hypertension C&p Results Ptsd Rating?

[bassrunnin]

Here are the results of my c&p exam...would like opinion on rating and whether they might give me tdiu that I applied for...thanks ahead of time for your input,,, I tried to narrow down the exam to only the important info...

1. Diagnostic Summary

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Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation?

[X] Yes [ ] No

ICD code: F43.10

2. Current Diagnoses

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a. Mental Disorder Diagnosis #1: PTSD, chronic

ICD code: F43.10

Mental Disorder Diagnosis #2: Bipolar I Disorder, mixed

ICD code: F31.13

b. Medical diagnoses relevant to the understanding or management of the

Mental Health Disorder (to include TBI): Hypertension, Obesity

3. Differentiation of symptoms

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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:

PTSD: hx of trauma, nightmares, flashbacks, traumatic memories, hypervigilance, avoidance of reminders of trauma, persistent guilt

Bipolar I: mood swings, manic episodes and depressed mood, low self esteem, increased appetite and weight gain

4. Occupational and social impairment

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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 deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood

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:

PTSD: 60%

Bipolar: 40%

2. History

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Veteran reports she has not been able to work since June 2014. Worked 4 out of the last 14 months. Worked at the Verizon call center doing tech support. "Had a good job and made good money. Having issues maintaining my composure. I was dissociating especially on breaks. Jumpy and emotional. Ususally very laid back person. Customer service don't always get nice customers. Started getting written up for poor performance. She reports she was on a leave of absence for 6 mos and then was let go because she was unable to perform her job. Too many triggers". She was told by her Dr Putatunda, psychiatrist, that she could not work. CWT: voc rehab at VA.

4. PTSD Diagnostic Criteria

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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

symptomsith 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).

[X] Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings).

[X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of 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 external reminders (people, places, conversations, activities, objects, situations) that arouse 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 and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined").

[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).

[X] Markedly diminished interest or participation in significant activities.

[X] Feelings of detachment or estrangement from others.

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 the following:

[X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.

[X] Reckless or self-destructive behavior.

[X] Hypervigilance.

[X] Problems with concentration.

[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 I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?:

[X] Stressor #1

5. Symptoms

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For VA rating purposes, check all symptoms that actively apply to the

Veteran's diagnoses:

[X] Depressed mood

[X] Anxiety

[X] Panic attacks more than once a week

[X] Chronic sleep impairment

[X] Flattened affect

[X] Impaired judgment

[X] Disturbances of motivation and mood

[X] Difficulty in establishing and maintaining effective work and social relationships

[X] Difficulty in adapting to stressful circumstances, including work or a worklike setting

[X] Suicidal ideation

8. Competency

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Is the Veteran capable of managing his or her financial affairs?

[X] Yes [ ] No

9. Remarks, (including any testing results) if any

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Medical Opinion:

"Does the Veteran have a diagnosis of (a) posttruamtic stress disorder that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) miitary sexual trauma during service?

Yes, the Veteran symptoms of posttraumatic stress disorder do meet DSM-5 criteria and are as least as likely as not (50 percent or greater probability) incurred in or caused by (the) miitary sexual trauma during service. Veteran has been working, studying and trying to function in her marriage, family and work settings. She has legitimately sought professional help for her sx and continues to do so. She has beenhospitalized three times for sx related to PTSD and bipolar disorder. The Veteran was consistent in her presentation and facts. She is compliant with treatment.

In your opinion, is it at least as likely as not, that the Veteran's documented history of STD on exit exam dated 5/28/1996 supports the occurrence of the described military sexual assault in November 1992?

In my clinical opinion, the documented history of STD on exit exam dated

5/28/1996 does support and add validity to the Veteran's claim of military sexual assault.

[Berta]

Thank you for your service!

You will definitely be granted a rating for service connected PTSD,in my opinion, based on what I see here.

This entry however is not a good way to determine any rating:

"If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis:

PTSD: 60%

Bipolar: 40%"

Under the VA Schedule of Ratings here at hadit, about halfway down the document they give the rating criteria for PTSD and that will help you determine a guessimate of the rating.

You will have appeal rights if you feel the rating is too low.

And you can apply for TDIU regardless of whatever the rating is.

Check out our discussions here too on 38 CFR 4.16. as to TDIU.

It seemed to me like you got a very adequate VA exam.

[bassrunnin]

I see where I should probably get 70% according to the mostly impaired in all areas comment...but what do they mean by ptsd 60 bipolar 40? Does that mean I'll get 60% of 70% overall? I did file bipolar has a secondary. Does that matter?

Thanks

[Mikemmlj]

I think they're saying PTSD makes up 60% of your mental health problems and bipolar makes up 40%

[bassrunnin]

Thanks for the responses. I understand the PTSD 60% of mental health problem and bipolar 40%. My question is will this affect my rating?