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  • Trouble Remembering? This helped me.

    I have memory problems and as some of you may know I highly recommend Evernote and have for years. Though I've found that writing helps me remember more. I ran across Tom's videos on youtube, I'm a bit geeky and I also use an IPad so if you take notes on your IPad or you are thinking of going paperless check it out. I'm really happy with it, I use it with a program called Noteshelf 2.

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  • 14 Questions about VA Disability Compensation Benefits Claims

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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Most Common VA Disabilities Claimed for Compensation:   

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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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    • So, my lawyer sent an IME w/ IMO and filed a supplemental claim solely for IU on March 20.

      It was closed on March 25, and va.gov just states claim closed and nothing more.

      Hopefully, I get good news.
    • Thanks for the responses. I am filing a new claim but will continue pushing the NOD. My new question is it stated in law or statute that if during the claims process the VA finds conditions that could possibly rate service connection that was not originally filed for, the VA will “invite” the veteran to file the claim on the claims form. Reason I ask is that my private DBQs, NEXUS letter, and even the VA nurse examiner's DBQs lists bilateral upper radiculopathy as present. If it is written in statute or official guidance it might qualify as a CUE. Just looking at all angles. 
    • Everyone needs to read our stories so they can try to avoid these screws by the va...
      Thank you, everyone contributes, good or bad, all of our stories will help others, and yes, they have been stated by others for ages, over and over, but we just get depressed, and the time turns into years as they screw us..

      Welcome to the department of Veterans Affairs!  I can honestly say, "been there, done that".  

      Even after winning my tdiu in 2017, it was back to the drawing board as VA hornswaggeld my effective date.  (but of course).  

      I finally won my tdiu effective date in Feb. 2020, 18 years after I first applied!!!  

      Here is how they managed to drag mine out 18 years:

      1.  They never adjuticated my decison until 2009, where they called it "moot".  

      2.  I appealed, said it was not moot because it could result in an earlier effective date and SMC S under Bradley vs Peake.  The judge agreed with me, and ordered VARO consider me for extra schedular TDIU, under 4.16 b.  

      3.  The VARO piddles with  the remand for 3 years, and hoped I wouldnt notice.  I noticed and raised cane until they adjuticated it.  (denied of course).  

      4.  Finally, after the baord denied again, I hired a lawyer, in 2014, and appealed to CAVC.   

      5.  The lawyer won a remand, got an IMO and I won tdiu in 2017.  But at the wrong effective date, even after 15 years.  

      6.  I hired another lawyer, Chris Attig, and appealed the effective date, and he won a remand for effective date.  Trip 2 to CAVC.  

      7.  Mr. Attig won a remand, and advised me to get another IMO.  

      8.  The board awarded my earlier effective date in Feb. 2020.  

           So, I do have advice fighting VA for TDIU, they fought and fought and I hung in there and won it all.  

      ADVICE:  Dont count on VA, they could easily throw your fax in the trash.  Follow up!  
    • "Keep in mind that due to the nature of the digestive system, VA would most likely combined your conditions and pay you at the higher rate to avoid pyramiding".    That is one of my main gripes.  They are only listing the GERD with hiatal hernia and ignoring the rest of my gastric issues such as the gastritis which I also had in service.  I included it in my 2007 request for increase and again in 2019.  The info from the civilian dr that stated I had the gastritis with H pylori was not even provided to the examiner in 2007, nor did he have my VA health records. The 2019 request was based on an EGD I had AT THE VA in Jan 2019.   I filed for an increase 6 Mar and they did an ACE on 27 Mar and downgraded to noncompensable on that date.  The only reason I was thinking CUE:  38 CFR § 3.326 - Under Examinations  it states (c) Provided that it is otherwise adequate for rating purposes, a statement from a private physician may be accepted for rating a claim without further examination".  
    • Enough has been said on this topic. This forum is not the proper forum for an attorney and former client to hash out their problems. Please take this offline
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Navy4life

C&p Results For Eating Disorder And Ptsd - What Do You Think?

