ptsd C&p Exam Results. Thoughts? Possible Rating?

[uh60james]

Had my exam for PTSD last Wednesday at the Birmingham VAMC. Exam lasted about an hour and 20 minutes, the doctor was very nice and joked during the exam. Got my results off of My HealtheVet today, if anybody feels like looking over this and sharing their thoughts I would greatly appreciate it, not really sure what to expect from this.

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

2. Current Diagnoses

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

a. Mental Disorder Diagnosis #1: PTSD, CHRONIC, MODERATE

Comments, if any:

CURRENT SYMPTOMS MEET DSM-IV AND DSM-V CRITERIA FOR PTSD. SYMPTOMS

OF PTSD APPEAR AS LEAST LIKELY AS NOT CAUSED BY OR RELATED TO

CLAIMED MILITARY STRESSORS AND VETERAN'S FEAR OF HOSTILE MILITARY

ACTION STEMMING FROM SERVICE IN IRAQ AND AFGHANISTAN. VET WAS

AWARDED COMBAT ACTION BADGE FOR SERVICE IN AFGHANISTAN.

Mental Disorder Diagnosis #2: UNSPECIFIED DEPRESSIVE DISORDER (PER DSM-V)

Comments, if any:

ALTERNATE DSM-IV DIAGNOSIS IS DEPRESSIVE DISORDER NOS. DEPRESSIVE

SYMPTOMS BEGAN CONCURRENT WITH PTSD AND ARE RELATED TO PTSD.

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

Mental Health Disorder (to include TBI): NON CONTRIBUTORY

Comments, if any: MEDICAL CARE IS THROUGH THE VA AND PRIVATE PROVIDERS.

3. Differentiation of symptoms

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

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

[X] Yes [ ] No

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

each diagnosis?

[X] Yes [ ] No [ ] Not applicable (N/A)

If yes, list which symptoms are attributable to each diagnosis:

PTSD: SYMPTOMS OF REEXPERIENCING, CUE AVOIDANCE, AND HYPERAROUSAL

DEPRESSION: DEPRESSED MOOD, FEELINGS OF HOPELESSNESS, OCCASIONAL

SUICIDAL IDEATION WITHOUT PLAN OR INTENT, HISTORY OF SUICIDAL

GESTURES (NONE SINCE 2011)

SYMPTOMS COMMON TO BOTH DISORDERS: SLEEP DISTURBANCE, APATHY,

ANHEDONIA, IRRITABILITY/ANGER, ATTENTION/CONCENTRATION PROBLEMS,

FEELINGS OF DETACHMENT, SOCIAL ISOLATION

c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?

[ ] Yes [ ] No [X] Not shown in records reviewed

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

If no, provide reason that it is not possible to differentiate what

portion of the indicated level of occupational and social impairment

is attributable to each diagnosis:

IT IS COMMON FOR PTSD AND DEPRESSION TO CO-OCCUR. DEPRESSION BEGAN

CONCURRENT WITH PTSD AND IS RELATED TO PTSD.

c. If a diagnosis of TBI exists, is it possible to differentiate what

portion

of the occupational and social impairment indicated above is caused by

the

TBI?

[ ] Yes [ ] No [X] No diagnosis of TBI

SECTION II:

-----------

Clinical Findings:

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

1. Evidence review

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

In order to provide an accurate medical opinion, the Veteran's claims folder

must be reviewed.

a. Medical record review:

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

Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed?

[X] Yes [ ] No

Was the Veteran's VA claims file reviewed?

[X] Yes [ ] No

If yes, list any records that were reviewed but were not included in the

Veteran's VA claims file:

RECORDS IN CPRS AND VISTA WERE ALSO REVIEWED.

