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C&p Results, Can I Get An Opinion Please?


Titan

Question

SECTION I:
----------
1. Diagnostic Summary
---------------------
Does the Veteran have a diagnosis of PTSD that conforms to DMS-5 criteria
based on today's evaluation?
[ ] Yes [ ] No
2. Current Diagnoses
--------------------
a. Mental Disorder Diagnosis #1: Posttraumatic Stress Disorder
Mental Disorder Diagnosis #2: Other Specified Depressive Disorder
(Depressive episode with insufficient symptoms)
Comments, if any:
The veteran reported experiencing depressive symptoms for at least
the past year and noted that these symptoms became more noticeable
as his PTSD symptoms increased. His depressive symptoms include
depressed mood, fatigue, restlessness, and worthlessness.
The veteran's diagnosis of Other Specified Depressive Disorder
is
at least as likely as not caused by or a result of his PTSD
diagnosis.
b. Medical diagnoses relevant to the understanding or management of the
Mental Health Disorder (to include TBI): Asthma
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:

- Intrusive thoughts
- Distressing dreams
- Avoidance of thinking and talking about the trauma
- Distorted cognitions of self-blame
- Persistent negative emotional state of fear
- Feelings of detachment from others
- Hypervigilance
Other Specified Depressive Disorder:
- Depressed mood
- Fatigue
- Feeling worthless
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 due to mild or transient symptoms
which decrease work efficiency and ability to perform occupational
tasks only during periods of significant stress, or; symptoms
controlled by medication
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:
I cannot determine without resorting to mere speculation. However,
social impairment (i.e., marital problems, distance from his
family, and lack of social support network) appears to be greater
than occupational impairment because there is no intermittent
periods of ability to perform occupational tasks.
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
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):
FAMILY:
Pre-military: The veteran was born and raised in New Orleans, LA by
his
father and stepmother. He has an older and a younger sisters. He
reported having good relationships with his family members growing up.
Military: He indicated having good relationships with his family
during
his military service and stated that he maintained regular contact
with
his parents during deployment. The veteran married his first wife in
2001, and they divorced in 2004. He stated that when he returned home
from Iraq after 15 months on deployment, his wife "had her own
life,
and I didn't fit in." He reported that he has two children
from this
marriage, whom he currently sees every couple months. He stated that
the children previously spent more time with him, but do not visit as
often as they live three hours away and "their mom causes
problems."
Post-military: The veteran described his current relationship with his
parents as "mediocre" and noted that they have
"different opinions." He
reported that he does not see his parents often and is not as close to
them as he was before his deployment to Iraq. He said that he does not
talk to his older sister and noted that he has no desire to do so. He
speaks with his younger sister regularly about family matters, and he
said that he wishes that he had a closer relationship with her. The
veteran remarried in 2011, and he has two stepsons, ages 14 and 15. T
he
veteran reported marital problems and said they are currently
participating in marriage counseling through the VA. He attributed
their problems to him "acting certain ways, being agitated easily,
and
not making any sense sometimes like worrying about a lot of
stuff." The
veteran described having good relationships with his stepsons and
reported going fishing with them on weekends when they do not go to
their father's house.
SOCIAL:
Pre-military: He described having a "normal" social life and
had "a lot
of friends" in elementary through high school. When asked what
social
activities he did with friends, he stated, "Drank and hung
out." The
veteran stated that he did not have much time for social activities
beginning at age 16 because he worked a part-time job after school and
on weekends. He denied any involvement in sports or other
extracurricular activities.
Military: He said he had good relationships with other soldiers in his
unit and denied having any difficulties getting along with others. He
indicated that they worked much of the time, but when they were not
working, they drank alcohol and played video games.
Post-military: He described his current social life as "not very
good."
He said that is one of the main issues in his marriage because his
wife
wants to participate in social activities and he wants to stay home