Question

I figured out how to post my C&P exams to the board. I posted some of this in the MST forum but would like opinions as to what anyone thinks regarding my C&P for PTSD due to MST and my Eating Disorder C&P. I know now that the Eating Disorder (thanks to a nice member here on this forum) will be rated separately but I am more curious about the PTSD C&P exam. The examiner denies PTSD but goes on to say "veteran has another Mental Disorder diagnosis. Continue to complete
this Questionnaire and/or the Eating Disorder Questionnaire:"
Thank you for any and all input!
****************************************************************************************************************************************************************
Initial Post Traumatic Stress Disorder (PTSD)
Disability Benefits Questionnaire
* Internal VA or DoD Use Only *
Name of patient/Veteran: XXXXX
SECTION I:
----------
1. Diagnostic Summary
---------------------
Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria
based on today's evaluation?
[ ] Yes [X] 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 criteria
[X] Veteran has another Mental Disorder diagnosis. Continue to complete
this Questionnaire and/or the Eating Disorder Questionnaire:
2. Current Diagnoses
--------------------
a. Mental Disorder Diagnosis #1: Anorexia Nervosa, purging type due to MST
Comments, if any:
See Eating Disorder DBQ
Mental Disorder Diagnosis #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 diagnoses relevant to the understanding or management of the
Mental Health Disorder (to include TBI): ankle pain
Comments, if any: fracture of ankle and injury of ankle inservice after
syncope episode secondary to excessive compensatory behaviors
3. Differentiation of symptoms
------------------------------
a. Does the Veteran have more than one mental disorder diagnosed?
[X] Yes [ ] No
b. Is it possible to differentiate what symptom(s) is/are attributable to
each diagnosis?
[X] Yes [ ] No [ ] Not applicable (N/A)
If yes, list which symptoms are attributable to each diagnosis and
discuss whether there is any clinical association between these
diagnoses:
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 to individual blame are
directly related to Veteran's Other Specified Trauma-and
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.
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 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?
[X] Yes [ ] No [ ] No other mental disorder has been diagnosed
If yes, list which portion of the indicated level of occupational and
social impairment is attributable to each diagnosis:
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 to individual blame are
directly related to Veteran's Other Specified Trauma-and
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.
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
theTBI?
[ ] 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?
[X] Yes [ ] No
If yes, list any records that were reviewed but were not included in the
Veteran's VA claims file:
C-file reviewed via VBMS/Virtual VA
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?
[X] Yes [ ] No
If yes, describe:
2. History
----------
a. Relevant Social/Marital/Family history (pre-military, military, and
post-military):
Prior Military: Veteran was raised by her mother until she was 11
years old. At that time her mother remarried, resulting in her gaining an
older step-sister and a step-father. She described her relationship
with her mother, step-sister and step-father as good. "He was the
father I never had." Veteran denied any childhood sexual or physical
abuse. She further reported having a normal childhood, overall. She
reported engaging in normal childhood activities including various
sports. Veteran denied getting married or having any children before
enlisting in the military.
During Military: Veteran reported maintaining contact with her family.
She also reported getting along well with other service persons.
Initially, during her leisure time she reported spending time with
other military personnel and engaging in various social activities.
However, shortly after boot camp, she reported a reduction in engaging
in social activities secondary to her obsession with focusing on
weight loss. Details will be provided in an eating disorder DBQ. Veteran
reported getting married to her first husband in September 1990. To
this union a child was born in June 1991. Shortly after their child
was born, Veteran and her husband divorced. She attributed their divorce
to them both being too young. Veteran remarried in December 1993. To this
union her second child was born in February of 1996.
Post Military: Veteran and her second husband were divorced in 2003
secondary to irreconcilable differences. Despite divorce, she reported
maintaining a good relationship with her children. She is currently in
a romantic relationship with her partner of 2 years. They have been in
a relationship, which she describes as good, since 2012. During her
leisure time she reported exercising 3-4 times for about an hour,
