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C&p Exam / Rating Questions


Patriot3g

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Hey guys,

I've been lurking here for awhile, figured I'd join in on the discussion. Last year I did an FDC claim for PTSD, after going to see a VA Pysch for almost a year (at the insistance of my family). She diagnosed me with PTSD, and encouraged me to go thru with a claim.

On the 7th I had my C&P exam. The doctor didn't ask very much....just if I was single, and why, if I drank a lot, etc. When I got up to leave after he was done (like 10 minutes), he said that the VA asked him to answer two questions: Do I have PTSD, and did my service in OIF cause it. He said he felt I had it, and that service in Iraq was the cause.

I forgot to do my in person authentication for Healthevet, so I just mailed in the form. I was just wondering if anybody here has any idea on what I might recieve as a rating, before I get the C&P exam results (hopefully soon).

When I submitted my claim, they asked me to fill out a form

"STATEMENT IN SUPPORT OF CLAIM FOR SERVICE CONNECTION FOR POST-TRAUMATIC STRESS DISORDER (PTSD)"

so I filled out two of them, one for the Battle of Zarqa. And one for the killing of my squad leader. I figured these would be the best two to put in my file, since they can be easily verified as true (squad leader was kinda famous, Zarqa was a huge fight).

I have my notes from the doctor that used to talk to me, and what she put in my file seems pretty convincing about PTSD and my service, but I guess I'm just stressed/worried/scared shitless that the VA will lowball me and give me 0% or something. I honestly have the worst luck with anything!

Thanks.

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It sounds like you'll get service connection but without the C+P report not much more info to give.

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Welcome aboard. Your rating will depend on your C & P exam, your VA medical records and any other relevant evidence provided to your VARO. After you get a copy of your C & P exam report look at the subsection under 38 CFR part 4 related to PTSD to get an idea on how PTSD is rated.

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For a rating? Let me ask you a question? At the end of the C@P exam for PTSD did he give you a number to pick... If you didnt pick a number, forgot about getting rated you didnt get anything....

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Hey guys,

I got a copy of my C&P Results in the mail today....I had to type it out, so I skipped some stuff. Let me know if you need more. I appreciate it.

The doctor had horrible spelling during my stressor description, etc. Hopefully that doesn't mean I have to go thru this all again :(

1. Diagnostic Summary

Does the Veteran have a diagnosis of PTSD that conforms to the DMS-5 criteria based on today's evaluation?

[X] Yes

ICD Code: PTSD

2. Current Diagnosis

a. Mental Disorder Diagnosis #1: PTSD

4. Occupational and social impairment

[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.

2. History

a. Relevant Social/Maritial/Family history (pre-military, military, and post-military):

Pre military: Raised by both his parents and well adjusted socially

Military: served in US Army, had honorable discharge.

Post military: veteran is single, never married and lives with his parents, he does not feel

close to any body and prefers to be alone al the time, he avoids people and isolates

himself and he doesnt not have any social relationships.

b. Relevant Occupational and Education history

Pre Military: Completed 12th grade. no work history noted.

Military: served in US Army, was deployed in Iraq from July 2006-Nov 2007 and Aug 2009-Aug 2010.

Post Military: veteran went to school from 2011-2014 but did not get degree. Has been working in local paper mill for the past

one year.

c. Relevant mental health history:

Veteran recieved PTSD treatment at VAMC Albany NY from oct 2012 to april 2013, currently not in mental health treatment, no h/o hospitalisations and no h/o suicidal attempts noted.

3. Stressors.

<Too long to type>

Does this stressor meet criterion A (to support diagnosis of PTSD)

[X] yes

Is the stressor related to the veterans fear of hostile military or terrorist activity?

[X] Yes

Is the stressor related to personal assault

[X] No

4. PTSD Diagnostic Criteria

Criterion A

[X] Directly experiencing the traumatic events

[X]Witnessing, in person, the traumatic events

[X] Learning that the traumatic events occured to a close family member, close friend...

Criterion B

[X]Recurrent, involuntary, and intrusive distressing memories of the events

[X]Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).

[X]Dissociative reactions (flashbacks)

[X]Intense of 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 events.

