but I recently completed a C&P exam and would like some thoughts on it. Also, I haven't worked in almost 2 yrs. Should I apply for IU and SS? I also turned in 2 reports, 1 from my former supervisor and 1 from supervisor from my internship and they both said they didn't thing I was employable do to my disabilities. I don't post often but I do lurk and I value the knowledge wisdom here.

I am currently SC for RK@ 20% and LK@10%.

a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)? [X] Yes [] No

[X] Axis I

Diagnosis #1:

Major Depressive Disorder, recurrent

Diagnosis #2:

Panic Disorder w/o agoraphobia

b. Axis III -Medical diagnoses (to include TBI): lCD code: n/a

Knee Issues, Migraine Headaches, Other Joint Issues

c. Axis IV- Psychosocial and Environmental Problems (describe, if any ):

Severe; chronic pain, unable to sustain work, serious mental health issues

d. Axis V- Current Global assessment of functioning (GAF Score): 45

2. Differentiation of symptoms

a. Veteran have more than one mental disorder diagnosed? [X]Yes [] No

If yes, complete the following question:

a. Because her symptoms of depression and anxiety are co-mingled.

Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [] Yes [X] No [] Not applicable (N/A)

3. Occupational and social impairment

[X] Occupational and social impairment with reduced reliability and productivity

a. 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?

Because her symptoms are co-mingled.

SECTION II

Clinical Findings:

1. Evidence review

C-file reviewed.

FPC Examination 10/2011, Diagnosis: Adjustment Disorder w/ depressed mood and Generalized Anxiety Disorder NOS.

Temple VAMC C & P Exam for Knee Jan 2006 diagnosed Patellofemoral Syndrome.

Temple VAMC C & P Exam for Knee 9/2010, Diagnosis: Normal Knee.

KZ, MS, LPC Evaluation on July 2013, Diagnosis: Generalized Anxiety Disorder with opinion that root cause was knee injury.

Report on veteran's internship at Elmira's Lux-Sury Care from 6/2013 to 8/2013 (brought to examination by veteran) stating veteran "would not be employable anywhere due to issues that were evident while she attended classes. Mentioned lack of ability to stay focused on task and forgetfulness. Noted opinion that veteran would only be able to work from home and likely even then not be successful due to her mental state."

2. History

NOTE: Initial examinations require pre-military, military, and post-military history. If this is a review examination only indicate any relevant history since prior exam.

a.Relevant Social/Marital/Family history (pre-military, military, and post-military):

Veteran is a 29-year-old African American female who was born and raised in Waco, TX. Her parents never married and separated when she was 9 years old, "but they were both very active in my life." She said there were no issues of neglect or abuse growing up. She said her relationship with both parents was "pretty strong, it's still strong." She has 3 sisters and 1 brother; she said "we're fine" both growing up and currently. Veteran has not married and does not have a significant other. She has two children ages 7 and 4 who live with her in a townhouse. She said she and her children "are close." In school growing up veteran said she was in the Gifted and Talented Program until high school, then became an "average" student. In high school she played softball for the City but did not participate in extracurricular school activities.

b.Relevant Occupational and Educational history (pre-military, military, and post-military):

After graduating from high school, she enlisted in the Army at age 17. She served 7 months and received an Honorable Discharge with the rank of E2. She was Med Boarded out due to her knees. She said she hurt her knee in Basic Training but does not know how she injured herself. She never had any Article 15s or other disciplinary issues. Her job in the military was Unit Supply. She was stationed in SC and VA. She left the Army in 2003 and has worked "off and on" for a temp service. She has not worked since Mar 2012. "Physically I just can't do the work; I'm in pain or the migraines are just too strong." She has never been fired from any job. She spends her time taking care of her children and is in college working toward an Associates in Network Administration.

c.Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post­ military:

Her first mental health treatment was shortly after she left the service at the Waco VA in 2004 or 2005 "off and on." She also saw a civilian counselor for a few months "before they cut my Medicaid off." She was put on several psychiatric medications at the VA clinic but "they didn't work." She is not currently taking any psychiatric medications. She said she has suicidal ideation (in the past

and currently, no attempts). She denied homicidal ideation and said she does not get violent. She said there is no mental health

historv in her family to her knowledge. (The underlined portion was left off).

