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C&P PTSD Increase & TDIU

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Jroocan

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Greetings ladies and gentlemen,

 

I received a 70% rating for PTSD from last years increase when it was at 50%.  I've been unemployed for over a year since being fired for several aggressive angry outbursts related to stressors tied to my PTSD.  Filed for TDIU May 11th of 2016 and I have a C&P scheduled for June 10th of 2016.  What the heck can I expect at a TDIU c&p? I sent in all of my formal write-ups and suspension paperwork from my previous employer as well as buddy statements from coworkers who witnessed my behavior and how my work performance was affected due to PTSD.  I have tried multiple times to have HR from my previous employer fill out the VA-form requesting employment info but they have not cooperated with me. Won't return calls or emails. Even sent them the form but nothing gets back to me.  I fear that will hurt me and also be I'm clean shaven and well dressed (I'm ocd about my appearance by it seems as if it's the only thing I can control).  

I stay home taking care of my daughter but she goes to daycare a couple times a week to give me a break. It gets too much at times. Should that be mentioned ?

I just thought my claim is moving fast and not sure if that is good or bad ?

 

Any thoughts? 

 

Thanks for all you do. It is greatly appreciated. 

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I am the sole owner of my checking account and I was deemed competent to handle my funds last year when they asked at a C&P exam. I have my fiancé who I trust to handle my funds if it had to come to it but that is not a route I want to take ? I think I'll be fine but the nerves are having a field day with me today.

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Any Vet that receives Comp or Pension, is always open for a VA Fiduciary Appointment, all it takes is for 1 of your Clinicians VA or Private, Dr's, Relatives or Social Workers to raise the possibility of your incompetance, either permanent or temporary.

The VA would notify you in writing and schedule an in-home examination by a Fiduciary Social Worker. If in the VA Soc Workers opinion, you need a Fiduciary, you could propose a relative or other trusted individual. They must meet the VA Qualifications and it's not an automatic, that they'll be appointed.

What did your VA Social Worker put into his Notes? His professional opinion could launch the Appointment process.

If in doubt, there are some financial move you need to address, yesterday, if not sooner. Do you have a copy of his Clinician Notes from your meeting? Should be in your MHV Med Records by now, get'em.

Semper Fi

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Good info! I just checked his notes and there is no mention of my competence in ability to manage funds. It was sidebar conversation and I didn't think he would include it but ya never know so I'm glad to have checked. Thanks. 

 

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Sorry to hear of your hard times bud. I just put in for PTSD increase and A&A last month, and already in a few weeks had one exam with PTSD Psych Doc thru VES on this past Tuesday. Today I had the A&A exam thru a VES Civilian Doc. The exams were brutal but I made it thru it, along with a Brain Scan I had yesterday. I collect SSDI as well, and they found me unfit to manage financials, dont bother me. I have 3 bank accounts and all are in my wife and me names. I trust her    It really is hard to tell with these Docs. The psych doc I  had the other day, was one of those Dry Nerdy type of guys that didnt show much emotion at all just went over the PTSD check list. He did however read my wife and buddys, support letter on Ebenefits. The Psych Doc today, was free flowing of words, kind of Street Talking type lady, who came off nice, but again just dont know. Good luck and keep us posted. God Bless

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Thanks. I went over my last C&P that was done April 2015 for my PTSD increase (50 to 70%). I'm hoping the examiner reviews that also bc it seems to me like it's an easy decision in regards to my TDIU claim (C&P is tomorrow).  The examiner put that I have extreme difficulty in maintaining employment due to SC PTSD and other notes he wrote seem to be in my favor. From then to now things have only gotten worse.  Just hope I don't clam up and minimize like I always do. Sucks being stubborn when it comes to this.  My fiancé is coming so she will help me speak up and address the pertinent details. 

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Just had the c&p on Friday and I am blown away as I just looked at the notes! Basically said I'm a drunk who doesn't have PTSD (anymore) and she diagnosed me with antisocial personality disorder?!? I've never had that diagnosis or even heard of it before. 

 

I think ink they are going to reduce my 70% ??

please help.

 

 
                                   SECTION I:
                                   ----------
    1. Diagnostic Summary
    ---------------------
    Does the Veteran now have or has he/she ever been diagnosed with PTSD?
    [X] Yes[ ] No
       ICD Code: F43.20

    2. Current Diagnoses
    --------------------
    a. Mental Disorder Diagnosis #1: ALCOHOL  USE DISORDER
         ICD Code: F12.20
         Comments, if any: THIS IS VET'S MAIN AND MOST DISABLING CONDITION.

