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

[carlie]

Hello Arng11,

Everything so far is all tied to my polymyositis from all the notes I have read on healthevet. My first visit acknowledges my MDD is tied to my service connected condition. Every visit I have had so far my condition is all we ever talk about as it is the center of my entire world honestly. We haven't really ever spoke about my pre-military life much I informed my psychologist that my mother was in the military and we moved alot and I had no problem adjusting to moving to new places which is also noted in his notes.

Great - that's a nexus for secondary SC to your SC'd condition.

IMO - it is best to stay away from pre-military conversations.

I think I will write down a list of things that I read in a blog that I should go in and discuss with the psychologist so that he can get a better picture. I thought about doing this before I was just worried that it looked like I was "to smart" or something. I just want to try and convey the honest picture I can. I don't really want to try and get PTSD because I know it's not what I really have depression definitely all due to my service connected condition. IMO - stick to these conversations and how your depression effects your life, especially in regards to occupational

and social functioning,

jmho - carlie

I appreciate all the insight you all have provided so far.

[ArNG11]

No problem, but frankly this topic hits home with me as I am still dealing with it. Follow the advise of the senior members as they have been around a lot longer than i and know the games that are played by the VA. The most important item here is that you get the care and treatment you need. At the same time, however, take everyone's opinions into consideration and make the best decision you can with the information that applies to you. JMHO,

Hello Arng11,

Everything so far is all tied to my polymyositis from all the notes I have read on healthevet. My first visit acknowledges my MDD is tied to my service connected condition. Every visit I have had so far my condition is all we ever talk about as it is the center of my entire world honestly. We haven't really ever spoke about my pre-military life much I informed my psychologist that my mother was in the military and we moved alot and I had no problem adjusting to moving to new places which is also noted in his notes.

I think I will write down a list of things that I read in a blog that I should go in and discuss with the psychologist so that he can get a better picture. I thought about doing this before I was just worried that it looked like I was "to smart" or something. I just want to try and convey the honest picture I can. I don't really want to try and get PTSD because I know it's not what I really have depression definitely all due to my service connected condition.

I appreciate all the insight you all have provided so far.

[asheth007]

I finally am locked into weekly visits with behavioral medicine/neurology? I think this is a health psychologist?

She said that their goal is focused on my condition and medications and helping me deal with the mental side of dealing with it. I believe that PTSD has a different mental health professional they see. I am seeing a psychology trainee who has to report to an actual health psychologist.

I think I am in the right place for the right treatment. Just had eval and questions on Wednesday appointment is next week.

Thank you for your insight arng11 I appreciate you sharing your experience.

Edited November 13, 2014 by asheth007

[ArNG11]

No worries, it's hard to know what to expect, there are good doctors in the VA and there are bad ones, just like the orivate sector, I hope that you meet the good kind. Good luck and take it step by step, day by day, in your recovery.