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My Ptsd C&p Exam

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gmankd

Question

Hello I was wondering if you guys can help me, and let me know what you think about my C&P exam. If you think that I will get a rating then what you think it might be. Thank you all.

SECTION I:

----------

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

Comments, if any:

The veteran also has depressive moods, but they are as likely as

not related to his PTSD.

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

Mental Health Disorder (to include TBI): Migraine headaches; 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

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

Veteran's VA claims file:

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):

Pre-Military - The veteran was born in the Dominican Republic, but his

family came to the U.S. when he was approximately 3 years old. He grew

up in Lynn, MA, in an intact family until age 13 when his parents

divorced. After the divorce, the veteran stayed with his mother who

did

not re-marry. He has one sister and two half-sisters (on his father's

side). There was no physical abuse during his childhood. He felt that

both of his parents were caring to him. His father stayed in contact

with him after he divorced the veteran's mother. The veteran also

reports that he had many aunts in the area and thus he had a big

extended family. He further notes that there were many children in his

neighborhood with whom he could play. The family also stayed in touch

with their relatives in the Dominican Republic.

Military - The veteran was in the Army from 1999-2002. He then was in

the Army Reserves and his unit was called up to serve in Iraq. He

served in Iraq for 12 months in 2003-4. In Iraq, he worked as a

petroleum supply specialist. He was first sent to Korea where he

states

that he got the difficult details. He was to change a tire but he was

called to another detail. He had a friend who was then asked to change

the tire. The tire exploded in his friend's face and he was killed.

This man had a newborn child at home whom he had never seen. The

veteran felt that this loss was heartbreaking. It was also a situation

where he could have been the victim. In another incident in Iraq, he

had gotten back from working security and he heard a big bang. He and

a

friend rushed to see what had happened. An Iraqi enemy group had

rammed

the barrier of an Italian military Police station with a truck. Then

they drove a car throught the breach and blew up the Police station.

The veteran found people who had beeen blown in half and many other

body parts. Over 30 people died in the explosion. It was a horrifying

event. The veteran also experienced alerts that signified possible

danger. He feels that he adapted to these alerts.

Post-Military - The veteran has never married, but he has a girlfriend

whom he met after his military service and they have an 8 year old

son.

They live in Lynn in a rented apartment. When the veteran first got

out

of the military, he moved to Florida to attend Valencia Community

College in computer technology. He met his girlfriend there. He

reports

that, after his war experience, he was somewhat withdrawn and did not

like to go out. He feels that this affected his girlfriend and,

although they had a child, they broke up for 4-5 years. They decided

to

give it another try about 2 years ago. During the separation, he

maintained contact with his son. The veteran moved to MA in 2010 to be

closer to his family. His girlfriend and his son then moved up here to

be with him in 2012. For the past 2 and 1/2 years, he has worked in IT

for Draeger Company which makes medical equipment. He states that he

and his girlfriend have matured and are able to tolerate each other's

differences better. He reports that he is still easily irritated,

however, and he sometimes feels that he has trouble with the demands

that an 8 year old son can make on him. He denies using any physical

pu

nishment with his son. The veteran states that his mother has

encouraged him to seek mental health care. He feels that she has done

this in a supportive way.

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

and

post-military):

Pre-Military - The veteran graduated from high school and joined the

Army. He reports that he was a B to C type student. He was never held

back a grade. He had no known learning problems. He states that he

played football in high school. In the summers, he worked in summer

camps that were sponsored by the city and he also worked at a

MacDonald's.

Military - As noted above, in Iraq, the veteran worked as a petroleum

supply specialist. He reports that he frequently inhaled fumes on his

job.

Post-Military - Immediately after his military service, the veteran

did

some contract IT work and one of his contracts was with Draeger

Company. Draeger then decided to hire him into a full time position.

He

has been employed by Draeger for 2 and 1/2 years. He feels that they

are satisfied with his performance. There are times when he gets

irritated and needs to take a break and get outside. He states that

his

supervisors have been tolerant of these needs. The veteran is also

taking college classes on-line. His objective is to get a bachelor's

degree in IT. He feels that he is doing well in his courses. He is

about 20 credits away from getting his bachelor's degree.

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

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

Pre-Military - The veteran did not need and was not referred for

mental

health care prior to entry into the Army.

Military - The veetran was not referred to and did not seek mental

health care while in the Army or the Army Reserves.

