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Anyone Care To Speculate At What Rating I Might With This C&p?


Victor_C3

Question

I know it's all a crap shoot, but does this look like a C&P that could likely lead to a 100% rating?
The only thing that throws me off is he checked the box next to "Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood" And not the "total impairment to work" option.
I've been hospitalized basically from 26 June through 2 October after a suicide attempt on the evening of the 25th of June. I've unfortunately had to return to work on the 7th of October and I've been having a hell of a time readjusting. I just had a C&P a few days ago and the rating doctor flat out told me that he doesn't recommend that I return to work and he told me that I should apply for SSDI. However, I'll have to at least work until I hopefully get 100% for PTSD. I'm the only financial provider for my family and, even with SSDI and 100% from the VA, my family will still take a large financial hit.
Any ideas?
SECTION I:
----------
1. Diagnostic Summary
---------------------
Does the Veteran now have or has he/she ever been diagnosed with PTSD?
[X] Yes[ ] No
2. Current Diagnoses
--------------------
a. Mental Disorder Diagnosis #1: Post Traumatic Stress Disorder
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[X] No[ ] 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] Occupational and social impairment with deficiencies in most areas,
such as work, school, family relations, judgment, thinking and/or
mood
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?
[ ] Yes[X] No
Was the Veteran's VA claims file (hard copy paper C-file) reviewed?
[X] Yes[ ] No
If yes, list any records that were reviewed but were not included in the
Veteran's VA claims file:
The veteran's records in the Hudson Valley Health Care System were
reviewed prior to the examination. The veteran's previous
Compensation
and Pension Examination for Post Traumatic Stress Disorder of 5/4/09 was
also reviewed prior to the examination.
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
[ ] 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. Recent History (since prior exam)
------------------------------------
a. Relevant Social/Marital/Family history:
Veteran remains married to his wife of 10 years. He stated that their
relationship is strained. Veteran stated that his wife often
complains
that he is moody and irritable. He says that they often sleep in
separate rooms due to his nightmares. Veteran stated that she worries
about him being depressed. Veteran stated that while he loves his
wife
dearly that he has difficulty expressing his feelings to her.
Veteran has two daughters ages 6 and 4 years-old. He stated that
while
he loves his daughters that he has difficulty not losing his temper
when in their company. He stated that he feels bad after yelling at
this girls. Veteran stated that he spends a good deal of his time
avoiding his daughters.
Veteran stated that he has no close friends. He stated that he
typically avoids people and keeps his feelings to himself. Veteran
stated that he feels anxious in social settings and often has panic
attacks. The veteran does not belong to any veteran organizations.
In summary, since his last examination the veteran displays a severe
deficit in social functioning. He has no close friends. He has
difficulty expressing his feelings to others. He is often irritable
and short-tempered. He is anxious in social settings and is prone to
panic attacks. The veteran is very socially isolated individual with
little emotional connection to people other than his wife and
daughters. The veteran's severe deficit in social functioning is
the
direct result of trauma related symptoms associated with Post
Traumatic
Stress Disorder.
b. Relevant Occupational and Educational history:
Veteran has not furthered his education since his previous
examination.
At the time of his last examination the veteran was employed by Amazon
as a production manager. He said that he lost his temper at work and
threatened several employees in October 2009. He said that this was
his second time that he had lost his temper and made threats toward
employees. The veteran was fired from Amazon in October 2009.
Veteran stated that he started working as a chemist at the United
States Mint at West Point in February 2010. He stated that he has had
difficult getting along with other employees. Veteran stated that he
typically isolates himself at work and tries to avoid any contact with
co-workers. Veteran stated that he has been repirmanded for losing
his
temper several times at work. Veteran stated that he also has
difficulty sustaining his concentration at work. He says that he has
often had to run the same tests several times because he forgets
important steps in the processes. Veteran stated that he has been
reprimanded about the slowness of his work.
Veteran stated that he has not been at work since his suicide attempt
of 6/25/14. He says that he feels too anxious and depressed to return
to work. Veteran stated that he will likely have to attempt to return
to work in the near future. The veteran is not sure that he will be
able to funtion effectively in the workplace.
In summary, since his last examination the veteran has displayed a
severe deficit in vocatio
nal functioning. He has been fired from one
job due to his inability to control his anger at work. He has had
extreme difficulties on his current job getting along with co-workers
due to high levels of anxiety and anger. He has difficulty sustaining
conentration and has difficulty completing assignments in a timely
manner. It is unclear if this veteran will be able to successfully
return to work in the near future. The veteran's severe deficit
in
vocational functioning is the direct result of trauma related symptoms
associated with Post Traumatic Stress Disorder.
c. Relevant Mental Health history, to include prescribed medications and
family mental health:
Veteran is presently under the care of a psychiatrist and receives the
following medications: Buspirone 15mg three times a day, Fluoxetine
60mg once a day, Hydroxyzine 25mg twice a day, Prazosin 2mg at bedtime
and Quetiapine 75mg at bedtime. The veteran receives individual and
group psychotherapy on an outpatient basis. Veteran stated that he is
compliant with his medications and experiences no major side effects.
