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Recent C&p Exam For Mst & Eating Disorder Anorexia Nervosa


Navy4life

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Hello there! I am a newbie so forgive me if I am not in the right area but I have done some research and I think I am in the correct area.

I had my C&P Exam last week for my Eating Disorder and PTSD due to MST. I am currently S/C as of June 2014 40% for IBS; Anemia, Tinnitus, Left Ankle. My original claim is from May 2013. The MH C&P was my last one I have been waiting for. As I stated, I had it last week and felt that it well and the examiner was quite compassionate, caring and considerate - considering my situation.

I do not know how to upload my exam results so I will try to give some of it here. The examiner did TWO DBQ's for me:

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Eating Disorder DBQ

1. Diagnoses is Yes I have an eating disorder and I was given the code of: Anorexia - Date of Diagnosis: 1992 (My military in service dates are 90-96) - ICD code: 307.1

it goes with my medical history which is extensive and then

3. Findings: Resistance to weight gain even when below expected minimum weight and without incapacitating episodes.

4. Other symptoms included my continue issues with extreme weight with the use of laxatives, reduction in eating and lack of food and energy.

5. Functional Impact: Does the Veteran's eating disorder(s) impact his or her ability to work? Yes

Remarks if any: Veteran's current diagnosis of Anorexia Nervous, purging type, is most likely incurred in the military service and a progression of Veteran's eating disorder diagnosed in service. There is no prior diagnosis or hospitalization for an eating disorder prior to service. Veteran's eating disorder was first documented in service. Additionally, episodes of syncope and excessive weight loss were also documented in the service treatment records. Emotional distress as a result of military sexual trauma and consistent berating because of her weight most likely resulted in Veteran utilizing purging behaviors to cope with stress. Veteran has recently south treatment. However, she continues to take 8-10 Ducolax a day despite restrictive eating behaviors to control her weight. Despite acceptable weight, she continues to view herself as fat.

It should also be noted that Veteran's Anorexia Nervous is most likely related to MST and berating of Veteran due to her weight beginning in bootcamp.

Rationale: There was an increase in purging behaviors and subsequent hospitalization after MST, subsequent pregnancy and miscarriage in 1992. Refer to Initial PTSD DBQ for additional markers.

Initial PTSD DBQ

1. Diagnostic Summary

Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? NO

if no diagnosis of PTSD, check all that apply:

X Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5

X Veteran has another Mental Disorder diagnosis. Continue to complete this Questionnaire and/or the Eating Disorder Questionnaire:

2. Current Diagnosis

a. Mental Disorder Diagnosis #1 - Anorexia Nervous, purging type due to MST Comments if any: See Eating DBQ

Mental DisorderDiagnosis #2 - Other Specified Trauma and Stressor - related disorder due to MST. Comments if any: subclinical level of PTSD, which is difficult to determine given the severity of her eating disorder and the overlap in areas regarding the symptom profile presentation.

b. Medical diagnosis relevant to the understanding or management of the MH disorder (to include TBI): ankle pain. Comments if any: fracture of ankle and injury of ankle inserve after syncope episode secondary to excessive compensatory behaviors.

3, Differentiation of symptoms:

a. Does Vet have one or more mental disorder diagnosed? Yes

b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? Yes

Symptoms such as purging through the use of laxatives, excessive food restriction and distorted perceptions regarding body image, excessive weight loss and consistent worrying about weight control are directly related to Veteran's diagnosis of Anorexia.

Nervosa, binging/purging type.

Symptoms such as intrusive memories related to the MST and avoidance of conversations, people and places related in some way to the MST, guilt and shame related to MST and distorted cognitions about the cause of the MST that lead the individual blame are directly related to Veteran's Other Specified Trauma Stressor.

Related Disorder: Her symptoms and resulting social and occupational impairments related to reported difficulty concentrating, anxiety and sleep disturbances are related to both disorders as Veteran reported experiencing anxiety and subsequent difficulty concentrating and sleeping secondary to persistent thoughts about her body image and some thoughts about the MST.

4. Occupational and Impairment

a. X - Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation.

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

Goes on to list same symptoms here

Clinical Findings

All my records were reviewed.

My prior military history is normal (meaning I had a normal childhood)

Stressor #1 - This is where I talk about the MST situation

Does this stressor meet Criterion A (i.e. is it adequate to support the diagnosis of PTSD?) NO

Is the stressor related to the Veteran's fear of hostile military or terrorist act? NO

Is the stressor related to personal assault, e.g. military sexual trauma? YES

This goes into detail about sick call visits, miscarriage, lose of body weight, fracturing my ankle due to weight loss/fainting, losing excessive amounts of weight in a rapid pace,

Goes on to state I was referred to Psych treatment in 1994

Stressor #2 - Is the description of the attack won't get into that here......

