ptsd CnP Results any input appreciated

[mskallday]

Hello all,

I was Active duty in the Army for 6 years and have two deployments to Iraq. I have been lurking on this site for a while and have learned so much! I recently got out and had all of my exams completed, and my claim is currently in the preparation for determination phase. I was wondering if i could get some advice on two of my exams and see what everyone thought.

    1. Diagnosis
    ------------
    Does the Veteran now have or has he/she ever been diagnosed with a central
    nervous system (CNS) condition?
    [X] Yes   [ ] No
    
    [X] Brain tumor      Date of diagnosis:  04/2013
    
    2. Medical history
    ------------------
    a. Describe the history (including onset and course) of the Veteran's
central
       nervous conditions (brief summary):
       veteran had a brain MRI due to c/o abnormal thyroid function. The MRI was
       done on 4/2/2013 and showed 14mm thin rim enhancing pineal gland lesion
       consistent with pineal cyst vs pineocytoma vs epidermoid. He subsequently
       had several more MRI's ( 5/13. 11/13, and 5/15) which were unchanged. It
       was felt that his symptoms were not related to the cyst.
       Veteran feels that his current symptoms which include vision changes,
       headaches, dizziness, nausea and memory problems are related to his
benign
       cyst. He has been seem for memory loss and found to have no deficits.
Seen
       by eye clinic diagnosed with benign retinal tuft and Myopic astigmatism.

       
       
    b. Does the Veteran's central nervous system condition require continuous
       medication for control?
       [ ] Yes   [X] No
       
    c. Does the Veteran have an infectious condition?
       [ ] Yes   [X] No
       
       If yes, is it active?
       [ ] Yes   [ ] No
       
    d. Dominant hand
       [X] Right   [ ] Left   [ ] Ambidextrous
       
    3. Conditions, signs and symptoms
    ---------------------------------
    a. Does the Veteran have any muscle weakness in the upper and/or lower
       extremities?
       [ ] Yes   [X] No
       
    b. Does the Veteran have any pharynx and/or larynx and/or swallowing
       conditions?
       [ ] Yes   [X] No
       
    c. Does the Veteran have any respiratory conditions (such as rigidity of the
       diaphragm, chest wall or laryngeal muscles)?
       [ ] Yes   [X] No
       
    d. Does the Veteran have sleep disturbances?
       [ ] Yes   [X] No
       
    e. Does the Veteran have any bowel functional impairment?
       [ ] Yes   [X] No
       
    f. Does the Veteran have voiding dysfunction causing urine leakage?
       [ ] Yes   [X] No
       
    g. Does the Veteran have voiding dysfunction causing signs and/or symptoms
of
       urinary frequency?
       [ ] Yes   [X] No
       
    h. Does the Veteran have voiding dysfunction causing findings, signs and/or
       symptoms of obstructed voiding?
       [ ] Yes   [X] No
       
    i. Does the Veteran have voiding dysfunction requiring the use of an
       appliance?
       [ ] Yes       [X] No
       
    j. Does the Veteran have a history of recurrent symptomatic urinary tract
       infections?
       [ ] Yes   [X] No
       
    k. Does the Veteran (if male) have erectile dysfunction?
       [ ] Yes   [X] No
       
    4. Neurologic exam
    ------------------
    a. Speech
       [X] Normal   [ ] Abnormal
       
    b. Gait
       [X] Normal   [ ] Abnormal, describe:
    c. Strength
         Rate strength according to the following scale:
           0/5 No muscle movement
           1/5 Visible muscle movement, but no joint movement
           2/5 No movement against gravity
           3/5 No movement against resistance
           4/5 Less than normal strength
           5/5 Normal strength
           
       Elbow flexion:
           Right:[X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5
           Left: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5

       Elbow extension:
           Right:[X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5
           Left: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5

       Wrist flexion:
           Right:[X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5
           Left: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5

       Wrist extension:
           Right:[X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5
           Left: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5

       Grip:
           Right:[X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5
           Left: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5

       Pinch (thumb to index finger):
           Right:[X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5
           Left: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5

       Knee extension:
           Right:[X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5
           Left: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5

       Ankle plantar flexion:
           Right:[X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5
           Left: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5

