ptsd What's The Turn Around Time For A C & P Exam

[Jaydog]

I had my c & p exam on 8 July 2015. I was wondering what the average turn around time for an exam to be completed ? This particular c & p was for PTSD secondary personal assault . It's been a week and still not complete. Is this normal they take so long to be completed ? Or is it mine might be a little more complex . Any advice would be appreciated .

[Jaydog]

I just received a copy of my C & P exam. It only took 20 days. I will post an edited copy of it and any feedback would be great.

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LOCAL TITLE: C&P PTSD

STANDARD TITLE: MENTAL HEALTH C & P EXAMINATION CONSULT

DATE OF NOTE: JUL 08, 2015@10:00 ENTRY DATE: JUL 29, 2015@18:07:05

AUTHOR: XXXXXXXXXx EXP COSIGNER:

URGENCY: STATUS: COMPLETED

Initial Post Traumatic Stress Disorder (PTSD)

Disability Benefits Questionnaire

* Internal VA or DoD Use Only *

Name of patient/Veteran:xxxxxxx

SECTION I:

----------

1. Diagnostic Summary

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

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

based on today's evaluation?

CONFIDENTIAL Page 5 of 54

[ ] 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: Major Depressive Disorder, Recurrent, Moderate ICD code: 292.32

Comments, if any:

Although Veteran has been treated for Bipolar II disorder, his

long hours of work are more conceputalized as avoidance rather than

hyperproductivity during those hours at work. Veteran does express

chronic irritability toward self and others. He denied other

hypomanic behaviors that met criteria for Bipolar II disorder at

the present time.

Mental Disorder Diagnosis #2: Other Specified Anxiety Disorder

ICD code: 300.09

Comments, if any:

Subthreshold for features of Social Anxiety Disorder and Other

Stressor Related Disorder. Please see "remarks" section below for further detail.

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

Mental Health Disorder (to include TBI): N/A

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:

Pervasive feelings of shame, negative view of self, passive

suicidal ideation without intent, anhedonia, isolation, anergia,

absent libido are more accounted for by Major Depressive Disorder.

Avoidance of social contact and relationships were reportedly

related to negative views of self, and negative self-appraisal.

Anxiety symptoms were reportedly largely related to interpersonal

relationships.

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

[ ] Yes [X] No [ ] 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] Occupational and social impairment due to mild or transient symptoms

which decrease work efficiency and ability to perform occupational

tasks only during periods of significant stress, or; symptoms controlled by medication

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

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:

[X] Military service treatment records

[X] Military service personnel records

[ ] Military enlistment examination

[ ] Military separation examination

[ ] Military post-deployment questionnaire

[X] Department of Defense Form 214 Separation Documents

[X] Veterans Health Administration medical records (VA treatmentrecords)

[X] Civilian medical records

[ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service)

[ ] No records were reviewed

[ ] Other:

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):

was born and raised in northern California, although

relocated frequently as his father served in the U.S. Coast Guard. He

is the 3rd of 2 brothers and 2 sisters and grew up in an intact family.

Veteran denied social or behavioral problems during development, was

social and made friends, and denied any history of childhood physical,

sexual, or emotional abuse or any exposure to violence in the home. He

enlisted in the military at age 18, serving from 1994-1996 when he was

discharged due to failed alcohol rehabilitation; discharge status was

honorable. Mr. xxxx reported continued problems related to alcohol

use and worked sporadic jobs after discharge. In 2005, he married his 1st

wife and had two children who are now 11 and 10 years old. He and

ex-wife divorced in 2006, and he last had any contact with his

children approximately 1.5 years ago. He married again in 2011 and has 1 child

age 3 y/o. He and his wife moved to xxxxxxx approximately 2 years

ago for a job transfer for him to manage a dealership in xxxxx. He

reported challenges with his wife, as he stated being emotionally shut

down with her, about which he feels very guilty. He denied any intimate

partner violence in his current marriage.

