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DRO, PTSD, Stressor Verification

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Jar Head 0811

Question

Good Afternoon All,

I had my C&P exams for PTSD, osteoarthritis (right knee) and sinusitis. I will try to give the good, the bad and the ugly in my situation:

-Operational Experience:

OEF (Garmsir, 2008). 24 MEU. Cannon Cocker. Conducted combat patrols (was fired upon by the enemy, did not return fire due to non-combatants in the area). Indirect fire on the enemy resulting in 98 enemy casualties. We had 2 KIA in our battalion. Saw a child that had JUST been raped by a family member.

Operation Unified Response. Boots on the ground. Conducting security operations for Hattian citizens coming back from US Navy Hospital ships. Saw some very horrific things.

Received campaign medals and Navy and Marine Corps Achievement Medals for both operations (no “V” or CAR for OEF. Received HSM for Haiti).

Three other various deployments.   

-Treatment in Service:

PTSD: 2 years of treatment prior to discharge, diagnosed at Naval Hospital Quantico, Behavioral Health

Treatment for knee throughout service diagnosed with osteoarthritis (right knee) in service.

Sinusitis treatment to include surgery (septoplasty and turbinoplasty). Diagnosed with sinusitis in service.

-VA claims process thus far.

Veteran’s Service Organization: DAV

PTSD, sinusitis and osteoarthritis on appeal, currently with DRO.

Stressor: Seeing small boy being raped in Afghanistan.

DRO had to gather records from the Marine Corps Archives (I am assuming to verify my stressor).

1. Diagnostic Summary

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

[X] Yes [ ] No

ICD code: 309.81

2. Current Diagnoses

a. Mental Disorder Diagnosis #1: Posttraumatic Stress Disorder

ICD code: 309.81

Mental Disorder Diagnosis #2: Major Depressive Disorder, Recurrent,

Severe

ICD code: 296.33

Comments, if any:

The diagnosis of major depressive disorder should be considered an inferred claim.

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

Mental Health Disorder (to include TBI):

No response provided.

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:

PTSD and depression are often co-occurring disorders with a great deal of shared symptomology. In general, the Veteran's PTSD accounts for his intrusive trauma memories, nightmares, flashbacks, avoidance behaviors, emotional numbness, hypervigilance,

hyperarousal, and related anxiety. His depression likely accounts for his chronic sad mood, feelings of worthlessness, tearfulness, lack of libido, self-criticalness, and change in appetite.

The following symptoms are found in both depression and PTSD and cannot be reliably distinguished without resorting to mere speculation: loss of interest in previously enjoyed activities, social isolation/withdrawal, sleeping disturbance (and associated fatigue), irritability, difficulty concentrating, distractibility, negative belief systems, restlessness, and feelings of guilt.

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 with reduced reliability and productivity

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:

The extent to which symptoms of each psychiatric disorder are independently responsible for occupational and social impairment is impossible to delineate without resorting to mere speculation.

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 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

[X] Military post-deployment questionnaire

[ ] Department of Defense Form 214 Separation Documents

[ ] Veterans Health Administration medical records (VA treatment records)

[ ] Civilian medical records

[X] 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 [ ] No

2. History

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

Pre-military: was kind of a shy child, taking a while to warm up to people. Was able to trust others. Raised by grandparents because his mom was young, parents divorced when he was 5. No siblings. His childhood was good, lived in a small town as a child and then moved to

Seattle to live with Dad when 13. No abuse in childhood.

Military: He didn't stay in the same unit so moved around it was difficult to keep friendships. He still talks to some of his military friends. Only lets people in so far with the exception of his wife.

Has trouble trusting people. His wife stated that his overall attitude towards people was: "Get them before they get me." and that this was with everything including her.

First marriage lasted for 8 years they did not have children. She cheated on him. "I was not the best husband." He was distant. No contact with her. Married second time in 2003, they have two children. He stated that the marital relationship was "not bad", she reported "it has

its moments". In the beginning it was very good, first four years. She stated that

"my husband went to Afghanistan and didn’t come back." Not the same at all, not the same with wife and kids. Before he would get mad at normal things now he blows up over everything. Was drinking everyday for about 3 years after he got back and got a DUI. He still drinks and states that he does this to stop the continuous loop of horror in his head.

She does not feel as close or connected to him, doesn't talk about what

happened while he was deployed or how he feels.

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

Pre-military: he stated that towards the beginning of school was below average but toward the end was above average. No attention or learning problems in childhood. Played soccer and swam.

Military: Graduated from HS early and joined the Marines at 18. The veteran served in the Marine Corps from August 17, 1994 to May 31,

2013. Jobs in the military: started in amphibious assault then went to artillery. Has had 5 deployments with 4 combat operations, 1)

Operation Southern Watch - Kuwait (2 months); 2) Operation Silent Lance - Serbia

(70 days); 3) OEF - (8 months); 4) OEF - (classified); 5 Operation disaster relief in Haiti (10 days). No difficulties on the job in the military. He retired early because of downsizing.

