ptsd Questions About Recent C&p And Possible Additional Claim(S)

[bleggett29]

Hello, fellow vets! This is my first post on this site but I have been lurking on and off for the past year or so.

Today I finally had one of two C&P exams since putting in my claim Sep. 2013. It was a mental health C&P for Anxiety, Agoraphobia, Panic Disorder, Social Anxiety, Bi-Polar, MDD. The second C&P is for an increase to my hearing loss. Reading some of the mental health C&P experiences on here, I wasn't too confident I would have a favorable outcome. But today's C&P seems to be very favorable to me. When filing the claim I was concerned that a nexus didn't exist to S/C as primary so I indicated they were all secondary to my S/C tinnitus (10%) and hearing loss (0%). However, the examiner found a nexus for a primary S/C from my separation exam. It happened to be that I indicated I had anxiety and shortness of breath on that exam, which it what she used at the nexus. I don't yet have a copy of the C&P but at the end of the exam I asked her what she had wrote. From what she read back to me, and what I looked up on the rating schedule after getting back home, I should be easily 70% with the possibility of 100%.

Now with the questions. lol.

How much faith should I put into this C&P that the rater would agree with the examiner and approve the claim?

My next C&P isn't until the end of July. Is it possible that my mental health claim be processed and approved before the July C&P?

I was recently diagnosed with OSA (Sleep Apnea) and will be getting a CPAP. Although I don't have PTSD, can OSA be secondary to other mental health issues (since many of my symptoms overlap with PTSD)? I also mentioned the recent diagnosis of OSA and the CPAP. Does the VA have an obligation to include this with my current claim, or will I have to file a new claim?

Thanks!

[bleggett29]

LOCAL TITLE: COMPENSATION ASSESSMENT COPY

STANDARD TITLE: C & P EXAMINATION NOTE

DATE OF NOTE: JUN 27, 2015@11:30 ENTRY DATE: JUN 29, 2015@08:41:22

AUTHOR: MARECK,SUSAN G EXP COSIGNER:

URGENCY: STATUS: COMPLETED

Mental Disorders

(other than PTSD and Eating Disorders)

Disability Benefits Questionnaire

Name of patient/Veteran:

***********

SECTION I:

----------

1. Diagnosis

------------

a. Does the Veteran now have or has he/she ever been diagnosed with a mental

disorder(s)?

[X] Yes[ ] No

ICD code: 300.01, 300.02

If the Veteran currently has one or more mental disorders that conform to

DSM-5 criteria, provide all diagnoses:

Mental Disorder Diagnosis #1: Panic Diosrder

ICD code: 300.01

Comments, if any:

Veteran has a history Panic Attacks, with persistent concern about

having another attack and significant maladaptive behavior change

related to the panic attacks.

Veteran's sleep disturbance is a symptom of Panic Disorder, he does not

meet criteria for alcohol abuse or another stress disorder at this

time.

He does not meet criteria for a DSM IV or DMS 5 diagnosis of PTSD.

Mental Disorder Diagnosis #2: Agorapobia

ICD code: 300.02

Comments, if any:

Veteran reports excessive axniety in using public transportation, being

outside the home alone or being in enclosed places. Agoraphobia is

secodary to Veteran's Panic Disorder.

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

Mental Health Disorder (to include TBI): non identified

2. Differentiation of symptoms

------------------------------

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:

Veteran's fear of leaving home is attributable to Agoraphobia and

his recurrent panic attacks and maladaptive behavior change related

to the panic attacks are attributable to panic disorder. Veteran

also has symptoms suggestive of Generalized Anxiety Disorder and

Social Phobia but does not meet full criteria for either condition.

c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?

[ ] Yes[ ] No[X] Not shown in records reviewed

3. Occupational and social impairment

-------------------------------------

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] Total occupational and social impairment

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?

[ ] Yes[X] No[ ] No other mental disorder has been diagnosed

If no, provide reason that it is not possible to differentiate what

portion of the indicated level of occupational and social impairment

is attributable to each diagnosis:

Both conditions significantly impact Veteran's social and

occupational functioning.

c. If a diagnosis of TBI exists, is it possible to differentiate what

portion

of the occupational and social impairment indicated above is caused by

the

TBI?