Criterion C

[X] Avoidance of or efforts to avoid distressing memories, thoughts or feelings...

[X] Avoidance of or efforts to avoid external reminders (people, places, conversations...)

Criterion D

[X]Inability to remember an important aspect of the traumatic event(s).

[X]Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.

[X]Persistent, distorted congnitions about the cause or consequences of the traumatic events that lead to the individual to blame

himself/herself or others.

[X]Persistent negative emotional state

[X]Markedly diminished interest or participation in significant activities.

[X]Feelings of detachment or estrangement from others

[X]Persistent inability to experience positivie emotions

Criterion E

[X]Irritable behavior and angry outbursts

[X]Reckless or self-destructive behavior

[X]Hypervigilance

[X]Exaggerated startle response

[X]Problems with concentration

[X]Sleep disturbance

Criterion F

[X]Duration of the disturbance is more than one 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

5. Symptoms

[X] Depressed mood

[X]Anxiety

[X]Suspiciousness

[X]Panic Attacks that occur weekly or less often

[X]Chronic sleep impairment

[X]Disturbances of motivation and mood

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

[X]Difficulty in adapting to stressful circumstances, including work or a work like setting

[X]Inability to establish and maintain effective relationships

8 Competency

Is the veteran capable of managing his or her financial affairs?
[X] Yes

Medical Opinion:

Restatement of requested opinion:

a. Opinion from general remarks: Provide opinion as to if it is as least likely as likely as not that PTSD is due to fear of hostile military activity:

b. Indicate type of exam for which opinion has been requested: Initial PTSD

A. The Condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness.

Rationale: Veteran urrently meets criteria of PTSD, did not have PTSD before he joined service, while in service he was deployed in combat where he was exposed to

hostile military activity to which he responded with intense fear. This fear of hostile military activity meets criteria of a PTSD stressor which is an adequate stressor to support

a DX of PTSD.

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Hey guys,

I got a copy of my C&P Results in the mail today....I had to type it out, so I skipped some stuff. Let me know if you need more. I appreciate it.

The doctor had horrible spelling during my stressor description, etc. Hopefully that doesn't mean I have to go thru this all again :(

1. Diagnostic Summary

Does the Veteran have a diagnosis of PTSD that conforms to the DMS-5 criteria based on today's evaluation?

[X] Yes

ICD Code: PTSD

2. Current Diagnosis

a. Mental Disorder Diagnosis #1: PTSD

4. Occupational and social impairment

[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.

2. History

a. Relevant Social/Maritial/Family history (pre-military, military, and post-military):

Pre military: Raised by both his parents and well adjusted socially

Military: served in US Army, had honorable discharge.

Post military: veteran is single, never married and lives with his parents, he does not feel

close to any body and prefers to be alone al the time, he avoids people and isolates

himself and he doesnt not have any social relationships.

b. Relevant Occupational and Education history

Pre Military: Completed 12th grade. no work history noted.

Military: served in US Army, was deployed in Iraq from July 2006-Nov 2007 and Aug 2009-Aug 2010.

Post Military: veteran went to school from 2011-2014 but did not get degree. Has been working in local paper mill for the past

one year.

c. Relevant mental health history:

Veteran recieved PTSD treatment at VAMC Albany NY from oct 2012 to april 2013, currently not in mental health treatment, no h/o hospitalisations and no h/o suicidal attempts noted.

3. Stressors.

<Too long to type>

Does this stressor meet criterion A (to support diagnosis of PTSD)

[X] yes

Is the stressor related to the veterans fear of hostile military or terrorist activity?

[X] Yes

Is the stressor related to personal assault

[X] No

4. PTSD Diagnostic Criteria

Criterion A

[X] Directly experiencing the traumatic events

[X]Witnessing, in person, the traumatic events

[X] Learning that the traumatic events occured to a close family member, close friend...

Criterion B

[X]Recurrent, involuntary, and intrusive distressing memories of the events

[X]Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).

[X]Dissociative reactions (flashbacks)

[X]Intense of 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 events.

Criterion C

[X] Avoidance of or efforts to avoid distressing memories, thoughts or feelings...