Post-military: work for the county does public service. It requires Him to have a lot of interactions with people. He goes from being very angry to being very happy and this happens daily. The anger builds like a bubble and then pops. Difficulty with co workers, I want to believe

that it is not their fault. Co-workers are frustrating and irritating, it is hard for me to function and smile. Not sure how much longer he will be able to work there, He has been written up several times at work for his behavior, he gets asked to leave the office, he has been told he acts crazy. Working since August of 2013, he snaps at people, sometimes he will think that is really stupid and have to apologize. He feels that he could be able to work alone.

Currently in school full-time for criminal intelligence degree. He is in a traditional classroom and is doing okay.

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

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

Pre-military: no psychiatric diagnosis or treatement.

Military: While at Quantico he was diagnosed with PTSD November 2010

after returning from a deployment to Haiti, Jordan and Oman. He was

followed from that time by psychiatrist and social work. He was tried

on multiple medications for, celexa, zoloft, ambien. Since 2010 he had

been diagnosed with Depression, Chronic PTSD, Anxiety NOS. and alcohol

abuse. Has had TBI testing (last incident 2010) have had irregular

imaging. Still has problems with attention and memory.

Post-military: He stated "I just lost himself. I don't even

know who I am anymore. All of this consumes me" Symptoms started in 2008 but

he is not sure. Depression, anxiety, panic once a week.

Sleep: maybe 3 hours of sleep a night, "I beat the shit out of my

wife", sweats, bought a bigger bed trying to help, thrashes around, having nightmares, sleep talking, Irritable, angry outbursts, easily starteled. Auditory hallucinations,

weird things, like a high pitched squeak, squealing every so often driving down the road. This has just started. It is unclear whether this is related to auditory dysfunction or a hallucination. Has visual anomalies, seeing movement out of the corner of his eye. If he sees trash on the side of the road he has to swerve around it. NO problem driving small distances but can't drive a long distance or "will lose my mind."

Suicidal and homicidal ideation denied.

Ritualistic behavior before bed, "have to get clothes ready they have to be in certain spot, if they are not in the right spot I go ape shit." If he can't do it it is very stressful he has to do it. "I am not me anymore. It happened after Afghanistan, like I don't have

A soul, like I am hollow every day." He has certain rituals during

morning and during the day. If he doesn't do these things he would be

completely lost. He doesn't know how he is going to function the

rest of his life. "I am a xxxxxxx horrible husband and father." He

reported that he feels close to his children. He stated that his yougest

daughter who is 10 "keeps me together."

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

post-military):

Had a DWI in October 10, 2010 which is why he had to start seeing

psychiatrist until he retired. Is not seeing a psychiatrist now or

therapist. Had the conviction set aside, his wife did all the work.

This was rough on both of them.

Trouble with drinking began in Marine Corps. Now he is not drinking

much at all, his wife stated one or two, once a week. Went a couple of

years without drinking.

No substance use

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

post-military):

See legal history

No current problem with alcohol or substance use.

f. Other, if any:

No response provided.

3. Stressors

a. Stressor #1: I saw a boy 9 to 10 years old get raped by one of his family

member and not being able to do anything about it. Happened in

afghanistan.

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 #6 - 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 (DMS-5).

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

injury,

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

[X] Directly experiencing the tramuatic event(s)

[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:

[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).

[X] 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:

[X] 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.

[X] 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.

[X] 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.

5. Symptoms

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

diagnoses:

[X] Depressed mood

[X] Anxiety

[X] Suspiciousness

[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] Difficulty in understanding complex commands

[X] Disturbances of motivation and mood

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

A worklike setting

[X] Inability to establish and maintain effective relationships

[X] Obsessional rituals which interfere with routine activities

[X] Impaired impulse control, such as unprovoked irritability with

Periods of violence

6. Behavioral Observations

The veteran and his wife arrived on time for his scheduled evaluation. He

Was appropriately dressed and groomed. Gait appeared normal, with no gross motor

deficits observed. He was alert and attentive. He shows no significant impairment of communication. Thought processes were normal and goal-directed,

with no signs of hallucinations or delusions. Eye contact was appropriate.

He is able to maintain his personal hygiene and perform other activities of

daily living independently. He endorses obsessive, ruminative thoughts as

well as mild compulsive behaviors. Suicidal and homicidal ideation were

denied. Remote and recent memory was grossly intact. Affectively, he was

noticeably anxious and labile throughout the examination; affect and mood

were congruent. His speech was logical and goal-directed, rate was at times

pressured, rhythm and flow were within normal limits. Throughout the

interview and assessment the veteran was fully compliant and cooperative.

