ptsd Ptsd C And P Results Thoughts?

[mbl22885]

SECTION I
1. Diagnostic Summary
This section should be completed based on the currem examination and clinical findings.
Does the Veteran bave a diagnosis ofPTSD that conforolS to DSM-5 criteria based on today's evaluation?
[X] Yes 0 No
If no diagnosis ofPTSD. check all U1at apply:
(]Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria
0 Veteran does not have a mental disorder Ula t conforms with DSM-5 criteria
O Veteran has another Mental Disorder dia2nosis
Continue to complete this Questio1Dl3ire and/or the Eating Disorder Questionnaire.
2. Currrnt diagnosrs
a. Mental Disorder Diagnosis #1

PTSD
Comments. if any:
Mental Disorder Diagnosis #2:
I Alcohol Abuse. In Remission
Comments. if any:
Mental Disorder Diai!Ilosis #3:
I Attention-Deficit. Hyperactive Disorder. Inattentive Type
Counnents, if an :
Diai!Ilosed since childhood and medicated durin~ childhood.
Mental Disorder Diai!Ilosis #4:
Comments. if any:
If additional diai!Iloses. describe usin~ above format :
b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI):
Comments. if any:
3. Difff'reotiation of svmptoms

3. Difff'reotiation of svmptoms
a. Does the Veteran have more than one mental disorder diagnosed?
[X] Yes 0 No
If yes. complete the following question (3b):
b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis?
[X] Yes 0 No 0 Not applicable (N/A)
If no. provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and
discuss whether there is any clinical association between these diagnoses:
Discuss whether there is an clinical association between those diaenoses:
If yes, list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these
dia101oses:
The veteran's difficulties with Alcohol Abuse do not currently impact functioning. since he bas abstained from alcohol since 2012.
He presents with significant PTSD symptoms which in1pact current functioning. resulting in problems maintaining relationships
with others, agitation. and excessive anxiety. The history is significant for a diagnosis of ADHD which binders ability to
concentrate.
c. Does the Veteran have a diagnosed traUDlatic brain injury (TBI)?
0 Yes [X] No 0 Not shown in records reviewed

4. Occupational and social impairml'nt
tom is attributable to each dial!llosis:
a. Which of the following best summarizes the Veter311's level of occupational and social impairment with regards to all mental
diagnoses?
(Check only one)
0 No mental disorder diagnosis
0 A mental condition has been foJIDally diagnosed. but symptoms are not severe enough either to interfere with occupational and
social functioning or to require continuous medication
O Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perfonn
occupational tas.ks only during periods of significant s tress. or: symptoms controlled by medication
0 Occupational and social impaiJIDent with occasional decrease in work efficiency and intennittent periods of inability to perfonn
occupational tasks. although generally fimctioning satisfactorily. wiUt nol1llal routine behavior. self-care and conversation
0 Occupational and social impairment with reduced reliability and productivity
[X) Occupational and social impairment with deficiencies in most areas. such as work. school. family relations. judgment. thinking
and/or mood
0 Total occupational and social impairment
b. For the indicated level of occupational and social impaimtent. is it possible to differentiate what portion of the occupational and
social impaimtent indicated above is caused by each mental disorder?
[X) Yes 0 No O 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 impaiJIDent
is attributable to each diagnosis:
If yes. list which portion of the indicated level of occupational and social impainnent is attributable to each dial!llosis:
Veteran's diagnosis of Alcohol Abuse. In Remission is no longer impacting functioning. However, he continues ro present with
severe PTSD symptoms resulting in excessive anxiety. startle response, hyper vigilance. agitation. and maintaining relations with
others.
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?
0 Yes [] No [X) No diagnosis ofTBI
If no. provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impaiJIDent
is attributable to each dial!.Dosis:
If yes. list which portion of the indicated level of occupational aud social i.mpairtnent is attributable to each diagnos is:

_______________________________________________________________________

Leaving some stuff out.