[ ] Yes[ ] No[X] No diagnosis of TBI

SECTION II:

-----------

Clinical Findings:

------------------

1. Evidence review

------------------

a. Medical record review:

Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed?

[X] Yes[ ] No

Was the Veteran's VA claims file (hard copy paper C-file) reviewed?

[ ] Yes[X] No

If no, check all records reviewed:

[ ] Military service treatment records

[ ] Military service personnel records

[ ] Military enlistment examination

[ ] Military separation examination

[ ] Military post-deployment questionnaire

[ ] Department of Defense Form 214 Separation Documents

[X] Veterans Health Administration medical records (VA treatment

records)

[ ] Civilian medical records

[ ] Interviews with collateral witnesses (family and others who have

known the Veteran before and after military service)

[ ] No records were reviewed

[X] Other:

efolder

b. Was pertinent information from collateral sources reviewed?

[ ] Yes[X] No

2. History

----------

a. Relevant Social/Marital/Family history (pre-military, military, and

post-military):

Veteran raised in an intact family with a younger brother, his parents

divorced when he was about 16. He lived with his mother for about a

year

and then moved in with father. His father had re-married, Veteran had a

younger step-sister in the home. No reported childhood abuse issues. He

described his childhood, his father was in the Navy, would be gone for

about 6 months of the year, most of his childhood, he lived overseas.

He

got along with other children and was active. He reports being

evaluated

at Walter Reed around age 10 due to some speech issues, but does not

recall the outcome of the evaluation and he does not recall being in

any

special education classes.

Veteran has been married since 2003, they have a 11 year old son and a

10 year old daughter. He reports his relationship with his wife is

"very

strained", "we have our ups and downs" depending on his mood.

b. Relevant Occupational and Educational history (pre-military, military,

and

post-military):

Veteran served in the USA from 1992-1998, he was given an Under

Honorable Conditions Discharge as an E1. He lost rank, from E4 to E1

due

to an DUI. His mos was combat engineer.

Veteran graduated from high school, he recently attempted to take some

college classes, he started in the fall of 2014, but reports not being

able to pass any classes.

After the military he worked in fast food restaurants, initially as a

driver, then assistant manager. He was fired due to anxiety symptoms in

2012 and has not worked since. He reports kicking over a trash can and

knocking over a few stacks of trays. He tried to return to work at

Pizza Hut in July, 204 but reports not only lasting 2 days, he was not

able to tolerate the noise.

c. Relevant Mental Health history, to include prescribed medications and

family mental health (pre-military, military, and post-military):

Veteran reports a history of ADHD and behavioral problems in his son

and

a maternal cousin has severe anxiety problems. Veteran exit exam

documented "SOB sometimes secondary to anxiety attacks". Veteran was

involved in a MVC, he hit three other vehicles, on 4/9/98 while under

the influence of alcohol.

Veteran reports no treatment for anxiety until 2012. He would

experience

a panic attack about once a year until 2012, when he started having

panic attacks one - two a day. He initially thought he was having heart

problems.

Veteran seen in the ER at St. Mary's Hospital on 2/16/12 with c/o chest

pain, on 4/13/12 with a diagnosed of Anxiety Disorder, 6/19/13 with c/o

Paresthesias in both hands and feet. Veteran was admitted to St. Mary's

Hospital with a diagnosis of Anxiety Disorder, Suicidal Risk, and

Depression in 10/2012. Medications included Paxil for mood and

Trazodone

for sleep with plan to f/u at Charlotte Hall CBOC.

Veteran initially seen by PCP at the CH CBOC on 0/6/12, he reported a

history of anxiety. He was referred to Psychiatry and see via

tele-health on 10/3/12 by Dr. Shao who diagnosed Veteran with a

Depressive Disorder NOS and Panic Disorder without Agoraphobia. He had

previously been in treatment at Walden Sierra, a non VA clinic, for

8-9

months. He was next seen by Dr. Shao on 3/7/14, after f/u at the

Baltimore Glen Burnie CBOC in 2013. He reports his son was being

treated

at St. Vincent's Villa for about a year, so Veteran would save gas by

being able to visit his son and be seen at the clinic.