Does this stressor meet Criterion A (i.e is it adequate to support the diagnosis of PTSD?) YES

Is the stressor related to the Veteran's fear of hostile military or terrorist act? NO

Is the stressor related to personal assault, e.g. military sexual trauma? YES

Goes on to describe how the stressor is related.

PTSD Diagnostic Criteria:

Criterion A:

-Directly experiencing the traumatic event

Criterion B:

-Recurrent, involuntary, and intrusive distressing memories of the traumatic event

Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event.

Criterion C:

-Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event.

Criterion D:

-Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead to the individual to blame himself/herself or others.

-Persistent negative emotional state (e.g., fear, horror, anger, guilt or shame)

Criterion E:

-Sleep disturbance

Criterion F:

-Duration of the disturbance is more than one month

Criterion G:

-The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Criterion H:

-The disturbance is not attributable to the physiological effects of a substance or another medical condition.

Criterion I:

-Which stressors contributed to the Veteran's PTSD diagnosis? Stressor 2

5. Symptoms

For the VA rating purposes, check all that actively apply to the Veteran's diagnosis:

Depressed Mood

Anxiety

Chronic Sleep Impairment

7. Other symptoms

Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? []Yes [X] No

8. Competency

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

9. Remarks, (including any testing results) if any

Given the current predominance of Veteran's eating disorder, she does

not

currently meet full criteria for PTSD. Therefore, Veteran was diagnosed with Other Specified Trauma and Stressor Related Disorder (subclinical level of PTSD) which is at least as likely as not related to reported military sexual trauma. There is no prior evidence of a mental health disorder. The exacerbation of Veteran's eating disorder, which began

in

the military in response to beratement related to her weight, was a response to MST, documented pregnancy and miscarriage. STRs document referral to a psychology clinic due to stress and excessive weight loss over a short period of time. It is additionally documented that Veteran was hospitalized due to syncope, ankle fracture resulting from eating disorder. It should be noted that eating disorders often develop as a method of coping with a stressor of which an individual feels he/she has no control over. Veteran continues to engage in behaviors that have resulted in her diagnosis of an eating disorder in service. It is

possible

that Veteran has continued to engage in these compensatory behaviors to manage her weight because it is an aspect of her life she feels she can control, unlike the MST event.

Rationale within in this section and the stressor section of this evaluation confirm that it is at least as likely that the reported MST occurred and resulted in current Other Specified Trauma and Stressor Related Disorder (subclinical level of PTSD)symptoms. It should be noted that once Veteran's eating disorder is treated, resulting in remission, it will be easier to more accurately access for the presence of other mental health disorders.

Please refer to the Eating Disorders DBQ for more specific details and medical opinions regarding Veteran's diagnosis of Anorexia Nervosa.

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My questions are as follows:

Is there only one MH rating?

I have been diagnosed with an Eating Disorder so will that rating fall under the Anorexia Eating Disorder and be S/C separately or is it a MH condition?

The Examiner did not diagnose me with PTSD but with Other Mental Disorder so will that be my S/C for MST?

Since she has stated my ankle fractures are a direct result of my fainting due to my ED should I expect the right ankle to be S/C? ( I am currently S/C for left ankle and right ankle is deferred for now)

Examiner stated my eating disorder impacts my ability to work - is this good for my S/C of my eating disorder?

Over all what do you conclude based on the above information regarding my S/C for my Eating Disorder and MST?

I understand that MST is not a rating but rather falls under PTSD (secondary to personal assault).

If you need additional info, let me know - the report was over 25 pages long LOL.....

Thank you for your responses and feedback!!!

Edited by Navy4life
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From what I can read in CFR 38, It says that anorexia or bulimia are rated separately from the mental health ratings. On the DBQ the examiner marked "without incapacitating episode's ". That would be a service connection of 0%. Unless there is other medical documentation or lay evidence in your records that would garner a higher rating, the rater usually has to go mostly with what the examiner says on the DBQ.

Here's the link to the rating schedule.