spending time with friends, watching sports, and taking care of their
dog.
b. Relevant Occupational and Educational history (pre-military, military,
and
post-military):
Prior Military: Veteran reported graduating from high school on time
and receiving and diploma. She reported maintaining a B average and
denied being diagnosed with any learning or developmental
Veteran denied any behavioral problems resulting in her being
suspended or expelled from school. She reported participating in volleyball,
track, softball, and the drama club. Veteran reported working at Sea
World while in school and denied being terminated or reprimanded.
Veteran reported completing one semester of college before enlisting
in the military. "I flunked out. My father gave me the option of
going to college or joining the military."
During Military: Veteran served active duty in the US Navy from May
1990 - April 1996. Her MOS was Intel Specialist. She was honorably
discharged as an E3 and denied any reduction in rank or pay. She
denied receiving any Article 15s or negative counseling statements. In boot
camp Veteran reported being berated for being overweight, which
continued throughout her military service. This beratement had a
negative impact on her emotional well-being. Veteran reported not
being able to perform her job as she should and an increased amount of
undocumented sick call visits in 1991-1993 secondary to MST,
subsequent eating disorder, syncope and breaking of ankle due to compensatory
behaviors utilized to control her weight.
Post Military: Veteran attended and completed paralegal school. She
reported working multiple jobs as an executive assistant and parlegal
secondary to relocations. She denied ever being terminated or
reprimanded. Veteran is currently working as a paralegal at Jaderisk,
where she has worked for a year since she moved to Texas.
c. Relevant Mental Health history, to include prescribed medications and
family mental health (pre-military, military, and post-military):
Prior Military: Veteran denied any personal or family history of any
mental health disorder to which she is aware. She denied any personal
or family history of suicide attempts. Veteran also denied any
personal or family history of alcohol or drug addiction to which she is aware.
During Military: Service treatment records dated Septebmer 1994,
documented that Veteran was referred to the Psychology Clinic in
Bethesda secondary to stress and signficant weight loss (approximately
30 pounds since February 1994). Service treatment records also confirm
multiple episodes of unexplained syncope, ankle injuries, in addition
to episodes of eating disorders and subsequent weight loss beginning
in 1990s. During the current evaluation, Veteran reported multiple
incidents of sexual harrassment after being transferred to Water Front
Operations in San Diego, beginning in September of 1992. She further
reported that harrassment eventually progressed to a sexual assault
(rape) occuring in November 1992. Service treatment records also
document Veteran's pregnancy and subsequent miscarriage in
December 1992. During the current evaluation, Veteran reported that the
pregnancy was the result of the MST occurring in November 1992.
Veteran reported the following symptoms after the MST: difficulty
initating and staying asleep secondary to her fear of having
nightmares about MST. She additionally reported having a significant amount of
difficulty sleeping secondary to taking laxatives excessively
resulting in her having to use the restroom throughout the night and thoughts
about controlling her body weight. She also reported experiencing
anxiety, which she described as being fidgety, restless and unable to
stay calm and racing thoughts about loosing weight. "I was
constantly thinking about loosing weight. I was so engrossed in it. I constantly
weighed myself and had been exercising too much over not eating. I
couldn't get myself to throw up. But I could get myself to have
loose stools."
Post Military: Electronic records confirm that Veteran came to the VA
as a walk-in through MH triage secondary to eating disorder issues in
June 2014. She reported being depressed a couple of times a week in
addition to the MST. The following diagnosis were given during her
mental health history in July 2014: Anorexia nervosa with restricting
and purging behaviors, mild BMI is 22.81 and Generalized Anxiety
Disorder. It was also suggested that the following diagnosis be ruled
out: PTSD due to MST, Unspecified depressive disorder with OCPD traits.
Veteran was initially prescribed Fluoxetine (Prozac), Hydroxyzine,
and Trazadone to manage her symptoms. Hydroxyzine was discontinued, but
Veteran continues to take Prozac and Trazadone as prescribed.
Veteran experiencing the following symptoms: anxiety about her weight
and thoughts about the MST, difficulty initiating and maintaining
sleep secondary to racing thoughts about MST and weight, excessive use of
laxatives to manage weights, intermittent depressed mood which she
describes as crying and withdrawal. She reports that it may last 2-3