Veteran is currently prescribed Paxil and Buspar by a non VAMC

provider.

He is currently followed by the Walden Sierra Clinic.

He reports in Bosnia he was involved with helping the Bosnian Army

remove land minds, he witnessed a local being killed by a land mind.

Another time, they were woken up in the middle of the night and left

camp, "I was panicking", he thought they were going to war and on the

way back an MIAI accidently went off and stuck the vehicle behind it,

Veteran was 2-3 three vehicles behind the struck vehicle. No one was

injured, Veteran reports it was very frightening at the time. He does

not report cuurent symptoms related to exposure to these incidents. He

reports occasional thoughts of his deployment that are not intrusive,

he

does not endorse avoidance symptoms or alterations in cognition related

to trauma exposure.

Veteran reports on-going anxiety issues since the military. He reports

being in a combat unit, drinking "seemed the thing to do", He reports

no

alcohol use prior to the military, his 2012 MH evaluation stated

Veteran

started drinking 2-3 months ago, and drinks 1-2 times a month. Veteran

did not think that was accurate, he states they do not keep alcohol in

the house and he does not drink.

Veteran reports he is very irritable. He has trouble falling asleep and

staying asleep. He reports leaving the house is a challenge. If he has

to go by himself, he will go into the store, get what he needs and

leaves. He is not able to go grocery shopping with his wife because he

becomes to anxious. He reports when he "gets up the courage" to go to

dinner, he has to sit in a corner with his back to the rest of the

people, "I don't want to see people, "I have a fear of what people

think

of me". He reports isolating himself at home. He reports experiencing a

panic attack at least once every two week. He worries about having a

panic attack. He reports he is able to drive in his local area, but if

he has to drive more than 15 miles, he will have a panic attack, "I

don't like the uncertainty of not being able to get home when I need

to". He has been offered free bus passes in his community but he has

refused them, because "I can't leave when I need to". He reports when

talking to people he avoids eye contact due to his anxiety. He reports

avoiding doing work outside around the house because he does not like

people watching him. He reports in 2012, he had thoughts of suicide by

ingesting his Xanax, which led to his hospitalization in 10/2012. Prior

to 2012 he also reports thoughts of death, he denies suicidal ideation

since 2012.

d. Relevant Legal and Behavioral history (pre-military, military, and

post-military):

Veteran has a history of DUI in 1998. Denies current legal issues. He

reports hitting his wife one time earlier this year, "I was almost

arrested but my wife decided not to press charges". He reports having

problems with anger and irritablity but has been to "stop myself"

before

acting out in anger.

e. Relevant Substance abuse history (pre-military, military, and

post-military):

Veteran has a history of DUI in 1998,

f. Other, if any:

Veteran idenitified by full name and DOB; limits of confidently

reveiwed.

3. Symptoms

-----------

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

Veteran's diagnoses:

[X] Anxiety

[X] Panic attacks that occur weekly or less often

[X] Near-continuous panic or depression affecting the ability to function

independently, appropriately and effectively

[X] Chronic sleep impairment

[X] Mild memory loss, such as forgetting names, directions or recent

events

[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] Impaired impulse control, such as unprovoked irritability with

periods

of violence

Behavioral observations:

Behavioral observations:

Veteran arrived on time for the evaluation.

Orientation: Alert and oriented x 4

Behavior/relatedness: Cooperative and attentive

Appearance: Appeared stated age, casually dressed, adequately groomed.

Eye Contact: appropriate

Psychomotor: WNL

Communication Barriers: None apparent or reported

Speech: WNL for rate, volume, production, prosody

Mood/Affect: Mood appears very anxious, affect appropriate to context

and content

Thought Content: WNL, no auditory of visual hallucinations reported,

no

apparent delusions or paranoia.

