ptsd Notes From My 3Rd Visit With My Psychologist

[asheth007]

I am service connected for inflammatory myopathy which is what polymyositis is. When I was doing my initial setup for my va and clams through PEB. The guy asked me if I wanted to claim adjustment disorder. I was like what is that? He said it means you have a hard time adjusting to stuff. I was like I don't know what that is. It wasn't a doctor just the IDES/VA guy setting up the paperwork for my claims. I didn't know in my medical records that I was diagnosed with adjustment disorder in 2009. I had just did a PDHRA and told them how I was feeling. I had another visit in 2010 and it states that my adjustment disorder isn't as bad. I had never looked over my medical records until recently so I didn't know it was even in there. There is isn't a claim for this in yet.

My mental health problem codes are:

Adjustment Reac W/Mixed Emotion (ICD-9-CM 309.28)

MDD, Single, Moderate (ICD-9-CM 296.22)

My Previous GAF was 53

Met with veteran for 55 minutes on 11/3/14 for scheduled follow-up to initial

MHARC assessment 10/9/14 for purposes of finalizing disposition.

Vet presents with his mother for the first 15 minutes, with whom vet continues

to live, and whom he relies on for caretaking as he continues to struggle with

mobility and ADL's due to Polymyositis. Today, vet presents as euthymic and

anxious, with full-range spontaneous affect, including tearfulness. He is

oriented, engaged, communicates clearly and is goal and future-directed. He

denies SI/HI.

Vet reports that he has started attending PT twice weekly through VA-outsourced

facility near his home. He has upcoming meeting with rheumatology later today to

prepare for rituximab injection therapy, scheduled to begin later this week. He

reports adherence to daily sertraline for mood and zolpidem for sleep as

directed. He is reminded about proper spacing of zolpidem doses. Vet now

ambulates using Rollator device, which vet reports is helpful in maintaining

better posture and balance. He has also been fitted with bilateral wrist splints

for carpal-tunnel related problems, which he reports is helpful for typing on

the computer, as he continues to progress with on-line college courses through

U. Phoenix in Business, toward Bachelor's degree.

Vet reports chronic LBP, rating 4 to 6 out of 10 on average, made worse by

rising from seated positions, He also complains of relatively new hip pain,

which he reports is ascribed to compensatory muscle behaviors.

Much of today's session is focused on accepting the uncertainty of his

condition and prognosis, and defusing from identification with his physical disability. He

is encouraged to maintain mental and physical structure, and he discusses

ambivalence about reconnecting with friends, as he has continued to isolate

socially.

Vet is informed that he will be contacted by Neurology/behavioral Medicine for

purposes of setting up individual therapy focused on adjustment issues related

to medical condition. He also needs to contact PP regarding setting up ongoing

psychotropic med mgmt, which is the location that he prefers.

Vet is encouraged to follow-up with this provider for any future

questions/referral needs.

Polymyosytis

Adjustment DO, Mixed

current GAF = 50

I am a little bit confused on the mental health claim process. I understand you can have multiple issues but you get one MH rating and it is usually the highest one rated since it is the most sever. Adjustment disorder is different than PTSD so I understand that. PTSD use to just be passed off as adjustment disorder. I have read something about the VA likes to give adjustment disorder diagnoses so that they can try to claim it happened prior to service. My mental health issues are all tied to my service connected disability. So I think I am good there.

So am I following along with how the VA looks at all this correctly so far? Do I need more evidence/visits with behavioral medicine/neurology and get there take on everything prior to submitting or do I have enough now? I have only been off active duty for 5 months

Edited November 6, 2014 by asheth007

[ArNG11]

I will give you my experience. You do not want your mental condition diagnosed as an adjustment disorder. That is a cope out in order to bail on a compensable condition. It sets you up as having a personality disorder which will most likely be put off as you having the condition prior to your service. Or in service which means either way no disability as this is not compensated. If you have anxiety or depression or both, PTSD, then those are compensable. If your service made it worse as in the condition pre existed then it can be compensated. But a personality disorder carries 0% , zero, zip, nada. JMHO

[asheth007]

Thanks for the feedback Arng11. What about my service connected disability? I do have MDD as a problem code related to my myositis. The Adjustment disorder seems to be something I don't want based on what I have read.

Not sure how to go about being diagnosed differently. All honesty is that my condition does make me depressed and I isolate myself because of the condition. I can't say that I have PTSD or that I feel that I really do. I just want to convey that it is my condition which is the source of my mental issues.

Is depression something totally seperate not associated it adjustment disorder?

[asheth007]

Also is behavioral medicine/neurology able to give a different diagnoses or is the most weight given to the psychologist and physchiatrist?

[john999]

I would claim depression if possible as a reaction to your service connected physical conditions. Forget adjustment disorder. That is what they use when the VA wants to avoid a PTSD claim. I was DX'ed and SC'ed for schizophrenia when I had PTSD and Dissociative Disorder This was back in 1972 and was just due to ignorance of the VA doctors and the fact there was no DX of PTSD. Now most of my MH problems are related to my physical conditions. I was suffering from symptoms of dissociative disorder way back in 1970 when military said I had a personality disorder. I have depression, sleep disorder, anxiety and residuals of PTSD these days. If I was physically well who knows where I would be now. You just can't separate the mental, emotional from the physical. The VA does this for rating purpose. It is a fraud and bad science.

John

[Pete53]

Adjustment disorder is code for personality disorder not compensable unless it is secondary to a mood disorder

[ArNG11]

They have been doing this for decades. The docs now the difference and they know what's rateable. Don't get me wrong I do know there are docs out there that take their job seriously and look out for their patient, however, there are those that are not looking out for your best interests. My case back in the day, in the Air Force my psych dr actually cared and helped me through the issues with medication at the time but working to be off the Meds. When in the Army, during and after, Iraq, I didn't quite handle leaving

Some memories behind. Some still haunt me today and fuel my anger, depression, and anxiety and well frankly some destructive tendencies. I lossed faith when the provider blantely stated " you know you're not getting anything for this" as if I cared about that then, for that matter now, I just want my demons to go away and stay in Iraq where they belong. So my advice is just use caution, watch your six, get out of it what you need to in order to be whole again or at least closer to being as close to normal as you once were. JMHO.