If no, check all records reviewed:

[ ] Military service treatment records

[ ] Military service personnel records

[ ] Military enlistment examination

[ ] Military separation examination

[ ] Military post-deployment questionnaire

[ ] Department of Defense Form 214 Separation Documents

[ ] Veterans Health Administration medical records (VA treatment

records)

[ ] Civilian medical records

[ ] Interviews with collateral witnesses (family and others who have

known the Veteran before and after military service)

[ ] No records were reviewed

[ ] Other:

b. Was pertinent information from collateral sources reviewed?

[ ] Yes [X] No

2. History

----------

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

post-military):

VET WAS BORN IN BAKERSFIELD CA AND RAISED IN CA, KA AND SD BY MOTHER

AND STEPFATHER. MOVED WITH STEPFATHER'S JOB AS A METHODIST PREACHER.

MOTHER WORKED FOR THE POST OFFICE. VET IS THE YOUNGEST OF 3 CHILDREN

(2

OLDER HALF SIBLINGS). VET DESCRIBED HOME LIFE TO HAVE BEEN "PRETTY

GOOD, NO REAL PROBLEMS." STATED HE BECAME SOMEWHAT REBELLIOUS IN HIS

TEENS AND THIS CAUSED SOME STRAIN WITH PARENTS FOR A PERIOD OF TIME.

MOTHER LIVES IN COLORADO AND STEPFATHER LIVES IN WYOMING. BIOLOGICAL

FATHER DIED WHEN VET WAS VERY YOUNG. VET REPORTED VERY GOOD

RELATIONSHIP WITH MOTHER AND POOR RELATIONSHIP WITH STEPFATHER.

VET MARRIED X 2. FIRST MARRIED FROM 2005 TO 2010. VET STATED THAT THEY

ELECTED TO SEPARATE COINCIDING WITH HIS IRAQ DEPLOYMENT. THEY DIVORCED

SOME YEARS LATER. "I DONT KNOW WHY WE SEPARATED. SHE JUST SAID SHE

DIDNT WANT TO BE WITH ME ANYMORE." VET HAS BEEN MARRIED TO CURRENT

WIFE

SINCE SEPARATE SINCE SEPT 2013. THEY HAVE DATED AND COHABITATED FOR

APPROX 4 YEARS NOW. VET REPORTED THIS RELATIONSHIP TO BE "GOOD FOR THE

MOST PART. SHE DEALS WITH MY ISSUES THAT MAKE ME UNPLEASANT TO BE

AROUND. I GET MAD REAL EASY. I AM GRUMPY. I DONT SLEEP WELL. I WAKE

HER

UP SO SOMETIMES WE SLEEP IN SEPARATE BEDS."

VET HAS ONE SON AGE 8 FROM HIS FIRST MARRIAGE. SON RESIDES IN

MISSISSIPPI WITH HIS MOTHER. VET SPEAKS WITH HIM BY PHONE WEEKLY AND

VISITS EVERY OTHER MONTH. VET REPORTED "TOUGH" RELATIONSHIP WITH HIS

SON; "HE DOES KID THINGS AND I GET REAL

UPSET. IT IS HARD FOR ME TO

CALM DOWN."

VET DENIED HAVING FRIENDS OR ENGAGING WITH OTHERS SOCIALLY. "I HAVE

TROUBLE TRUSTING PEOPLE. I DONT LIKE TO GET ATTACHED TO PEOPLE. I DONT

LIKE SOCIAL SETTINGS BECAUSE I DONT LIKE LOUD MUSIC OR GROUPS OF

PEOPLE."

PAST HOBBIES AND INTERESTS INCLUDING BICYCLING AND HIKING; "I JUST

NEVER FEEL LIKE GETTING OUT AND DOING MUCH OF ANYTHING." SPENDS TIME

WATCHING TV AND PLAYING VIDEOGAMES. WATCHES CRIME DRAMAS AND FILMS ON

NETFLIX. AVOIDS WATCHING THE NEWS; "I JUST END UP GETTING MAD AT WHAT

I

SEE." STATED "I HAVE A REAL HARD TIME WATCHING STUFF THAT CAN RELATE

TO

THINGS IVE SEEN. MAYBE A FILM WITH A SUBMARINE BUT ANYTHING ELSE NO."