Thought Process: logical, linear, goal-directed, and coherent

Judgment: Intact

Insight: Intact

Suicidal Ideation: Denied, reports history of suicidal ideation, last

in 2012.

Homicidal Ideation: Denied

4. Other symptoms

-----------------

Does the Veteran have any other symptoms attributable to mental disorders

that are not listed above?

[X] Yes[ ] No

5. Competency

-------------

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

[X] Yes[ ] No

6. Remarks (including any testing results), if any:

---------------------------------------------------

DBQ PSYCH Mental disorders:

Please review the Veteran's electronic folder in VBMS and state that it

was reviewed in your report.

MEDICAL OPINION REQUEST

TYPE OF MEDICAL OPINION REQUESTED: Direct service connection

OPINION: Direct service connection

Does the Veteran have a diagnosis of mental disorder with depression,

anxiety, sleep disturbances, alcohol abuse, and stress disorder that is

at least as likely as not (50 percent or greater probability) incurred in

or caused by events and/or activities that occurred during service?

Rationale must be provided in the appropriate section.

Additional remarks for the examiner:

The Veteran's miliatary personnel file and DD 214 shows that he served in

Saudi Arabia from 08/05/1993 to 12/06/1993 and in Bosnia from 03/20/1997

to 10/27/1997. The Veteran relates a stressor which began mid deployment

to Bosnia in 1997. Veteran states that he performed mine clearing and

lane proofing with an M60 Panther and was subject to frequent threats of

attack from local citizens, witnessing 2 incidents of local military

members being killed from a detonated mine while mine clearing. Veteran

also states that he was near (2-3 miles) the Brcko riot on 08/26/1998.

Veteran also describes an incident when he was woken in the middle of the

night and instructed to be battle ready and were leaving camp within the

hour. After traveling approximately 3-4 hours they arrived at a large

open field, several hours later they began to return to camp, on the way

back the COAX from a M113 behind the HMMWV was hit. The Veteran states

that these events caused several minor anxiety attacks which he had never

experienced prior to these events and that these anxiety attacks have

increased in number and severity over time.

***Please comment on the effect of the Veteran's service connected

disabilities on his or her ability to function in an occupational

environment and describe any identified functional limitations. Please

refrain from opining on if the veteran is unemployable or employable;

instead focus and reflect on the functional impairments and how these

impairments impacts occupational and employment activities.

MEDICAL OPINION REQUEST

TYPE OF MEDICAL OPINION REQUESTED: Secondary Service connection.

OPINION REQUESTED: Secondary Service Connection.

Is the Veteran's mental disorder with depression, anxiety, sleep

disturbances, alcohol abuse, and stress disorder at least as likely as

not (50 percent at least as likely as not (50 percent or greater

probability) proximately due to or the result of bilateral hearing loss?

Rationale must be provided in the appropriate section.

***Please comment on the effect of the Veteran's service connected

disabilities on his or her ability to function in an occupational

environment and describe any identified functional limitations. Please

refrain from opining on if the veteran is unemployable or employable;

instead focus and reflect on the functional impairments and how these

impairments impacts occupational and employment activities.

Potentially relevant evidence

NOTE: The examiner's review of the record is NOT restricted to the

evidence listed below. This list is provided in an effort to assist the

examiner in locating potentially relevant evidence.

Tab#1: STRs, Vol.#1, Pg.#56; Entrance Physical Examination dated

06/19/1992.

Document ID# 2829/CACI_143153101P001020602.pdf

Tab#2: Military Personnel Records Vol.#5, Pg.#7; DA Form 2-1, Personnel

Qualification Record - Part II shows service in Saudi Arabia 08/05/1993

to 12/06/1993.

Document ID# 2829/CACI_143153101P001020602.pdf

Tab #3: DD 214 shows service in Bosnia from 03/20/1997 to 10/27/1997.

Document ID# 2829/CACI_143153101P001020602.pdf

Tab#4: STRs, Vol.#2, Pg.1; Separation Physical Examination dated

05/19/1998.

Document ID# 2829/CACI_143153101P001020602.pdf

VHA CAPRI data base to include VISTAWEB and DOD Records:

Washington VAMC current problem list shows diagnosis for Anxiety,

Depression , memory impairment and hearing loss.