________________________________________________________________________

4. PTSD Diagnostic Ct·itc.•r·ia
Please cht rk crtte1ia used ror establisWng the CUJTt nt PTSD diagnosis. Do ~OT mark symptoms below that are clearly not
attributable to the criteria A stressor/PTSD. Instead, overlapping symptoms clearly aflributable to other things sbould 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. 5tb edition {DSM-5).
Clittiion A: Exposure to actual or tbreatened a) death. b) serious injury. c) sexual violation. in one or more of tbe following ways:
[X) Directly experiencing the traumatic event(s)
O Witnessing. in person. tbe traumatic event(s) as they occurred to otbers
O Learning tbat the traumatic event(s) occurred to a close family member or close friend: cases of actual or threatened death must
bave been violent or accidental: or. experiencing repeated or extreme exposure to aversive details oftbe tramuatic event(s} (e.g ..
first responders collecting human remains: police officers repeatedly exposed to details of cbild abuse): Ulis does not apply to
exposure through electronic media. television. movies. or picrures. unless this exposure is work related
Cliterion B: Presence of (one or more) oftbe following intrusion symptorus associated with the traumatic event(s). beginning after
U1e traumatic event(s) occurred:
[X] Recurrent. involuntary. and intrusive distressing memories of tbe traumatic event(s).
[X} Recurrent disil-essing dreams in which tbe content and/or affect of tbe dreant are related to the traumatic event(s).
O Dissociative reactions (e.g .. flashbacks) in wh.icb Ute individual feels or acts as if the tramnatic e\·ent(s) were recurring. (Snell
reactions may occur on a continuum. witb the most extreme expression being a complete loss of awareness of present
stUTOimdings.)
0 Intense or prolonged psychological distress at exposure to internal or external cues tbat symbolize or resemble an aspect of tbe
traumatic event(s).
O Marked physiological reactions to internal or eJo.iernal cues tbat symbolize or resemble an aspect of tbe traumatic event(s).
Ctituion C: Persistent avoidance of stimuli associated witb tbe tramnatic evem(s). beginning after tbe traumatic event(s) occurred. as
evidenced by one or both of tbe following:
O Avoidance of or efforts to avoid distressing memories. tboughts. or feelings about or closely associated witb tbe traumatic event(s).
[X] Avoidance of or efforts to avoid external reminders (people. places, conversations, activities, objects, situations) tbat arouse
diStressing memories. thoughts. or feelings abom or closely associated with tbe rratmlatic event(s).
Clituion D: Negative alterations in cognitions and mood associated with tbe traumatic event(s), beginning or worsening after the
traumatic e\·em(s) occurred, as evidenced by two (or more) of Ute following:
0 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative anmesia and not to other factors
such as bead injury. alcohol. or drugs).
O Persistent and exaggerated negative beliefs or expectations about oneselt albers. or tbe world (e.g .. "I am bad." "No one can be
trus ted." ·'The world is completely dangerous." "My whole nervous system is pennanently ruined").
O Persistent, distorted cognitions about the cause or consequences of tbe tramnatic event(s) tbat lead to the individual to blame
himself/herself or others.
O 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.
O Persistent inability to experience positive emotions (e.g., inability to experience happiness. satisfaction, or loving feelings.)
Ctiterlon E: Marked alterations in arousal and reactivity associated v,itllthe 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 (witb little or no provocation) typically expressed as verbal or physical aggression toward
people or objects.
[X} Reckless or self-destructh·e behavior.
[X} Hypervigilance
[X] Exaggerated startle response.

[X] Problems with concentration.
(X) Sleep disrurbance (e.g .. difficulty fallin!! or staying asleep or restless sleep).
Ctitt tion F:
[X} Duration of the disrurbance (Criteria B. C. D. and E) is more than 1 month.
Q·Herioo G:
(X) The disttu·bance causes clinically significant distress or impairment in social, occupational. or other imporrant areas of
functioning.
Ctiterioo 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 raring purposes. check all symptoms Uta! actiYely apply to lhe Veterans diagnoses. Text boxes after the symptoms can contain
information for addressing frequency. severity, duration. as well as additional pertinent comments.
[X} Depressed mood
[X) Anxiety
0 Suspiciousness
O Panic attacks rhar occur weekly or less often
0 Panic attacks more than once a week
0 Near<ontinuous panic or depression affecting the ability to function independently. appropriately and effectively
(X) Chronic sleep impairment
0 Mild memory loss. such as forgetting names. directioJlS or recent events
O Impairment of shorr· and long-rerm memory. for exatllple. retention of only highly learned material. while forgetting to complete
tasks
O Memory loss for names of close relatives. own occupation. or own name
(X) Flattened affect
0 Circumstantial, circumlocutory or stereotyped speech
O Speech intermittently illogical, obscure. or irrelevant
0 Difficulty in understanding complex coD1lllands
0 Impaired judgment
0 Impaired absn·act thinking
O Gross impairment in thought processes or communication
[X} Disturbances of motivation and mood
[X] Difficulty in establishing and maintaining effecti,·e work and social relationships
0 Difficulty in adapting to stressful circumstances. including work or a work like setting
0 Inability ro establish and maintain effective relatioliShips
0 Suicidal ideation
O Obsessional rituals which interfere with routine activities
O Impaired impulse control. such as unprovoked irritability with periods of violence
0 Spatial disorientation
O Persistent delusions or hallnciuatio.ns
0 Grossly inappropriate behavior
0 Persistent danger of hurting self or others
O Neglect of personal appearance and hygiene
O intermittent inability ro perform activities of daily li\·ing. including mainrenance of minimal personal hygiene