PLAYS FIRST PERSON SHOOTER COMBAT RELATED VIDEOGAMES "EVERYDAY" FOR

APPROX 1 HOUR ON WEEKDAYS AND 4-5 HOURS ON WEEKENDS; HE WILL PLAY

ONLINE WITH SOME MEMBERS OF HIS MILITARY UNIT. VET STATED THAT THIS IS

ONE ACTIVITY THAT ELICITS SOME SENSE OF EMOTION FROM HIM. DOES NOT

ATTEND MOVIES LIKE HE USED TO. DOES NOT ATTEND CONCERTS. "I REALLY

DONT

GET OUT MUCH."

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

and

post-military):

VET WAS KICKED OUT OF SCHOOL DURING SOPHMORE YEAR OF HIGH SCHOOL. "I

PLAYED A PRANK. VET REPORTED MAKING B/C

IN

SCHOOL. VET DENIED LEARNING DIFFICULTIES IN SCHOOL. DENIED OTHER

BEHAVIORAL PROBLEMS IN SCHOOL OTHER THAN THE ONE THAT RESULTED IN HIS

EXPULSION.

VET BEGAN WORKING FULL TIME AT WALMART AT AGE 16 AND REMAINED IN THIS

POSITION X 1 YEAR. THEN WORKED FOR JOBCORP X 1 YEAR. VET DENIED

PROBLEMS ON THESE JOBS.

VET SERVED IN THE ARMY FROM 2000 TO 2008. HIGHEST OBTAINED RANK WAS

E-5. MOS WAS BLACKHAWKE HELICOPTER CREW CHIEF. VET SERVED IN IRAQ FROM

9-2-03 TO 3-1-04 AND IN AFGHANISTAN FRO M1-18-07 TO 2-5-08. VET

ENDORSED DIRECT AND INDIRECT COMBAT EXPOSURE. WAS AWARDED COMBAT

ACTION

BADGE FOR SERVICE IN AFGHANISTAN. VET DENIED PHYSICAL INJURIES

SUSTAINED IN COMBAT. DENIED HISTORY OF MST. VET REPORTED GETTING ALONG

WELL WITH OTHERS IN THE MILITARY. DENIED HISTORY OF DISCIPLINARY

ACTION. VET WAS HONORABLY DISCHARGED UPON COMPLETION OF REQUIRED TERM

OF SERVICE.

WORK "I ENJOY IT WHEN I CAN CONCENTRATE ON

IT. A LOT OF TIMES I FIND MYSELF JUST DAZING OUT AND NOT AWARE OF WHAT

IS GOING ON." VET REPORTED GETTING ALONG "FOR THE MOST PART PRETTY

GOOD" WITH OTHER COWORKERSS AND SUPERVISORS. "I HAVE MY OWN OFFICE AND I

CAN STAY IN THERE AND NOT HAVE TO DEAL WITH ANYONE ELSE." VET STATED

THAT HIS SHIFT TO DESK WORK WAS THE RESULT OF HAVING BEEN BRIEFLY

HOSPITALIZED FOR SUICIDAL THOUGHTS IN 2011. VET DENIED FREQUENT

TARDINESS. STATED THAT HE WILL TAKE A SICK DAY 1-2 TIMES A MONTH "WHEN

I FEEL LIKE I REALLY CANT GO IN. SOME DAYS I JUST WAKE UP AND FEEL

LIKE

I CANT FUNCTION."

c. Relevant Mental Health history, to include prescribed medications and

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

PREMILITARY: VET DENIED PARTICIPATION IN FORMAL MH TREATMENT OR

MEDICATIONS FOR MOOD, THINKING OR SLEEP. VET DENIED PROBLEMS WITH

DEPRESSED OR ANXIOUS MOOD OR OTHER MH SYMPTOMS. VET REPORTED SLEEP TO

HAVE BEEN GOOD.