       Ankle dorsiflexion:     
           Right:[X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5
           Left: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5

    d. Deep tendon reflexes (DTRs)
         Rate reflexes according to the following scale:
           0   Absent
           1+ Decreased
           2+ Normal
           3+ Increased without clonus
           4+ Increased with clonus
           
       Biceps:
           Right:[ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+
           Left: [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+

       Triceps:
           Right:[ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+
           Left: [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+

       Brachioradialis:
           Right:[ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+
           Left: [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+

       Knee:
           Right:[ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+
           Left: [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+

       Ankle:
           Right:[ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+
           Left: [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+

    e. Does the Veteran have muscle atrophy attributable to a CNS condition?
       [ ] Yes   [X] No
       
    f. Summary of muscle weakness in the upper and/or lower extremities
       attributable to a CNS condition (check all that apply):
       
       Right upper extremity muscle weakness:
       [X] None

       Left upper extremity muscle weakness:
       [X] None

       Right lower extremity muscle weakness:
       [X] None

       Left lower extremity muscle weakness:
       [X] None

    5. Tumors and neoplasms
    --------
---------------
    a. Does the Veteran have a benign or malignant neoplasm or metastases
related
       to any of the diagnoses in the Diagnosis section?
       [X] Yes   [ ] No
       
    b. Is the neoplasm:
       [X] Benign   [ ] Malignant
       
    c. Has the Veteran completed treatment or is the Veteran currently
undergoing
       treatment for a benign or malignant neoplasm or metastases?
       [ ] Yes   [X] No; watchful waiting
       
    d. Does the Veteran currently have any residual conditions or complications
       due to the neoplasm (including metastases) or its treatment, other than
       those already documented in the report above?
       [ ] Yes   [X] No
       
    6. Other pertinent physical findings, complications, conditions, signs,
       symptoms and scars
    -----------------------------------------------------------------------
    a. Does the Veteran have any other pertinent physical findings,
       complications, conditions, signs or symptoms related to any conditions
       listed in the Diagnosis Section above?
       [ ] Yes  [X] No
       
    b. Does the Veteran have any scars (surgical or otherwise) related to any
       conditions or to the treatment of any conditions listed in the Diagnosis
       Section above?
       [ ] Yes  [X] No
       
    7. Mental health manifestations due to CNS condition or its treatment
    ---------------------------------------------------------------------
    a. Does the Veteran have depression, cognitive impairment or dementia, or
any
       other mental health conditions attributable to a CNS disease and/or its
       treatment?
       [ ] Yes   [X] No
       
    8. Differentiation of Symptoms or Neurologic Effects
    ----------------------------------------------------
    Are you able to differentiate what portion of the symptomatology or
    neurologic effects above are caused by each diagnosis?
    [ ] Yes   [X] No
    
    9. Assistive devices
    --------------------
    a. Does the Veteran use any assistive device(s) as a normal mode of
       locomotion, although occasional locomotion by other methods may be
       possible?
       [ ] Yes   [X] No
       
    10. Remaining effective function of the extremities
    ---------------------------------------------------
    Due to a CNS condition, is there functional impairment of an extremity such
    that no effective function remains other than that which would be equally
    well served by an amputation with prosthesis? (Functions of the upper
    extremity include grasping, manipulation, etc., while functions for the
lower
    extremity include balance and propulsion, etc.)
    
    [ ] Yes, functioning is so diminished that amputation with prosthesis would
    equally serve the Veteran.
    [X] No

    11. Diagnostic testing
    ----------------------
    a. Have imaging studies been performed?
       [X] Yes   [ ] No
       
       If yes, provide most recent results, if available:
           Several brain MRI's since intial one in 4/2013 unchanged as described
           in medical history
           
           
    b. Have PFTs been performed?
       [ ] Yes   [X] No
       
    c. If PFTs have been performed, is the flow-volume loop compatible with
upper
       airway obstruction?
       [ ] Yes   [ ] No
       
    d. Are there any other significant diagnostic test findings and/or results?
       [ ] Yes   [ ] No
       
    12. Functional impact
    ---------------------
    Do the Veteran's central nervous system disorders impact his or her ability
    to work?
    [ ] Yes   [X] No
    
    13. Remarks, if any:
    --------------------
    No remarks provided.

I have some issues for this because I Have documented insomnia issues since 2011 and the exam states no sleep disturbances, also the examiner say no to ED, which i was diagnosed in service with and was also in my DBQ for it. The examiner was aware that i have not had an MRI in a year and did not think it mattered, also the examiner only spend a total of 5 minutes with me total.