****************************************************************************

Initial Post Traumatic Stress Disorder (PTSD)

Disability Benefits Questionnaire

* Internal VA or DoD Use Only *

Name of patient/Veteran:

***********

SECTION I:

----------

1. Diagnostic Summary

---------------------

Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria

based on today's evaluation?

[ ] Yes [X] No

If no diagnosis of PTSD, check all that apply:

[X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under

DSM-5 criteria

[X] Veteran has another Mental Disorder diagnosis. Continue to complete

this Questionnaire and/or the Eating Disorder Questionnaire:

2. Current Diagnoses

--------------------

a. Mental Disorder Diagnosis #1: Panic Diosrder

ICD code: 300.01

Comments, if any:

Veteran has a history Panic Attacks, with persistent concern about

having another attack and significant maladaptive behavior change

related to the panic attacks.

Veteran's sleep disturbance is a symptom of Panic Disorder, he

does

not meet criteria for alcohol abuse or another stress disorder at

this time. He does not meet criteria for a DSM IV or DMS 5

diagnosis of PTSD.

Mental Disorder Diagnosis #2: Agorapobia

ICD code: 300.02

Comments, if any:

Veteran reports excessive axniety in using public transportation,

being outside the home alone or being in enclosed places.

Agoraphobia is secodary to Veteran's Panic Disorder.

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

Mental Health Disorder (to include TBI): non identified

3. Differentiation of symptoms

------------------------------

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:

Veteran's fear of leaving home is attributable to Agoraphobia and

his recurrent panic attacks and maladaptive behavior change

related

to the panic attacks are attributable to panic disorder. Veteran

also has symptoms suggestive of Generalized Anxiety Disorder and

Social Phobia but does not meet full criteria for either condition.

c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?

[ ] Yes [ ] No [X] Not shown in records reviewed

4. Occupational and social impairment

-------------------------------------

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] Total occupational and social impairment

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?

[ ] Yes [X] No [ ] No other mental disorder has been diagnosed

If no, provide reason that it is not possible to differentiate what

portion of the indicated level of occupational and social impairment

is attributable to each diagnosis:

Both conditions significantly impact Veteran's social and

occupational functioning.

c. If a diagnosis of TBI exists, is it possible to differentiate what

portion

of the occupational and social impairment indicated above is caused by

the

TBI?

[ ] Yes [ ] No [X] No diagnosis of TBI

SECTION II:

-----------

Clinical Findings:

------------------

1. Evidence review

------------------

In order to provide an accurate medical opinion, the Veteran's claims folder

must be reviewed.

a. Medical record review:

-------------------------

Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed?

[X] Yes [ ] No

Was the Veteran's VA claims file (hard copy paper C-file) reviewed?

[ ] Yes [X] No

If yes, list any records that were reviewed but were not included in the

Veteran's VA claims file:

If no, check all records reviewed:

[ ] Military service treatment records

[ ] Military service personnel records

[ ] Military enlistment examination

[ ] Military separation examination

[ ] Military post-deployment questionnaire

[ ] Department of Defense Form 214 Separation Documents

[X] Veterans Health Administration medical records (VA treatment

records)

[ ] Civilian medical records

[ ] Interviews with collateral witnesses (family and others who have

known the Veteran before and after military service)

[ ] No records were reviewed

[X] Other:

e-folder

b. Was pertinent information from collateral sources reviewed?

[ ] Yes [X] No

2. History

----------

a. Relevant Social/Marital/Family history (pre-military, military, and

post-military):

Veteran raised in an intact family with a younger brother, his parents

divorced when he was about 16. He lived with his mother for about a

year and then moved in with father. His father had re-married, Veteran

had a younger step-sister in the home. No reported childhood abuse

issues. He described his childhood, his father was in the Navy, would

be gone for about 6 months of the year, most of his childhood, he

lived

overseas. He got along with other children and was active. He reports

being evaluated at Walter Reed around age 10 due to some speech

issues,

but does not recall the outcome of the evaluation and he does not

recall being in any special education classes.