MILITARY: VET DENIED PARTICIPATION IN FORMAL MH TREATMENT. PRESCRIBED

AMBIEN DURING DEPLOYMENTS TO AID SLEEP. SLEEP PROBLEMS BEGAN APPROX 6

MONTHS AFTER RETURN FROM IRAQ IN 2008 AND WORSENED AFTER ETS; "I

STARTED HAVING NIGHTMARES AND STUFF."

POST MILITARY: VET PARTICIPATED BRIEFLY IN COUNSELING WITH WORK. SUPERVISORS RECOMMENDED HE DO THIS DUE TO WORK RELATED

STRESS AND ANGER ISSUES. PRESCRIBED ZOLOFT BY PRIVATE PRIMARY CARE

DOCTOR. DISCONTINUES USE OF ZOLOFT DUE TO SIDE EFFECT OF INCREASED

AGITATION. VET DENIED HAVING BEEN TAKEN OFF DUTY STATUS

DURING THIS TIME. VET WAS TREATED AT BVAMC FROM APRIL 2011 TO APRIL

2013 FOR PTSD AND ASSOCIATED DEPRESSION. WAS PRESCRIBED CITALOPRAM AND

TRAZODONE BY PSYCHIATRIST. THESE MEDS WERE LAST FILLED IN MARCH 2014.

DENIED ADVERSE SIDE EFFECTS. VET ALSO PARTICIPATED IN INDIVIDUAL

THERAPY DURING THIS TIME. VET STATED THAT HE FORGET HIS LAST SCHEDULED

APPOINTMENT IN SEPT 2013 "AND NO ONE CALLED ME BACK. I KEEP MEANING TO

DO IT BUT I FORGET DURING WORK HOURS. I WILL GO UP AFTER THIS TO MAKE

AN APPOINTMENT."

PSYCHIATRIC HOSPITALIZATIONS: TVAMC FROM 7/30/11-8/1/11 FOR SUICIDAL

IDEATION WITHOUT ATTEMPT.

SUICIDE ATTEMPTS: REPORTED 2-3 SUICIDE ATTEMPTS; "NONE SINCE THE

HOSPITALIZATION." REPORTED ATTEMPTED OVERDOSE ON WIFE'S PILLS; "IT

SLOWS YOUR HEART DOWN IF YOU TAKE ENOUGH." WIFE FOUND HIM AND MADE HIM

THROW UP. DENIED MEDICAL CARE AFTER THIS EVENT. VET IS NOTED TO HAVE

BEEN OUT DRINKING WITH FRIENDS. HE ASKED THEM TO DROP HIM OFF IN A BAD

NEIGHBORHOOD WITH INTENT TO "LET WHATEVER HAPPENED HAPPEN." THIS

CONTRIBUTED TO HIS HOSPITALIZATION AT TVAMC. JUST SHORTLY BEFORE THIS,

VET IS NOTED TO HAVE TAKEN HIS PISTOL, PUT IT TO HIS HEAD, AND PULLED

THE TRIGGER.

FAMILY PSYCHIATRIC HISTORY: VET DENIED.

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

post-military):

VET REPORTED HAVING BEEN ARRESTED AS A TEEN FOR CALLING A BOMB THREAT

INTO HIS SCHOOL. SERVED PROBATION FOR 2 YEARS UNTIL ENTERING THE

MILITARY. DENIED OTHER LEGAL INFRACTIONS. VET REPORTED HISTORY OF

VERBAL ALTERCATIONS IN PUBLIC SETTINGS. "I HAVENT GOTTEN KICKED OUT OF

WALMART BUT I WILL TELL PEOPLE WHAT I AM THINKING." DENIED ARGUMENTS

AS

ESCALATING TO POINT OF PHYSICAL AGGRESSION. VET WAS REFERRED FOR

COUNSELING WITH WORK IN APPROX 2011 FOR ANGER ISSUES.

e. Relevant Substance abuse history (pre-military, military, and

post-military):

PREMILITARY: VET DENIED USE OF ALCOHOL OR ILLICIT DRUGS. BEGAN USING

CIGARETTES AND CHEWING TOBACCO AT AGE 17.