Post-Military - When living in Florida after his Iraq War experience,

the veteran felt very frustrated and sought care at the VA Clinic in

Kissemmee, FL. He was seen there for a few sessions but he felt

embarrassed to be seeking psychological care and he dropped out. In

Massachusetts, he has sought treatment at the VA Clinic in Lynn. He

sees Dr. Dennis O'Neil, a psychiatrist, about once every 2 months. Dr.

O'Neil is treating him for PTSD and depression and he prescribes

zoloft

and trazadone. The veteran feels that the medication has helped with

his mood and it seems to allow him to get out socially a bit more.

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

post-military):

Pre-Military - The veteran did not have legal or disciplinary problems

prior to entry into the Army.

Military - The veteran did not have any disciplinary problems while in

the Army or the Army Reserves.

Post-Military - The vetran has not had any legal or disciplinary

problems since leaving military service.

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

post-military):

Pre-Military - The veteran did not have a problem with alcohol or

drugs

prior to his military service.

Military - The veteran drank on the weekends while in the Army. He

became drunk on some occasions, but he denies that his drinking then

created any problems for him in regard to carrying out his military

duties. He did not abuse other drugs.

Post-Military - The veteran reports that when he first got out of the

military, the only way he could be happy was to drink alcohol. He

drank

every other day and he would drink to intoxication. He feels that he

drank to improve his mood. Currently, the veteran has about 1-2 drinks

on a weekend and that's about all. He does not abuse drugs.

f. Other, if any:

No response provided.

3. Stressors

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

a. Stressor #1: While stationed in Korea, the veteran was to change a tire

but he was called to another detail. He had a friend who was then

asked

to change the tire. The tire exploded in his friend's face and he was

killed. This man had a newborn child at home whom he had never seen.

The veteran felt that this loss was heartbreaking. It was also a

situation where he could have been the victim.

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?

[ ] Yes [X] No

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

trauma?

[ ] Yes [X] No

b. Stressor #2: In an incident in Iraq, the veetran had gotten back from

working security and he heard a big bang. He and a friend rushed to

see

what had happened. An Iraqi enemy group had rammed the barrier of an

Italian Military Police station with a truck. Then they drove a car

through the breach and blew up the Police station. The veteran found

people who had beeen blown in half and many other body parts. Over 30

people died in the explosion. It was a horrifying event.

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).

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).

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] 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] Chronic sleep impairment

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

events

[X] Disturbances of motivation and mood

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

relationships

[X] Obsessional rituals which interfere with routine activities

6. Behavioral Observations

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

No response provided

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:

The veetran has survivor guilt in regard to the event in Korea

when

his friend was killed attempting to change a tire that exploded.

8. Competency

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

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

[X] Yes [ ] No

9. Remarks, if any

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

This veteran meets criteria for a DSM-5 diagnosis of PTSD with associated

depressive feelings. His PTSD has clearly had an effect on his

relationships with his significant other and with his son. At work, when

suffering from PTSD-related frustration and irritability, he is able to

take a time out and stabilize himself. he has also been able to take

college courses on-line. His disability is as likely as not

mild-moderate.

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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In my opinion, you will need to prove one of the stressors. I believe this would be the easiest one to prove, and it should be well documented:

An Iraqi enemy group had rammed the barrier of an

Italian Military Police station with a truck. Then they drove a car

through the breach and blew up the Police station. The veteran found

people who had beeen blown in half and many other body parts. Over 30

people died in the explosion. It was a horrifying event."

Were you directly involved in the recovery operation by virtue of your MOS?

I suggest you google your unit on line and see if you can find a buddy ,to give you a buddy statement as an eye witness account of this event, stating you were there.

We have info here under a hadit search as to what a Buddy Statement should involve.

Also I would think a Morning Report was done by your unit on this horrific incident.

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this is an excerpt from the VA ratings and it appears you meet the 30% criteria if they dont low ball you which has been known to happen.

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events) ............................ 30%

the higher levels are:

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (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 ………………..50%

Occupational and social impairment, with 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 irrelevant; near-continuous 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 ...................................... 70%

Total occupational and social impairment, due to such symptoms as: gross impairment in thought process or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name …………………..100%

these are the criteria. You dont have to meet every part of it but it depends on the examiner and what not...hope this helped

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Occupational impairment in some areas usually awards 10% or if you are lucky 30%. Good luck and keep us posted.


I was low balled 30% PTSD when I retired last year, and now I am 70%. So you can always challenge the VA's %s if you are not happy with the outcome.

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