ptsd C&p Results

SSG O · July 31, 2014

Just received my result on my Knees and PTSD, Can someone tell me if it is positive as i was 0% SC when i originally filled my claim in 06. i was diagnose by ARMY PA for Keloids and was 0% SC but during my C&P i was told it was not Keloids. Do i file a new claim for what i was diagnose by the Dermatology once i get my appointment?

KNEES

18. Functional impact

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

Does the Veteran's knee and/or lower leg condition(s) impact his or her

ability to work?

[X] Yes [ ] No

If yes, describe the impact of each of the Veteran's knee and/or

lower

leg conditions providing one or more examples:

current knee sx are worsened w/ prlonged standing, ladder

climbing,

squatting, running, and sitting for prolonged periods.

19. Remarks

-----------

a. Remarks, if any:

n/a

b. Mitchell criteria:

If any joint is affected by: PAIN, WEAKNESS, FATIGABILITY or

INCOORDINATION during flare, after repetitive use, or use over a period

of time, ROM in degrees must be documented.

X: Cannot specify Please provide rationale: Speculation

PTSD

2. Current Diagnoses

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

a. Mental Disorder Diagnosis #1: PTSD

ICD code: 309.81 (F43.10)

Mental Disorder Diagnosis #2: Unspecified Depressive Disorder

ICD code: 311 (F32.9)

Mental Disorder Diagnosis #3: Cannibas Use Disorder--Moderate

ICD code: 304.30 (F12.20)

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

Mental Health Disorder (to include TBI): Defer to medical

records.

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?

[ ] Yes [X] No [ ] 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:

Given the known overlap in symptoms between PTSD and

depression,

the three disorders are likely related to each other.

Additionally, within the context of the avoidant

symptom cluster of

PTSD, sufferers tend to use a variety of methods to

minimize or

eliminate distressing intrusive experiences and hyper-

arousal

symptoms related to their trauma. Commonly, sufferers

will resort

to the use of alcohol and/or recreational drugs in an

attempt to

deal with their difficulties. It is this examiner's

impression

that this situation is evident in this case. Given the

chronicity,

progressiveness, and comorbidity of the diagnoses

listed, it is not

possible to separate the individual effects of each

disorder.

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 deficiencies in

most areas,

such as work, school, family relations, judgment,

thinking and/or mood

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:

Given the known overlap in symptoms between PTSD and

depression,

the three disorders are likely related to each other.

Additionally, within the context of the avoidant

symptom cluster of

PTSD, sufferers tend to use a variety of methods to

minimize or

eliminate distressing intrusive experiences and hyper-

arousal

symptoms related to their trauma. Commonly, sufferers

will resort

to the use of alcohol and/or recreational drugs in an

attempt to

deal with their difficulties. It is this examiner's

impression

that this situation is evident in this case. Given the

chronicity,

progressiveness, and comorbidity of the diagnoses

listed, it is not

possible to separate the individual effects of each

disorder.

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 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] Near-continuous panic or depression affecting the ability

to function

independently, appropriately and effectively

[X] Chronic sleep impairment

[X] Flattened affect

[X] Disturbances of motivation and mood

[X] Difficulty in establishing and maintaining effective work

and social

relationships

[X] Inability to establish and maintain effective

relationships

[X] Suicidal ideation

Keloids

2. Medical History

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

a. Describe the history (including onset and course) of the Veteran's

skin

conditions (brief summary):

Vetern is service connected for "keloids, residuals of hematoma,

right

thigh ( previously coded 7805). The C&P skin exam dated 31 Jul

2006

describes " keloids... 5 lesions on right leg, 2 on left leg, and

1 on

posterior acilla... as well as " hematom of right thigh,

...resolved...". At the time of this examination, the veteran doesnot

have evidence of keloids on BLEs or left axilla/posterior upper arm.

He

has focal circumscribed pigmented papules BLE, and a larger pigmened

papule w/ macular border, left posterior axilla/ upper arm. The

diagnosis is uncertain; and I have recommended that he see PC today

for

Dermatology Consultation w/ lesion bx. He stated he will do this.