MILITARY: VET REPORTED WEEKEND SOCIAL USE OF ALCOHOL. ENDORSED

INTOXICATION. ENDORSED DRINKING TO PASSING OUT ON ONE OCCASION. DENIED

WITHDRAWAL SYMPTOMS. VET DENIED PROBLEMATIC EFFECTS RELATED TO ALCOHOL

USE. DENIED USE OF ILLICIT DRUGS. VET CONTINUED TO USE TOBACCO

PRODUCTS.

POST MILITARY: VET REPORTED "HEAVY DRINKING" ON WEEKENDS. 12 BEERS

EACH

DAY. LIMITED USE OF 1-2 BEERS ON WEEKDAYS. VET DENIED PROBLEMATIC

EFFECTS RELATED TO ALCOHOL USE. HOWEVER, ONE BINGE DRINKING EPISODE

WITH FRIENDS IN 2013 CONTRIBUTED TO BRIEF PSYCHIATRIC ADMISSION FOR

SUICIDAL IDEATION. DENIED USE OF ILLICIT DRUGS. CONTINUES TO USE 1/2

CAN CHEWING TOBACCO A DAY. VET CONSUMES 2 MONSTER ENERGY DRINKS, 2

MOUNTAIN DEWS, AND 2 COKES A DAY. DENIED MISUSE OF PAIN MEDS OR OTHER

PRESCRIPTION MEDS.

f. Other, if any:

PREMILITARY STRESSORS: VET DENIED MAJOR STRESSORS.

MILITARY STRESSORS: VET DENIED OTHER THAN COMBAT RELATED STRESSORS.

SEE

CLAIMED MILITARY STRESSORS.

POST MILITARY: VET DENIED MAJOR STRESSORS.

3. Stressors

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

a. Stressor #1: VET IS AWARDED COMBAT ACTION BADGE FOR SERVICE IN

AFGHANISTAN

FROM 2007-2008. STRESSOR IS CONCEDED BY VARO. IN ADDITION TO CAB, VET

WAS INVOLVED IN A HELICOPTER CRASH WHILE SERVING IN IRAQ IN 2004. VET

ENDORSED EXPOSURE TO DIRECT AND INDIRECT COMBAT. WITNESSED OTHER

WOUNDED AND KILLED IN ACTION. VET HAD RESPONSIBILITY OF GOING TO THE

SCENE OF ANOTHER HELICOPTER CRASH. "OUR JOB WAS TO RECOVER THE

AIRCRAFT

BUT THERE WERE BODY PARTS AND THE SUCH." VET NOTED TO BECOME RESERVED

DURING DISCUSSION.

Does this stressor meet Criterion A (i.e., is it adequate to support

the diagnosis of PTSD)?

[X] Yes [ ] No

Is the stressor related to the Veteran's fear of hostile military or

terrorist activity?

[X] Yes [ ] No

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

trauma?

[ ] Yes [X] No

4. PTSD Diagnostic Criteria

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

Please check criteria used for establishing the current PTSD diagnosis. Do

not mark symptoms below that are clearly not attributable to the criteria A

stressor/PTSD. Instead, overlapping symptoms clearly attributable to other

things should be noted under #6 - other symptoms. The diagnostic criteria

for PTSD, referred to as Criteria A-H, are from the Diagnostic and

Statistical Manual of Mental Disorders, 5th edition (DMS-5).

