First CDR and very worried!!

[cavscout1967]

Hello, I have been on SSDI for the last 3.5 years and got the long form in the mail last night. Obviously, I am very concerned that my SSDI benefits may be stopped. A bit about me. I am a veteran with a 50% rating for issues that are not mental health related but I do have open appeals for depression and anxiety with the VA that have been remanded from the BVA to my local office about 2 weeks ago after being on appeal since 2009. I was awarded a 10% increase in this  remand  for a physical issue and received back pay for it. The other mental health issues( depression and anxiety) are still on remand

I was awarded SSDI for a combination of mental health and physical disabilities. I have been diagnosed by the VA since 2010 with depression not otherwise specified, Paranoid personality disorder, alcoholism in remission, anxiety and history of other psychotic disorder all this was pulled from the  ebenefits  website blue button thing.

I take Zoloft and Buspar daily and Abilify sometimes and am mostly in compliance with the meds. It has stated in my medical records that I have been  non compliant  before and then things get worse and I report it to my doctors and I get back on the meds but if I have to give it a percentage I would say I am 80-90% compliant and take the meds. I have seen my treatment team at least every 2 months since 2010 and the team includes a  pyschchiatrist  and a  physcologist  although the  pscycholgist  recently left the VA a few months ago but I was transferred to another  pscychologist  on the same team.

I have included a (scrubbed of personal data) one of my latest session notes from the new psychologistI see from just a few months ago

Longstanding Hx of psych  sxs , including depression and paranoid personality traits.  Some interpersonal  difficiulties  and problems managing anger.  Chronic, fleeting violent thoughts (baseline), but has not acted on them 
in a long time, stated that he is in control of his behavior.  Had SI in the past, stated that he might get to that point again at some time in the future, but denied any current SI.  No job. 

Protective factors:   Social support (living with his wife, her daughter, and his son from a prior relationship, mentioned his wife to be supportive). Future-orientation . Interested in MH treatment.  Pt denied any current suicidal 
ideation.  Some positive coping skills.  Pt seems committed to his son, stated that he is very protective of him.  Stated that he is in control of his behavior.  Offered to review MH Safety Plan, but pt declined, stated that he has 
the plan at home, agreed to adhere to it should he start feeling worse. 

Assessment: Pt is currently considered to be at lower risk for suicide given the above-mentioned factors.
Pt denied any homicidal ideation, has chronic, fleeting violent thoughts, but is 
clearly aware of them, does not have plan or intent to hurt any specific person, 
has not acted on them in a long time, stated that he is in control of his behavior, agreed that this would go against his value of being a good father. 

Patient Education:   Readiness to learn:      Attended session, Appeared to listen attentively, Asked questions, Responded to other's questions
   Content: Behavioral strategies for managing depression and impulses.
   Patient Understanding:      Verbalized comprehension of material, Asked questions for clarification, Demonstrated application of content
A - Active Problems Treated This Encounter: Paranoid Personality D/O (per chart).   Unspecified  Depressive D/O (double depression).   Alcohol use d/o (dependence), in remission
Mental Status: Grooming: Good Motor: tense Mood: mildly irritable and guarded Affect: Appropriate to content; limited range Speech: Overall Normal Thought Content: Normal Thought Processes: Overall Logical Suicidality: Absent  Homicidality : Absent Hallucinations: Absent Delusions: Absent Oriented: Fully Oriented Judgement: Fair Insight: Fair
Progress Toward Goals: At the start of today's session, pt confirmed full Social Security number and DOB, and I discussed my scope of practice, documentation practices, confidentiality constraints, and mandatory reporting requirements. Pt orally consented to participate in psychotherapy sessions.
Discussed pt's goals for treatment.  He described his MH tx  hx , described how he is dealing with violent thoughts.  Agreed that those thoughts are not problematic as long as he is able to control his behavior, and he stated that he 
is able to do that.  Explored what  startegies  help him with that, and he agreed that remembering his value of being a good father is helpful, and also thinking about possible consequences should he ever act out those thoughts. 
He also mentioned that not having to work has reduced his stress, which has also 

been helpful in controlling his behaviors. 
Briefly touched upon the concept of values (things that are meaningful to him) and Encouraged him to think about other aspects that might give his life more purpose and meaning. 
Pt did not mention any significant  sxs  of depression, but it seems that these issues at times contribute to  pt  feeling  frutsrated  and depressed.  He also mentioned occasional urges to drink, but knows that the consequences would not be good, has overall been in control of this. 
Pt also mentioned some discord with his wife's grown-up daughter, wants to bring his wife for a collateral session next time.
Reviewed MH crisis phone numbers and offered pt card with them, but he declined, 
stated that he has those numbers. 
P - 1. Ind. psychotherapy with this writer, once or twice/month (offered  earlier  session, but pt wanted to return in about a month) 2. Continue psych med mgmt with DR. Soo. 3. Consider supportive groups (if pt interested)

