ptsd Looking For Help Interpreting An Initial Ptsd C&p Exam

[dritz77]

I pasted a sanitized version of my c&p I got from my heathevet. I tried to marry it up with the rating percentages on the compensation chart but I seem to have symptoms from 10, 30, 50 and 70 percent thresholds. Any help guessing at the rating level would be appreciated.

Thanks

Does the Veteran have a diagnosis of PTSD that conforms to DSM-5Criteria based on today's evaluation?[X] Yes [ ] No

ICD code: 309.812.

Current Diagnoses--------------------a. Mental Disorder Diagnosis #1: PTSD with dissociative symptoms (derealization)

ICD code: 309.81 4.

Occupational and social impairment--------

Which of the following best summarizes the Veteran's level ofoccupational and social impairment with regards to all mental diagnoses?(Check only one)

[X] Occupational and social impairment with reducedreliability and productivity

5. Symptoms-----------For VA rating purposes, check all symptoms that actively applyto theVeteran's diagnoses:

[X] Depressed mood

[X] Anxiety

[X] Suspiciousness

[X] Panic attacks that occur weekly or less often

[X] Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively

[X] Impairment of short- and long-term memory, for example,retention of only highly learned material, while forgetting tocomplete tasks

[X] Disturbances of motivation and mood

[X] Inability to establish and maintain effectiverelationships

Behavioral Observations-------------------

During the interview, veterans appearance and grooming wereunremarkable. He looked physically tense. When asked to describe stressor events, he became mildly agitated and upset, and he asked for a few minutes to calm down before the interview continued. He was alert and oriented to time, person, and place. He spoke in an organized, logical,coherent, and relevant manner, displaying a full range of appropriate affect.He expressed some anger and frustration at being offered another course of exposure-based therapy when CPT had not been effective, and he also expressed anger at recent events in Iraq. He asked me what the odds were that his PTSD would never get better, which is a question I was unable to answer (I did encourage him to continue seeking treatment). There were no indications of psychosis, such as delusions, hallucinations or paranoia.

The veteran fully meets DSM-5 diagnostic criteria for PTSD With Dissociative Symptoms (Derealization), which is as least as likely as not the result of a fear of hostile military or terroristactivity stemming from his two deployments to Southwest Asia.

Although the veteran's VA providers rated his GAF score as 60or 65 ("Moderate symptoms OR any moderate difficulty in social,occupational, or school functioning"), one provider also noted the veteran'suse of clich?s and minimizations in describing his functioning and history.These verbal behaviors are best understood as characteristic of PTSD, in that alexithymia (i.e., difficulty in finding words to identifyfeelings, and associated emotional numbing). Furthermore, in my opinion, a score of 60-65 is overly optimistic, given the veteran's current report concerning occupational and social functioning. Specifically, he had a verbal outburst at a supervisor, has had anger issues that have caused his wife to leave him twice in the past and which are still at a serious level, has distanced himself from family, has no friends or social activities, has depressed mood and anhedonia daily, and has failed to complete simple tasks at work due to distractibility associated with PTSD. If the GAF score were in use as part of DSM-5, a GAF score of 35-40 would be appropriate ("Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations,judgment,thinking, or mood).The following opinions reflect impairments stemming solelyfrom PTSD and not from any other conditions that may be present:The veteran is considered fully capable of managing funds inhis own best interest.

His ability to understand and follow instructionsis considered not impaired. His ability to retain instructions as well as sustain concentration to perform simple tasks is considered mildly impaired. His ability to sustain concentration to task persistence and pace is considered mildly impaired. His ability to respond appropriately to coworkers, supervisors, or the general public is considered moderately impaired. His ability to respond appropriately to changes in the work setting is considered not impaired. His ability to acceptsupervision and criticism is considered not impaired. His ability to accept criticism is considered moderately impaired. His ability to be flexible in the work setting is considered not impaired. His ability to work in groups is considered not impaired in small groups, but markedly impaired in larger groups (the veteran currently works at night and does not deal with large groups at work). His ability for impulse control in the work setting is considered moderately impaired with respect to verbal outbursts but not impaired concerning physical aggression. The veteran's ability to sustain meaningful interpersonal relationships is profoundly impaired.

