ptsd Humble Request For Opinion - C&p Exam For Ptsd

[sapper6]

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

[carlie]

My wag is SC granted with an evaluation anywhere from 50 % to 100%.

Since you are employed the 100% might not come through.

[sapper6]

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.

[USMC_HVEQ]

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

[vet201060]

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 October 2, 2014 by vet201060 (see edit history)

[carlie]

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.

IMO -sure - there are some vets in receipt of SC at 100% due solely to a MH disorder,

that are substantially gainfully employed - they are few and far between.

At sometime the vets in this category will have a re-evaluation and receive a

reduction in their evaluation.

Also, the vet SC'd at 100% due solely to a MH disorder and substantially gainfully

employed - will not be granted P&T status.

For the record, P&T status carries many more benefits with it than just SC at 100%.

jmho

[sapper6]

Thank you for your insights, I am glad you have all this experience here to count on. I just want my life back, I am really shamed to be so broken when I was the first one to the fight every single time. I really don't want P&T or 100%, I just want access to care so I can have my life back. I had a much better life before this, P&T could not come close to my civilian compensation, I just want to go back to where I was and it seems like a mirage right now.

Edited October 2, 2014 by sapper6 (see edit history)

[Navy04]

It should be 100% bud, but if you are in that bad of shape, please don't work. I had to resign from a high paying Govt job last year due to my Mental and Physical health. I know that you are tough, and want to take care of the family, but I don't think that you should risk the 100% for the PTSD, which is what I believe the VA will grant. God Bless and good luck.

[Mikemmlj]

My VA has been great on PTSDctreatment. I am 100%, but might go back to work one day if things keep getting better. There is hope either way.

[sapper6]

I wish I could, my wife is sick and we need the insurance. So I have to do whatever it takes to keep family together though it is consuming me from the inside. I sleep 2-3 hours a night, I have been through several PTSD programs and sleep therapy, only marginal improvement. Thanks for all your help guys, I will let you know if/when I hear back on the claim.

Edited October 2, 2014 by sapper6 (see edit history)

[vet201060]

I feel you brother!

I have to agree with everything Carlie just posted. I dont see how they could justify reducing me since I miss over 3 months of work per year. If I didnt have any issues and improve then I understand the reduction. But I know I dont make the rules and the VA may do whatever they want. That is when I will seek an attorney for help. I dont think I would ever get P&T and still be working. If I knew for sure I would get P&T with my 100% I would retire right now and see if I could become a VSO or some other job that would be within the rules. P&T would be the golden ticket for me and my family otherwise I have to bring in more money to support my family and provide healthc care benefits. Maybe a part time meaningful job like a VSO. I would love to help vets and really put effort to getting them the benefits they deserve. I just hate to see vets give up on having a life just to get that 100% P&T rating. I know I should not be working but my employer has bent over backwards for me. I do lose thousands of dollars every year due to my mental condition. VA makes up for it by paying me 100%. I dont have health care or education benefits for my family since I am not P&T. So I can not just quit my job and leave my family hanging without health benefits

Edited October 2, 2014 by vet201060 (see edit history)

[john999]

If you are over 40 years old and in bad shape take the 100% from the VA and get P&T when you can. If you have a 401-K you can borrow from it until you get your P&T to buy insurance for your family. What you don't want is to be fired and out on the curb with no plan. It happened to me and it was great weight loss program. I worried off 30 lbs in no time. My wife was working and had insurance. It took about 18 months to get P&T and then ChampVA. I was 51 years old and pretty washed up due to pain and anxiety.

[vet201060]

I am mid 30's with 4 kids. So I am justs hanging on. My wife doesnt have a job either.

Edited October 2, 2014 by vet201060 (see edit history)

[DDuck]

Sapper,

The positive: Life will get better, however it takes a effort now. Most people live and die without having to make a effort for happiness, sadly you are not in the catagory any longer. I repeat however that LIFE WILL GET BETTER. Hang tough. You are in the company of many people who have been and will be where you are, so you are far from alone hold onto that fact YOU ARE NOT ALONE.

The catch: The effort to have a better live needs to be made by you, everybodies tools are different on how they get there. This is the part I believe you are struggling with and feels like you are losing the battle. You cannot use the same tools that you had before you became a warrior. Make no mistake you are a warrior and it comes with some pretty heavy baggage. But one thing is certain you can use the same "first to the fight" attitude to help when you get the tools you need to fight for yourself and then your family. Remember hanging tough does not mean "suck it up" it means do not give up getting through this dark tunnel, it doesn't mean not talking about it. It means talk to qualified people about it and remember as you sit in that room emotional, it does not make you less of a warrior. Hang tough.

[airborne82_11b2p]

I would think this should be rated at 100% even if you are working. A lot depends on your employer and the people you work with and their understanding of your limitations from the sacrifices made in service. Hopefully you have an understanding employer. I think a lot of places miss the boat when it comes to vets with disabilities. Even though it requires some adjustments, imo you can't find a better employee than a vet. Keep fighting the fight brother, things have a way of working out.

[Navy4life]

I am concerned that you stated "Sadly, If this is how rest of my life is going to shape up, I would rather die."

Please get help! It is there for you. You can go to the ER and get yourself admitted for these thoughts. I am sure you are in a pretty touch situation with your issues and your wife's issues to take on. Please get help you needed it!