This one here is my  lastest  one from my  phvstiatrist  that  perscribes  me pills at the VA

IDENTIFICATION: ****is a 48-year old, married (and previously divorced), male Army veteran with a history of depressive symptoms, cluster B personality traits, paranoid ideation (of overvalued rather than delusional intensity), and recurrent problems with irritability and anger management.  He was last seen by me on 10/23/15 and returns today for a 30-minute follow-up appointment. 
For further details related t the patient's present illness and other aspects of his history, please refer to the C&P exam note from 2/4/10, Dr. ###'s notes from 5/19/10 to 7/14/10, Dr. Erickson's note from 7/26/10,  Dr. $$$'s 

therapy notes from 6/28/10 to 10/12/11, Dr. ###'s therapy notes, and my initial note from 9/2/10.
CURRENT PSYCH MEDS:
Zoloft 200 mg  po   qday  (pt has been taking it on most days) Buspar 30 mg  po  bid  (pt currently takes 40 mg a day)
Abilify 30 mg  po   qday  (pt is no longer taking the medication)  
PSYCHIATRIC MEDICATION HISTORY: 
Has been on Paxil "on and off" for several years but did not find it helpful. Dr.  $$$ therefore  switched him to Celexa on 5/19/10.  Pt also tried Seroquel very briefly, in July 2010, but did not like its effects (felt "goofy" on the medication).  The record also alludes to past trials of lithium.   On 1/11/11, I started him on Abilify, to augment his antidepressant medication (which at that time was Celexa) and address intrusive, possibly obsessive thoughts. The medication seemed to help initially, but he decided to discontinue 
it because he did not think it was beneficial Because of sexual side effects, he 
called in on 3/30/11 with a request to D/C the Celexa, which I agreed to substitute with Wellbutrin.  He eventually decompensated and stopped taking the medication. Following his admission to 1K in Aug 2011, he was not restarted on Wellbutrin but was prescribed Zoloft, which was continued when he was discharged 
to St. Cloud RRTP.  Buspar was also added during his stay at St. Cloud, for anxiety. 
Abilify- started on in Aug 2012, as he was experiencing intrusive/obsessive paranoid thoughts that were worsening his anxiety and irritability. The medication helped. When he went off it months later, he had a resurgence of paranoia (believed that members of Hells Angels, with whom he had never encountered, were trying to harm him).  He resumed the medication but stopped it 
again in mid-2013. This time, he did not experience a return of the aforementioned thoughts and elected to stay off it. I discontinued the medication on 8/30/13.  As he began experiencing obsessive and intrusive suicidal ideation (with no clear trigger), I restarted him on the medication in mid-July 2014.
Prazosin- started on 10/3/14, to address nightmares. Pt eventually stopped taking it as his dream subsided.

INTERVAL HISTORY:
Although he looks  mildly anxious and pensive (per his baseline), **** has been 
feeling "pretty decent" overall. He is concerned, however, about two "attacks of paranoia" that he experienced recently, in the presence of his wife. Apparently, while lining up at Walmart, an African-American man, with a "teardrop"  tatoo  over his eye came up behind him.  His proximity made **** extremely uncomfortable, so he moved away, at which point  the other person moved closer. He subsequently moved to a different aisle and noticed that man peering at him, which evoked a lot of fear.  %%%% thought that this individual was planning to kill him and  initially considered confronting him aggressively.  Instead, he called Dr. %%% and talked through the situation. He left the store without incident. Later, he had a  terrifying moment at another store when a "Mexican" man, who looked like a "gang member", entered the same aisle as him.  He again needed to restrain himself from attacking but, in the end, refrained  form  any provocative action. He now recognizes that his fears were exaggerated and that what he interpreted to be threatening actions may have actually been benign.
He wonders why he would have such a reaction in the first place.   Possibly, the 
ethnicity of the individuals involved may have been a trigger, especially when coupled with his chronic distrust and anxiety. To some degree, his wariness is not completely inappropriate, as many reasonable people might feel temporarily uncomfortable in the situations he described.  However, the degree of fear he experienced and the assumptions to which he  leapt  require some modulation.  I affirm that, ultimately, he was able to manage his fears appropriately. 
Since these incidents, he has begun taking a higher dose of Buspar (40 mg  po   qday  instead of 30 mg  po   qday ).  It is too soon to tell if this has had any effect. I note that, should he continue to experience such "paranoia" on a consistent basis, he could consider restarting Abilify ( twhich  is still on his prescription list, even though he has not taken it for many months).  He acknowledges this possibility.
He is otherwise doing relatively well. He and his wife are still adjusting to the presence of his son, ###, but the transition is going a bit better than he expected (although some tensions between his wife and his son are present). 
MSE: Pt describes  mood  as "pretty decent" but affect remains pensive. At one point, he expresses irritation at a misunderstanding on my part.  Thought process generally logical. No delusional  thoughs  noted.  No hallucinations. Insight and judgment seem adequate at this time for maintaining safety.