Veteran has had three psychiatric hospitalizations at the Franklin
Delano Roosevelt (FDR) VA Hospital. Veteran was hospitalized from
7/2/14 through 7/21/14 after a suicide attempt. He was hospitalized
again from 7/31/14 through 8/6/14 for suicidal ideation. The veteran
was admitted again on 8/19/14 and successfully completed the Vietnam
Veterans Evaluation and Treatment Program (VVETP)for treatment of Post
Traumatic Stress Disorder on 10/2/14.
Veteran sleeps only a few hours a night due to combat related
nightmares. He has intrusive thoughts about Iraq. He has difficulty
expressing his feelings to others. He is often irritable and
short-tempered. Veteran is easily distracted and often loses his
train
of thought. He often scans his environment. He is agitated by loud,
unexpected noises.
Veteran stated that he experiences these symptoms on a daily basis.
He
says that the symptoms are severe. Veteran stated that he rarely goes
a day without experiencing these symptoms.
d. Relevant Legal and Behavioral history:
Veteran has not been arrested or received a DWI since his last
examination. The veteran has not been assaultive since his last
examination. Veteran attempted suicide on 6/25/14. He stated that he
was very depressed and was arguing with his wife. The veteran cut his
wrists several times.
e. Relevant Substance abuse history:
Veteran stated that he drank about three beers a day prior to his
suicide attempt. The veteran has not drank alcohol since his suicide
attempt. The veteran does not use illegal drugs.
f. Other, if any:
None.
3. PTSD Diagnostic Criteria
---------------------------
Please check criteria used for establishing the current PTSD diagnosis. The
diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual
of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to
combat, personal trauma, other life threatening situations (non-combat
related stressors.) 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 #6 - "Other
symptoms".
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, 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] Irritable behavior and angry outbursts (with little or no
provocation) typically expressed as verbal or physical
aggression toward people or objects.
[X] Reckless or self-destructive behavior.
[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] The duration of the symptoms described above in Criteria
B, C, and D are more than 1 month.
Criterion G:
[X] The PTSD symptoms described above cause 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.
4. Symptoms
-----------
For VA rating purposes, check all symptoms that actively apply to the
Veteran's diagnoses:
[X] Depressed mood
[X] Anxiety
[X] Suspiciousness
[X] Panic attacks more than once a week
[X] Near-continuous panic or depression affecting the ability to function
independently, appropriately and effectively
[X] Chronic sleep impairment
[X] Mild memory loss, such as forgetting names, directions or recent
events
[X] Flattened affect
[X] Impaired judgment
[X] Impaired abstract thinking
[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
[X] Impaired impulse control, such as unprovoked irritability with
periods
of violence
5. Behavioral Observations:
---------------------------
The veteran is a 34 year-old white male of short staturee and slender
build. He was straightforward in his responses and a good rapport was
established between the veteran and the examiner. The veteran was
oriented in all three spheres. His affect was flat and his mood was
tense
and sad. The veteran had difficulty sitting still and squirmed in his
chair and often tapped his feet. He displayed a mild deficit in
short-term memory. His long-term memory was intact. The veteran did not
exhibit any symptoms indicative of a formal thought disorder.
6. Other symptoms
-----------------
Does the Veteran have any other symptoms attributable to PTSD (and other
mental disorders) that are not listed above?
[ ] Yes[X] No
7. Competency
-------------
Is the Veteran capable of managing his or her financial affairs?
[X] Yes[ ] No
8. Remarks, (including any testing results) if any:
---------------------------------------------------
Veteran is a 34 year-old white male that is presently 70%
service-connected for Post Traumatic Stress Disorder. The veteran
continues to meet the DSM-5 criterion for Post Traumatic Stress Disorder.
The veteran displays a severe deficit in both social and vocational
functioning. These deficits are the direct result of trauma related
symptoms associated with Post Traumatic Stress Disorder.
The prognosis for this veteran is unclear. He has just recently
completed
an residential treatment program for Post Traumatic Stress Disorder. He
appears very anxious and fragile at this time. The veteran is having
difficulty in his marriage and is unsure about his ability to maintain
employment. It is hoped that with continuing mental health services that
the veteran can develop the skills necessary to effectively control his
trauma related symptoms. If he can do so, he may begin to strengthen his
marriage and return to work and begin to lead a more enjoyable and
productive life.
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an older post from USMC_HVEQ, atates as follows:

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

Being that the examiner elected the option that generally accompanies a 70% rating for ptsd, in which you already have a 70% rating in, may prove challenging. Hopefully, ( and Im sure) an elder here has more info on resources to assist you with an increase.

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As long as you are working you probably won't get 100% for PTSD. I would not quit my job just to try and get 100%. It could take years. If you become unable to work that's different. Then file for SSDI and TDIU if you want a faster result.

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I find it strange that the examiner marked the box which corresponds to the 70% rating but they repeatedly said "severe". The MH hospitalizations, you would think, would be enough for them to mark the 100%. Hopefully you will get a good rater who takes the time to read everything the examiner wrote along with the rest of your medical file. The only thing I can come up with is perhaps because you still have a job...

Keep us posted when you get your decision.

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