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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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Question

I am attaching a copy of my husband's c&p exam. I welcome any advise, because I don't see a GAF score as many on this site mention in their exams, nor do I see a statement from the Psychiatrist that did the exam stating " more likely than not". The Psychiatrist did suggest that my husband continue with Mental Health for further treatment. He mentioned that he did not make the final decision on the claim and told us the steps that should occur after the exam once it is sent to VBA. There are some detail things that my husband told the psychiatrist that I chose to leave out due to the graphic details.

Thanks for any advise.

1. Diagnostic Summary

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

Does the Veteran have a diagnosis of PTSD that conforms to DMS-5 criteria

based on today's evaluation?

[X] Yes [ ] No

b. Medical diagnoses relevant to the understanding or management of the

Mental Health Disorder (to include TBI): Low testosterone and Vit D

3. Differentiation of symptoms

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

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

[ ] Yes [X] No

4. Occupational and social impairment

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

a. Which of the following best summarizes the Veteran's level of occupational

and social impairment with regards to all mental diagnoses? (Check only

one)

[X] Occupational and social impairment with occasional decrease in work

efficiency and intermittent periods of inability to perform

occupational tasks, although generally functioning satisfactorily,

with normal routine behavior, self-care and conversation

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?

[ ] Yes [ ] No [X] No other mental disorder has been diagnosed

Clinical Findings:

Relevant Mental Health history, to include prescribed medications and

family mental health (pre-military, military, and post-military):

In-patient psych care for substance use in 96 (twice) and 2002

SATP in TVHS. Extensive treatemnt in TVHS initially for

substance use disorder and mood disorder. Currently, receiving care for

PTSD (MST) and depression.

d. Relevant Legal and Behavioral history (pre-military, military, and

post-military): DUI X 2

3. Stressors

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

a. Stressor #1: MST - see above

Is the stressor related to personal assault, e.g. military sexual

trauma?[X] Yes [ ] No

If yes, please describe the markers that may substantiate the

stressor.

Marital discord; poor self esteem

Substance use (self medication: - see citation:Hein DA et al: Do Treatment Improvements in PTSD Severity AffectSubstance Use Outcomes? A Secondary Analysis from a Randomized

Clinical Trial in NIDA's Clinical Trials Network. Am J Psychiatry

2010; 167:95-101

4. PTSD Diagnostic Criteria

Criterion A: Exposure to actual or threatened a) death, b) serious injury,

c) sexual violatrion, in one or more of the following ways:

[X] Directly experiencing the tramuatic event(s)

Criterion B: Presence of (one or more) of the following intrusion symptoms

associated with the traumatic event(s), beginning after the

traumatic event(s) occurrence

[X] Recurrent, involuntary, and intrusive distressing memories of the

traumatic event(s).

[X] Recurrent distressing dreams in which the content and/or affect of

the dream are related to the traumatic event(s).

[X] Dissociative reactions (e.g., flashbacks) in which the individual

feels or acts as if the traumatic event(s) were recurring. (Such

reactions may occur on a continuum, with the most extreme

expression being a complete loss of awareness of present

surroundings).

[X] Intense or prolonged psychological distress at exposure to internal

or external cues that symbolize or resemble an aspect of the

traumatic event(s).

[X] Marked physiological reactions to internal or external cues that

symbolize or resemble an aspect of the traumatic event(s).

Criterion C: Persistent avoidance of stimuli associated with the traumatic

event(s), beginning after the traumatic events(s) occurred,

as evidenced by one or both of the following:

[X] Avoidance of or efforts to avoid distressing memories, thoughts, or

feelings about or closely associated with the traumatic event(s).

[X] Avoidance of or efforts to avoid external reminders (people,

places, conversations, activities, objects, situations) that arouse

distressing memories, thoughts, or feelings about or closely

associated with the traumatic event(s).

Criterion D: Negative alterations in cognitions and mood associated with

the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of

the following:

[X] Persistent and exaggerated negative beliefs or expectations about

oneself, others, or the world (e.g., "I am bad,: "No one can be

trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined").

[X] Persistent, distorted cognitions about the cause or consequences of

the traumatic event(s) that lead to the individual to blame

himself/herself or others.

[X] Persistent negative emotional state (e.g., fear, horror, anger,

guilt, or shame).

[X] Markedly diminished interest or participation in significant activities.

[X] Feelings of detachment or estrangement from others.

[X] Persistent inability to experience positive emotions (e.g.,

inability to experience happiness, satisfaction, or loving

feelings.)