The current level of functioning should not be considered permanent, since further treatment may alter the veteran's symptoms

[Berta]

It is hard to know what VA will do and I hesitate to even guess on ratings but this doc made an important point:

"If the GAF score were in use as part of DSM-5, a GAF score of 35-40 would be appropriate "

I think between 30 to 50 %...because of that statement but VA isn't using GAF these days so I assume they wont use this GAF score either:

"Although the veteran's VA providers rated his GAF score as 60 or 65"

Do you feel that the exam results reflected your disability level?

Once you get a rating ( I am sure you will) you can appeal it if you feel it is too low.

[john999]

I see 30-50%. I see the exam doctor did not discuss the symptoms of your dissociative reaction. I had that reaction for some years after Nam. Derealization and depersonalization are the weirdest symptoms and scary also. That is your minds last stand. Your mind sort of splits off from your emotions to save your sanity. You feel like you are in a dream. You are watching yourself go through the motions, but nothing seems real. Since you are able to work that makes all the difference. If you had the same symptomology and were unable to work you would have 70-100%. Not that I recommend quitting your job.

[Patrick428]

dritz77,

My only concern is the C and P examiner is referencing GAF scores on previous and likely outdated C and P exams. If you do not know, the GAF scale is no longer a part of DSM-5 nor is the Axis system for diagnoses. What concerns me is by referencing a GAF score, it may lead the rater to consider the GAF score as some indication of how a claim should be rated. Essentially, undo influence that is not supported in the new DSM-5. Back in the day this was a common approach to rating a claim. Much easier to do than reading the entire C-file. I've kept this formula for several years and is no logner to be used by any rating officer in determining a disability rating for mental health :

"The rule of thumb for the amounts the VA assigns for psychiatric disabilities is/was:

GAF Percentage

0-40=100%
41-50=70%
51-60=50%
61-70=30%
71-80=10%
81-100=0%

Patrick

[Berta]

Yeah those GAF scores concerned me too Patrick.

I am surprised the examiner even mentioned them.

The chart makes sense.

[Gastone]

Dritz: The GAF score can be all over the map. I've read regarding the reason that DSM V places little to no enfcince on it, 5 diff Clinicians can come up with 5 different GAF scores, o dont't worry.

As to your eventual rating 30% or 50%, I think you have both of those covered by your DBQ. However,if you (which I did) compare your PTSD C&P DBQ against the 38 CFR 4 for PTSD, Dr Gastone thinks your a lock on 70% SC. Back in 2011, my VA mental health clinician had me at 58-61 GAF. The VA Staff Psychiatrist that did my C&P DBQ had me at 52. The Rater will look at your complete C&P DBQ. I ended up with a 70% SC and I think you will too. Start thinking about filing a claim for your "Inferred IU Claim."

Semper Fi

Gastone

[john999]

I had a GAF of 50 back in 2002. I got 70% but I was on SSDI and retired from my job on disability. I think that the fact a vet can hold a job is the key to the rating system for PTSD or any mental condition. That was usually the first or second question C&P exam doctor's adked me was "Are you working?" The question before that was " Are you hearing voices, or seeing things?" However you answer that you lose. People who hear voices and have hallucinations don't believe these things are odd. They would probably deny them. Then the VA doctor says "Vet denies vision or audio hallucinations". I remember describing dissociative symptoms, and the VA doctor said "Schizophrenia" which was wrong. The dummy! In all the years I have been examined at the VA I never had an MMPI or any sort of reliable test for emotional disorder. Just the "impression" of some quack VA doctor, or exam doctor/whore. You just have to get all the buzz words and buzz phrases in line and you are home. It is a terrible system. About 10,000 RVN vets probably went to the VA for PTSD and were diagnosed with PD's, anxiety and/or depression not related to service. I got 10% for schizophrenia. Schizophrenia is the cancer of mental health conditions. The DX in 1972 was grim. " 10% veteran, and be thankful for that you potential freeloader. We don't like your kind, and we know just how to deal with you".

John