       Mental Disorder Diagnosis #2: ANTISOCIAL PERSONALITY DISORDER
         ICD Code: F60.2
         Comments, if any: VET HAS 8 FELONIES INCLUDING 4 COUNTS OF AGGRAVATED
         BATTERY OF POLICE OFFICERS IN 2007 AND 2010, DOMESTIC BATTERY IN 2007,
         CRIMINAL DAMAGE TO GOVT PROPERTY IN 2010, CRIMINAL DAMAGE TO STATE
         PROPERTY IN 2006, AND AGGRAVATED DUI (3RD) IN 2006. HE HAS BEEN
         INCARCERATED IN STATE PRISONS TWICE AND IS FACING JAIL TIME AT HIS NEXT
         COURT DATE.

       Mental Disorder Diagnosis #3: PTSD
         ICD Code: F43.20
         Comments, if any: PCL-5 TOTAL SCORE TODAY WAS 65 SUGGESTING MODERATE
         PTSD SYMPTOMS. HE HAS NOT BEEN COMPLIANT WITH MEDICATION OR MH 
TREATMENT
         AND HAD IMPROVED PTSD SYMPTOMS IN THE PAST WHEN MEDICATED AND ATTENDING
         TREATMENT MORE REGULARLY.

    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 and
           discuss whether there is any clinical association between these
           diagnoses: 

           ALCOHOL USE DISORDER - CONTINUED EXCESSIVE USE OF ALCOHOL DESPITE
           SOCIAL AND LEGAL CONSEQUENCES, DEPRESSED AND ANXIOUS AFFECT, 
DECREASED
           MEMORY, POOR JUDGMENT, DECREASED MOTIVATION, INTERPERSONAL 
DIFFICULTY,
           DIFFICULTIES IN A WORK SETTING, IMPULSE CONTROL DIFFICULTIES,
           DECREASED CONCENTRATION, PERSISTENT NEGATIVE COGNITIONS, 
IRRITABILITY,
           ANGER OUTBURSTS, INSOMNIA, DECREASED INTEREST.

           ANTISOCIAL PERSONALITY DISORDER - CONTINUED CRIMINAL ACTS WITH 8
           FELONIES AND REPEATED INCARCERATION, CONNING OTHERS FOR PERSONAL
           PROFIT, IMPULSIVITY, IRRITABILITY, AGGRESSIVENESS, RECKLESS DISREGARD
           FOR SAFETY OF SELF OR OTHERS, CONSISTENT IRRESPONSIBILITY WITH
           REPEATED FAILURE TO HONOR FINANCIAL OBLIGATIONS, LACK OF REMORSE,
           INTERPERSONAL DIFFICULTY IN THE WORKPLACE, POOR JUDGMENT.

           PTSD - FLASHBACKS, NIGHTMARES, AVOIDANCE, EMOTIONAL NUMBING,
           HYPERVIGILANCE, SUSPICIOUSNESS.
           
           
    c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?
       [ ] Yes[X] No[ ] Not shown in records reviewed
       
           Comments, if any: TBI EXAM DATED 5/18/15 DID NOT DIAGNOSE TBI BUT 
PTSD
           AND ALCOHOL DEPENDENCE
           
    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?
       [X] Yes[ ] No[ ] No other mental disorder has been diagnosed
       
           If yes, list which portion of the indicated level of occupational and
           social impairment is attributable to each diagnosis: 

           ALCOHOL USE DEPENDENCE, SEVERE - SOCIAL AND OCCUPATIONAL IMPAIRMENT 
IN
           MOST AREAS INCLUDING SCHOOL, FAMILY RELATIONSHIPS, INTERPERSONAL
           RELATIONS, WORK, MOOD, JUDGMENT AND IMPULSE CONTROL.

           ANTISOCIAL PERSONALITY DISORDER - SOCIAL AND OCCUPATIONAL IMPAIRMENT
           IN MOST AREAS INCLUDING SCHOOL, FAMILY RELATIONSHIPS, INTERPERSONAL
           RELATIONS, WORK, MOOD, JUDGMENT AND IMPULSE CONTROL.

           PTSD - REDUCED RELIABILITY AND PRODUCTIVITY.
           
    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 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
        [X] Other:
              CP PTSD REVIEW EXAM DATED 4/30/15 WAS ALSO REVIEWED.
              
    b. Was pertinent information from collateral sources reviewed?
    [X] Yes[ ] No
    
      If yes, describe:
        VET'S FIANCEE AMBER ACTIVELY PARTICIPATED IN TODAY'S EXAM. BOTH WERE
        TEARFUL DURING THE EXAM.
        
    2. Recent History (since prior exam)
    ------------------------------------
    a. Relevant Social/Marital/Family history:
          MR JUSTIN AARON SOROKA IS A 33 YEAR OLD SINGLE, UNEMPLOYED, CAUCASIAN
          MALE VETERAN OF THE MARINE CORPS WHO SERVED IN IRAQ AND IS 70% SC FOR
          PTSD.

