ptsd C&p For Ptsd

[VietnamVetsWife]

Hello everyone, I'm new here and first would like to thank everyone for their bravery and service. My husband served 3 terms in Vietnam, approx 2 years ago he was rated 50% for PTSD only after the VA doctor who treats him for IHD (he's had 3 heart attacks and was rated 30%) told him to reapply for IU. The VA psychyatrist agreed and also told him to apply for IU, he did and had his C&P almost 4 months ago. The PTSD C&P reports reads dx code309.81 meets full DSV-M criteria, symptoms chronic and severe, 296.23 major depressive disorder, total occupational and social impairment, the VA dr who treats him was quoted from his notes saying PTSD symptoms very severe and interfere with daily function. The C&P examiner checked all the boxes under the section PTDS diagnostic criteria then wrote in the note section suffers considerably from long untreatedPTSD and depression related to trauma in Vietnam, his symptoms are found to be profound for social, emotional and occupationtionality.

He had this C&P months ago, the claim sat in review of evidence then said evidence requested from VA medical facility overdue, I uploaded and faxed them the C&P ( I don't understand how the VA can't get records that show in the blue button section) now the claim is sitting in pending decision showing under notes evidence no longer required, my question is could anyone please offer me a opinion on what his % may be. I appreciate and thank everyone for their time and opinion.

[gohan4202]

3. PTSD Diagnostic Criteria
The diagnostic criteria for PTSD, referred to as Criteria A-H, are from the
Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
Please check criteria used for establishing the current PTSD diagnosis. Do NOT
mark symptoms below that are clearly not attributable to the criteria A
stressor/PTSD. Instead, overlapping symptoms clearly attributable to other
things should be noted under #5 - other symptoms.
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)
__ Witnessing, in person, the traumatic event(s) as they occurred to
others
__ Learning that the traumatic event(s) occurred to a close family
member or close friend; cases of actual or threatened death must have been
violent or accidental; or, experiencing repeated or
extreme exposure to aversive details of the traumatic events(s) (e.g., first
responders collecting human remains; police officers repeatedly exposed to
details of child abuse); this does not apply to exposure through electronic
media, television, movies, or pictures, unless this exposure is work-related.
Criterion B: Presence of (one or more) of the following intrusion symptoms
associated with 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 effect
of the dream are related to the traumatic event(s).
__ 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).
__ Intense or prolonged psychological distress at exposure to
internal or external cues that symbolize or resemble an aspect of the
traumatic event(s).
__ Marked physiological reactions 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 distressing memories, thoughts,
or feelings about or closely associated with the traumatic event(s).
_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:
__ Inability to remember an important aspect of the traumatic event
(s) (typically due to dissociative amnesia and not to other factors such as
head injury, alcohol, or drugs).
_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.
__ Persistent inability to experience positive emotions (e.g.,
inability to experience happiness, satisfaction, or loving feelings.)
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.
__ Reckless or self-destructive behavior.
_X_ Hypervigilance.
_X_ Exaggerated startle response.
_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 H:
_X_ The disturbance is not attributable to the physiological effects
of a substance (e.g., medication, alcohol) or another medical condition
Criterion H:
_X_ The disturbance is not attributable to the physiological effects
of a substance (e.g., medication, alcohol) or another medical condition.
4. Symptoms
For VA rating purposes, check all symptoms that actively apply to the
Veteran's diagnoses:
The veteran denied current SI/HI. He admits to a history of vague SI without
any plan or intent to act. The veteran reported he would not harm himself. He
notes that he has reduced his risk by disabling the firing mechanisms on guns in
his home, and reports only his spouse has access to a firearm. The veteran does
have ongoing risk factors such as ongoing mental health problems, a history of
military deployment, and some occasional feelings of losing hope etc. He does
however report a desire to keep working to improve things, and states he has a
good rapport with his provider --------. The veteran also denied any prior
suicidal attempts, and stated no current desire to harm self or others. He is
future oriented, speaking about intent to continue psychotherapy. He has
been hospitalized once when he was in the military, though the veteran stated
that he did not know the context of this. The veteran is help seeking and has
some hope for improvement. The veteran was provided with the veteran's
crisis
hotline and advised to call 911 or go to the ER for any medical or mental health
emergencies. He agreed to do so should the need arise. The veteran is
considered sustainable as an outpatient at this time.
_X_ Depressed mood
_X_ Anxiety
_X_ Suspiciousness
__ Panic attacks that occur weekly or less often
__ Panic attacks more than once a week
_X_ Near-continuous panic or depression affecting the ability to function
independently, appropriately and effectively
_X_ Chronic sleep impairment
__ Mild memory loss, such as forgetting names, directions or recent events
__ Impairment of short- and long-term memory, for example, retention of only
highly learned material, while forgetting to complete tasks
__ Memory loss for names of close relatives, own occupation, or own name
_X_ Flattened affect
__ Circumstantial, circumlocutory or stereotyped speech
__ Speech intermittently illogical, obscure, or irrelevant
__ Difficulty in understanding complex commands
__ Impaired judgment
__ Impaired abstract thinking
__ Gross impairment in thought processes or communication
_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
work-like setting
_X_ Inability to establish and maintain effective relationships
__ Suicidal ideation
__ Obsessional rituals which interfere with routine activities
_X_ Impaired impulse control, such as unprovoked irritability with periods of
violence
__ Spatial disorientation
__ Persistent delusions or hallucinations
__ Grossly inappropriate behavior
__ Persistent danger of hurting self or others
_X_ Neglect of personal appearance and hygiene
__ Intermittent inability to perform ADLs, including maintaining minimal
personal hygiene
__ Disorientation to time or place
Behavioral Observations:
MOOD: "pretty rattley" (meaning anxious)
AFFECT: flat
ORIENTATION: fully oriented
APPEARANCE: disheveled, wearing wrinkled white t-shirt and pants
BEHAVIOR: cooperative
THOUGHT PROCESSES: coherent
THOUGHT CONTENT: logical and goal-directed
DELUSIONS/HALLUCINATIONS: none elicited
5. Other symptoms
Does the Veteran have any other symptoms attributable to PTSD (and other
mental disorders) that are not listed above?
[ ] Yes [X] No
If yes, describe:
7. Competency
Is the Veteran capable of managing his or her financial affairs?
_X_ Yes __ No
If no, explain: __________________________
8. Remarks, if any:
This evaluation was scheduled because the veteran filed a claim for an increase
in his service connection for Posttraumatic Stress Disorder. Evidence considered
for today's evaluation includes review of vet's VBMS record, review of
vet's
electronic VA medical record, and vet's self-report during today's
clinical
interview. Based on this information vet currently meets DSM-5 criteria for
diagnoses of (1) PTSD, (2) Major Depressive Disorder, and (3) Unspecified
Personality Disorder