most of the time. He denied involvement in social organization or a
religious affiliation. He denied having any close friends.
b. Relevant Occupational and Educational history (pre-military, military,
and
post-military):
EDUCATION:
Pre-military: Veteran completed the 12th grade. He described himself
as
a C student. He went to summer school once in high school to repeat
French and Chemistry courses. He denied having any problems with
learning and indicated that he was bored in school and was not
motivated. He said that he enrolled at College
directly after high school, but only attended classes for six weeks
before quitting to join the Army.
Military: Veteran completed all trainings as scheduled. He denied
completing any coursework during his military service and indicated
that he attempted to take college course once, but his school was
interrupted before he completed one semester when he was deployed to
Iraq.
Post-military: He completed an Associate's degree in Radiology
Technology in May 2012. He reported that it took him "a really
long
time" to obtain a degree because he changed his major after
completing
the majority of the coursework required to earn a nursing degree. He
indicated that when he began clinicals, he realized that he
"hated"
nursing. The veteran reported having a B average in college and denied
having difficulty with the coursework.
OCCUPATIONAL:
Pre-military: The veteran worked part time as a cook at an athletic
club from age 16 until he graduated from high school in May 1998. He
reported that he "fixed cars for a short time" before joining
the
military in October 1998. He denied problems on the job, poor
performance appraisal, or interpersonal conflict with coworkers.
Military: The veteran's DD214 indicates that he served in the
Army
10/9/1998 - 10/15/2004. He received an honorable discharge at the rank
of SGT (E-5). His specialty was 91W (Combat Medic). His DD214 also
shows service in Iraq 4/26/2003 - 7/15/2004.
Pre-military: He reported being diagnosed with ADHD in elementary
school and was prescribed Ritalin. He said that he did not want to
take
the medication, so his parents allowed him to stop taking it after a
few months.
Military: The veteran denied mental health problems and mental health
treatment in the military.
Post-military: He saw a psychiatrist at SLVHCS in 2008 (see MENTAL
HEALTH - PSYCHIATRY note dated 3/21/2008) for medication to treat his
ADHD while attending college. He indicated that he received two
prescriptions that lasted him a few years. The veteran presented to
the
same psychiatrist in 2014 (see MENTAL HEALTH - PSYCHIATRY note dated
3/11/2014) seeking marriage therapy due to "Marked arguing.
growing
apart fr wife." He was referred to the family program, and he and
his
wife have been participating in marriage counseling from 4/18/2014 to
the present time. The veteran noted receiving benefit from the
marriage
therapy as he and his wife are communicating more about his mental
health problems. The veteran was referred to the PTSD program for an
evaluation by the marriage therapist after he scored high on a PTSD
self-report measure (see MH OEF/OIF/OND OUTPT CONSULT dated 5/9/2014).
He was diagnosed with PTSD during the intake evaluation (see PTSD
CONSULT NOTE dated 5/27/2014), and he recently began participating in
an evidence-based treatment for PTSD. He denied a history of
psychiatric medications other than Ritalin which he is no longer
taking.
Other notable records:
Post Deployment Health Assessment dated 7/20/2004: The veteran
responded "yes" to all four PTSD screening questions.
DD Form 2801-1 dated 9/16/2004: The veteran denied experiencing
depression, anxiety, and trouble sleeping.
CLINIC INTAKE SCREENING NOTE dated 8/31/2006: Negative PTSD and
Depression screens
NURSING NOTE dated 3/10/2008: Negative PTSD and Depression screens
CLINIC INTAKE SCREENING NOTE dated 7/1/2009: Negative PTSD and
Depression screens
d. Relevant Legal and Behavioral history (pre-military, military, and
post-military):
Pre-military: The veteran stated that he received Saturday detention
multiple times in high school for not completing schoolwork. He denied
other behavioral problems, including fighting.
Military: The veteran reported he received one Article 15 for underage
drinking at age 20. His discipline included six weeks of extra duty
and
loss of rank.
Post-military: Veteran denied a lifetime history of arrest,
conviction,
or incarceration. He denied destruction of property or physical
altercations. He denied a history of domestic violence.
e. Relevant Substance abuse history (pre-military, military, and
post-military):
Pre-military: The veteran denied drug use and indicated he began
drinking alcohol socially at age 16. He denied problematic effects of
drinking. He denied tobacco use.
Military: The veteran denied drug use and stated that he drank alcohol
"normally." He denied any alcohol related problems although