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, if any

Testing battery was completed including: Insomnia Severity Index (ISI),

Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS),

Beck

Anxiety Inventory (BAI), Posttraumatic Stress Disorder Checklist-Military

Version for the DSM-IV (PCL-M), the Mississippi Scale (MISS) and the

Combat Exposure Scale (CES).

The ISI is a self-report measure which provides a global measure of

perceived insomnia severity. The first item includes 3 scored responses,

and items 2-5 provide a total of 4 additional responses, for a total of 7

scored items for the questionnaire. Question 6 is not scored, but rather

provides a subjective assessment of daytime symptoms which allows one to

determine if the respondent meets full diagnostic criteria for an

insomnia diagnosis, which requires a deficit in daytime functioning. Each of the

scored items are rated on a 5-point Likert scale for a total score

ranging from 0-28. The ISI has adequate psychometric properties, has been

validated against diary and polysomnographic measures of sleep, and has

been shown sensitive to therapeutic changes in a pilot study for veterans

with PTSD. Veteran scored 26/28 on the ISI which indicates a severe

level of insomnia. The daytime affects of poor sleep that were endorsed

by veteran included: daytime fatigue (tired, exhausted, washed out,

sleepy), difficulty functioning (performance impairment at work/daily

chores, difficulty concentrating, memory problems), mood problems

 (irritable, tense, nervous, groggy, depressed, anxious, grouchy, hostile,

angry, confused), and physical symptoms (muscle aches/pain, light-headed,

headache, nausea, heartburn, muscle tension).

The Beck Depression Inventory (BDI-II) was administered to determine the

degree to which specific depressive symptoms are experienced by the

Veteran. Scores on the BDI-II range from 0 to 63, with higher scores

indicating more severe depression. Today, the veteran scored a 45 on the

BDI-II which indicates a severe level of depression. The interpretation

Of the BDI-II is based on normative data and is consistent with self report

of severe depressive symptoms and behavioral observation during the

clinical interview. The Beck Anxiety Inventory (BAI) is a 21 item self-report measure used to

assess anxiety symptom severity as well as to assist in the diagnosis of

anxiety. The veteran is asked to rate each item on a scale from 0 to 3

with 0 being "Not at all" and 3 being "Severely" to indicate the degree to

which they have been bothered by symptoms of anxiety during the past week

including today. Each of the 21 items is then added to provide a total

score, with higher scores indicating greater anxiety. Today, the veteran

scored a 30 on the BAI which indicates a severe level of anxiety. The

interpretation of the BAI is based on normative data and is consistent

with self report and behavioral observations of anxiety symptoms during

the clinical interview.

The Beck Hopelessness Scale (BHS) was used to measure attitudes about

hopelessness, feelings about the veteran's future, loss of motivation

and expectations. The BHS has been shown to predict suicidal ideation and

intent. Today the veteran scored 18/20 indicating a severe level of

hopelessness. The veteran denied suicidal ideation. The scores from the

BHS indicated that he has negative feelings about his future, loss of

motivation and negative expectations of what his future holds.

The PCL-M was used to asses PTSD symptom severity as well as to assist in

diagnosis. The 17 item self-report measure has three subscales following

the DSM-IV criteria; re-experiencing subscale, avoidance/numbing

subscale, hyperarousal subscale. The Veteran rates each item on a scale from 1 to 5

with 1 being "not at all" and 5 "extremely" to indicate the degree to

which they have been bothered by the symptom over the past month. This

instrument provides a total score which can range from 17 to 85.

Veteran’s score indicated that he has experienced severe to

Extreme symptoms of PTSD over the past month. It appears that veteran has had

difficulties with re-experiencing, avoidance behaviors and hyperarousal.

The total score is well above the suggested cutoff for combat veterans.

Total Score (cutoff = 50, Veteran's score = 82)

The Mississippi Scale (MISS) was used to assess the presence of symptoms

reflecting the three main DSM-IV criteria for PTSD: re-experiencing,

avoidance and numbing, and hyperarousal along with associated features

such as depression and substance abuse. The 35 items are rated on a

five-point scale asking respondents to rate their symptoms over time

"since the event." Symptom severity can range from 35-175. The

Cutoff score of 107 was suggested for combat related PTSD (Vietnam).

Veteran’s score of 155 is well above the suggested cutoff.

Total Score (cutoff = 107, Veteran's score = 155)

The Combat Exposure Scale (CES) was used to assess wartime stressors

experienced by the examinee. The 7-item self-report measure is rated on a

5-point frequency (1 = "no" or "never" to 5 = "more than 50 times"),

5-point duration (1 = "never" to 5 = "more than 6 months"), 4-point

frequency (1 = "no" to 4 = "more than 12 times") or 4-point degree of loss

(1 = "no one" to 4 = "more than 50%") scale.