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5

9520 Anorexia nervosa

9521 Bulimia nervosa

Rating Formula for Eating Disorders

Rating

Self-induced weight loss to less than 80 percent of expected minimum weight, with incapacitating episodes of at least six weeks total duration per year, and requiring hospitalization more than twice a year for parenteral nutrition or tube feeding. 100

Self-induced weight loss to less than 85 percent of expected minimum weight with incapacitating episodes of six or more weeks total duration per year. 60

Self-induced weight loss to less than 85 percent of expected minimum weight with incapacitating episodes of more than two but less than six weeks total duration per year. 30

Binge eating followed by self-induced vomiting or other measures to prevent weight gain, or resistance to weight gain even when below expected minimum weight, with diagnosis of an eating disorder and incapacitating episodes of up to two weeks total duration per year. 10

Binge eating followed by self-induced vomiting or other measures to prevent weight gain, or resistance to weight gain even when below expected minimum weight, with diagnosis of an eating disorder but without incapacitating episodes. 0

Note 1: An incapacitating episode is a period during which bed rest and treatment by a physician are required.

Note 2: Ratings under diagnostic codes 9201 to 9440 will be evaluated using the General Rating Formula for Mental Disorders. Ratings under diagnostic codes 9520 and 9521 will be evaluated using the General Rating Formula for Eating Disorders.

For the PTSD DBQ, the examiner did state, more likely than not, giving you the service connection nexus statement. On question number 4, the examiner marked the box that corresponds to a 30% rating. Once again, if there is additional medical evidence in your file that would garner a higher rating then it may be higher. If not, then the rater mostly goes with the examiner.

The good thing with both of these DBQ's is that the examiner did give you the Nexus statement for service connection. Often times that is the hardest thing to get for a VA claim. The percentages may not be as high as you would like right now, but you can always go back and request an increase. Additionally you could see a private doctor and have them fill out the DBQ and you might get more accurate results.

*** Also if you're not able to work due to your service connected conditions you can file for TDIU once this claim is completed.

CFR 38 MH rating

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

A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. 0

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WOW- at first I was surprised that they did not diagnose SC PTSD but you are correct....they will only pay comp for one MH disorder.

However Navywife found something that indicates they will rate these separately....

GREAT job Navywife!

If you go to the VA Schedule of Ratings here (a long document) the ratings for your eating disorder will be there and you can get some idea of how they will rate this.

I feel the C & P exam almost sort of deferred the PTSD issue.....but in a good way, if that can eventually be SCed as well and separately from the eating disorder.

Are you employed?

If not do you receive SSDI solely for the same established SCs and/or the eating disorder?

"It is additionally documented that Veteran was hospitalized due to syncope, ankle fracture resulting from eating disorder"

They should definitely SC that ankle.with this statement. But do you have residuals from it that would give you more then "0" SC ?

Thank you for your service.

One question

"Medical diagnosis relevant to the understanding or management of the MH disorder (to include TBI"

Did you claim TBI?

If so was it from the syncope fall or from the MST situation?

Sorry if I repeated points Navywife already made.....

many of us get online at the same time and post replies at the same time......

Edited by Berta
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WOW- at first I was surprised that they did not diagnose SC PTSD but you are correct....they will only pay comp for one MH disorder.

However Navywife found something that indicates they will rate these separately....

GREAT job Navywife!

If you go to the VA Schedule of Ratings here (a long document) the ratings for your eating disorder will be there and you can get some idea of how they will rate this.

I feel the C & P exam almost sort of deferred the PTSD issue.....but in a good way, if that can eventually be SCed as well and separately from the eating disorder.

Are you employed? YES

If not do you receive SSDI solely for the same established SCs and/or the eating disorder?

"It is additionally documented that Veteran was hospitalized due to syncope, ankle fracture resulting from eating disorder"

They should definitely SC that ankle.with this statement. But do you have residuals from it that would give you more then "0" SC ? I am currently 10% S/C left ankle and awaiting a decision for my right ankle. I injured both in the military.

Thank you for your service. Thank you very much :biggrin:

One question

"Medical diagnosis relevant to the understanding or management of the MH disorder (to include TBI"

Did you claim TBI? NO

If so was it from the syncope fall or from the MST situation? The several syncopes I had were all related to me fainting/passing out due to my eating disorder and I never hit my head.

Sorry if I repeated points Navywife already made.....

many of us get online at the same time and post replies at the same time......

Thank you much appreciated!

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Navywife;

Thank you for taking the time to review my post. I am okay with the 0% S/C for the Eating Disorder if that is what it will be. Along with your guess that I would be 30% S/C for my PTSD due to MST would be two separate ratings?

Also I failed to mention that at the end of the Criterions A-I the Symptoms were as follows:

For the VA rating purposes, check all symptoms that actively apply to the Veteran's diagnosis:

Depressed Mood

Anxiety

Chronic sleep impairment

Will those be added in/lumped so to speak with all the MH as one????

Thank You

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