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

xxxxxx completed high school and attended some college. While in the

military, he worked as a mechanic and after discharge, worked in

various jobs. Most recently he has been working as a sales manager at a

car dealership in xxxxxxx, and stated that he works approximately 13

hours per day, 6 days a week, "to avoid going home." He reported

feeling that his work provides a place for him to focus on tasks,

though he acknowledged that it is not service of productivity as much

as it serves his avoidance.

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

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

xxxxxxx denied any mental health treatment prior to the military,

although VA progress notes indicate that he reported onset of

depressive symptoms at age 13 (see notes MH-Medication Management by

, MD on 5/1/08 and MH Biopsychosocial signed by J Leif

on 6/26/08). During the military, after his DUI and

continued alcohol use, he reported to be referred to an Alcohol and

Drug Program "for a few weeks" that included some group and individual

sessions, though he reported not receiving much benefit. After the

military, xxxxxxxx was hospitalized once in 2005 for suicide attempt

by drug overdose and multiple times in 2006 for suicidal ideation in

the context of alcohol use. He was treated in the community at xxxxx

xxxxxxxxxxxx CDDP and outpatient treatment. VA medical records

indicate sporadic and minimal engagement, first presenting to VANCHCS in 1999 (2

visits), 2003 (1 visit); he engaged in medication management visits

2008-2013 for the treatment of depression by xxxxxxxx at VANCHCS.

He relocated to xxxxxxx in 2013 and started being treated by

xxxxxxxxxxxxxxx, NP on 10/16/2013 for bipolar II disorder. His current

psychiatric medication regimen includes quetiapine 50 mg, gabapentin

100 mg, sertraline 100 mg, and buspar 5 mg. On 8/6/2014, he disclosed

to xxxxxxx and his treatment was adjusted to

include PTSD 2/2 MST. This disclosure precipitated his submitted

statement for service connection for PTSD due to MST dated 8/21/2014,

after 1st denial of claim for depression/anxiety on 8/23/2013 and his

notice of disagreement on 9/10/2013. He attended a screening and 1

group appointment for men with MST support, but has not received

psychotherapy for mental health problems since the mid-1990s

when he was being treated for alcohol abuse and attending AA. He

reported to continue to be abstinent from alcohol

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

Prior to the military, Veteran went to juvenile hall for being drunk in

public. During the military, Veteran denied any demotions or Article

15s. Veteran was arrested in 1995 for domestic violence against his

wife. He denied current problems with behavioral violence or legal

issues.

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

Mr. xxxx reported use of alcohol 1x when 15 y/o and was arrested for

being drunk in public. He denied drinking again until he was in the

service and began drinking heaviily while in the service. He reported

having one "wet reckless" detainment as he was driving wet but under

the BAC limit, and received 1 DUI in 1996. He reported drinking heavily

"off and on" from 1996 - 2008. He reported attending AA and has a

sponsor; last drink was reportedly July 15, 2008. He reported being in

contact with his sponsor by phone. He denied current use of nicotine,

marijuana, cocaine, opiates, hallucinogens or other illicit substances.

f. Other, if any:

No response provided.

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: Edited

Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)?

[ ] Yes [X] No

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

[ ] Yes [X] No

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

[X] Yes [ ] No

If yes, please describe the markers that may substantiate the stressor.

It is at least as likely as not that the stressor occurred.

Veteran attributes increase in quantity and frequency of drinking

and disturbed self-image after this incident, although that is

unclear, as he reportedly had been drinking even prior to this

incident. Veteran stated in his statement of disagreement with

denial of claim for depression/anxiety on 9/10/2013: "I will not

say it was one single event that happened during my time in

service. It was a series of experiences that happened during my

service... I still have a very hard time when ever I hear

helicopters and smell diesel fuel exhaust." When queried in

the exam interview about the "series of experiences" that

he found to be distressing, he reported that antagonistic harassment by

superiors related to alcohol rehabilitation contributed to his

distress. The intrusive reminders of diesel exhaust and

helicopters are not consistent with the MST and the experience

of antagonism by his superiors do not meet criterion A for PTSD.

Clinical symptoms appear to be more consistent with major

depressive disorder with strong anxiety features contributing to

avoidance. Please see "Remarks" below for further results from

the examination.