days a week. Please note, that with regard to sleep CPRS records
document that Veteran is sleeping well with Trazadone. Therefore,
nightmares likely occur to a minimal degree at this time. "It
just depends on if I am thinking about it. I try to block it out. But I
knowthat going through therapy now I am going to have to deal with the
issues." She also reported feeling guilty and the MST. "I
sometimes feel as if it was my fault." She also reported becoming angry,
which she describes as being emotionally angry. "I don't lash out
at any other people. But I am angry at myself for having the eating disorder,
but I am afraid to get fat. I am just emotional when I think about the
sexual trauma. She denied major difficulty concentrating or manic
symptoms. Veteran also reported continuing to have a significant
amount of sadness because of the miscarriage. "Regardless of how it was
conceived. I still have sadness because I lost my baby. Those thoughts
will never leave my mind."Veteran denied SI/HI, AVH, psychiatric hospitalizations.
d. Relevant Legal and Behavioral history (pre-military, military, and
post-military):
Veteran denied any legal or behavioral problems, before during or
after
military.
e. Relevant Substance abuse history (pre-military, military, and
post-military):
Veteran denied use of illegal drugs before during and after military
service. She acknowledged occassional use of alcohol but denied abuse.
She also denied receiving any DWIs, DUIs public intoxications, or
attendance at any substance abuse treatment programs. Veteran also
denied anyone ever telling her that she drank too much and needed to
cut back.
f. Other, if any:
No response provided.
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: Veteran reported that in September of 1992, omitted
the statement here to graphic and too personal....
Does this stressor meet Criterion A (i.e., is it adequate to support
the diagnosis of PTSD)?
[ ] Yes [X] No
Is the stressor related to the Veteran's fear of hostile military
or
terrorist activity?
[ ] Yes [X] No
If no, explain:
non-combat related
Is the stressor related to personal assault, e.g. military sexual
trauma?
[X] Yes [ ] No
If yes, please describe the markers that may substantiate the
stressor.
1) December 1992, documented pregnancy and miscarriage.
2) Reported attempts and documentation of her going to sick
call,for miscarriage. Veteran also reported multiple sick call visits that are
undocumented in order to avoid her perpetrator.
3) Reported documentation of significant loss of body weight
over
short periods of time
---loosing 20 pounds over in boot camp, which lasted 6-8 weeks,
loosing 62 pounds over 5 months after birth of her daughter.
4) December 1991 seen in emergency room secondary to syncope,
fractured ankle secondary to excessive use of compensatory
behaviors to lose weight.
5) Service treatment records dated Septebmer 1994, documented
that Veteran was referred to the Psychology Clinic in Bethesda
secondary to stress and signficant weight loss (approximately 30
pounds since February 1994).
b. Stressor #2: In November 1992, Veteran and her supervisor (1st class
petty
officer) again omitted the statement here as too graphic and personal but this
is where I provided the details of the attack/rape
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?
[ ] Yes [X] No
If no, explain:
non combat related
Is the stressor related to personal assault, e.g. military sexual
trauma?
[X] Yes [ ] No
If yes, please describe the markers that may substantiate the
stressor.
1) December 1992, documented pregnancy and miscarriage.
2) Reported attempts and documentation of her going to sick
call,
for miscarriage.
Veteran also reported multiple sick call visits that are
undocumented in order to avoid her perpetrator.
3) Reported documentation of significant loss of body weight
over
short periods of time
---loosing 20 pounds over in boot camp, which lasted 6-8 weeks,
loosing 62 pounds over 5 months after birth of her daughter.
4) December 1991 seen in emergency room secondary to syncope,
fractured ankle secondary to excessive use of compensatory
behaviors to lose weight.
5) Service treatment records dated Septebmer 1994, documented
that Veteran was referred to the Psychology Clinic in Bethesda
secondary to stress and signficant weight loss
(approximately 30 pounds since February 1994).
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)
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).
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).
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).
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
[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 #2
5. Symptoms
-----------
For VA rating purposes, check all symptoms that actively apply to the
Veteran's diagnoses:
[X] Depressed mood
[X] Anxiety
[X] Chronic sleep impairment
6. Behavioral Observations
--------------------------
Veteran arrived promptly for her scheduled evaluation. She self-identified
as
a 43 year old Caucasian female who appeared her stated age. Her grooming and