Sentinel Event(s) (other than stressors

g. Other , if any:

Currently , her symptoms include sleep problems (takes on average up to 5 hours to fall asleep; she wakes up on average "no more than 3" times a night ; nightmares several times a week about death or demons). She is depressed (suicidal ideation, feeling hopeless , crying spells daily , anhedonia , self-isolation) and has anxiety (worrying , panic attacks with racing heart, can't breathe, feels "like I'm dying" multiQ!e times a week). She has anger issues "over little things."

3. Symptoms

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

[X] Depressed mood

[X] Anxiety

[X] Panic attacks more than once a week

[X] Chronic sleep impairment

[X] Flattened affect

[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 a work like setting

[X] Suicidal ideation

[X] Persistent danger of hurting self or others

4.Other symptoms

Does the Veteran have any other symptoms attributable to mental disorders that are not listed above?

[]Yes [X] No

5. Competency

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

[X]Yes []No

4.Medical opinion for secondary service connection

a. [X] The claimed condition is at least as likely as not (50 percent or greater probability) proximately due to or the result of the Veteran's service connected condition.

c. Rationale:

Veteran received the injury in Basic Training and has become increasingly depressed and anxious because of the limitations in her activities caused by her knee problems. There is no evidence in either her statements or her records that she experienced panic attacks or depression prior to the injury.

Edited January 4, 2014 by Tela

[Berta]

Tela, thanks for returning to us with these results.

This statement should get you a grant for the secondary disability:

4.Medical opinion for secondary service connection

a. [X] The claimed condition is at least as likely as not (50 percent or greater probability) proximately due to or the result of the Veteran's service connected condition.

If I were you I would apply for SSDI and TDIU.......but maybe best to wait for the results of your current claim first....before filing for the TDIU.

This could be a possible point of contention for both SSA and the VA for TDIU:

"Report on veteran's internship at Elmira's Lux-Sury Care from 6/2013 to 8/2013 (brought to examination by veteran) stating veteran "would not be employable anywhere due to issues that were evident while she attended classes. Mentioned lack of ability to stay focused on task and forgetfulness. Noted opinion that veteran would only be able to work from home and likely even then not be successful due to her mental state."

But it is speculative and might not in fact be from a medical professional.

SSA looks for ANY work a SSDI claimant can do, that could cause them to deny SSDI.

BUT that could be overcome, I feel, if you get any retro from the initial claim and then get a Vocational expert's IMO. Yet you might not even need an IMO.

Because the C & P doc did state this:

"Axis IV- Psychosocial and Environmental Problems (describe, if any ):

Severe; chronic pain, unable to sustain work, serious mental health issues"

And states

"She was put on several psychiatric medications at the VA"

If the SSA awards you solely for SC conditions, (and they work faster then the VA does on disability claims) then that would be excellent evidence for TDIU.

The side affects of medications (that come with the meds and/or can be googled at a good med site, can often hinder employment because they can cause sleep problems, prevent the patient from driving a car, and affect one's ability to function in a task oriented environment.

I am assuming you are not in college under Voc Rehab:

"She spends her time taking care of her children and is in college working toward an Associates in Network Administration."

Has the college provided you with any documented accomodations or can you get documentation from the college that could indicate your memory problems and MH issues have hindered your ability in school?

You might go to an online college but I would think even online schools (because there is one to one input ...at least at my college there was)

might have some documentation on how your SCs affect your scholastic abilities.

The reason I am bringing that up is that the ^%$#@!& VA tried to lower my husband's comp years ago for 2 reasons:

1. He had just acquired a part time crap job from the local VA ( so he wouldnt pursue a very valid EEOC case against them long story there)

(VA said he had attained substantial employment which was ridiculous beased on his fortmer work background.

And VA said his one sole semester of Voc Rehab at Corning College (he need accommodations and even a tutor) had suddenly tiurened him into a rocket scientist.

They tried to lower his 30% PTSD at that time to 10% but then they dropped that when they got the NOD I wrote.

3 years later his posthumous SC PTSD award EED was for 100% P & T so it shows how wrong VA can be in assessing higher education experience when one is disabled.

I know I told that Voc Rehab story here many times before.....but the proposed reduction came on Dec 24th and the Christmas tree went flying out the front door because he was so upset and I still have flashbacks of all that.

Have you formally claimed the migraines as secondary to your SCs ?

[Navy04]

Berta,

Is right on the money as usual. I think that you could get 30-50% for Depression. Go ahead and file for SSDI because if you go 5 years without working the SSA will not let you apply for SSDI. Wait to get your final %s from the VA before you apply for TDIU. Good luck and with all the good folks on this site, you can ask any questions, and probably get the best help here.

