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

[Victor_C3]

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.

[Victor_C3]

You're still on the job with a 100% schedular rating for PTSD? Take care of yourself and keep up with the therapy man, that's the main thing. Maybe give Social Security a call and tell them about your situation and ask if you still being employed is going to affect their decision. It will all work out man, you're in a spot that I was recently in. Never give up.

Yes, I'm still on the job with my 100% schedular rating for PTSD. However, I only got the rating Tuesday.

I gave the SSA people a call and they said that what could happen is they might adjust the date I claimed I was disabled so long as my medical evidence was pretty strong (which it is). I'm contesting 25 June 2014 (the date of my suicide attempt) as the date I wasn't able to work anymore.

Thanks for your comments.