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)

[X] Witnessing, in person, the traumatic event(s) as they occurred to

others

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

symptoms

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

traumatic event(s) occurred:

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

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

[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] 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] 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] Panic attacks that occur weekly or less often

[X] Chronic sleep impairment

[X] Mild memory loss, such as forgetting names, directions or recent

events

[X] Flattened affect

6. Behavioral Observations

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

VET WAS ATTRACTIVE, NICELY BUILT, CLEANLY AND CASUALLY DRESSED, AND WELL

GROOMED IN APPEARANCE. VET WAS ALERT, PLEASANT, AND COOPERATIVE WITH

INTERVIEW. AFFECT WAS BLUNTED. PRESENTATION WAS STOIC. SUBJECTIVE MOOD WAS

"FINE." SPEECH WAS UNREMARKABLE. SPEED OF THINKING AND RESPONDING WAS WITHIN

NORMAL LIMITS. THOUGHT PROCESSES WERE LOGICAL AND GOAL DIRECTED. THERE WAS

NO

OVERT EVIDENCE OF MENTAL CONTENT SYMPTOMATOLOGY, PERCEPTUAL DISTURBANCE, OR

GROSS COGNITIVE CONFUSION. INSIGHT AND JUDGMENT WERE GOOD.

VET RECALLED 3/3 WORDS IMMEDIATELY AFTER PRESENTATION AND 2/3 WORDS AFTER A

DELAY. BENEFITTED FROM SEMANTIC CUEING (1/1). VET WAS ORIENTED X 3. MENTAL

CALCULATIONS WERE GOOD (93,86,79,72,65,58). NO ERRORS IN BACKWARD SPELLING

(DLROW). VERBAL ABSTRACT REASONING AND INTERPRETATION OF PROVERBS WERE

WITHIN

NORMAL LIMITS. VET REPORTED ATTENTION AND CONCENTRATION TO VARY; "SOME DAYS

GOOD, SOME DAYS BAD." STATED THAT HE WILL "DAZE OUT SOME DAYS AND I DONT GET

ANYTHING ACCOMPLISHED. OTHER DAYS I GET A LOT DONE." DESCRIBED "SHORT TERM

MEMORY IS TERRIBLE." FORGETS WHAT HE DID EARLIER THAT DAY. FORGETS TASKS HE

WIFE ASKS HIM TO DO. REMOTE MEMORY IS BETTER PRESERVED.

VET DROVE TO THIS APPOINTMENT. DENIED PROBLEMS WITH DRIVING. VET MANAGES HIS

OWN MEDICATIONS. ADMITTED THAT HE FORGETS TO TAKE CITALOPRAM SEVERAL DAYS A

WEEK. VET MANAGES FINANCES AND PAYS BILLS. "I HAVE TO MAKE SURE I DO

EVERYTHING ON PAY DAY OR I FORGET."

7. Other symptoms

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

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

mental disorders) that are not listed above?

[X] Yes [ ] No

If yes, describe:

VET REPORTED PROMINENT APATHY AND ANHEDONIA. "OTHER THAN PLAYING

X-BOX, REALLY NOTHING INTERESTS ME." DESCRIBED LIMITED RANGE OF

EMOTION AND FINDS IT HARD TO EXPERIENCE POSITIVE EMOTIONS AS HE

DID

IN THE PAST. REPORTED DOWN, DEPRESSED MOOD "ALL THE TIME."

MOTIVATION IS "RARE ANYMORE" AND ENERGY LEVEL IS "AWFUL, I AM TOO

TIRED TO DO ANYTHING." DENIED CRYING SPELLS; STATED THAT

OCCASIONALLY HE WANTS TO CRY BUT CANT. ENDORSED FEELINGS OF

HOPELESSNESS AND ADMITTED "SOMETIMES I FEEL I HAVE NOTHING TO LIVE

FOR. NOTHING TO LOOK FORWARD TO IN LIFE." THESE THOUGHTS OCCUR

SEVERAL TIMES A WEEK. VET HAS HISTORY OF SUICIDE ATTEMPT. VET

DENIED SUICIDAL IDEATION, PLAN OR INTENT AT THIS TIME. "I MAY

THINK

ABOUT IT BUT I CAN TALK MYSELF OUT OF IT BEFORE I DO ANYTHING."