hygiene were good. Her posture and gait were unremarkable. She maintained
good eye contact. There were no abnormalities noted in psychomotor activity
or gross motor activity. She was cooperative with no inappropriate behavior
observed. Her rate and flow of communication was clear, logical, and
coherent
with no indications of irrelevant, illogical, or obscure speech patterns.
Thought processes were clear, coherent and goal directed. Thought content
was
unremarkable and void of any perceptual or delusional disturbances. The
veteran's mood was anxious and her affect was of full range. Veteran
became
tearful when discussing her military experiences including the military
sexual trauma and constant beratement related to her weight. She denied
current SI/HI.
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 restulted 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 prescense 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.
NOTE: VA may request additional medical information, including additional
examinations if necessary to complete VA's review of the Veteran's
application
******************************************************************************************
*** COMP & PEN MENTAL HEALTH/PSYCHOLOGY EXAM Has ADDENDA ***
Eating Disorders
Disability Benefits Questionnaire
Name of patient/Veteran: XXXXXXX
1. Diagnosis
------------
Does the Veteran now have or has he/she ever been diagnosed with an eating
disorder(s)?
[X] Yes [ ] No
[X] Anorexia
Date of diagnosis: 1992
ICD code: 307.1
Name of diagnosing facility or clinician: U.S. Military diagnosed
eating disorder and VANTXHCS diagnosed Anxorexia Nervosa binging/purging
type
2. Medical history
------------------
Describe the history (including onset and course) of the Veteran's
eating disorder (brief summary):
Veteran reported being constantly berated secondary to her weight in boot
camp. As a result, in August/September 1990 she began engaging in
compensatory behaviors to manage her weight including laxatives, food
restriction, and excessive exercising. Veteran was 178 pounds at the
beginning of boot camp, which lasts 6-8 weeks. At the end of boot camp
she was 158 pounds. Between June 1991 and December 1991 she lost 62 pounds
(200 to 138)through the use of diet pills, laxatives, exercise, and food
restriction after the birth of her daughter. In December 1991, service
treatment records also document an episode of fainting, which resulted in
her fracturing her ankle, which was secondary to eating behaviors. She
had another episode of syncope in 1993, which resulted in another injury to
her ankle due to weakness. In 1992, Veteran was hospitalized for a
complete shut down of her gastrointestinal system secondary to excessive
use of compensatory behaviors to keep her weight low. In 1994 Veteran was
referred to a psychology clinic in Bethesda secondary to stress and
eating disorder. Veteran currently takes 8-10 ducolax per day despite
restrictive eating behaviors. These behaviors induce approximately 6 loose stools per
day.
3. Findings
-----------
[X] Resistance to weight gain even when below expected minimum weight
[X] Without incapacitating episodes
4. Other symptoms
-----------------
Does the Veteran have any other symptoms attributable to an eating disorder?
[X] Yes[ ] No
If yes, describe:
Restriction of energy intake relative to requirements, leading to
significantly low body weight in the context of age, sex,
developmental trajectory, and physical health; intense fear of
gaining weight or of becoming fat, or persistent behavior that
interferes with weigh gain, even though at a significantly low
weight; distubance in the way in which one's body weight or
shape is experienced, undue influence of body weight or shape on
self-evaluation. Eating small amounts of food and taking 8-10 laxatives
(Ducolax) a day to prevent weight gain; history
of loosing 62 pounds in 5 months; 20 pounds in 6-8
weeks during boot camp; emergency room visits seconday to syncope
and subsequent fractured ankle as a result of extreme weight loss via laxatives, lack of food and
energy.
5. Functional impact
--------------------
Does the Veteran's eating disorder(s) impact his or her ability to
work?
[X] Yes[ ] No
If yes, describe impact, providing one or more examples:
Veteran has approximately 6 loose stools a day secondary to
excessive use of laxatives. Though she can continue to work a full
time job, her productivity may be negatively impacted by
consistent
diarrhea.
6. Remarks, if any:
-------------------
Veteran's current diagnosis of Anorexia Nervosa, purging type, is
most
likely incurred in 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 sought 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 Nervosa is most likely
related
to military sexual trauma and berating of Veteran due to her weight beginning in
boot camp.
Rationale: There was an increase in purging behaviors and subsequent
hospitalization after military sexual trauma, subsequent pregnancy and
miscarriage in 1992. Refer to Initial PTSD DBQ for additional markers.
Edited by Navy4life