he received
an Article 15 for underage drinking.
Post-military: He denied illicit drug use or abuse of prescription
medication. He stated that he has "drank less and less as time has
gone
on" and estimated consuming one drink every two months.
f. Other, if any:
SENTINEL EVENT(S):
The veteran denied a lifetime history of physical, emotional, and
sexual abuse.
1. The veteran reported he was involved in a car accident
approximately
one month ago. He stated that he was "daydreaming and ran into
two
cars." He noted that no one was injured and that this was his
first
automobile accident. He stated, "I've tried to blow it off.
Insurance
will take care of it."
2. The veteran said that he witnessed "people blown up, mortars,
rockets, IEDS, grenades" while in Iraq and estimated witnessing
these
types of events once a week.
3. The veteran stated that he witnessed exposure to toxic chemicals
when he had to go into a "yellow cake uranium factory" in
Iraq for two
weeks. He was sent there to give the factory workers fluids through IV
due to the extreme heat conditions. He said he wore a lead suit to
avoid exposure to the chemicals.
4. The veteran noted that he witnessed fire fights almost every day
when he was a part of a Calvary unit in Iraq.
5. The veteran reported having to clean up after two soldiers
committed
suicide by gun, both in the same week. He denied witnessing the actual
suicide, but witnessed "the mess afterwards."
6. The veteran stated that he witnessed an Iraqi national blow himself
up with a grenade. He said they had to store "what was left of
the
body" in their storage room for a few days.
7. The veteran said that on several occasions while riding in convoys
through cities, his vehicle would crash into cars in front of them to
get them out of the way. He sometimes had to work on the injured
bodies.
MEDICAL:
Pre-military: Denied.
Military: Denied.
Post-military: The veteran reported having Asthma and Sleep Apnea. He
noted that his asthma is well controlled by making changes suggested
by
doctors including using a heap filter in his home, removing all
carpet,
and using a mattress cover. He indicated that his Sleep Apnea was
"fixed" after he had a surgery on his nose in 2009. He denied
taking
any prescription medication at the present time.
Veteran denied a history of head injury or loss of consciousness. He
indicated that on a scale from 0 (no pain) to 10 (worst pain
imaginable), his current pain level is at a 1. The pain is generally
located in lower back. He stated that he has been prescribed a muscle
relaxer; however, he does not take it because it makes him sick. He
reported taking an over-the-counter pain reliever.
VA Active Problem LIST:
3. Stressors
------------
a. Stressor #1: The veteran reported three months into his deployment in
Iraq, he and another medic were called up to the front gate on the
base, where there were two young teenagers each shot in the chest. He
and the other medic drove the boys to the closest hospital. The
veteran
reported riding in the back of the vehicle to work on the wounded. He
stated that one of the boys died before they arrived at the hospital.
When they arrived at the hospital, the teenagers' families were
there
visibly distraught in the waiting area. He stated that he blames
himself for the one teenager dying because he did not do enough to
save
him. This is one of the events that the veteran reported on VA Form
21-0781 (Statement in Support of Claim of PTSD).
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] 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).
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] 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.
[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] Hypervigilance.
[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] Chronic sleep impairment
6. Behavioral Observations
--------------------------
Appearance: Neatly groomed and dressed appropriately
Affect: Constricted
Mood: Depressed and mildly anxious as evidenced by fidgeting and mild
restlessness
Eye contact: Adequate
Speech: Fluent in rate and low in volume
Approach to clinical interview: Cooperative
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 veteran indicated that he has disturbing memories every day of
his time in Iraq, specifically the stressor event involving the
two
teenagers. He reported experiencing these intrusive thoughts for
the last 10 years. He stated, "I thought it was memories that
would
go away, but it seems like it has only gotten worse." He
reported
that he has had disturbing dreams about his stressful experiences
in Iraq five times a week. His dream content includes the stressor
event as well as other events of death from his deployment. He
also
reported that his wife has told him on several occasions that he
has woken up in the middle of the night shaking, sweating, and