STATED THAT CONCERN FOR HIS WIFE AND HIS SON KEEP HIM FROM ACTING

OUT ON SUICIDAL THOUGHTS. VET WAS WELL AWARE OF SUITABLE OPTIONS

FOR AVOIDING ACTING OUT ON SUICIDAL THOUGHTS IF NEEDED.

VET REPORTED DAILY IRRITABILITY. "THE SMALLEST THINGS IRRITATE ME.

I THINK I AM BETTER AT CONTROLLING MY ANGER BUT IT IS STILL

THERE."

ENDORSED ANGER OUTBURSTS IN WHICH "I WILL START YELLING AT WHO

EVER

MADE ME ANGRY OR AT MYSELF OR AT WHATEVER IT IS I CANT GET TO WORK

RIGHT." THROWS THINGS IN ANGER. DENIED PROBLEMS WITH DOMESTIC

VIOLENCE. FINDS IT HARD TOLERATE HIS 8 YO SON FOR MORE THAN BRIEF

PERIODS. "I DONT WANT HIM TO THINK I AM ALWAYS MAD." VET DENIED

PHYSICAL ALTERCATIONS BUT DOES ENGAGE IN VERBAL ARGUMENTS WITH

OTHERS IN PUBLIC SETTINGS. DENIED HOMICIDAL THOUGHTS.

APPETITE IS GOOD. WEIGHT IS STABLE. SEX DRIVE IS ALRIGHT. SLEEP IS

"TERRIBLE." VET REPORTED PROBLEMS FALLING ASLEEP IN ABSENCE OF

TRAZODONE. CONTINUES TO WAKE MULTIPLE TIMES A NIGHT. IN THE PAST

HAD COMBAT RELATED NIGHTMARES SEVERAL TIMES A WEEK. STATED THAT

SINCE STARTING TRAZODONE, HE STARTLES AWAKE BUT DOES NOT RECALL

THE

NATURE OF DREAMS UPON WAKING. CONTINUES TO EXPERIENCE NIGHTSWEATS

"ALMOST EVERY NIGHT." WAKES IN RESPONSE TO SUBTLE SOUNDS. AVERAGES

5-6 HOURS OF INTERRUPTED SLEEP A NIGHT. SLEEP IS DESCRIBED AS

RESTLESS WITH FREQUENT TOSSING AND TURNING AND FOR THIS REASON VET

AND WIFE OFTEN SLEEP IN SEPARATE ROOMS. VET REPORTED OCCASIONAL

INTRUSIVE DAYTIME RECOLLECTIONS USUALLY TRIGGERED BY SIGHT OR

SOUND

OF A HELICOPTER OR SOUNDS SIMILAR TO GUNSHOTS. DESCRIBED THESE

MEMORIES AS ELICITING DOWN, IRRITABLE MOOD.

VET REPORTED FEELING ANXIOUS AND TENSE "A LOT OF THE TIME."

DESCRIBED SITUATIONAL ANXIETY. AVOIDS CROWDS AND BUSY PUBLIC

SETTINGS. AVOIDS WAR RELATED FILMS AND DOCUMENTARIES. RARELY IF

EVER TALKS WITH ANYONE ABOUT HIS COMBAT EXPERIENCES. DESCRIBED

HIMSELF AS "VIGILANT, CONSTANTLY LOOKING FOR THREATS" IN HIS

ENVIRONMENT. FINDS IT DIFFICULT TO RELAX OR LET HIS GUARD DOWN.

