ptsd New Pysch Diagnosis

[betrayed]

Got the copy of progress notes from my last pyschiatrist visit it says

Axis I Major Depressive disorder

Generalized anxiety order v panic disorder with agoraphobia

Nicotine dependence

R/o PTSD

what does the R/o mean?

[rigo]

FLHRCI, this is my opinion, I will not be happy with a diagnosis of depression, if I could have a diagnosis of PTSD. When you are diagnosed with depression that is it, but when you are diagnosed with PTSD, you could also have: Anxiety disorder, Panic disoder, agoraphobia, depression etc.... if later in your life you required SMC, HB, or anything else, it will be easier to get with a diagnosis of PTSD. This doctor R/O PTSD, but other doctor my think that you have chronic PTSD, is such fine line between mental disorders. Rigo

[Stretch]

Rule-out means the opposite of what you think.

Rule-out means that, whatever it is, could be a possibility.

Rule-out does not mean that there is no-way PTSD could be it. It means that PTSD could be it.

This could mean that he does not have enough evidence to conclusively diagnose PTSD, yet, but that many of the criteria could have been met, so far. Also it could mean that he does not have the credentials to diagnose PTSD himself.

I think this is part of their code to try to confuse us even more than we already are.

Edited December 5, 2006 by Stretch

[Pete53]

If you don't have an iorn clad proof of stressor major depression and panic is not a bad thing in my opinion. John was right.

[betrayed]

you could also have: Anxiety disorder, Panic disoder, agoraphobia,

He listed as #2 of Axis I "Genralized Anxiety Disorder v Panic Disorder w agoraphobia"

IMO I think they are confusing my PTSD symptoms with agoraphobia

[Berta]

Jim- what I see is that he did say "probable" PTSD but noted that the PTSD clinic report was still not filed.

He made no mention of any nexus statement- maybe because he did not have that report.

This is odd because I haven't seen many exams like this that do not have a clear nexus statement.

No mention of any stressor at all----do you have a copy of the report he said was "still not filed" when he prepared this?

Do the stressors still have to be verified by CURR or is there enough evidence to support them already? It seemed to me you had some good evidence already.

Edited December 5, 2006 by Berta

[timetowinarace]

Stretch is correct. PTSD is NOT ruled out. PTSD is a possibility and must be further examinined.

Varo is not supposed to use an exam with a "rule out" as it is incomplete for rating purposes.

This is from the VA's 2002 "Clinicians Guide". (I can also find USC stating incomplete exams must be sent back for further exam, if I need to)

1.12 Diagnoses do’s (also see diagnoses don’ts)

1. Definite diagnosis: Give a definite diagnosis or use the previously established diagnosis.

2. No Diagnosis found: If no diagnosis is found for any claimed condition, state this. For example, state “Lower back pain: There is insufficient evidence to warrant a diagnosis of an acute or chronic low back disorder or its residuals.” Explain in detail the reason why a diagnosis cannot be established for the condition claimed.

3. Diagnosis of Unknown Etiology: If a disability does exist but a definite diagnostic name cannot be given to it, state this. For example, state “Muscle strain of unknown etiology”. (See Gulf War Examination Worksheet concerning “undiagnosed illnesses” in Gulf War veterans.)

4. Support each diagnosis: Support each diagnosis with subjective (history) and objective (physical) data.

5. Effect on daily activities and work: Comment on the disability’s effect on the veteran’s daily activities and his ability to work.

1.13 Diagnoses don’ts (also see diagnoses do’s)

1. Non-committal diagnosis: Don’t use phrases such as “differential diagnosis” or “rule out”.

2. Symptoms or signs: Don’t use symptoms (pain) or signs (tenderness) for a diagnosis if a more exact diagnosis is known. If a disease appears to exist but an etiology cannot be determined, you may say, for example, “fatigue of unknown etiology”.

3. Opinion for further studies, evaluations, or laboratory tests: If further studies, evaluations or tests are necessary, perform them before making a final decision. Otherwise the examination is incomplete and will be returned as inadequate.

4. Change the previously established service connected diagnoses: Don’t change previously established diagnoses, unless you carefully explain the discrepancy and adequately substantiate the new diagnoses.

38 CFR

4.2 Interpretation of examination reports.

Different examiners, at different times, will not describe the same disability in the same language. Features of the disability which must have persisted unchanged may be overlooked or a change for the better or worse may not be accurately appreciated or described. It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. Each disability must be considered from the point of view of the veteran working or seeking work. If a diagnosis is not supported by the findings on the examination report or if the report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes.

[41 FR 11292, Mar. 18, 1976]