PTSD CnP

1. Diagnostic Summary
    ---------------------
    Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria
    based on today's evaluation?
    [X] Yes   [ ] No
    
    2. Current Diagnoses
    --------------------
    a. Mental Disorder Diagnosis #1: PTSD

    b. Medical diagnoses relevant to the understanding or management of the
       Mental Health Disorder (to include TBI): hypothyroid, migraine headaches,
       low back pain

    3. Differentiation of symptoms
    ------------------------------
    a. Does the Veteran have more than one mental disorder diagnosed?
       [ ] Yes   [X] No
       
    c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?
       [ ] Yes   [X] No   [ ] Not shown in records reviewed
       
           Comments, if any:
              the veteran described no clear incident of TBI
              
    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 occasional decrease in work
           efficiency and intermittent periods of inability to perform
           occupational tasks, although generally functioning satisfactorily,
           with normal routine behavior, self-care and conversation

    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   [ ] No   [X] 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:
      
        [ ] 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
        [ ] 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):
          The veteran said that his life at home when he was growing up was
good,
          no history of abuse. His father is a Catholic Deacon so family worked
          with the church. He was pretty well behaved in high school.

          Bought a house with his brother prior to joining the Army. That
          brother's son also lives with them now. The veteran stated that he
          "hates" the current arrangement. His nephew is very active and "drives
          me nuts." The veteran said that he feels like he has no time to relax.

          Never married and no children.

          The veteran reported that he served in the Army from 2009-2016. His
job
          was in satellite communications. He deployed to Iraq in 2011 and 2014.

          His 2011 deployment was during the drawdown so not lot of security
          available. He experienced a lot of indirect fire. Rockets came in by
          his housing area during 1 incident, landing and exploding about 15
          meters away. Alarms went off, one round came in, then another, third
          was very close. He jumped to the ground and slammed his head on a wall
          locker. No LOC.

          He described having a "near death" expereince from an IED. He was
          traveling to a green zone and the vehicle hit an IED. He said there
          were no injuries but "that scared the shit out of me." Lot of
          experience with indirect fire, he felt under constant threat. He
          started having bad sleep issues during his first deployment. He said
          that he did not want to go to sleep because all fire came in at night.

          During his 2014 deployment he was in an apache attack helicopter
          batallian. He said that he had very little security at that time, were
          under constant threat, and had a very heavy workload, averaging 16
hour
          days. He ran all the apache feeds, drone feeds, worked in strike cell,
          saw over 100 strikes through video feeds on Isis where people were
          injured or killed.

          Thinks about deployments daily, including "how shitty it was there."
He
          said those thoughts put him into a bad mood. He said that he thinks
          about many near death experiences, and being desensitized to violence.
          He said that he has violent dreams about weekly. Avoids crowds,
traffic
          jams, and fireworks. He said the driving gives him panic. Nothing that
          is particularly hard to talk about from his experiences. No real
guilt.
          Can't connect with others like he used to. Can only get along with a
          few people that he knew from the Army. Since he got out he hasn't
          talked to anyone other than who he has to. Feels detached from others.
          Lost interest in many things. Used to like sports, exercise, and video
          games but he doesn't do those things anymore. Goes to school, comes
          home, and then "I just sit there." No positive feelings. He frequently
          feels paranoid about people, such as strangers who are walking around.
          Paranoid about vehicles that look run down or like something is heavy
          in the car. Concentration not good. Stays up for a day or two then
          crashes, and will sleep 4-5 hours before waking again. He said that
his
          mind races during times when he stays up, but not making bad decisions
          during those times. Not happier than usual during those times.

          He said that a pineal gland tumor was discovered
 in 2012. His thyroid
          lab values were off, did brain scan to look at pituitary. Tumor on or
          near the pineal gland. Told that he would likely either have more
          physical or mental symptoms. No treatment for that tumor. Plan was to
          monitor it.

