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Humble Request For Opinion - C&p Exam For Ptsd


sapper6

Question

Please take a look at this, everything I do has been tainted by PTSD. I really hope it gets better, everything is so dark and hopeless. I have tried counseling, meds, etc. nothing seems to take it away. I have never filed for anything including unemployment and am embarrassed to do this but I have no safety net and I seem to be failing and flailing at life. I hope I get some kind of SC so I can continue to get medical care.

I appreciate your time in taking a look at this and sharing your opinion on it.

Thank you.

=========================================================================
Date/Time: 22 Sep 2014 @ 0900
Note Title: C&P EXAMINATION
Location: DALLAS TX, VAMC
Signed By: MCMANUS,John Scott
Co-signed By: MCMANUS,John Scott
Date/Time Signed: 22 Sep 2014 @ 0949
-------------------------------------------------------------------------

LOCAL TITLE: C&P EXAMINATION
STANDARD TITLE: C & P EXAMINATION NOTE
DATE OF NOTE: SEP 22, 2014@09:00 ENTRY DATE: SEP 22, 2014@09:49:34
AUTHOR: MCMANUS,CHRISTOPHER EXP COSIGNER:
URGENCY: STATUS: COMPLETED

Initial Post Traumatic Stress Disorder (PTSD)
Disability Benefits Questionnaire
* Internal VA or DoD Use Only *

Name of patient/Veteran: John Joe Doe

SECTION I:
----------
1. Diagnostic Summary
---------------------
Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria
based on today's evaluation?
[X] Yes [ ] No

ICD code: 309.81

2. Current Diagnoses
--------------------
a. Mental Disorder Diagnosis #1: PTSD due to Military Service
ICD code: 309.81

b. Medical diagnoses relevant to the understanding or management of the
Mental Health Disorder (to include TBI):
No response provided.

3. Differentiation of symptoms
------------------------------
a. Does the Veteran have more than one mental disorder diagnosed?
[ ] Yes [X] No

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] Total occupational and social impairment

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 (hard copy paper C-file) reviewed?
[ ] Yes [X] 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
[X] 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):
Married 22 years with two children; wife with schizophrenia. Impaired
relationship given his avoidance, isolation, and emotional lability.
Reports preference for isolation along with marked hypervigilance and
suspiciousness of others' motives given his war experiences.

b. Relevant Occupational and Educational history (pre-military, military,
and
post-military):
Master's degree in computer science; was in PhD program for electrical
engineering. Thirty year career in technology field; currently only
able to work half-time for XXXX Corporation, a Exxon vendor,
responsible for selling technology to Exxon. Marked occupational
impairment given frequent emotional and physiological reactions to
trauma reminders and distrust and suspiciousness of others at work;
reports feeling ostracized and labeled as "a crazy vet," prompting his
superiors to interview others to replace him and push him out.

c. Relevant Mental Health history, to include prescribed medications and
family mental health (pre-military, military, and post-military):
The Veteran denies symptoms prior to service. Reports seeking help
for
symptoms in service at Camp XXXX at his superior's suggestion;
however, states that the major in Texas National Guard at the help
center felt that "you all are just trying to get a handout" and needed
to "suck it up" and therefore allegedly turned them away. Currently,
compliant with VHSO MHC individual therapy and medication management
(Sertraline and Divaloprex); has also completed 12 week CPT class and
is going to a sleep group. 9/17/14 IT note reported he had presented
for an emergency visit due to his perception that his son was a
potential threat and resulting assault; he came to his senses and knew
he needed to see someone about the incident.

d. Relevant Legal and Behavioral history (pre-military, military, and
post-military):
N/A

e. Relevant Substance abuse history (pre-military, military, and
post-military):
N/A

f. Other, if any:
DD 214 indicates receipt of CAB and having served in imminent danger
area.