"physically checking her to make sure she's okay."
He indicated
that he does not remember these experiences. He stated that this
has been occurring approximately three nights a week for at least
the past two years.
he veteran stated that he avoids thinking and talking about his
military experience by trying to distract himself and stay busy.
He
noted that he is currently involved in a therapy that involves him
writing about the traumatic event with the two teenagers. He
reported having significant difficulty completing this assignment.
He stated that he had to read the written account of the trauma in
a session, and he almost walked out and only read half of the
account. He noted that he has trouble remembering what occurred
"three or four hours" after the traumatic event. The
veteran
reported feeling guilt and having thoughts of self-blame about the
traumatic event because he believes that he did not do enough in
the situation to save the boy's life. He reported feeling
persistent negative emotions of fear and concern for others
safety.
He noted that this has caused problems in his marriage-"I
drive my
wife crazy. I think about the worse possible scenario that can
happened in a situation. I feel that I have to prepare her for
anything. Like when she runs, I make sure she has a stun gun and
pepper spray." He stated that his wife goes on business trips
often, and if he does not speak to her before going to bed, he
will
stay up all night worrying about what could have happened to her.
He indicated that he also worries about their children's
safety, as
well as his own. He reported that before his deployment to Iraq he
could fly on a plane with no difficulty, but after he returned, he
had his first and only panic attack on a plane. He has an upcoming
trip planned, and he is worrying about the flight. He denied
worrying about issues other than safety.
The veteran stated that after exposure to the stressful military
experience, he no longer enjoys going to social gatherings and
playing video games. He said he has no desire to go to social
events and wants to stay home much of the time. He noted that he
sometimes goes to social gatherings with wife, but he ends up
leaving because he feels uncomfortable, anxious, and like he does
not fit in. The said that he feels distant from most people,
especially his family and friends. He acknowledged feeling closer
to his wife since they began marriage counseling. He noted that he
felt completed cut off from his first wife when he returned from
deployment, which led to their divorce. The veteran does not feel
like he is able to have loving feelings toward his family and
stated, "I feel numb, just not a lot of emotions at
all."
The veteran endorsed having sleep impairment including difficulty
maintaining and reinitiating sleep. He reported that he typically
obtains six hours of broken sleep per night. He indicated waking
the night at least five times a week and feels very tired the
following day. The veteran noted that he sometimes has significant
difficulty reinitiating sleep and can stay up for two or three
hours until returning to sleep. He said that he has experienced
increased irritability and is easily irritated by "normal
life
things that I blow way out of proportion and cause a lot of
arguments." He reported that he raises his voice a few times a
week
and throws objects occasionally. The veteran reported that he has
difficulty concentrating; however, he has a history of a diagnosis
of ADHD so it cannot be determined if his difficulty concentrating
is trauma-related or related to the ADHD. The veteran indicated
that he is watchful and always on guard. He described looking out
of the windows of his home "constantly?even during the
night." He
also said he repeatedly checks that doors are locked. He reported
experiencing hypervigilance outside of his home, which
leads to avoidance of crowds, stores, and long lines. He noted
that
he shops online for most items he needs.
The veteran endorsed worrying about dirt and germs for
approximately the past ten years. He indicated that he takes three
showers a day and frequently imagines germs that could be on door
handles and in bathrooms. He denied any excessive behavioral
compulsions or mental acts. He noted that he believes that he
takes
three showers daily because he can remember not being able to take
showers for days during deployment.
The veteran endorsed experiencing depressed mood most days. He was
not able to determine when he first began having depressed mood
but
indicated that he "realized" it approximately a year ago.
He noted
that his depressed mood became more noticeable as his nightmares
and sleep difficulties increased. The veteran also endorsed
restlessness, which was observed in the evaluation, and fatigue.
He
endorsed having negative feelings about himself including feeling
like a failure and feeling worthless. He denied suicidal ideation.