As noted above, with regard to PTSD symptoms, the veteran reports that he
regularly has intrusive thoughts about his traumatic event, and this tends to be
accompanied by distress related to guilty cognitions about his role in that
event. He has nightmares about combat themes a few nights per week, and
struggles to go back to sleep after waking. He tends to avoid talking about his
experiences in Iraq, and avoids most activities particularly those which would
require him to leave the home. He notes that he experiences strong anxiety
coupled with lability when encountering others and while driving, thus chooses
to avoid most things altogether. He experiences persistent negative thoughts
about himself and others, and has few personal relationships as he typically
feels the need to avoid being around other people. Irritability is notable, and
it is the opinion of this examiner that a portion of his irritability is related
to PTSD, but that the level of his irritability/lability/interpersonal problems
is strongly contributed to by his diagnosed personality disorder. The veteran
notes that he feels consistently on guard when out of the home, and often loses
out on sleep because he hears noises that he feels the need to check on, or he
feels the need to check door or window locks. He has also noted ongoing
problems with concentration where his mind tends to wander sometimes in the
midst of a conversation. Additionally, it was noted that the veteran was
noticeably startled during the exam when something was dropped loudly in the
hallway outside the exam room, and he noted that he tends to react strongly to
startling noises. Outside of his experience of nightmares, the veteran
experiences chronic problems with sleep onset and maintenance.
The veteran's symptoms of Major Depressive Disorder include low energy, lack
of
interest in activities, sleeping problems, decreased appetite, psychomotor
retardation, feelings of worthlessness, and problems with concentration. The
veteran reports that he has consistently felt this way for several years. He
notes that in addition to the anxiety noted above, he has low energy on account
of poor sleep and his judgment of his own abilities as being of low value. He
reports that he tends to feel that due to his limits in going out of the home
with his spouse (due to anxiety issues noted above), this makes him worthless
and feels more depressed as a result. His low energy and his feelings of
worthlessness further compound his lack of interest in activities, and can
contribute to additional negative cognitions which impact his sleep.
With regard to the diagnosis of Unspecified Personality Disorder, the veteran
continues to have problems regulating his emotions, as was noted
during his last examination. Although some emotional regulation issues are
commonly associated with PTSD, the problems detailed by the veteran would be
considered more significant than is typically seen with PTSD alone. In
particular he notes affective instability and lability, problems with angry
outbursts towards others which commonly result in him destroying property,
difficulty regulating his emotions effectively, and pervasive negative

perceptions about himself and others above which would be accounted for by PTSD
and depression alone.
As noted above, the various symptoms of these conditions combine to produce a
significant level of impairment in the veteran's functional abilities.

[Berta]

A similar report warranted my husband 100% SC P & T for PTSD, upgrading from his original 30%.

As long as the nexus ia not in question (are you an OIF OEF incountry Afganistan/Iraq veteran), I see this as TDIU if you are unemployed.

The only thing here that concerns me is this:

"With regard to the diagnosis of Unspecified Personality Disorder, the veteran
continues to have problems regulating his emotions, as was noted
during his last examination. Although some emotional regulation issues are
commonly associated with PTSD, the problems detailed by the veteran would be
considered more significant than is typically seen with PTSD alone. In
particular he notes affective instability and lability, problems with angry
outbursts towards others which commonly result in him destroying property,
difficulty regulating his emotions effectively, and pervasive negative

perceptions about himself and others above which would be accounted for by PTSD
and depression alone."

That was a main part of my husband's PTSD, anger, and in my opinion, a significant manifestation of PTSD in many veterans.

And None of them ,in my opinion, ever had anything remotely close to a "personality disorder".

Edited February 13, 2015 by Berta