VET

STATED THAT HE HAS GOTTEN BETTER IN RESPONDING TO LOUD UNEXPECTED

NOISES IN SOME SETTINGS LIKE WORK WHERE HE DOES NOT WANT OTHERS TO

BE AWARE OF HIS SYMPTOMS; "MY HEART FEELS LIKE IT IS COMING OUT OF

MY CHEST BUT I DONT JUMP." VET REPORTED PANIC ATTACKS 1-2 TIMES A

MONTH CHARACTERIZED BY "THE ROOM CLOSING IN ON ME AND I HAVE TO

GET

OUT OF THERE, MY HEART BEATS FAST, I GET TUNNEL VISION." SYMPTOMS

CONTINUE UNTIL HE REMOVES HIMSELF FROM THE SITUATION. DENIED

AWARENESS OF SPECIFIC TRIGGERS. NO OCD SYMPTOMS.

NO HALLUCINATIONS OR DELUSIONS. VET REPORTED THAT HE TRUSTS "A FEW

PEOPLE I WAS IN THE ARMY WITH, MY WIFE AND MY MOM." VET STATED

THAT

HE SOMETIMES FEELS THAT SOME PEOPLE IN HIS ENVIRONMENT HAVE ILL

INTENT; "FOR NO REAL REASON, MAYBE THE WAY THEY LOOK."

8. Competency

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

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

[X] Yes [ ] No

9. Remarks, if any

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

No remarks provided.

NOTE: VA may request additional medical information, including additional

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

application.

Edited April 15, 2014 by uh60james

[Mikemmlj]

Sounds like you will get service-connection. Also sounds like you are doing relatively well. Hope things improve with your son.

[uh60james]

Thanks Mike. Getting angry with my son is one of the things that bothers me the most, as he has been getting older things have started to get a bit better.

[Mikemmlj]

I think 1 hour 20 minutes is a relatively short exam.

[uh60james]

I think 1 hour 20 minutes is a relatively short exam.

Well, I was scheduled for 8 and didn't get called back until 840 because the lady at the front never called the doc and told her I arrived. She finally came up and asked the lady if her 8 o'clock had ever showed up. I think it probably would have gone longer had I gotten in there on time, she started going through the questions a lot faster as 10 approached. I also did not have to go into detail about my primary stressor with her since I have a CAB.

[john999]

I have never heard of a vet at an exam as being described as "attractive". You must have rung her chimes. I never had a C&P that lasted longer than 20 minutes in my life, and I am SC for about ten different conditions. I think you will get 30% or maybe 50%. Next time you get an exam I would try and nix anything to do with life before the military. If the exam doctor wants they can hang you with once sentence about your childhood. You are lucky she did not ask about teenage drinking or fighting. You would have gotten a personality disorder added to your DX. I think the PTSD DX has become the hardest claim to win at the VA. That doctor covered everything from soup to nuts.

John

[uh60james]

I have never heard of a vet at an exam as being described as "attractive". You must have rung her chimes. I never had a C&P that lasted longer than 20 minutes in my life, and I am SC for about ten different conditions. I think you will get 30% or maybe 50%. Next time you get an exam I would try and nix anything to do with life before the military. If the exam doctor wants they can hang you with once sentence about your childhood. You are lucky she did not ask about teenage drinking or fighting. You would have gotten a personality disorder added to your DX. I think the PTSD DX has become the hardest claim to win at the VA. That doctor covered everything from soup to nuts.

John

Thanks John, I was surprised to see that she put "attractive" in her notes but it gave me a little laugh. I was actually expecting the exam to be short and sweet since the few people I know locally who have had C&P exams have been in and out. I actually think she would have taken longer if her 10 o'clock appointment hadn't arrived or I had actually been in the office with her on time. I appreciate the advice about leaving out pre military issues, I had actually been thinking about that prior to the exam and only mentioned my trouble in school with the bomb threat because it is in my OMPF and I have no clue if they reference that or not.

I have 2 more C&P exams today that I'm thinking will be pretty quick for Tinnitus/Hearing Loss and Left Knee Issues. I'm hoping my claim will move along smoothly from here since I can't seem to keep myself from looking at Ebennies all the time.