0 Disorientation to time or place
Behavioral Observations:
Vereran presented as alert and well oriented. He presented as casually dressed. with marginal grooming and adequate hygiene. He
required no assistive devices and presenred with normal motor functioning. He reporred dyshphoric mood. frustration related to
ongoing concentration difficulties impacting his ability to succeed in school. poor sleep. excessive anxiety. starrle response. hyper
vigilance. difficulty maintaining relationships. He appeared uncomfortable and anxious during !be interview. with a soft and
trembling voice. He denied self-injurious ideation. plan. and intent. He did nor present as a danger to self or ollters.
DBQ lnitial Post· Traumatic Stress Disorder (PTSD)-DSM V

Sorry for the twerked words here and there, had trouble converting the scanned pdf document into something readable.

I'm already in with a private provider for EMDR therapy and start next week. Any thoughts on my rating level would be appreciated.

[Berta]

"Had c&p in 2012 doctor checked most of the boxes and rated me 100% total social & occupational impairment. After two days I noticed My claim in admin. review. they put in new claim of depression for me. just wondering I thought Ptsd included depression. I thought my rating should be 70%-100% or IU since My ptsd has prevented me from employment since 1997. "

Do you receive SSDI solely for your SC disabilities?

Has VA Voc Rehab ever turned you down, documenting your SCs make Voc Rehab unfeasible?

But even without SSDI or the Voc Rehab documentation, I dont see why the VA didnt at least take you up to 70% and enclose a TDIU form for you.if the doc's Total Social and occupational statement was solely due to your SC disabilities.

VA might have committed a CUE in the decision.....

Can you scan and attach the VA's Reason and Bases here? And the evidence list in the decision? (cover name, address, and C file number before scanning)

It is odd about the 'new' claim as there is only one MH rating they give anyhow.

Fco75th25div is right.....

Although VA wont except a private shrink statement to initially diagnose PTSD, a private psychologist can certainly help a PTSD rating with a strong IMO.

Dr. Valette, a psychologist, does IMOs for MH issues and his contact number is in the June 11th,2014 blog radio show to the right of this page.

We spent more time talking to him about mid way in the link, when Dr Bash had to leave the show.

Just click on the show and it should pop up into your PC media player.

Edited July 22, 2014 by Berta

[LarryYoung3]

Thank you for replying. I don't receive SSDI. I'm too old for Voc Rehab. I'm a Vietnam Veteran. Below is the VA's Reasons and Bases. The VA examiner rated me on my PTSD Stressors.

VA Reasons and Bases
"Outpatient treatment records from February 2005 through Mat 7, 2014, were reviewed and considered. There has been continuous treatment for psychiatric problems. The treatment is reported having started in 2006. You reported feeling increasingly irritable and mentioned having a temper. You were going to group therapy and being open discussing the problems you were having with posttraumatic stress disorder symptoms. In June 2013 you reported having started back taking medication following fear of thoughts to harm yourself ; adding that voices have decreased and you denied thoughts of hearing self/others.

. April 11, 2006, the report was moderate symptoms ( e.g. flate affect and circumlocutory speech, occasional panic attacks or moderate difficulty in social occupational, or school functioning (e.g. few friends, conflicts with peers or co-workers).

. January 30, 2008, the report was serious symtoms ( e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational or school functioning (e.g., no friends,unable to keep a job, cannot work).

. February 14, 2012, the report was serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g. no friends, unable to keep a job, cannot work.)

. January 10, 2013, it was moderate symptoms (e.g., flat affect and circumlocutory speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g. few friends, conflicts with peers or co-workers).

. January 24, 2013, the report was serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serous impairment in social, occupational or school functioning (e.g., no friends, unable to keep a job, cannot work.)

You are reported to be receiving service through the military sexual trauma program at_________. You are seeing a psychiatrist and been prescribed three medications, Citalopram (used as an antidepressant to treat the depression associated with mood disorders,) Risperidone (a benzisoxazole derivative used as an antipsychotic agent), and Clonazepam (kloe NA ze pam) is a benzodiazepine. It is used to treat certain types of seizures. It is also used to treat panic disorder.)