Criterion E: Marked alterations in arousal and reactivity associated with

the traumatic event(s), beginning or worsening after the

traumatic event(s) occurred, as evidenced by two (or more) of

the following:

[X] Irritable behavior and angry outbursts (with little or no

provocation) typically expressed as verbal or physical aggression

toward people or objects.

[X] Hypervigilance.

[X] Exaggerated startle response.

[X] Problems with concentration.

[X] Sleep disturbance (e.g., difficulty falling or staying asleep or

restless sleep).

Criterion F:

[X] Duration of the disturbance (Criteria B, C, D, and E) is more than

1 month.

Criterion G:

[X] The disturbance causes clinically significant distress or

impairment in social, occupational, or other important areas of

functioning.

Criterion H:

[X] The disturbance is not attributable to the physiological effects of

a substance (e.g., medication, alcohol) or another medical

condition.

5. Symptoms

-----------

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

diagnoses:

[X] Depressed mood

[X] Anxiety

[X] Suspiciousness

[X] Flattened affect

[X] Disturbances of motivation and mood

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

worklike setting

6. Behavioral Observations

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

Withdrawn

7. Other symptoms

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

Does the Veteran have any other symptoms attributable to PTSD (and other

mental disorders) that are not listed above?

[ ] Yes [X] No

8. Competency

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

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

[X] Yes [ ] No

9. Remarks, if any

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

While depressive symptoms were elicited in Vet's examination today,

depression is not being diagnosed as a co-occurring disorder due to the

following:

In a seminal research, it was found that PTSD and comorbid PTSD/depression

are effectively one and same thing. The data suggest that depressive

symptoms are often integral to PTSD and that to separate depression out as

a distinct disorder when it occurs with PTSD is a somewhat arbitrary

distinction. The researchers concluded: "While PTSD and co-morbid

PTSD/depression are indistinguishable, the findings support the existence

of depression as a separate construct in the acute, but not the chronic,

aftermath of trauma".

Reference: O'Donnell ML, Creamer M, Pattison Phillipa: Posttraumatic

stress disorder and depression following trauma: Understanding

comorbidity. Am J Psychiatry 2004; 161:1390-1396

NOTE: VA may request additional medical information, including additional

examinations if necessary to complete VA's review of the Veteran's

application.

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5 answers to this question

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Global Asset Functioning Scale (GAF Scale)

The DSM-5 was published in May 2013 and it appears the GAF Scale is no longer being used in DSM-5. Below I've quoted from dsm5.org website. After that quote I have also included the GAF Scale from the DSM-IV for reference purposes.

With the removal of the multiaxial system in DSM-5, how will disability and functioning be assessed? The Global Assessment of Functioning (GAF) scale, recommended for Axis V in the DSM-IV, was used for determinations of medical necessity for treatment by many payers, and eligibility for short- and long-term disability compensation. Clinician-researchers at the APA have conceptualized need for treatment as based on diagnosis, severity of symptoms and diagnosis, dangerousness to self or others, and disability in social and self-care spheres. We do not believe that a single score from a global assessment, such as the GAF, conveys information to adequately assess each of these components, which are likely to vary independently over time.

Therefore, we are recommending that clinicians continue to assess the risk of suicidal and homicidal behavior and use available standardized assessments for symptom severity, diagnostic severity, and disability such as the measures in Section III of DSM-5 (online at http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures). For those who relied on the use of a GAF number, we expect there will be a transitional period from the GAF to the use of separate assessments of severity and disability.

The World Health Organization Disability Assessment Schedule (WHODAS 2.0) was judged by the DSM-5 Disability Study Group to be the best current measure of disability for routine clinical use. The WHODAS 2.0 is based on the International Classification of Functioning, Disability, and Health (ICF) and is applicable to patients with any health condition. The scale, as well as scoring information is included in Section III of DSM-5.

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Tbird,

Is right, the VA will give GAF Scores, but they no longer use the score to rate conditions. This statement is the most important "

[X] Occupational and social impairment with occasional decrease in work

efficiency and intermittent periods of inability to perform

occupational tasks, although generally functioning satisfactorily

Based on the VAs % Criteria, it looks to me, that it would be rated 30% and maybe 50%, depending on the Rater. Good luck and keep us posted.

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I agree with you Navyo4. That is what it looks like to me if the vet is still working. If the Vet is unable to work due to PTSD then he is getting low ball evaluation.

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John is right, if he is not working, than this should be higher, or he should submit for IU.

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Thank you so much for your responses.

My husband does work, but he calls in at work often, some weeks 1 day, some weeks 2-3 days it just depends on how depressed he is or how his ptsd is effecting him. I Thank God that he works at the VA because he probably would be fired from any other job.

Hopefully we will hear something in the next month or so.

Thank you again, will update.

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