Veteran has been married since 2003, they have a 11 year old son and a

10 year old daughter. He reports his relationship with his wife is

"very strained", "we have our ups and downs" depending on his mood.

b. Relevant Occupational and Educational history (pre-military, military,

and

post-military):

Veteran served in the USA from 1992-1998, he was given an Under

Honorable Conditions Discharge as an E1. He lost rank, from E4 to E1

due to an DUI. His mos was combat engineer.

Veteran graduated from high school, he recently attempted to take some

college classes, he started in the fall of 2014, but reports not being

able to pass any classes.

After the military he worked in fast food restaurants, initially as a

driver, then assistant manager. He was fired due to anxiety symptoms

in

2012 and has not worked since. He reports kicking over a trash can and

knocking over a few stacks of trays. He tried to return to work at

Pizza Hut in July, 204 but reports not only lasting 2 days, he was not

able to tolerate the noise.

c. Relevant Mental Health history, to include prescribed medications and

family mental health (pre-military, military, and post-military):

Veteran reports a history of ADHD and behavioral problems in his son

and a maternal cousin has severe anxiety problems. Veteran exit exam

documented "SOB sometimes secondary to anxiety attacks". Veteran was

involved in a MVC, he hit three other vehicles, on 4/9/98 while under

the influence of alcohol.

Veteran reports no treatment for anxiety until 2012. He would

experience a panic attack about once a year until 2012, when he

started

having panic attacks one - two a day. He initially thought he was

having heart problems.

Veteran seen in the ER at St. Mary's Hospital on 2/16/12 with c/o

chest

pain, on 4/13/12 with a diagnosed of Anxiety Disorder, 6/19/13 with

c/o

Paresthesias in both hands and feet. Veteran was admitted to St.

Mary's

Hospital with a diagnosis of Anxiety Disorder, Suicidal Risk, and

Depression in 10/2012. Medications included Paxil for mood and

Trazodone for sleep with plan to f/u at Charlotte Hall CBOC.

Veteran initially seen by PCP at the CH CBOC on 0/6/12, he reported a

history of anxiety. He was referred to Psychiatry and see via

tele-health on 10/3/12 by Dr. Shao who diagnosed Veteran with a

Depressive Disorder NOS and Panic Disorder without Agoraphobia. He had

previously been in treatment at Walden Sierra, a non VA clinic, for

8-9 months. He was next seen by Dr. Shao on 3/7/14, after f/u at the

Baltimore Glen Burnie CBOC in 2013. He reports his son was being

treated at St. Vincent's Villa for about a year, so Veteran would save

gas by being able to visit his son and be seen at the clinic.

Veteran is currently prescribed Paxil and Buspar by a non VAMC

provider. He is currently followed by the Walden Sierra Clinic.

He reports in Bosnia he was involved with helping the Bosnian Army

remove land minds, he witnessed a local being killed by a land mind.

Another time, they were woken up in the middle of the night and left

camp, "I was panicking", he thought they were going to war and on the

way back an MIAI accidently went off and stuck the vehicle behind it,

Veteran was 2-3 three vehicles behind the struck vehicle. No one was

injured, Veteran reports it was very frightening at the time. He does

not report cuurent symptoms related to exposure to these incidents. He

reports occasional thoughts of his deployment that are not intrusive,

he does not endorse avoidance symptoms or alterations in cognition

related to trauma exposure.

Veteran reports on-going anxiety issues since the military. He reports

being in a combat unit, drinking "seemed the thing to do", He reports

no alcohol use prior to the military, his 2012 MH evaluation stated

Veteran started drinking 2-3 months ago, and drinks 1-2 times a month.

Veteran did not think that was accurate, he states they do not keep

alcohol in the house and he does not drink.

