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Somatic Disorder


kevin4998

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My first C&P (2013) read:

"2. Service connection for Pain disorder (claimed as depression, anxiety, post-traumatic
stress disorder and gulf war syndrome) as secondary to the service-connected disability of Spinal stenosis.

We have assigned a 30 percent evaluation for your based on:

o 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)

o Chronic sleep impairment

Your Global Assessment of Function (GAP) score is 61. A range of 61-70 indicates some mild symptoms; or some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships.

The overall evidentiary record shows that the severity of your disability most closely approximates the criteria for a 30 percent disability evaluation.

A higher evaluation of 50 percent is not warranted unless there is 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);"...

My second C&P (2014) exam read the following which they(VA) now use Somatic instead of Pain Disorder as noted in the copied text below.

"1. Evaluation for somatic symptom disorder (previously rated as Pain disorder, claimed as
depression, anxiety, post-traumatic stress disorder and gulf war syndrome).

Evaluation for somatic symptom disorder (previously rated as Pain disorder (claimed as depression, anxiety, post-traumatic stress disorder and gulf war syndrome) currently rated as 30 percent disabling, is continued.

An evaluation of 30 percent is continued.

We have continued a 30 percent evaluation for your somatic system disorder (previously coded
as Pain disorder, claimed as depression, anxiety, post-traumatic stress disorder and gulf war syndrome) based on:

Difficulty in establishing and maintaining effective work and social relationships

Anxiety

Depressed mood

Symptoms controlled by continuous medication

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.

No Global Assessment of Function (GAF) score was reported. (The paper work I received, stated they don't use GAF anymore)

The overall evidentiary record shows that the severity of your disability most closely
approximates the criteria for a 30 percent disability evaluation."...

1) Has anyone else "Pain Disorder" been changed too Somatic Disorder that you know of?

2) Why was this change made to the cfr if that is what has happened? (speculation)

I tried during this bout (2014 C&P) with the VA to connect sleep apnea secondary too Gerd, but if I would of done my research better I would of realized that I would of been better off going with my mental disabilities. But now, with the way this last exam was worded and the change to somatic... I am wondering if that "is" even a possibility now. To me they threw every mental disability I have into a pot and took out the reasoning which was spinal stenosis. I am not sure what to make out of the changes and what it means too me.

I have been diagnosed with sleep apnea, through the VA. They have that documentation in their files. I am also diabetic and from the research I have done sleep apnea and diabetes type 2 can be linked to each other.

(question will it be the chicken or the egg first)

But, for now I need to get sleep apnea secondary to my major depression.

Any thoughts on this would be greatly appreciated.

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Somatic Symptom Disorder

By Johnna Medina, M.A.

http://psychcentral.com/disorders/somatic-symptom-disorder/

Somatic symptom disorder has replaced the what was formerly known as “Somatization Disorder” in DSM-IV. Somatic Symptom disorder involves being distressed or having one’s life disrupted by concerns involving physical symptoms for which a physical cause cannot be found. A person with this disorder may worry excessively over a certain health sensations and symptoms, such as stomach pain. They may believe the sensation indicates a serious illness like stomach cancer, although they may not have objective evidence from a doctor to substantiate that concern. They may go to great lengths to attend to or to investigate their health symptoms. Diagnostic criteria states that the person must exhibit signs of somatic symptom disorder (e.g., concern over physical health or anxiety over somatic sensations) for at least 6 months, although the actual pain or symptom does not have to be present the entire duration.

This may not be good but at least VA continued your rating for now. When I was first diagnosed with this condition I went through hell. I was in all kinds of pain until I got to the head of the VA psych hospital and some really good doctors who cared. I am sorry that you are going through this. If MRIs are not working or coming up with any for your spine you may want to see if you can get a bone scan, it may tell a different story.

Hope the best

P. S. You are really going to need a doctor's statement linking your mental health condition to your sleep apnea with a good medical rationale.

Edited by pete992 (see edit history)
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See that is what is really confusing, they say the Pain disorder in the first exam is associated with my spinal stenosis. Which IS service connected and well documented and I have had two some what failed surgeries for it. So I am not for sure what they are talking about, because their IS a documented cause for the pain.

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Nuero Surgeon informed me not to have surgery on my spinal stenosis, said it would most likely make it worst. I have several buddies who have multiple operations and they are no better then I am, so for now I choose not to have surgery. It has been about 15 years since I was diagnosed with spinal stenosis and DDD. I hurt all the time. Either at your last C & P exam or in one of your recent mental health progress report one of your doctor's must have diagnosed you with somatic symptom disorder.