          SINCE HIS LAST C&P PTSD EXAM ON 4/30/15, HE CONTINUES TO BE SINGLE BUT
          LIVES WITH HIS FIANCEE AND THEIR 2 YEAR OLD DAUGHTER IN A HOME THAT
          THEY RECENTLY PURCHASED. HE DESCRIBED THEIR RELATIONSHIP AS
          CATASTROPHIC SINCE "I CAN'T EVER DO ANYTHING RIGHT". HE SAID THEY 
ARGUE
          CONSTANTLY BUT PUT ON A HAPPY FACE WHEN AROUND HER FAMILY. HE SAID SHE
          IS WORN OUT FROM DEALING WITH HER PTSD. HIS 2/3/16 SW NOTE INDICATED
          THAT HE CHEATED RECENTLY ON HIS FIANCEE AND THAT STRAINED THEIR
          R
ELATIONSHIP. HE HAD ALTERCATIONS WITH HER FAMILY MEMBERS. IN 10/15,
          VET WAS ARRESTED AFTER ASSAULTING AMBER'S STEP-FATHER, PUNCHING HIM
          NUMEROUS TIMES IN THE FACE AND CAUSING A BLACK EYE. CHARGES WERE
          DROPPED. HE MAINTAINS CONTACT WITH HIS SISTER WHO IS IN THE ARMY AND 
IN
          KANSAS. HIS FATHER LIVES AN HOUR AWAY BUT HAS LITTLE TO DO WITH THEM,
          TAKES THEM TO DINNER AND LEAVES. VET FEELS VERY DISTANT FROM HIS DAD.
          HIS MOTHER DIED NEARLY 8 YEARS AGO WHILE HE WAS INCARCERATED AND VET
          CONTINUES TO GRIEVE FOR HER. HE HAS SOCIAL MEDIA CONTACT WITH MILITARY
          FRIENDS. HE HAS ONE FRIEND THAT HE MET WHEN HE WORKED AT GOOD WILL. 
VET
          CALLS HIM TO TAKE HIM TO VA APPOINTMENTS. VET CURRENTLY LIVES IN
          LASALLE, IL IN A HOME THAT HE AND HIS FIANCEE RECENTLY PURCHASED. HE
          MET ONE NEIGHBOR BUT GENERALLY HE KEEPS TO HIMSELF. HE SAID HE HAS AN
          AWESOME RELATIONSHIP WITH HIS 2 YEAR OLD DAUGHTER HALEY, BUT HE HAS 
HAD
          EXTREME VIOLENT BEHAVIOR IN FRONT OF HER. HE HAS YELLED AT HER AND
          FEARS THAT HE WILL LOSE HER IF THINGS DON'T WORK OUT WITH AMBER. IT
          HURTS HIM TO SEND HER TO DAYCARE RECENTLY BECAUSE HE WOULD PREFER TO
          TAKE CARE OF HER. A DCFS CHILD ENDANGERMENT CASE WAS FOUNDED IN 2/16
          AFTER VET WAS VIOLENTLY ASSAULTING HIS FIANCEE'S STEPFATHER IN FRONT 
OF
          THE CHILD. WHILE VET STATED THAT HE HAS NO/FEW FRIENDS, HIS 6/6/16
          PSYCHIATRIST NOTE INDICATED THAT HE GOES OUT TO BARS DRINKING WITH
          FRIENDS.
          
    b. Relevant Occupational and Educational history:
          VETHAS BEEN ATTENDING COLLEGE CLASSES SINCE 2006 COMMUNITY COLLEGES 
AND
          FAILED 3 CLASSES LAST SEMESTER BUT PASSED HIS MATH CLASS. HE HAS BEEN
          TRYING TO GET HIS ASSOCIATE'S DEGREE FOR THE PAST 10 YEARS AND HOPES 
TO
          GET A DEGREE IN SOCIAL WORK EVENTUALLY. HIS GPA IS LESS THAN 1.0. HE
          TOOK 3 ONLINE CLASSES WHICH HE FAILED BUT PASSED THE MATH CLASS IN THE
          CLASSROOM CLASS. HE DIDN'T ASSOCIATE WITH TEACHERS OR OTHER STUDENTS.

          VET LAST WORKED FULL TIME AT GOOD WILL INDUSTRIES FROM 2/13 TO 4/15,
          WAS PROMOTED TO KEYHOLDER, THEN WAS TERMINATED IN 4/15. REASONS FOR 
THE
          TERMINATION WERE UNCLEAR BUT DOCUMENTS FROM WORK INDICATED THAT HE HAD
          LOUD VERBAL ALTERCATION WITH A COWORKER IN 1/14, WAS ABSENT 8 TIMES IN
          12 MONTHS AND WORKED 3 PARTIAL SHIFTS BY 12/14, AND POINTED HIS FINGER
          AT COWORKERS CAUSING TENSION AT WORK ON 12/18/14. THERE WAS NO OTHER
          DOCUMENTATION OF WORK PROBLEMS SUBMITTED TO INDICATE WHY HE WAS
          TERMINATED IN 4/16.