          Memory issues have gotten worse over last 1.5 years. Mid sentence he
          forgets things. Needs notes to remember. Will drive and realize he
          doesn't remember the route, like zoning out "but at the extreme."
          Conversations depend on how important the topic was. Memory gaps in
his
          life, like his family's birthdays. Has blurred memory for some events
          from Iraq, things that he feels that he should remember but can't.
          
          
    b. Relevant Occupational and Educational history (pre-military, military,
and
       post-military):
          The veteran said that he did poorly in school. He said "everything was
          hard, even gym." He said that he learned to read without difficulty
and
          never repeated a grade. He recalled being placed in a special study
          group with a teachers aid. Graduated from high school in 2008. Now
          going to MATC for criminial justice. Not enjoying it, grades are
middle
          of the road. Doesn't like being there, including getting irritated
with
          "kids that are self-entitled." They are rude and he gets upset because
          they didnt have to serve in the Army to be able to go to school. Used
          profanity once to tell a student to stop talking and was reprimanded
by
          the teacher.

          The veteran said that he has not worked since being discharged from
the
          Army. Wants to work in law enforcement eventually.
          
          
    c. Relevant Mental Health history, to include prescribed medications and
       family mental health (pre-military, military, and post-military):
          When asked about his current mood the veteran said "I'm in a miserable
          state all the time." He said that he is felt like that for over a
year.
          Same issues when he was in active duty. He said that he began
treatment
          through mental health in the military in 2012. Knew he was having
          issues after his first deployment. His brother encouraged him to seek
          help. He said that he had a few sessions with a psychologist but
          indicated that he doesn't like to talk so did not continue that
          treatment. Saw a psychiatrist monthly. No meds were really helpful,
          only adderall, which he has been on for year. Sleep meds don't work.
He
          said that he has taken many SSRIs but they dont help and he said that
          he doesn't feel depressed anyway. Taken anxiety medication but that
          didn't help either.

          No mental health treatment since he was discharged from the military.

          Mood most days is irritable, like an emotional roller coaster. The
          constant in his life is being annoyed. Doesn't have good days, just
          worse days. Worries about himself or other people getting injured. If
          he is in a scenario he pictures people getting injured in various
ways,
          he said "I make things up in my mind." He said that he isn't accident
          prone so he doesn't know why he is thinking about such catastrophes.
          Took adderall in middle school into high school, stopped becasue he
          thought he couldn't take that medication in the Army. He started that
          treatment again in the Army.

          Hearing has gotten worse since his last deployment when he was on an
          airfield. Hears things that aren't there such as talking and noises.
          Inaudible talking. Not threatening. No one giving him prescription for
          Adderall presently.
          
          
    d. Relevant Legal and Behavioral history (pre-military, military, and
       post-military):
          denied.
          
          
    e. Relevant Substance abuse history (pre-military, military, and
       post-military):
          No alcohol now for one year. Was drinking heavily in 2012, not daily,
          but he binged on the weekends. No recreational drugs. Started drinking
          heavily in the Army.
          
          
    f. Other, if any:
          Before he leaves the house he checks every faucet multiple times, goes
          out door, goes back in, to make sure that no water is running. He said
          that he has a fear of flooding the house. Makes sure he locks the door
          four times before he leaves. Likes to have everything a certain way,
          and he doesn't deviate from that way. "Freaks out" if things are
messed
          up.

          Gets sweaty with racing heart and feeling flushed during panic times.
          He said that his mind races at times, which happens frequently when he
          is driving. Sometimes he can talk himself down, sometimes not. Tries
to
          get himself out of situations that make him panic. Doesn't do anything
          in his free time. Gets panicked on Sunday nights about homework and
          does it at the last minute. Hates himself for procrastinating because
          he will need to stay up all night doing work.

          He said that he was assaulted in 2012. He said that he was in a bar
and
          his buddy was saying derogatory things that got a group of people
          upset. Vet tried to stop them going after his buddy. He tried
shielding
          him, but took a few hits to the head. Not really unconscious but felt
          like "the lights were on and off." Confused after that incident and
had
          a headache and his jaw hurt. Didn't report it because he was underage.
          Happened when he was in the Army.
          