[Tela]

Tela, thanks for returning to us with these results.

This statement should get you a grant for the secondary disability:

4.Medical opinion for secondary service connection

a. [X] The claimed condition is at least as likely as not (50 percent or greater probability) proximately due to or the result of the Veteran's service connected condition.

If I were you I would apply for SSDI and TDIU.......but maybe best to wait for the results of your current claim first....before filing for the TDIU.

This could be a possible point of contention for both SSA and the VA for TDIU:

"Report on veteran's internship at Elmira's Lux-Sury Care from 6/2013 to 8/2013 (brought to examination by veteran) stating veteran "would not be employable anywhere due to issues that were evident while she attended classes. Mentioned lack of ability to stay focused on task and forgetfulness. Noted opinion that veteran would only be able to work from home and likely even then not be successful due to her mental state."

But it is speculative and might not in fact be from a medical professional.

SSA looks for ANY work a SSDI claimant can do, that could cause them to deny SSDI.

BUT that could be overcome, I feel, if you get any retro from the initial claim and then get a Vocational expert's IMO. Yet you might not even need an IMO.

Because the C & P doc did state this:

"Axis IV- Psychosocial and Environmental Problems (describe, if any ):

Severe; chronic pain, unable to sustain work, serious mental health issues"

And states

"She was put on several psychiatric medications at the VA"

If the SSA awards you solely for SC conditions, (and they work faster then the VA does on disability claims) then that would be excellent evidence for TDIU.

The side affects of medications (that come with the meds and/or can be googled at a good med site, can often hinder employment because they can cause sleep problems, prevent the patient from driving a car, and affect one's ability to function in a task oriented environment.

I am assuming you are not in college under Voc Rehab:

"She spends her time taking care of her children and is in college working toward an Associates in Network Administration."

Has the college provided you with any documented accomodations or can you get documentation from the college that could indicate your memory problems and MH issues have hindered your ability in school?

You might go to an online college but I would think even online schools (because there is one to one input ...at least at my college there was)

might have some documentation on how your SCs affect your scholastic abilities.

The reason I am bringing that up is that the ^%$#@!& VA tried to lower my husband's comp years ago for 2 reasons:

1. He had just acquired a part time crap job from the local VA ( so he wouldnt pursue a very valid EEOC case against them long story there)

(VA said he had attained substantial employment which was ridiculous beased on his fortmer work background.

And VA said his one sole semester of Voc Rehab at Corning College (he need accommodations and even a tutor) had suddenly tiurened him into a rocket scientist.

They tried to lower his 30% PTSD at that time to 10% but then they dropped that when they got the NOD I wrote.

3 years later his posthumous SC PTSD award EED was for 100% P & T so it shows how wrong VA can be in assessing higher education experience when one is disabled.

I know I told that Voc Rehab story here many times before.....but the proposed reduction came on Dec 24th and the Christmas tree went flying out the front door because he was so upset and I still have flashbacks of all that.

Have you formally claimed the migraines as secondary to your SCs ?

Thank you for your response Berta. I am in the Voc Rehab program now but can't seem to ever get a hold of my Counselor. Also, my internship report also included statements from my advisor and why she allowed me to do my internship remotely (I worked from home). She stated she did not want to send me out on assignment because she feared I would fail because of my disabilities. She also stated that I missed more than the allowable days, my grades suffered and I had issues adapting in the classroom. She talked about the mock interviews we did and how I couldn't make it through it. It's all there, I just hope it has some weight.

I also submitted another letter from my supervisor from the temp service I used to work for off and on and he stated that my disabilities affected my work and how my hours were severely decreased because of it. From Jan-March of 2012, I made a total of $464. I left in March and been unemployed since.

No, I haven't file for migraines yet. I will along with TDIU and for my back once my current claim is complete.

[Tela]

Thank you for the advice. I will keep you guys updated.

[Berta]

"It's all there, I just hope it has some weight."

YES I sure think it will.

Navy04 made an excellent point that many disabled vets dont think of and that I often forget........

"Go ahead and file for SSDI because if you go 5 years without working the SSA will not let you apply for SSDI. "

[cham1968]

As Berta stated it looks good. My suggestion with VOCREHAB counselors is EMAIL is the best way to contact them. Hopefully that is not what you've been doing. Also as long as your school is providing the 1905 your money should be coming in. Until that changes I would continue to email and flag those for your records. Good Luck