Blown Away!

[Scout Swimmer]

So I just got home from my C&P and am still slightly in disbelief. The day started with this computer examination asking questions such as "do you dress like a woman". And "Do you feel aroused harming animals". Ok, standard stuff. I then had my 11:00 am appointment with the head shrink. I was escorted to his office and he introduced himself. Older guy with a cane. I noticed immediately that something was drastically off with him, as if he had mild Parkinson's disease or something. I thought "oh xxxxxxx great". About 40 minutes later he asked me a question that I won't/can't repeat in a public forum. This dude asked me if he can tell me something personal, off the record. He then proceeds to tell me the VA has been trying to terminate his employment for the last 2 years because he gives favorable opinions and they are saying he is unfit to practice due to his illness. He then tells me that he is the only veteran shrink at the facility and he can't stomach how his civilian colleges look at veterans. He finished by saying that he has been doing these C&P exams for 20 years and knows exactly what I'm going though and that his opinion would base my claim as service connected. He then told me he is trying to get Early retirement to get away from the ass-hats he works with. I told him not to do that because guys like me need him exactly where he is. He then started sobbing. I am in disbelief right now but I needed this story told. Thank you.

[OEFMP]

I'm wondering what my rating maybe if at all... I had my C&P for PTSD and I'm hoping I didn't get to screwed, it only lasted 35 mins. Please help me out with a "ballpark %" ... thanks in advance.

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

ICD code: F43.1

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

Mental Health Disorder (to include TBI): See below.

Comments, if any: CPRS indicates 30% service-connection for:

IMPAIRED HEARING (0%-SC)

PARALYSIS OF MEDIAN NERVE (10%-SC)

TINNITUS (10%-SC)

LUMBOSACRAL OR CERVICAL STRAIN (10%-SC)

PARALYSIS OF SCIATIC NERVE (10%-SC)

LIMITED FLEXION OF FOREARM (0%-SC)

Computerized records indicate:

Knee pain

Tobacco Dependence

Overweight

Tinnitus, Subjective

Elevated Liver Function Tests

Lumbar Radiculopathy

Degen Disc Dis, Lumbar

Hearing loss

Low Back Pain

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

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

[ ] Yes [X] No

2. History

----------

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

post-military):

Mr. XXXXX was born in Corpus Christi, TX and raised in TX and NV.

His parents never divorced. Mr. XXXXX has no siblings and has an

excellent relationship with his parents.

Mr. XXXXX's first marriage lasted from 2003-2005 and his

second

from 2007-2010. He remarried in 2010 and described his current

relationship as "rocky." Mr. XXXXX has four children and

described

the relationship with his children as also "rocky." He

currently lives

with his parents in XXXXX, NV. Income sources include the GI Bill and

current service-connection.

Mr. XXXXX enjoys target practice every couple of months. He rarely

socializes.

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

and

post-military):

Veteran completed a GED in 2003. Veteran noted that he was diagnosed

with Attention Deficient Disorder as a child.

Mr. XXXXX joined with the National Guard in 2004 and is currently

enlisted. MOS include infantry (11B), combat engineer (21B) and

military police (21B). Mr. XXXXX reported exposure to combat fire

(small arms, mortars, rockets, RPGs) in Afghanistan from 2011-2012.

His current rank is E-5.

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

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

Interim Mental Health History:

Mr. XXXXX and his wife currently participate in marital counseling

at the XXXXX Vet Center. Mr. XXXXX also participates in individual

therapy with Dr. Krogh and group therapy targeted at PTSD symptoms.

Mr. XXXXX is also followed by Dr. Pai for psychiatric medication

management.

CPRS lists active medications as:

AMITRIPTYLINE TAB 50MG

PRAZOSIN CAP,ORAL 1MG

HydrOXYzine PAMOATE CAP,ORAL 25MG

GABAPENTIN CAP,ORAL 300MG

METHOCARBAMOL TAB 500MG

LAMOTRIGINE TAB,ORAL 25MG

DICLOFENAC TAB,EC 75MG

MORPHINE TAB,SA 15MG

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

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

PTSD Symptoms:

Intrusive Thoughts - Mr. XXXXX reported intrusive thoughts

regarding stressor #1 on a weekly basis.

Sleep/Nightmares - Mr. XXXXX reported nightmares that occur on a

weekly basis.

Dissociative reactions - Denied.

Psychological/Physiological Reactions - Anxiety, heart palpitations

And perspiration.