[X] Avoidance of or efforts to avoid external reminders (people, places, conversations...)

Criterion D

[X]Inability to remember an important aspect of the traumatic event(s).

[X]Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.

[X]Persistent, distorted congnitions about the cause or consequences of the traumatic events that lead to the individual to blame

himself/herself or others.

[X]Persistent negative emotional state

[X]Markedly diminished interest or participation in significant activities.

[X]Feelings of detachment or estrangement from others

[X]Persistent inability to experience positivie emotions

Criterion E

[X]Irritable behavior and angry outbursts

[X]Reckless or self-destructive behavior

[X]Hypervigilance

[X]Exaggerated startle response

[X]Problems with concentration

[X]Sleep disturbance

Criterion F

[X]Duration of the disturbance is more than one 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

5. Symptoms

[X] Depressed mood

[X]Anxiety

[X]Suspiciousness

[X]Panic Attacks that occur weekly or less often

[X]Chronic sleep impairment

[X]Disturbances of motivation and mood

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

[X]Difficulty in adapting to stressful circumstances, including work or a work like setting

[X]Inability to establish and maintain effective relationships

8 Competency

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

[X] Yes

Medical Opinion:

Restatement of requested opinion:

a. Opinion from general remarks: Provide opinion as to if it is as least likely as likely as not that PTSD is due to fear of hostile military activity:

b. Indicate type of exam for which opinion has been requested: Initial PTSD

A. The Condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness.

Rationale: Veteran urrently meets criteria of PTSD, did not have PTSD before he joined service, while in service he was deployed in combat where he was exposed to

hostile military activity to which he responded with intense fear. This fear of hostile military activity meets criteria of a PTSD stressor which is an adequate stressor to support

a DX of PTSD.

I would speculate that

service connection of PTSD will be granted

with an evaluation anywhere between 10 and 50 percent.

Here is a link to the schedule of ratings for you.

General Rating Formula for Mental Disorders

http://www.ecfr.gov/cgi-bin/text-idx?SID=e69f0e6d3ab42a7d79e69bb1a81cd20f&node=se38.1.4_1130&rgn=div8

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For a rating? Let me ask you a question? At the end of the C@P exam for PTSD did he give you a number to pick... If you didnt pick a number, forgot about getting rated you didnt get anything....

What are you talking about - never heard of such a thing.

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You'll probably get somewhere between 10 and 50 percent as Carlie has said. It is hard to tell what percent that you will get. I had to keep filing for a rating increase to get to 50%. If you don't agree with it you can file a letter of disagreement.

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Hopefully higher than 10%. This thing has dragged on for almost a year and it's sucked.

It just moved to the "prep for decision" phase. I'm freaking out waiting :(

You guys have any idea how long it takes to upgrade your Healthevet account to "premium"? I sent the form in the mail and faxed it. It's been a month and nada.

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Today Ebenefits update, claim complete. I haven't recieved my packet yet (probably takes a while?) I got 50%. Pretty surprised, I figured I'd get low balled like most people do.

Even though I filed the claim in october, the benefit is awarded 1 Decemeber 2013. So that means 10 months of back pay, right? Does anyone have any idea how long it takes to recieve that chunk of change? Also, my claim is up for review in 2019...is that normal? Atleast I have 5 years to worry.

Thanks for your help!!

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Congratulations. Check your direct deposit account for your retro pay. Sometimes, as in my case, the retro will show up in your account before you receive the official notification. The 2019 date for your five year review is normal since you are not P & T.

Do you have dependents and have you already claimed them? You are entitled to additional compensation for your dependents if your rating is 30% or higher. You are also eligible for travel pay for your VA appointments. Also, no more copays for your appointments and your prescriptions.

Good luck to you.

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Thanks. Only took 14 months! I guess thats faster than most veterans claims. Atleast I can stop checking ebenefits everyday and freaking out.

Is backpay calculated in some weird VA fashion? or is just the 50% rate from dec to now?

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Like a lot of C&P examiners, he doesn't realize what he's doing when he checks off various boxes on the DBQ. But in this case, his ignorance is probably to your advantage.

This is the exact description from the General Rating Formula for Mental Disorders (the link Carlie posted) for a 10% rating:

[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.