    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: being close to a rocket attack
    
          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
          
    b. Stressor #2: his vehicle was hit by an IED
    
          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
          
    c. Stressor #3: witnessing enemy deaths via drone feeds
    
          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] Directly experiencing the traumatic 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] 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 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] 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] 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 I: Which stressor(s) contributed to the Veteran's PTSD
                    diagnosis?:
          [X] Stressor #1
          [X] Stressor #2
          [X] Stressor #3

    5. Symptoms
    -----------
    For VA rating purposes, check all symptoms that actively apply to the
    Veteran's diagnoses:
    
       [X] Depressed mood
       [X] Anxiety
       [X] Suspiciousness
       [X] Panic attacks that occur weekly or less often
       [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

    6. Behavioral Observations
    --------------------------
    The veteran arrived on time for the evaluation. He ambulated independently
    and was casually dressed. Speech and comprehension were within normal
limits.
    His affect was mildly restricted and his mood appeared depressed. There was
    no obvious evidence for psychosis. His thought process was grossly logical
    and linear. Insight into his condition was intact. His cognitive functioning
    appeared within normal limits.

    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
    --------------------------------------------------
       The veteran scored in the low average range on a test of his intellectual
       functioning. Verbal comprehension was average, perceptual reasoning was
       borderline, working memory was average, and processing speed was low
       average. He demonstrated low average ability to learn a story over trials
       and average ability to recall the material after a delay. His recognition
       memory for that information was average. He showed average ability to
       learn a list of words over trials and his recall of the material after a
       delay was mildly impaired. His recognition memory for that information
was
       mildly impaired. He showed moderately impaired ability to copy a complex
       figure and borderline ability to recall the material immediately and
after
       a delay. His recognition memory for that information was average. Word
       reading was average range. He scored in the low average range on a test
of
       attention and visual scanning and in the average range on a related
       measure of mental flexibility. His performance on a test of
       conceptualization was borderline and he had tendency to lose his train of
       thought on that measure. He had difficulty on a measure of sustained
       attention. The veteran endorsed symptoms of severe level depression and
       significant symptoms of PTSD. He reported significant inattention both as
       an adult and a child. He performed poorly on a test of effort. On a
       measure of personality functioning he showed evidence of magnifying the
       severity of his psychiatric difficulties. He also reported preoccupation
       with his physical functioning, anxiety, depression, suspicion of other
       people, isolation, and an aggressive attitude. His overall profile was
       most suggestive of PTSD.

       In summary, this was an abnormal neuropsychological profile. The veteran
       performed poorly on a test of effort and had difficulty on measures of
his
       visual-perceptual skills, thought processing speed, memory,
       conceptualization, sustained attention, and planning. His poor effort
       likely accounts for those findings. It is more likely than not that the
       veteran has PTSD that is due to hostile military or terrorist activity.

       Based on his report and review of records, the veteran had no incident
of
       head injury with clear loss of consciousness; therefore, is less likely
       than not that he has any residual difficulties due to head injury. It is
       less likely than not that his reported pineal gland tumor or cyst has any
       impact on his current cognitive or psychiatric functioning. His claimed
       memory difficulty is likely a symptom of PTSD.

[Berta]

They should definitely award for PTSD.

The rating schedule for PTSD ( Diagnostic Ciode 9411) is here in the VA Schedule of Ratings.

The brain tumor....there certainly are benign brain tumors. Were the MRIs done at a VA?

[mskallday]

Thank you for the responses! Berta, I had all the MRIs done at army medical facilities including one at Walter reed. She told me to goto my primary care if I wanted a new one. 

As for the PTSD rating, I'm a little confused because I have symptoms and issues from the 50%,70% groups but I realize that the occupational block checked up top is the 30% one.

[mskallday]

Thanks for the input Dot09!

[mskallday]

Anyone else have any opinions on how these issues will get rated?

[flores97]

Mskallday, I agree with Dot09, they should assign a rating between 50-70% for PTSD. I believe the raters rely more on "For VA rating purposes, check all symptoms that actively apply to the veterans diagnosis."Good Luck!!

[mskallday]

35 minutes ago, flores97 said:

Mskallday, I agree with Dot09, they should assign a rating between 50-70% for PTSD. I believe the raters rely more on "For VA rating purposes, check all symptoms that actively apply to the veterans diagnosis."Good Luck!!

Thanks for the input Flores97!