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Good Luck

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Sounds like you deserve a higher rating than they're proposing.

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Went to my first therapy appointment for treatment assessment and saw my notes from the visit in myhealthyvets. Here is the diagnosis part of the evaluation. What do you think of this? Does it sound like she thinks I am suffering from PTSD/MST?

I am still waiting to get S/C for both my Eating Disorder and my PTSD/MST

*************************************************************************************

ASSESSMENT OF PTSD
DSM-5 Stressor Criterion: Exposure to actual or threatened death, serious
injury, or sexual violence in one of the following ways:
1) directly experiencing the traumatic events(s)
2) witnessing, in person, the event as it occurred to others
3) learning that the event occurred to a close family member or close friend
(actual or
threatened death must have been violent or accidental in these cases)
4) experiencing repeated or extreme exposure to aversive details of the
traumatic events (in person, not through electronic media)
Based on Index trauma listed earlier: MST
[X] Yes, criterion above met
[ ] No, criterion above not met
Symptom Onset: Immediately or shortly after traumatic exposure (within six
month time period)
Symptom Duration: Trauma experience to present
Remissions: Denied
Intrusive Symptoms (one or more):
[X] recurrent, involuntary and intrusive distressing memories
[X] recurrent distressing dreams - nightmares will be about lost
pregnancy (her perpetrator did not know about the pregnancy). She feared him
and so she did not want him to know; he left her alone after she
[ ] feeling/acting as if the traumatic event were recurring
(flashbacks)
[X] intense distress at exposure to cues that resemble event
[X] physiological reactivity on exposure to cues
Persistent Avoidance (one or both of the following):
[X] avoidance of distressing thoughts, feelings, memories
[X] avoidance of external reminders (people, places, memories) - will
avoid sleeping in the bed; more comfortable on the sofa
Negative alterations in cognitions and mood (two or more):
[ ] Inability to remember important aspects of the events
[X] Persistent and exaggerated negative beliefs
("I am bad." "No one can be trusted.")
[X] Persistent, distorted cognitions about the cause or consequences
of the traumatic event(s) that lead the individual to blame himself /herself
or others.
[X] diminished interest/participation in activities
[X] feelings of detachment/estrangement from others
[X] persistent inability to experience positive emotions
Alterations in arousal and reactivity (two or more):
[X] Irritable behavior
[ ] Reckless or self-destructive behavior
[ ] Hypervigilance
[X] Exaggerated startle response
[ ] Problems with concentration
[X] Sleep disturbances (difficulty falling/staying asleep)
[X] Symptoms have lasted more than one month
[X] The disturbance causes clinically significant distress or impairment
in
social, occupational, or other important areas of functioning.
PTSD Symptoms are:
[ ] with dissociative symptoms
[ ] with delayed expression
ASSESSMENT OF DEPRESSION:
[X] Five (or more) of the following Sx present for the same 2 week
period
and represent a change from previous functioning. At least one of
the
symptoms is either depressed mood loss of interest/pleasure
[X] Depressed mood daily
[X] Diminished interest/pleasure in activities
[X] Increase/Decrease in appetite
[X] Insomnia
[ ] Psychomotor agitation/retardation
[X] Fatigue/loss of energy
[X] Feelings of guilt
[ ] Poor concentration/indecisiveness
[ ] SI, plan or attempt (see Suicide Risk Assessment)
She reported no history of suicidal ideation or history of suicide attempts
[X] Symptoms not consistent with a mixed episode
[X] Symptoms have caused clinically significant distress or impairment
[X] Symptoms are not due to medical condition or substance use
[X] Symptoms are not better accounted for by bereavement

****************************************************************************************

DIAGNOSIS
She has an established diagnosis of Anorexia Nervosa, binge-eating/purging type
PTSD secondary to MST (while it is the opinion of this writer that the patient
does met DSM 5 criteria for PTSD, this writer does agree with the Comp &
Pen
Examiner that the prominent symptoms are Anorexia Nervosa). Furthermore, she
did endorse symptoms of depression but more information will need to be gathered
from her in order to determine if a separate Mood Disorder will need to be added
to her existing diagnoses. She is currently on antidepressant medications.
However, her prominent symptoms are consistent with Anorexia Nervosa and second
are her symptoms of PTSD related to the MST.

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Can anyone answer my above ^^^^^^^^^^ - I would love feedback!

Thanks

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I would much appreciate some feedback..... :smile:

The original post was my C&P exam for my claims and then the post above was my visit with my therapist....

Any opinions please?

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