Me1984 · August 1, 2014

To me it looks as though you might hit between 50 or 70% for your PTSD. Keloid my possibly be a 10%

Navy04 · August 1, 2014

I believe you will be 70% for PTSD, as I too am 70% and your symptoms are very similar. As far as the Keloids, I believe you might get the 10% increase, and will have a new condition to file for. It is not uncommon to go to an Exam and get diagnosed with an entirely different condition. I have filed claims for atleast 5 different new conditions, that I did not know until the exam, and Doc mentioned them. God Bless, good luck and keep us posted.

SSG O · August 1, 2014

Thank you ME1984 and Navy04 for the response. Can you tell me if i will received benefits for my knees? I was 0% SC for

for my knees for retropatellar pain syndrome in 2006 Side affected: [ ] Right [ ] Left [X] Both

Diagnosis #2: Chondromalacia lateral tibial plateau diagnosis: 2014 Side affected: [ ] Right [ ] Left [X] Both.

4. Initial range of motion (ROM) measurements

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

a. Right knee flexion

Select where flexion ends (normal endpoint is 140 degrees):

[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25

[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55

[ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85

[ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115

[ ] 120 [ ] 125 [ ] 130 [X] 135 [ ] 140 or greater

Select where objective evidence of painful motion begins:

[ ] No objective evidence of painful motion

[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25

[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55

[ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85

[ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115

[ ] 120 [ ] 125 [ ] 130 [X] 135 [ ] 140 or greater

b. Right knee extension

Select where extension ends:

[X] 0 or any degree of hyperextension (check this box if there is

no

limitation of extension)

Select where objective evidence of painful motion begins:

[X] No objective evidence of painful motion

c. Left knee flexion

Select where flexion ends (normal endpoint is 140 degrees):

[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25

[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55

[ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85

[ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115

[ ] 120 [ ] 125 [X] 130 [ ] 135 [ ] 140 or greater

Select where objective evidence of painful motion begins:

[ ] No objective evidence of painful motion

[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25

[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55

[ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85

[ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115

[ ] 120 [ ] 125 [X] 130 [ ] 135 [ ] 140 or greater

d. Left knee extension

Select where extension ends:

[X] 0 or any degree of hyperextension (check this box if there is

no

limitation of extension)

Select where objective evidence of painful motion begins:

[X] 0 or any degree of hyperextension (check this box if there is

no

limitation of extension)

e. If ROM does not conform to the normal range of motion identified above

but

is normal for this Veteran (for reasons other than a knee and/or leg

condition, such as age, body habitus, neurologic disease), explain:

n/a

5. ROM measurements after repetitive use testing

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

a. Is the Veteran able to perform repetitive-use testing with 3 repetitions?

[ ] Yes [X] No

If unable, provide reason:

discomfort

6. Functional loss and additional limitation in ROM

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

a. Does the Veteran have additional limitation in ROM of the knee and lower

leg following repetitive-use testing?

[ ] Yes [X] No

b. Does the Veteran have any functional loss and/or functional impairment of

the knee and lower leg?

[X] Yes [ ] No

c. If the Veteran has functional loss, functional impairment or additional

limitation of ROM of the knee and lower leg after repetitive use, indicate

the contributing factors of disability below (check all that apply and

indicate side affected):

[X] Less movement than normal [ ] Right [ ] Left [X] Both

[X] Pain on movement [ ] Right [ ] Left [X] Both

[X] Swelling [ ] Right [X] Left [ ] Both

7. Pain (pain on palpation)

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

Does the Veteran have tenderness or pain to palpation for joint line or soft

tissues of either knee?

[X] Yes [ ] No

If yes, side affected: [ ] Right [ ] Left [X] Both

8. Muscle strength testing

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

Rate strength according to the following scale:

0/5 No muscle movement

1/5 Palpable or visible muscle contraction, but no joint movement

2/5 Active movement with gravity eliminated

3/5 Active movement against gravity

4/5 Active movement against some resistance

5/5 Normal strength

Knee flexion:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Knee extension:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

9. Joint stability tests

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

a. Anterior instability (Lachman test):

Right: [X] Normal [ ] 1+ (0-5 millimeters)