Veteran reports he is very irritable. He has trouble falling asleep

and

staying asleep. He reports leaving the house is a challenge. If he has

to go by himself, he will go into the store, get what he needs and

leaves. He is not able to go grocery shopping with his wife because he

becomes to anxious. He reports when he "gets up the courage" to go to

dinner, he has to sit in a corner with his back to the rest of the

people, "I don't want to see people, "I have a fear of what people

think of me". He reports isolating himself at home. He reports

experiencing a panic attack at least once every two week. He worries

about having a panic attack. He reports he is able to drive in his

local area, but if he has to drive more than 15 miles, he will have a

panic attack, "I don't like the uncertainty of not being able to get

home when I need to". He has been offered free bus passes in his

community but he has refused them, because "I can't leave when I need

to". He reports when talking to people he avoids eye contact due to

his

anxiety. He reports avoiding doing work outside around the house

because he does not like people watching him. He reports in 2012, he

had thoughts of suicide by ingesting his Xanax, which led to his

hospitalization in 10/2012. Prior to 2012 he also reports thoughts of

death, he denies suicidal ideation since 2012.

d. Relevant Legal and Behavioral history (pre-military, military, and

post-military):

Veteran has a history of DUI in 1998. Denies current legal issues. He

reports hitting his wife one time earlier this year, "I was almost

arrested but my wife decided not to press charges". He reports having

problems with anger and irritablity but has been to "stop myself"

before acting out in anger.

e. Relevant Substance abuse history (pre-military, military, and

post-military):

Veteran has a history of DUI in 1998,

f. Other, if any:

Veteran idenitified by full name and DOB; limits of confidently

reveiwed.

3. Stressors

------------

Describe one or more specific stressor event(s) the Veteran considers

traumatic (may be pre-military, military, or post-military):

a. Stressor #1: Deployed to Bosnia, witnessed a Bosnian SM killed, was on

night mission, when a weapon accidently fired and hit another vehicle

Does this stressor meet Criterion A (i.e., is it adequate to support

the diagnosis of PTSD)?

[X] Yes [ ] No

Is the stressor related to the Veteran's fear of hostile military or

terrorist activity?

[X] Yes [ ] No

Is the stressor related to personal assault, e.g. military sexual

trauma?

[ ] Yes [X] No

4. PTSD Diagnostic Criteria

---------------------------

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 #7 - Other symptoms. 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).

Criterion A: Exposure to actual or threatened a) death, b) serious

injury,

c) sexual violation, in one or more of the following ways:

[X] Witnessing, in person, the traumatic event(s) as they occurred to

others

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:

No response provided.

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:

No response provided.

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:

No response provided.

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:

No response provided.

Criterion F:

No response provided.

Criterion G:

No response provided.

Criterion H:

No response provided.

Criterion I: Which stressor(s) contributed to the Veteran's PTSD

diagnosis?:

No response provided.

5. Symptoms

-----------

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

Veteran's diagnoses:

[X] Anxiety

[X] Panic attacks that occur weekly or less often

[X] Near-continuous panic or depression affecting the ability to function

independently, appropriately and effectively

[X] Chronic sleep impairment

[X] Mild memory loss, such as forgetting names, directions or recent

events

[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] Impaired impulse control, such as unprovoked irritability with

periods

of violence

6. Behavioral Observations

--------------------------

Behavioral observations:

Veteran arrived on time for the evaluation.

Orientation: Alert and oriented x 4

Behavior/relatedness: Cooperative and attentive

Appearance: Appeared stated age, casually dressed, adequately groomed.

Eye Contact: appropriate

Psychomotor: WNL

Communication Barriers: None apparent or reported

Speech: WNL for rate, volume, production, prosody

Mood/Affect: Mood appears very anxious, affect appropriate to context and

content

Thought Content: WNL, no auditory of visual hallucinations reported, no

apparent delusions or paranoia.

Thought Process: logical, linear, goal-directed, and coherent

Judgment: Intact

Insight: Intact

Suicidal Ideation: Denied, reports history of suicidal ideation, last in

2012.

Homicidal Ideation: Denied

7. Other symptoms

-----------------

Does the Veteran have any other symptoms at

[bleggett29]

Above is the C&P exam DBQs.

After further review, I am worried that the symptoms listed may limit me to 30%, despite that the examiner checked Total Occupational and Social Impairment.