Avoidance - Veteran tends to avoid thoughts and conversations

Regarding combat experience.

Difficulty Remembering - Denied.

Distorted expectations/beliefs/blame - Chronic self-blame and

suspiciousness.

Persistent negative emotion - Chronic anger.

Loss of Interest - Rarely participates in hobby activities.

Distant/Emotionally Numb - Rarely socializes.

Irritability - Irritability on a daily basis.

Self-destructive/reckless - Denied.

Hypervigilance/Startle - Mr. XXXXX often scans for environmental

threats and is easily startle by sudden noises.

Difficulty Concentrating - He has difficulty concentrating on mundane

tasks.

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

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

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

post-military):

Veteran reported legal problems for failure to comply with a court

order.

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

post-military):

Alcohol:

Pre military: Rarely.

During Military: Weekend binge drinking.

Post Military: Three beers/week.

3. Stressors

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

a. Stressor #1: Exposure to combat fire.

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, 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] 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.

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] Panic attacks that occur weekly or less often

[X] Chronic sleep impairment

[X] Disturbances of motivation and mood

[X] Difficulty in establishing and maintaining effective work and social

relationships

6. Behavioral Observations

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

Mr. XXXXX arrived on time for his appointment. Grooming and hygiene

Were adequate. He was alert and cooperative throughout the examination.

Expressive speech was fluent; thought processes were logical. Veteran

described his mood as "frustrated and eager to get out of here";

affect was congruent with his mood state. He denied any suicidal/homicidal ideation,

plan, or intent. There were no indications of delusions, hallucinations or

other signs of frank psychosis. Insight and judgment were intact.

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

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

Veteran completed the PCL-5, a self-report measure of PTSD and obtained a

56.

On the BDI-II, a self-report measure of depression, Veteran obtained a

34, suggesting severe depression. The BAI is a self-report measure of

anxiety; his score of 20 indicates moderate anxiety.

Veteran currently meets DSM 5 criteria for PTSD and currently

Participates in relevant mental health treatment at the XXXXX VAMC.

NOTE: VA may request additional medical information, including additional

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

application. Income sources include the GI Bill and current service-connection. Patient enjoys target practice every couple of months. He rarely socializes.

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

and post-military):

Veteran completed a GED in 2003. Veteran noted that he was diagnosed

with Attention Deficient Disorder as a child.

Patient joined with the National Guard in 2004 and is currently

enlisted. MOS include infantry (11B), combat engineer (21B) and

military police (21B). Patient reported exposure to combat fire

(small arms, mortars, rockets, RPGs) in Afghanistan from 2011-2012.

His current rank is E-5.

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

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

Interim Mental Health History:

Patient and his wife currently participate in marital counseling

at the XXXXX Vet Center. Patient also participates in individual

therapy with Dr. XXX and group therapy targeted at PTSD symptoms.

Patient is also followed by Dr. XXX for psychiatric medication

management.

CPRS lists active medications as:

AMITRIPTYLINE TAB 50MG

PRAZOSIN CAP,ORAL 1MG

HydrOXYzine PAMOATE CAP,ORAL 25MG

GABAPENTIN CAP,ORAL 300MG

METHOCARBAMOL TAB 500MG

LAMOTRIGINE TAB,ORAL 25MG

DICLOFENAC TAB,EC 75MG

MORPHINE TAB,SA 15MG

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

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

PTSD Symptoms:

Intrusive Thoughts - Patient reported intrusive thoughts

regarding stressor #1 on a weekly basis.

Sleep/Nightmares - Patient reported nightmares that occur on a

weekly basis.

Dissociative reactions - Denied.

Psychological/Physiological Reactions - Anxiety, heart palpitations

And perspiration.

Avoidance - Veteran tends to avoid thoughts and conversations

Regarding combat experience.

Difficulty Remembering - Denied.

Distorted expectations/beliefs/blame - Chronic self-blame and

suspiciousness.

Persistent negative emotion - Chronic anger.

Loss of Interest - Rarely participates in hobby activities.

Distant/Emotionally Numb - Rarely socializes.

Irritability - Irritability on a daily basis.

Self-destructive/reckless - Denied.

Hypervigilance/Startle - Patient often scans for environmental

threats and is easily startle by sudden noises.

Difficulty Concentrating - He has difficulty concentrating on mundane

tasks.

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

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

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

post-military):

Veteran reported legal problems for failure to comply with a court

order.

a. Stressor #1: Exposure to combat fire.

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