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

[Navy4life]

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 November 13, 2014 by Navy4life

[Pete53]

Good Luck

[Mikemmlj]

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

[Navy4life]

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.

[Navy4life]

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

Thanks

[Navy4life]

I would much appreciate some feedback.....

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?

[NavyWife]

The most important thing that I got out of these two results are that the C&P examiner felt that the symptoms were not severe enough to meet the criteria for an official diagnosis of PTSD

but that your therapist felt that IT IS severe enough and gave you an official diagnosis of PTSD.

As you know, an official diagnosis is required for any issue to receive a rating.

So I think this is very good news!

The C&P examiner diagnosed it as , "Other Specified Trauma and Stressor Related Disorder (subclinical

level of PTSD)". Whatever the hell that means… I don't think there's even a rating code for that.

But then the therapist talked about adding depression into the mix. So I'm kind of wondering if they will want to schedule another C&P exam for depression or just put that on the back burner for now.