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]

asheth007

First off - there is NO PROBLEM in getting SC for MH due to DX of Adjustment Disorder.

A DX of Adjustment Disorder can fully be SC'd.

Adjustment Disorder IS COMPLETELY DIFFERENT than a PD.

You are just getting started in MH treatment and the MH providers will most likely fine tune

the medical reports as they continue.

A DX of PD will only be SC'd if secondary to TBI or Epilepsy.

Scroll to the bottom for Adjustment Disorder - clearly on the list for MH SC.

http://www.ecfr.gov/cgi-bin/text-idx?SID=8d66c0c8bc269866a5b9738782f167ec&node=se38.1.4_1130&rgn=div8

4.130 Schedule of ratings—Mental disorders.

The nomenclature employed in this portion of the rating schedule is based upon the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (see §4.125 for availability information). Rating agencies must be thoroughly familiar with this manual to properly implement the directives in §4.125 through §4.129 and to apply the general rating formula for mental disorders in §4.130. The schedule for rating for mental disorders is set forth as follows:

9201 Schizophrenia

9202 [Removed]

9203 [Removed]

9204 [Removed]

9205 [Removed]

9208 Delusional disorder

9210 Other specified and unspecified schizophrenia spectrum and other psychotic disorders

9211 Schizoaffective disorder

9300 Delirium

9301 Major or mild neurocognitive disorder due to HIV or other infections

9304 Major or mild neurocognitive disorder due to traumatic brain injury

9305 Major or mild vascular neurocognitive disorder

9310 Unspecified neurocognitive disorder

9312 Major or mild neurocognitive disorder due to Alzheimer's disease

9326 Major or mild neurocognitive disorder due to another medical condition or substance/medication-induced major or mild neurocognitive disorder

9327 [Removed]

9400 Generalized anxiety disorder

9403 Specific phobia; social anxiety disorder (social phobia)

9404 Obsessive compulsive disorder

9410 Other specified anxiety disorder

9411 Posttraumatic stress disorder

9412 Panic disorder and/or agoraphobia

9413 Unspecified anxiety disorder

9416 Dissociative amnesia; dissociative identity disorder

9417 Depersonalization/Derealization disorder

9421 Somatic symptom disorder

9422 Other specified somatic symptom and related disorder

9423 Unspecified somatic symptom and related disorder

9424 Conversion disorder (functional neurological symptom disorder)

9425 Illness anxiety disorder

9431 Cyclothymic disorder

9432 Bipolar disorder

9433 Persistent depressive disorder (dysthymia)

9434 Major depressive disorder

9435 Unspecified depressive disorder

9440 Chronic adjustment disorder

General Rating Formula for Mental Disorders

[carlie]

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

Adjustment Disorder does not = a Personality Disorder.

1) A DX of PD CAN BE SC'd as secondary to TBI - DC 8045 - Post October 2008 Schedule for Rating Disabilities.

2) A DX of PD CAN BE SC'd as secondary to Epilepsy - DC 8910/8911 - 9304 / 9326, as a dementia.

http://www.ecfr.gov/cgi-bin/text-idx?SID=8d66c0c8bc269866a5b9738782f167ec&node=se38.1.4_1124a&rgn=div8

Mental Disorders in Epilepsies:

A nonpsychotic organic brain syndrome will be rated separately under the appropriate diagnostic code (e.g., 9304 or 9326). In the absence of a diagnosis of non-psychotic organic psychiatric disturbance (psychotic, psychoneurotic or personality disorder) if diagnosed and shown to be secondary to or directly associated with epilepsy will be rated separately. The psychotic or psychroneurotic disorder will be rated under the appropriate diagnostic code. The personality disorder will be rated as a dementia (e.g., diagnostic code 9304 or 9326).

[asheth007]

Thanks for the input so far from everyone. I do have the MDD code also but it is single. So I'm guessing chronic is what I am actually looking for.

It is probably my fault as I never saw MH when I was in. I was very depressed for 2 years and I feel like I have gotten somewhat better since moving home 4 months ago. I just tried to deal with it myself when I was in basically by staying away from people. I still don't want to socialize even now because of my disability. Hopefully these MH visits with Behvioral medicine go better. The psychologist is a nice guy but the sessions feel kind of question and answer. Like I am kind of apprehensive to opening up fully.

[carlie]

The psychologist is a nice guy but the sessions feel kind of question and answer. Like I am kind of apprehensive to opening up fully.

The feelings you are having are normal - most starting any MH therapy feel the same,

sometimes it can get pretty raw in therapy.

jmho

[ArNG11]

Carlie, I stand corrected in my post, however, I was trying to state is that unless the personality disorder is tied to say a compensable condition, say depression, anxiety, or PTSD, then they will try to to mark it as a pre existing condition, and state it as a personality disorder which would be zero unless accompanied by other symtoms or rather as a result of. I can attest to this fact as it is happening to me of sorts. With any traumatic event or stressor I can assure you, your personality will be altered and changed. the ticket though is that it's has tied to a rateable service induced condition. Maybe I'm confusing the issue or making my argument muddy. My apologies.

[asheth007]

Carlie, I stand corrected in my post, however, I was trying to state is that unless the personality disorder is tied to say a compensable condition, say depression, anxiety, or PTSD, then they will try to to mark it as a pre existing condition, and state it as a personality disorder which would be zero unless accompanied by other symtoms or rather as a result of. I can attest to this fact as it is happening to me of sorts. With any traumatic event or stressor I can assure you, your personality will be altered and changed. the ticket though is that it's has tied to a rateable service induced condition. Maybe I'm confusing the issue or making my argument muddy. My apologies.

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.