4. PTSD Diagnostic Criteria

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

No response provided

5. Symptoms

-----------

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

Veteran's diagnoses:

[X] Depressed mood

[X] Anxiety

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

relationships

[X] Suicidal ideation

6. Behavioral Observations

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

Appearance and Behavior: A&Ox4, appeared stated age, casually

dressed/groomed, avoidant eye contact, clammy palms consistent with

presentation of anxiety, cooperative with interview, polite, did not require redirection.

Motor Activity:

No PMA/PMR, no abnormal movements

Speech: regular rate and rhythm, normal prosody and tone

Mood: Anxious, dysphoric

Affect: congruent with content, restricted range of affect

Thought Process: linear, goal oriented

Thought Content: the patient reported passive suicidal/homicidal ideation,

but denies intent. No evidence of psychosis, mania, or other formal thought disorder.

Perception: No evidence of auditory/visual hallucinations.

Insight/Judgment: limited/limited; intact/intact

7. Other symptoms

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

Does the Veteran have any other symptoms attributable to PTSD (and other

mental disorders) that are not listed above?

[ ] Yes [X] No

8. Competency

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

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

[X] Yes [ ] No

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

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

xxxxxxxxx was examined via clinical interview and the gold-standard

Clinician-Administered PTSD Scale (CAPS-5), and self-report measures via

Minnesota Multiphasic Personality Inventory (2nd edition; MMPI-II),

Millon Clinical Multiaxial Inventory (3rd edition; MCMI-III), Beck Depression

Inventory (2nd edition; BDI-II), Alcohol Use Disorders Identification

Test (AUDIT), and Life Events Checklist (LEC). In addition to this examiner,

with the patient's verbal consent, another licensed psychologist

observed the examination for disability examination training purposes.

On the LEC, Veteran endorsed witnessing a friend accidentally shooting

himself in the leg and taking him to the hospital, and experiencing the

sexual molestation during the military by another man. On the CAPS-5, xxxx

endorsed physical sensations associated with anxiety, feelings of

hopelessness and sadness, feelings of alienation, self-blame, shame,

anhedonia, irritability, guardedness, and exaggerated startle response.

He denied other symptoms of PTSD, or other symptoms could not be determined

as directly associated with the military sexual molestation incident. His

symptoms were most consistent with Major Depressive Disorder (BDI-II =55)

and Other Specified Anxiety Disorder (subthreshold for Social Anxiety

Disorder and Other Stressor-Related Disorder). Consistent with self-report

during clinical interview, Veteran's anxiety, disturbed and negative

self-image, guilt, irritability, and poor mood contribute to avoiding

interaction with family at home (thus leading him to be at work for 13

hrs/day, 6 days/week, but not necessarily reflecting hyperproductivity at

work). His score on the AUDIT was 4, indicating no current alcohol use disorder.

Mr. XXXX' results on the MMPI-II reflected a response pattern of

overendorsing distress, leading to an invalid profile that should not be

interpreted (MMPI-II F = 104; F-K = 17; FBS = 90). Similarly, his

responses on the MCMI-III also reflected a pattern of responses that

overly portrayed himself in a negative light(MCMI-III X BR = 100; Z BR =

. Due to these response patterns, dissimulation and/or

characterological factors could not be ruled out at the present time.

Thus, while it is at least as likely as not that the MST occurred,

Veteran's responses and report of his symptoms are not consistent with a

PTSD diagnosis and are better accounted for by Major Depressive Disorder

and Other Specified Anxiety Disorder (subthreshold for Social Anxiety

Disorder and Other Stressor-Related Disorder). He does appear to have

difficulty with social functioning apart from his current wife and child,

and he reported avoidance of even those intimate relationships. He denied

current impaired occupational functioning, though did report often

expressing irritation with work colleagues. Veteran's depressive symptoms

were reported to be related to significant negative views of self and

guilt/shame over his past alcohol abuse and its sequelae including

domestic violence, DUIs, impact on his military career, and current

alienation from wife and child. It cannot be said with confidence that his

depression or anxiety are solely attributed to the MST.

[Fat]

I simply go the VA Hospital (Release Of Information) after a week and they print the information for me.