However, he endorsed the following symptoms/problems, which correspond with the various rating levels as indicated:

[X] Depressed mood [30%]

[X]Anxiety [30%]
[X]Suspiciousness [30%]
[X]Panic Attacks that occur weekly or less often [30%]
[X]Chronic sleep impairment [30%]
[X]Disturbances of motivation and mood [50%]
[X]Difficulty in establishing and maintaining effective work and social relationships [50%]
[X]Difficulty in adapting to stressful circumstances, including work or a work like setting [70%]
[X]Inability to establish and maintain effective relationships [70%]
There are three general scenarios:
1) Mean-spirited or lazy Rater - "The doc checked off the 10% description, so vet gets 10% rating."
2) Perhaps overly generous, less thorough, or "vets have been screwed, so I'm going to give 'em as much as I can" Rater - "Doc checked off two of the 70% items on the Symptom List, therefore vet gets 70% rating."
3) Conscientious, hard-working, caring Rater - Reviews all the relevant evidence, especially progress notes from your treating psychiatrist and/or psychologist (or clinical social worker), statements you and any family members or friends submitted, and your military personnel records. He or she will start with 70% and look for evidence to support that rating, since the C&P examiner did endorse two of the 70% items from the Rating Formula. If the Rater finds information that supports those two items, e.g., frequent, fairly serious problems at work due to PTSD symptoms, strained marriage (or no spouse or partner), no friends, alienates others, etc., then he/she assigns a 70% rating. If the Rater doesn't find evidence (or not enough evidence) for those two items, but he or she does find evidence for other 70% items (see the Rating Formula that Carlie posted for the list), then they rate at 70%. If the only 'evidence' for 70% is the two check boxes the (uninformed) C&P psychologist checked off, then they move down to 50% and look for evidence supporting that rating level. And so on.
In your specific case, from the examiner's report, and especially if your treatment notes are consistent with what the C&P doc wrote, it looks like there is evidence for "Inability to establish and maintain effective relationships", but there is not evidence for "Difficulty in adapting to stressful circumstances, including work or a work like setting" (since you are working and he didn't say anything about major problems on the job). Obviously that would change if your treatment notes or other documentation shows you have been having major problems on the job.
The fact that you haven't been in treatment for the last year is a concern for two reasons:
a) You are suffering from a very painful and disabling mental disorder. Free help is available. Why aren't you getting it? You served honorably, risked your life to protect the rest of us, and you are hurting--get the help and support you deserve!
b) Some Raters will reasonably ask, "If it's so bad, why isn't he getting help?" Now, they can't officially use that against you, but you have to admit it's a reasonable question for them to ask, and it can influence their decision.
But, having said all that, I'd put good money on 50%.
And I'm going to say it again: Get back in treatment. If you didn't like the VAMC, go to a Vet Center. If you didn't like the psychiatrist, ask for another one. If they put you in group therapy when you're uncomfortable with groups of people (duh, it's a major problem with PTSD, I don't know why the VA pushes group therapy so much), insist (politely) on seeing an individual therapist. If they say there's a 6 month waiting list for individual therapy, ask for a referral via the Non-VA Care office to a PTSD specialist in private practice that the VA will pay for (that was part of the new law Congress passed and the President signed into law in the wake of the phony wait list scandal). If they give you the run around, call your Senators and Congressman, your VSO, and your local news stations. If there's one thing VA administrators don't like, it's bad publicity. So if they f--k with you, give 'em hell.
Hopefully you won't need to do that since it sounds like you received decent treatment back when you were going, and, despite all the bad press recently, most VA docs and therapists genuinely care and try to do a good job.
Good luck man. I honor and respect you for your service to our country.
Henry
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Thanks. Only took 14 months! I guess thats faster than most veterans claims. Atleast I can stop checking ebenefits everyday and freaking out.

Is backpay calculated in some weird VA fashion? or is just the 50% rate from dec to now?

No, fortunately no "VA math" for your back pay. You receive the 50% rate from the date you filed the claim to the date they cut the check.

Henry

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The December 2013 date is probably the date of the last COLA and has nothing to do with your actual effective date.

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