ptsd Almost Done I Think Guys

[bojack]

Dear members

My calim effective date is 03/04/2014 under FDC program.

My mos in usmc was heavy machine gunner and sniper my last deployment. I have done 3 combat deployments total (2004 to 2008). Currently, I am working as a desk deputy at Sheriff's Department due to my PTSD and other medical conditioins. The departmnet does not let me work as a street deputy. Right now I am taking 8 medicaitons for my TBI migranies and PTSD. In fact, the doctor just ordered me a vigra due to having difficult time responding to my partner when I am in a relationship.

I field for hearing loss (New), PTSD (New), mental health that includes depression and insomnia (New), shoulder joint pain (New), neck pain (New), Sleep apnea (New), headaches (New), knee pain (New), feet pain (New), TBI (New), tinnitus (New), chest pains due to breathing problems (New), lower back condition (New).

I am in the pending for approval decision phase since 3 days ago and I was told it is almost over now. Also, I was told under new FDC program I will get additional one year backpay from my effective date as well.

My PTSD combat intake doctor gave me 85/85 pclm on my ptsd with severe depression. Also, sleep clinic just gave me CPAP machine for my sleep apena.

Little bit about me:

ASSESSMENT:

Nutrition Screening:

The patient notes an unexplained weight loss.

Amount: 9 lbs since 6/25/2014

Most recent measurements:

Measurement DT WEIGHT

LB(KG)[bMI]

06/25/2014 08:20 149(67.59)[23]

05/28/2014 08:27 152(68.95)[24]

02/06/2014 13:52 171.9(77.97)[27]

10/05/2011 15:51 155(70.31)[24]

Med:

PAROXETINE

TOPIRAMATE

TRAZODONE

MIRTAZAPINE

PRAZOSIN

Vigra

Primary Symptoms for which veteran is seeking care:

1.Depression

2.Anger

3.Insomnia

4.Hypervigilance

5. Avoidance

Mental Status Evaluation:

Orientation: alert and oriented to person, place, time and situation

Appearance and grooming: casual dress with good grooming, sits on edge of chair

and prefers to keep backpack on. Sunglasses on .

Behavior: guarded, slumped posture with head hanging down at times

Speech: soft volume, reduced amount initially

Mood: "depressed", anxious and depressed

Affect: congruent with stated with constricted range

Diagnoses (All diagnoses are based on DSM-5 criteria)

PTSD

MDD, recurrent, moderate-severe

Insomnia

Medical illnesses relevant to treatment: probably OSA

[bojack]

"Thank you for the update and I am sorry to hear that things have been difficult

for you. We will discuss medication change and also the plan to have you start

weekly therapy to work on the PTSD symptoms. Both of these will help.

Please remember if you have ANY thoughts of hurting yourself or others that is

a very urgent issue, and you can call the veteran crisis line at 800-273-8255

24 hours per day. You can also come to the VA emergency room or call 911 if it

is an emergency."

the patient has chronic headache, most likely migrine,and I instructed him to

get Magnesium citrate or magnesium sulfate 300 to 400mg twice a day and also

riboflavin ( vitamin B2) 100mg twice a day for the prevention of migraine, and

he has been instructed to get the magnesium and also riboflavion (over the

counter).

[bojack]

Describes mult severe/extreme traumatic events:

-Witnessed buddy shot by sniper while pt was talking to him and joking with him.

-kid threw grenade at pt but forgot to pull pin

-another incident when somebody threw propane with flare attached; struck pt in

him head and shoulder but somehow malfunctioned and did not explode

-s/p TBI x 4. In one instance pt was passenger, driver fell asleep as had been

on duty driving 14 hours straight, crashed in ditch, pt hit head against

widnshield and cracked bullet proof windshield

-worst instance of TBI was fall from 2nd story bldg d/t stair collapsed, was

unconcious for less than 1/2 hour

-pt shot in leg, bullet went through pants and grazed him

[bojack]

Combat Trauma:

Being in danger often

Being close to explosions/gunfire

Being hit by shrapnel/bullets

Being severely injured

Interpersonal violence

Witnessing others being severely injured/killed

Having to shoot at/harm others

Combat Exposure Scale

Total Score: 26 /33

Trauma History Questionnaire

Events / Events possible per category

Combat Experiences: 1 /1

Crime-Related Events: 4 /4

General Disaster: 7 /12

Physical and Sexual: 0 /6

Other Events: 1 /1

PTSD Checklist

Total Score: 85 /85

PTSD Category: Positive

Positive if Total Score > 50

Item average for each cluster

Intrusion (Items 1-5): 5.00 /5.00

Avoidance (Items 6-12): 5.

00 /5.00

Hypervigilance (Items 13-17): 5.00 /5.00

Beck Depression Inventory

Total Score: 33 /63

Severity: Severe

* 0-13 None or minimal, 14-19 Mild, 20-28 Moderate, 29+ Severe

Hopkins Symptom Checklist

Scale is 1-4

Average: 4.00 /4.00

Cutoff: Above

* 1.75+ is clinically significant anxiety

Brief Addiction Monitor

Drank ANY alcohol (Item 4): 0 /30

Drank a lot (Item 5): /30

Used drugs (Item 6): 0 /30

Illness Attitude Scales

Total scale score / Possible scale score

Worry about illness: 12 /12

Concerns about pain: 12 /12

Health habits: 8 /12

Hypochondria: 6 /12

Thanatophobia: 12 /12

Disease phobia: 3 /12

Bodily perceptions: 8 /12

[bojack]

The TBI C&P examier also gave me 50% greater than my injuires occured while I was in the service about my migrines, headache, and other TBI injuries.

I think I am going to get service connected for TBI, PTSD w/mental health, ringing in the ear,and sleep apena since I was issued CPAP machine.

Anybody know ball park of my % will be since I am worry about my job security as of now.

Thank you

[bojack]

Does the Veteran now have or has he/she ever been diagnosed with a headache

condition?

[X] Yes [ ] No

[X] Migraine in

cluding migraine variants

ICD code: 346 Date of diagnosis: 7-24-14

Headaches- daily, 10/10 at times, photophobia, phonophobia, bilateral

tension pain.

a. Does the Veteran experience headache pain?

[X] Yes [ ] No

[X] Pain on both sides of the head

b. Does the Veteran experience non-headache symptoms associated with

headaches? (including symptoms associated with an aura prior to headache

pain)

[X] Yes [ ] No

[X] Nausea

[X] Sensitivity to light

[X] Sensitivity to sound

c. Indicate duration of typical head pain

[X] Less than 1 day

d. Indicate location of typical head pain

[X] Both sides of head

4. Prostrating attacks of headache pain

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

a. Migraine / Non-Migraine- Does the Veteran have characteristic prostrating

attacks of migraine / non-migraine headache pain?

[ ] Yes [X] No

RESTATEMENT OF REQUESTED OPINION:

a. Opinion from general remarks: Two Medical opinions

1. Is the veteran's TBI at least as likely as not incurred in or caused

by

combat experiences.

2. Is the veteran's headaches at least as likely as not incurred in or

caused

by combat experiences.

Idicate type of exam for which opinion has been requested: Neruology

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE

CONNECTION ]

a. The condition claimed is at least as likely as not (50% or greater

probability) proximately due to or the result of the Veteran's service

connected condition.

c. Rationale: In my medical opinion the events that occurred during the

patients service time are great than 50% likely to have resutled in the

patients diagnosis of TBI and Migraine headaches.

Edited August 18, 2014 by bojack