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I have reviewed the notes that is available to me, but have not seen that diagnoses... but who really knows what is actually in our records behind the wall? Yea, that is pretty much what I was told, if I was to have surgery again than it would probably just make it worst. When the VA even offered for that particular surgery I told them, only if I was unable to walk at all will I would even consider that surgery again. Yes the first, well second, surgery did help but only to the point I can move with the help of medication, but I am unable to lift or do anything that would stress my lower back at all. That issue was called low back pain in the my smr's, but never fully diagnosed. Only after I had gotten out and years later became almost totally unable to walk with out sever pain did my private physician diagnose me with spinal stenosis. Then I had surgery and I was able to walk for awhile with out hardly any issues, but now my pain is back to an 8-9 with out meds, meds puts it down too 6 till I over do it with what little I do. I lost my job because of it, and that lead to depression as I no longer could take care of myself let alone a family. So major depression was secondary to the spinal stenosis. I did not even know I could claim my issues.. got out in 97, pain got bad in 2005, surgery in 2006, good till 2011, that's when things got bad, but also the same time I was told to look in to my smr and see if had a possible claim. Had never even heard of that possibility. But luckily that issue and a few others was in my smr's. I have been slowly getting better since, even though the pain is still there, at least I am being taking care of for the most part. But, I fully believe my diabetes, sleep apnea and weight issues are related to my spinal stenosis, because I didn't have these problems a few years ago till I was not able to basically have a life... people that know of these issues, know that your life drastically changes when you just can do the normal things in life that you once did which includes keeping in shape. Cant work out with this or I would be in tears, even with meds. I would love to work out to some extent, something that would help with my diabetes and weight, but so far I have not found a thing I could do to help with them. Light works out is not going to do it.

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  • HadIt.com Elder

I I have pain disorder but have not checked recently to see it has been changed to somatic disorder. Somatic disorder means it is in your head. My pain is not in my head. it is in my feet, spine, shoulder, neck and hands. I have PN. I am not dreaming up my pain. It really put me out of work.

John

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  • Content Curator/HadIt.com Elder

Another key phrase docs like to use is "idiopathic", which means they can't find a cause

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Pain Disorder has been removed off of the e-CFR

Old version had it at code 9422

http://www.law.cornell.edu/cfr/text/38/4.130

while the new version has 9422 with "Other specified somatic symptom and related disorder"

You have to look at DSM-5 which is new this year.

http://dsm.psychiatryonline.org/book.aspx?bookid=556

I pulled up a site that reflects what notable changes was made from DSM-4 too DSM-5

http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf

This is what I see:

Somatic Symptom and Related Disorders

In DSM-5, somatoform disorders are now referred to as somatic symptom and related disorders. In DSM-IV, there was significant overlap across the somatoform disorders and a lack of clarity about their boundaries. These disorders are primarily seen in medical settings, and nonpsychiatric physicians found the DSM-IV somatoform diagnoses problematic to use. The DSM-5 classification reduces the number of these disorders and subcategories to avoid problematic overlap. Diagnoses of somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder have been removed.

Somatic Symptom Disorder

DSM-5 better recognizes the complexity of the interface between psychiatry and medicine. Individuals with somatic symptoms plus abnormal thoughts, feelings, and behaviors may or may not have a diagnosed medical condition. The relationship between somatic symptoms and psychopathology exists along a spectrum, and the arbitrarily high symptom count required for DSM-IV somatization disorder did not accommodate this spectrum. The diagnosis of somatization disorder was essentially based on a long and complex symptom count of medically unexplained symptoms. Individuals previously diagnosed with somatization disorder will usually meet DSM-5 criteria for somatic symptom disorder, but only if they have the maladaptive thoughts, feelings, and behaviors that define the disorder, in addition to their somatic symptoms.

In DSM-IV, the diagnosis undifferentiated somatoform disorder had been created in recognition that somatization disorder would only describe a small minority of "somatizing" individuals, but this disorder did not prove to be a useful clinical diagnosis. Because the distinction between somatization disorder and undifferentiated somatoform disorder was arbitrary, they are merged in DSM-5 under somatic symptom disorder, and no specific number of somatic symptoms is required.

Pain Disorder

DSM-5 takes a different approach to the important clinical realm of individuals with pain. In DSM-IV, the pain disorder diagnoses assume that some pains are associated solely with psychological factors, some with medical diseases or injuries, and some with both. There is a lack of evidence that such distinctions can be made with reliability and validity, and a large body of research has demonstrated that psychological factors influence all forms of pain. Most individuals with chronic pain attribute their pain to a combination of factors, including somatic, psychological, and environmental influences. In DSM-5, some individuals with chronic pain would be appropriately diagnosed as having somatic symptom disorder, with predominant pain. For others, psychological factors affecting other medical conditions or an adjustment disorder would be more appropriate.

My question is why doesn't the updated e-CFR not reflect more accurately too DMS-5? Why wouldn't it reflect more accurately should be the question, is their a reason why they don't want it too?

Edited by kevin4998 (see edit history)
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I know this post is about 7 months old, but just had a C&P exam done for depression and anxiety secondary to chronic pain of 2 S/C disabilities.

The doctor wrote it up as somatic symptom disorder and linked the 2 issues.

Hope for the best now.

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