3. Stressors
------------
Describe one or more specific stressor event(s) the Veteran considers
traumatic (may be pre-military, military, or post-military):

a. Stressor #1: In July 2010, the Veteran's unit was clearing numerous IED's
and he witnessed aftermath consisting of severe carnage of dead bodies
and burning vehicles. Sobbing as he recounts feeling that he had
"failed people" and his getting to the scene too late had cost people
their lives.

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

b. Stressor #2: In May 2013, the Veteran was driving into XXXX to
meet military officials when suicide bombers struck them killing 14
people, some of whom were officials he was going to meet.

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

c. Stressor #3: In April 2013, engaged in two small arms firefights within a
week; subsequently awarded CAB.

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 #7 - 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 (DSM-5).

Criterion A: Exposure to actual or threatened a) death, b) serious
injury,
c) sexual violation, in one or more of the following ways:
[X] Directly experiencing the traumatic 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, 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] 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.

Criterion I: Which stressor(s) contributed to the Veteran's PTSD
diagnosis?:
[X] Stressor #1
[X] Stressor #2
[X] Stressor #3

5. Symptoms
-----------
For VA rating purposes, check all symptoms that actively apply to the
Veteran's 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] Impairment of short- and long-term memory, for example, retention of
only highly learned material, while forgetting to complete tasks
[X] Flattened affect
[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
worklike setting
[X] Inability to establish and maintain effective relationships
[X] Suicidal ideation

6. Behavioral Observations
--------------------------
The Veteran presents appropriately dressed with good grooming and hygiene.
Cooperative and polite, yet markedly emotional and labile when discussing
military stressors; had to compose himself numerous times. Visibly anxious
at being here.

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:
Feelings of worthlessness and inadequacy. Addendum to suicidal
ideation: reports persistent thoughts of a passive nature without
intent; states that he has informed his MHC therapist about these
thoughts.

8. Competency
-------------
Is the Veteran capable of managing his or her financial affairs?
[X] Yes [ ] No

9. Remarks, (including any testing results) if any
--------------------------------------------------
There appears to be a nexus between the Veteran's PTSD and identified
markers, given absence of symptoms prior to service and development of
symptoms post service. Thus, PTSD is more than likely as not the result

of or caused by military service.

NOTE: VA may request additional medical information, including additional
examinations if necessary to complete VA's review of the Veteran's
application.


/es/ John Scott MCMANUS, PhD
PSYCHOLOGIST
Signed: 09/22/2014 09:49
-------------------------------------------------------------------------

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I am unfortunately working only half-time and they are really trying to push me out. Unsure how long the job will last. I am struggling every day and I show up at work about 4 hours before anyone else shows up since I cannot sleep at night and I get to avoid people and stressors. Sadly, If this is how rest of my life is going to shape up, I would rather die.

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sapper, based on a quick scan, the other poster was correct anywhere from 50-100. More than likley since you are working, even part time, that will definitley not meet their criteria for 100%, since we are compensated mainly for occupational loss. I would prepare for 50%, which is ok. I would think you might fit into the 70% category more but it all depends on your entire c-file history and treatment records. THey will base it mainly off this 1 report/exam but also will factor in any progress notes or what not. I wish you good luck in your quest for inner peace. S/F

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I read it as 100% according to what the Dr put regarding the C&P exam. You can be 100% PTSD and working too. They checked the criteria for you to get 100% PTSD due to " [X] Total occupational and social impairment". Some people here will tell you you cant work and be 100% for mental disability,which is incorrect. However, they can use that against you to lower your rating at a later date if your mental illness doesnt have any bearing on you working fulltime. I work for the Feds so they have leave set up for me that I can take when I am doing bad. I just call in and tell them my service connected disability is causing me issues and they cant fire me. I just work with them and communicate and I am entitled to 12 weeks of FMLA. I dont know how it is out in the real world tho.

I wish you the best and hope you get 100%!

I have included the rating criteria for mental disorders below. The Dr. checked on your exam..... [X] Total occupational and social impairment

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
Edited by vet201060
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