PSYCHOLOGICAL TESTING:
PCL-5: Veteran scored a 59. No score interpretation will be
provided as cut-points specific to PCL-5 are preliminary and still
being validated.
PAI: The veteran completed the Personality Assessment Inventory
(PAI) before the clinical interview. For this protocol, the number
of uncompleted items is within acceptable limits. His scores
suggest that he attended appropriately to item content; however,
there is evidence of some unusual responding (INF = 67).
Elevations
on this score can be due to reading difficulties, random
responding, confusion, idiosyncratic item interpretation, or
failure to follow the test instructions. Regardless of the cause,
due to some unusual responses, any interpretive hypotheses based
on
this protocol should be reviewed with caution. Notably, there is
no
evidence of positive or negative impression management.
The veteran's profile reflects an individual experiencing
impairment associated with anxiety and fear surrounding some
situations; this scale elevation is driven by a distressing
reaction to traumatic events. His fear is also related to common
phobic fears. These fears may lead him to monitor his environment
in an effort to avoid contact with the feared situation which is
consistent with the veteran's report of worry related to
germs,
safety, and hypervigilance. Individuals with a similar profile
also
report experiencing significant anxiety and tension. The
veteran's
profile indicates that his anxiety manifest primarily in cognitive
and affective sources of anxiety. Individuals with similar
profiles
experience significant worry and are likely to be overconcerned
about situations over which they have no control. Additionally,
they tend to be easily fatigued as a result of perceived high
stress. This is consistent with the veteran's report of
worries
about others' safety and experiencing fatigue. Also consistent
with
data from the clinical interview, the veteran's profile
indicates
that he experiences significant depressive symptomatology.
Depressed mood, lack of interest in normal activities, sleep
impairment, and feelings of worthlessness and failure are
prominent. He perceives himself as isolated, misunderstood, and
detached from others. As verified in the clinical interview, he
experiences discomfort in interpersonal contact. The veteran
shared
that he feels like he does not "fit in" in social
situations
anymore. While the veteran's profile includes an elevation on
a
scale assessing severe personality disorder, as the scale
elevation
was driven only by a high degree of identity problems. People with
similar scale elevations experience uncertainty about major life
issues and have difficulty developing and maintaining a sense of
purpose. Notably, the veteran reported that he has experienced
increased irritability; however, the aggression and irritability
scales were not significantly elevated in his profile.
Veteran's clinical scale T-scores are provided below for
reference.
ICN 46
INF 67
NIM 59
PIM 34
SOM 52
ANX 79
ARD 90
DEP 83
MAN 52
PAR 64
SCZ 73
BOR 70
ANT 58
ALC 50
DRG 42
AGG 56
SUI 49
STR 53
NON 72
RXR 35
DOM 44
WRM 24
8. Competency
-------------
Is the Veteran capable of managing his or her financial affairs?
[X] Yes [ ] No
9. Remarks, if any
------------------
This C&P evaluation was completed by
(psychology
intern) and cosigned by (licensed psychologist).
The veteran was given an opportunity to provide any additional
information
regarding his mental health and overall functioning that was not covered
in the structured clinical interview. He indicated that he did not have
anything else to add.
The veteran currently meets criteria for a diagnosis of PTSD. The
veteran's PTSD is at least as likely as not caused by or a result of
the
reported traumatic stressors experienced during his military service in
Iraq.
Notably, the veteran currently is involved in evidence-based
psychotherapy
for PTSD, and it is likely that with continued treatment, he may
experience a significant reduction in symptoms. Also important to note,
while engaging in treatment, individuals' symptom frequency and
severity
tends to increase especially at the beginning of treatment. Therefore,
the
current evaluation may not be an accurate reflection of the
veteran's
symptom severity prior to entering treatment nor the severity after he
completes treatment.
Although ADHD was not fully assessed in the present evaluation, the
veteran denied significant ADHD symptoms with the exception of
concentration difficulties. ADHD does not appear to be part of the
clinical picture at the present time and as a result, the diagnosis was
not assigned.
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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thanks for posting, scanning it quickly I would say 10% area for PTSD, due to the box they selected aka Lowballed you.