Respondents are asked to answer based on their exposure to various combat situations, such as

firing rounds at the enemy and being on dangerous duty. The total CES

score (ranging from 0 to 41) is calculated by using a sum of weighted

scores, which can be classified into 1 of 5 categories of combat exposure

ranging from "light" to "heavy." The CES was developed to be easily administered and scored.

The veteran's total score is 24 indicating a moderate level of

Combat exposure. Combat experiences endorsed by the veteran included: combat

patrols or other dangerous duty, was under enemy fire, was surrounded by

the enemy, had soldiers in his unit that were KIA, wounded or MIA, fired

rounds at the enemy, saw someone hit by incoming or outgoing rounds and

was in danger of being injured or killed.

Based on DSM-IV and DSM-5 criteria, current interview with veteran and

his wife, review of the VA and VBMS electronic record, as well as scores

on the ISI, BDI-II, BAI, BHS, PCL-M, MISS and CES, the Veteran has

symptoms consistent with Post Traumatic Stress Disorder and Major

Depressive Disorder, Recurrent, Severe. THE DIAGNOSIS OF MAJOR DEPRESSIVE

DISORDER SHOULD BE CONSIDERED AN INFERRED CLAIM (Veteran was diagnosed in

service). Overall, chronic psychiatric symptoms have resulted in very

severe disruptions in family, social, leisure, occupational and

psychological domains of functioning. He is having great difficulty in

his job which requires him to interact with co-workers and the public

appropriately when there is evidence of significant irritability, low

frustration tolerance, and angry outbursts. This has resulted in

reprimands and being written up for inappropriate behavior in the office

which threatens his job. His symptoms create an incredible burden for the

veteran and his family. The veteran and his wife are unable to have any

social experiences. He was diagnosed and treated in 2010 for PTSD and

depression while he was in the Marines. There is no record or report of

psychiatric diagnosis or treatment before the military. He is currently

prescribed lexapro by a private primary care physician for PTSD and

depressive symptoms which is not effective. Severe symptoms of PTSD and

depression which began during his service is at least as likely as not

due to the cumulative effects of daily, multiple exposures to war and fear of hostile military or terrorist activity.

 

Any help or insight with this would be great. Thank you again.

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  • Content Curator/HadIt.com Elder

Welcome to Hadit!

Thank you for your service. I don't really see a specific question other than help or insight, so I'll provide my nonprofessional opinion. With details about your knee and sinus issues missing, I cannot offer an opinion other than the fact that having surgery in service can help in some cases.

 

Service connection looks good based on what's in bold below:

Severe symptoms of PTSD and depression which began during his service is at least as likely as not due to the cumulative effects of daily, multiple exposures to war and fear of hostile military or terrorist activity.

 

In my opinion, they will probably give a 70% rating, but it is unfortunately common for the VA raters to issue low-ball ratings initially that get corrected on appeal. I see that you are already in line for a DRO, which may be able to help sort it out. If you are unable to work, you can file for individual unemployability (IU) and/or social security disability (SSD).

Please keep in mind that they rate by the effects the mental health disorders have on you, not the number of of diagnosed disorders.

 

The schedule of ratings for mental health disorders is found here and is copied below:
§4.130 Schedule of ratings - Mental disorders

Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.100
Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.70
Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.50
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).30
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 continuous medication.10
A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.0

 

 

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Looks like a 70% rating to me. I'm not sure why he chose "Occupational and social impairment with reduced reliability and productivity ", that is a 50% level of impairment, but your symptoms clearly indicate at least 70%. This is the second time I've seen this on a DBQ today. I don't think the C&P doctors are trained very well on what levels of impairment are suggested by which symptoms. It could be he went low because you're in school and functioning well. The VA is required to look at the total picture. They don't just go by the examiners opinion on level of impairment. My first C&P examiner actually gave me an impairment opinion equal to 30%, even though my symptoms suggested 70%. The good news is that the rater went by the symptomology, as he is supposed to do and rated me 70%, although they denied service connection, which I'm appealing now. I think you'll get rated 70, if you don't, there's always the DRO.

Edited by bluevet
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  • Content Curator/HadIt.com Elder

bluevet,

Looks like you might be on to something

 

Jar Head,
Identifying the correct rating based on documented symptoms, as bluevet indicated, is a good way to point the DRO in the correct direction. I did this with my DRO and basically said my symptoms match X, Y, and Z, which fall under this % rating, and included copies of the evidence. Also, keep in mind that the table is more or less a guideline because not all situations are covered. It may seem confusing because there are varying combinations of factors, AND's, and OR's in there. They state you have total social impairment and really bad occupational impairment, which looks good for 70%. The DRO is supposed to provide a fresh set of eyes. Good luck!

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