VA examination performed March 8, 2012, at _____ was reviewed and considered. The examiner had an opportunity to review the claims folder prior to the examination being performed. There was a diagnosis of posttraumatic stress disorder. Global Asssessment Functioning Scale (GAF Scale) shows you having serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job, cannot work). Thre was no evident of traumatic brain injury (TBI) symptoms. You have been married twice with the current marriage being for the past 14 years. You reported no friends to speak of an you remain a loner. Your work record is reported being spotty. You are receiving disability benefits from Social Security Administration.

The posttraumatic stress disorder symptoms are reported being: difficulty falling or staying asleep; irritability or outbursts of anger; difficulty concentrating; hypervigilance; exaggerated startle response. You have a depressed mood (feeling state or prolonged emotion that influences the whole of one's psychic life) with anxiety and suspiciousness. There are sleep problems and impairment with short and long term memory. You have problems establishing relationships, impaired impulse control and suicidal ideations. There is neglect on personal hygiene and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. All of this is attributable to posttraumatic stress disorder.

Statement in Support of Claim (VA Form 21-4138) received June 11, 2012, was your request to cancel the request for Individual Unemployability consideration.

Veteran's Application for Increased Compensation based on Individual Unemployability (VA Form 21-8940) was returned not completed.

38 U.S.C.$5107(b) provides that when "there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant." Therefore, "when a veteran seeks benefits and the evidence is in relative equipoise (balance), the law dictates that the veteran prevails.

The benefit of the doubt rule does not apply because there is no approximate balance of positive and negative evidence as to the issue being considered. There are variations in degree of disablement associated with the posttraumatic stress disorder. The evidence when viewed as a whole supports an evaluation of 50 percent is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flatten affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term member (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Although you reported having problems in your marriage, you remain married. Also, when asked to complete an Veteran's Application for Increased Compensation based on Individual Unemployability (VA Form 21-8940) for a history on employment, you returned the application and asked that issue be dropped.

A higher evaluation of 70 percent is not warranted unless there are deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as; suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrevelant; near-continuously panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.

Although the Global Assessment Functioning Scale (GAF Scale) may be particularly useful in tracking the clinical progress of individuals in global terms, using a single measure, it is to be rated with respect only to psychological, social, and occupational functioning. It is important to note that the GAF score is a scale reflecting the psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness.

The evidence of record does not show that the case presents such an exceptional or unusual disability picture as to render impractical the application of the regular scheduler standards. This case has not been submitted for extra-scheduler consideration because there are no exceptional factors or circumstances associated with the disablement. For example, the disability has not required frequent periods of hospitalizations, nor does it present marked interference with employment."

[NavyWife]

Larry--

You should definitely be receiving 100% compensation.

There are so many errors by VA in your reasons and bases I don't even know where to begin!

Maybe it's time for you to hire a lawyer. They don't charge you anything upfront and only take a percentage of your retro. Do a google search for veterans disability lawyer. They do not need to be located near you. Nowadays everything is done by phone, email & mail.

If you in fact did it, I hope you had a really good reason for withdrawing your TDIU application. For many vets that is the only way they ever will get to 100%.

Edited July 24, 2014 by NavyWife

[LarryYoung3]

I withdrew my tdiu application because american legion told me that I could not file since I had original appeal in for ptsd. that was in 2012. Must be true because I filled again in 2013 and claim was closed because of my appeal for ptsd . I am going to hire lawyer in a few more weeks. Hoping that since im in admin.review at prep.for decision stage I might get some action soon. thanks for advice. My appeal has been going on since 2006.

[mbl22885]

They ended up giving me a rating of 50%.

Edited October 19, 2014 by mbl22885

[Navy04]

Larry good luck on your appeal bud. MBL, sorry to hear of your troubles, but remember that you can always put in for an increase. When I was Medically Retired last year the VA only gave me 30% for PTSD, instead of submitting NOD, I just requested an increase and less than 7 months later my PTSD was increased to 70%. The VA Doc Examiner even stated that I should have been 70% or higher to begin with, as my symptoms met the Criteria. My VSO wanted me to submit a CUE, but to me $2500 worth of Retro was not worth fighting for years to me. I just had my 2 FDC completed in a little over 4 months and was denied 7 conditions and give 30% for R Shoulder. Everything is a win in the end, you just have to keep going. God Bless