General Rating Formula for Mental Disorders:

Total occupational and social impairment, due to such symptoms as:

gross impairment in thought processes 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

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

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 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

**** Occupational and social impairment due to mild or transient symptoms

which decrease work efficiency and ability to perform occupational

tasks only during periods of significant stress, or; symptoms controlled

by continuous medication .................................................................................. 10

You can see what each rating, they use. Granted not all things within each rating category on mental must be met. I too was lowballed when I got out of the Marines. Originally they tried to just gave me 10% that DOD tried to stick me with, when my life was a complete mess. It still is. I was gathering my own evidence for my initial claim when they rec'd my DOD retirement ratings. It took until 2012 for my DOD rating to be corrected for the PTSD to a minimum of 50%. Law had changed due to the Sabo case in 2008. I was medically retired in 2007, figures... So, I appealed that rating since everything pointed to at least 50%. I appealed and asked for a de novo review, which is a new set of eyes at the VA Regional Office (RO) if the rater low balls you based on the C&P. Now the C&P usually confirms for the rater a certain percetnage and since most raters are not doctors, they base a huge amount of their decisions on these exams and often disregard progress notes. I feel like they skim through the notes and look for certain specific lines within diagnosis sections. I could be wrong. In the past they would use GAF score to help as well, but from my understanding they are moving away from it. Well I won my appeal and was granted 50% and backpayed for the 2 yrs. It did take a whle. Once you go to appeal status, it will take a while, so be prepared regardless if you have all the dots lined up for them to connect. I then had an increase to 70% in 2009 and not 100% TDIU P&T.....
sorry to go into so much detail about myself. I was just trying to show a correlation and by no means am I trying to hog or hijack your thread. Personally I would write a letter about PTSD to have submitted to your file and how it impacts your life. Go into every aspect. Talk about how it has changed you. Talk about anger issues, relationship issues, any court issues, job issues. Talk about how you were vs how you are now. Even if they somehow ignore it. You will get it into your file and it will help you gain a better persepctive of the true impact PTSD has had on your life. Since 2004, how has your life changed? DO you go out like you did before? like crowds still? any issues with sleep? nightmares? irritability? road rage? seemingly innocent things suddenly piss you off at all? panic attacks? drinking issues? work issues?
i can post more another time, I think this will get the ball rolling. I would have this prepared soon. Since you just had the C&P, they will wait for you to send any further information. If you say you ahve it all to them in writing they will move it to the raters and the decision should come fairly quickly another month or 2. I would also have any family members or friends write letters for you, as it cant hurt. Have them talk about any changes they noticed and have noticed. I'm never telling you to make anything up. You need to get it across to the VA how it is on your worst day. They dont want to know everything is sunshine and rainbows either, so don't minimize or make stuff up. Not sending anything in will give them that thought in their minds, why you ask? no clue, just think they do. You can refute some of their findings as well, if you chose,but merely making a statement whether it is a long letter or short letter will help. I think mine ended up being like 5 pages single spaced. I tend to ramble, just like in this post, but I feel getting anything out from inside you will help you in the long run.
I would also write up a NOD (Notice of diasagreement) so you have it ready for when they lowball you with 10-30%. 50% is the magic # in the VA to be fully covered for all medical condtions to be treated at the VA regardless if they are compensated or not. Less than 50% then you can only go for specific service connected issues.
sorry for long reply. I hope this has helped and I can continue to help.
S/F
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Get an IME/IMO or you will be stuck with 10% just like the others say. At this point you probably will be rated 10%, but that opens the door. Now you must get more medical evidence to support a rating of 30%-50% if you are still able to work. The difference between 50% rating and 70%-100% is the ability to work full time at above poverty level wages. I started with a rating for a "nervous condition" rated 10% in 1971. It took many years and IME's to get to 70% TDIU. I was robbed for the first 15 years after ETS and only got 30% in 1996 and then 70% TDIU in August, 2001. I was actually on SSD and OPM disability retirement before I got even 70% for a emotional disorder. You probably have a long fight ahead of you, but you cracked the door, so congrats. I would appeal the low ball rating for sure, but get new medical evidence.

John

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i read it as 10% also, based on what the Dr. checked here

[X] Occupational and social impairment due to mild or transient symptoms
which decrease work efficiency and ability to perform occupational
tasks only during periods of significant stress, or; symptoms
controlled by medication
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