ptsd Past Two C&p Exams Been Trying To Get Tdiu

[gohan4202]

also im on ssdi for depression and anaxity any thoughts on this if i can get iu. was denied last year for it

(RECENT EXAM) 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.

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

(OLD EXAM) significant functional impairment. The veteran maintains few meaningful
interpersonal relationships, and is largely socially isolated. Although he is
currently enrolled in college, his mental health symptoms have led to
difficulties with attendance and getting along with other students. Vet has not
held a job since his discharge from the military, and he states that he has not
sought out employment due to his fear of the problems his irritability might
cause in a work setting (particularly if confronted by a rude supervisor).
Regarding the question of unemployability: Based upon today's evaluation it
is
less likely than not (less than 50% probability) that the veteran's symptoms
of
PTSD render him unable to secure or maintain substantially gainful employment.
The veteran has not attempted to work since his discharge from the military, and
as such, there is no clear evidence that his symptoms would render him entirely
incapable of working in any context. Vet reported difficulties with
concentration and irritability within an educational setting; however, it is
likely that were the veteran to obtain a job which provided him with an optimal
environment (e.g. a secure setting with good visibility) and job duties (e.g. an
isolative position requiring little interaction with coworkers or customers) he
would be able to function within an occupational setting. It should also be
noted that the veteran's symptoms are not well-managed at present partially
due
to his unwillingness to engage meaningfully in treatment. He takes his
medications sporadically and recent psychotherapy notes indicate that although
his therapist has encouraged the veteran to begin working on useful coping
strategies (particularly aimed at reducing irritability and anger outbursts) the
veteran has shown little interest in doing so.
It should also be noted that a good deal of vet's functional impairment does
appear to be attributable to his personality disorder symptoms. His emotional
lability and extreme irritability (greater than what is typically reported by
individuals suffering from PTSD alone) reportedly result in a good deal of
interpersonal difficulty. Further, vet's rigid and negativistic beliefs
about
himself and others also result in lessened engagement in activities and
treatment that would likely lead to some relief from his Axis I symptomology. It
is important to point out that all personality disorders, by definition, are
longstanding mental health conditions representing an enduring pattern of
behavior and symptoms that can often be traced back to childhood or adolescence.
A review of vet?s original mental health C&P exam reveals that the
veteran
endured substantial physical and emotional abuse during childhood, and was
suffering from various mental health symptoms (e.g. self-harm, mood
fluctuations) prior to his enlistment in the military.

this is from my last e

[Navy04]

It is just hard to tell with the VA when it comes to the IU bud. As you can see from my signature, I have a lot of chronic medical issues and I am only 100% Temporary. My PTSD was 30% in 2013, upped to 70% in 2014, and was not suppose to have a PTSD review until Feb 16. I just found out that I have a PTSD review next week along with other 8 exams. I was approved SSDI last year in less than 10 weeks for PTSD alone, wife has to manage finances, and Navy changed my Temporary to Permanent. Yet the VA keeps messing with my PTSD after 5 years of deployments. Sorry for the ramble bud, what I am trying to say is that the DAM*** VA just wants to run us in the ground when it comes to PTSD and other Mental Conditions. How in the hell does the Mental Exam Doc check all of those Symptoms for you, then the Dang Raters either deny you IU or making your Mental Rating 100%. Again sorry, God Bless and good luck.

[gohan4202]

Yeah I know what you mean i was on ssdi before I ever left the army they rated me for depression and anxiety wich are secondary to my ptsd. Haven't worked in 5 yrs and had my teachers tell me to drop college classes because of always galling asleep due to med and then the anger caused a lot of problems I hardly ever leave home due to a phobia of driving. They said I didn't show proof I couldn't work but how can I have proof if im not working and on social security lol. Whole thing just blows my mind

[Berta]

You said you get SSDI for PTSD and depression.

This statement in the new C & P seems to strongly suggest that the depression is part of the PTSD:

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

Is the VA aware of the fact that you get SSDI ?

I dont see, in the new C & P any statement the doctor made as specifically to your ability to work.Maybe I am missing it.

The older C &P seeems to indicate work is feasible but obviously the SSA doesnt think that way

Is there more to this new C & P that you can attach here?

The older C & P.....this certainly is different from the more recent one.The doc threw in the personality disorder BS.

If a vet gets SSDI SOLELY for SC conditions,this is prime facie evidence that they are unemployable solely due to Service connected disabilities.

If they know of the award and do not consider it as evidence, they have comitted a CUE under 38 CFR 4.6.

"Yeah I know what you mean i was on ssdi before I ever left the army they rated me for depression and anxiety wich are secondary to my ptsd. Haven't worked in 5 yrs and had my teachers tell me to drop college classes because of always galling asleep due to med and then the anger caused a lot of problems I hardly ever leave home due to a phobia of driving.

I dont understand how you could get SSDI ans still be in the Army.

If you can get documentation from VA Voc Rehab as to why Voc Rehab could not continue due to your PTSD, that too is excellent evidence of TDIU.

"was denied last year for it" Did you file a timely NOD?

Can you scan and attach the denial here ( the Reasons and Bases part and the Evidence list) and cover your C file , name, address prior to scanning it.

It is the actual words VA uses against us in these denials, that are the words we need to read here, in order to help.

Do you have a vet rep?

Is the 70% you get now for SC PTSD?

[gohan4202]

[gohan4202]

the ssdi is not soley for ptsd but for depression and anxity. also i was granted ssdi while still in a transition unit within the army dunno how but it was possible. i did file a nod and was denied a second time so iv since then enlisted the help of a lawyer.

[gohan4202]

reasforden.pdf