IMPRESSION:  Other than for two recent episodes of anxiety and acute suspiciousness towards strangers, pt has been doing relatively well. He was able 
to handle the  aformentioned  situations appropriately and without resorting to violence. He is also adjusting to the presence of his son, ###. 
He has not had suicidal or homicidal thoughts and feels well supported by his wife.

DSM-5 DIAGNOSES:
Persistent depressive disorder
ETOH use disorder, in remission 
History of other psychotic disorder
Other specified personality disorder (paranoid traits) 

PLAN:
1) Continue    Zoloft 200 mg  po   qday ,  Buspar 30 mg  po  bid, and Abilify 30 mg  po  
qday .  Pt not currently taking Abilify and is taking a smaller dose of Buspar. Will not change his existing prescriptions, so that he can return to his original regimen should anxiety worsen and paranoia return.
2)   He will continue to see Dr. ### for therapy.
3) He can resume AA meetings as needed.
4) He will return for follow-up in 2 months. We discussed my upcoming  depature  from the VA. While he is naturally quite concerned about this development, he seems to accept it   overall. We spend some time processing some of his fears regarding the transition.      




Am I in danger of losing SSDI? Would you need more information to give me an idea? Anyone else been in this position?

[broncovet]

My first question is what would make you think your SSDI is being taken away?  

There are 2 obvious possibilities:

1.  You got some sort of letter from SS indicating the same.  You should deal with this. 

2. Its possible, or even likely, that this paranoia is part of your mental health disorder.  I see this in Vets

who are P and T and have not worked for 10 years and worried the Va will reduce them.  Its an unnatural phobia, because VA can not reduce P and T unless you "actually improved" under ordinary conditions of life(working).  

 

If you are not working, and especially if you are not trying to earn money under the table without telling SS, then you are fine.  But, if you are working and collecting SS, whether its "under the table or not", then beware.  Make sure you know:  Im not accusing you of anything.  I presume all Vets tell the truth until I know other wise.  Unfortunately, others have tried to work while telling SS they cant work, so SS is looking for them.  

Social Security has a rather generous program for those who are disabled and trying to return to the workforce (that dont try to scam them).  Im not for sure, but I think you tell social security you are gonna try to work, and I think you get to keep your social security and paycheck for a year or so while you transition back to the work force.  Something like that, anyway.  

Edited April 19, 2016 by broncovet

[cavscout1967]

No I am not working in any capacity and have never worked since I was awarded SSDI. I just got the letter and am worried they will say since I am not as crazy as I used to be that I am better and can work and I am feeling terrified of that. When I was initially awarded I had police run ins as well as a  some weapons taken away but none of that kind of stuff has happened since I have been seeing doctors and taking medicines. Thank you for taking the time to talk to me.

 

Edited April 19, 2016 by cavscout1967

[rpowell01]

I just completed my first SSDI CDR and all SSDI wants to know if you have improved, thats all. Get them all your medical records, va and private as it appears the VA won't send them all the records that are pertinent. No the VA will not send all your records, trust me I know. Get your VA records and give them to SSDI. What I did was write up my own appeal letter to the CDR. I showed them I am getting treatment, am on all the medications I am on, MD notes and a new IMO. Show them your issues and that your getting treated for them. So folks do a hit and miss with the VA and SSDI. They get approved and boom they quit getting treatment. This tells SSDI you are better.  They will also send you to their own doctors and just be honest with them. If you have back issues and can bend that day bend. What happened to me was I was able to bend some but laying on the table the MD could not raise my legs without pain down my back and legs. Believe it or not leg lifts affect you differently than if you stand up and bend. Best of luck and listen to Broncovet..