          HE HAS HAD NO OTHER PAID WORK SINCE 4/15. MH NOTES INDICATED THAT HE
          WAS NOT LOOKING FOR EMPLOYMENT BUT WAS GOING TO COLLEGE FULL TIME AND
          WATCHING HIS YOUNG DAUGHTER WHILE HIS WIFE WORKED. THERE WAS NO
          EVIDENCE THAT HE HAD APPLIED FOR WORK BUT HIS 8 FELONIES, LOSS OF
          DRIVER'S LICENSE (SINCE 2006), 3RD DUI(IN 2010), AND CONTINUED 
CRIMINAL
          BEHAVIOR ARE LIKELY TO INTERFERE WITH OBTAINING WORK.

          VET'S MH NOTES REPEATEDLY NOTE THAT HE IS ONLY VIOLENT AND AGGRESSIVE
          WHEN DRINKING. THERE WAS NO EVIDENCE IN TODAY'S EXAM OR IN REVIEW OF
          VET'S MH RECORDS SINCE 2006 THAT HIS PTSD WAS EVER SEVERE ENOUGH, BY
          ITSELF, TO PREVENT HIM FROM OBTAINING OR MAINTAINING SUBSTANTIALLY
          GAINFUL EMPLOYMENT.

          
          
    c. Relevant Mental Health history, to include prescribed medications and
       family mental health:
          SINCE 4/15, HE HAS BEEN FOLLOWED BY SHAWN SLAGLE, SW AND DR LIM,
          PSYCHIATRIST AT THE LASALLE CBOC. HE HAS NOT BEEN COMPLIANT WITH
          TREATMENT AND WAS TOLD BY HIS SW ON 2/3/16 THAT NOT GETTING TREATMENT
          FOR HIS PTSD IS THE PROBLEM, NOT HIS PTSD. HE DID NOT SEE HIS
          PSYCHIATRIST FROM 10/26/15 UNTIL 6/6/16 AND LAST FILLED ALL HIS MH
          MEDICATIONS IN 2/16. HE ONLY CONTACTED HIS PSYCHIATRIST IN 11/15 AND
          12/15 WHEN HE NEEDED FORMS DOCUMENTING HIS TREATMENT FOR COURT DATES.
          HE RETURNED TO MH ON 6/6/16 DUE TO HAVING A COURT DATE ON 6/30/16 THAT
          WILL DECIDE WHETHER HE GOES TO JAIL OR RESIDENTIAL TREATMENT.

          HE DID NOT SEE HIS SW FOR INDIVIDUAL THERAPY BETWEEN 6/15 AND 2/16,
          MISSING SEVERAL APPOINTMENTS.

          HE APPLIED FOR ADMISSION TO LOVELL'S SDTU PROGRAM (RESIDENTIAL TRAUMA
          TREATMENT) BUT WAS TOLD THAT HE HAD TO COMPLETE SUBSTANCE ABUSE
          TREATMENT FIRST SINCE HIS SUBSTANCE USE WAS STILL HIGH. HE HAS BEEN
          ENCOURAGED TO ENTER THE SDTU AT LOVELL VAMC BY HIS SW SINCE 8/27/12 
BUT
          HAS REFUSED AND NOT FOLLOWED THROUGH. A PHONE INTERVIEW WITH THE SDTU
          WAS HELD ON 5/3/16 AND VET WAS REFERRED TO THE MHRRTP TO TREAT HIS
          ADDICTIONS BEFORE ADDRESSING TRAUMA WORK. HIS ADMISSION TO THE SDTU IS
          DELAYED UNTIL HE COMPLETES ADDICTIONS TREATMENT. HE HAS AN INTERVIEW
          WITH THE MHRRTP PROGRAM ON 6/20/16. 

          CURRENTLY, HE WILL BE TAKING DULOXETINE AND TRAZODONE FOR HIS PTSD AND
          NALTREXONE FOR ALCOHOL CRAVINGS. THEY WERE ORDERED ON 6/7/16 BUT VET
          HAS NOT RECEIVED THEM YET. HE STOPPED TAKING MH MEDS AFTER 2/16 AND
          DIDN'T REORDER MEDICATIONS AFTER THEY RAN OUT.

          HE WENT TO ILLINOIS VALLEY COMMUNITY HOSPITAL ER WHEN INTOXICATED ON
          10/25/15 AND WANTED TO TRANSFER TO 2S AT HINES BUT VET INSISTED ON A
          PRIVATE BED. WHEN HE WAS TOLD THEY COULDN'T GUARANTEE A PRIVATE BED,
          VET REFUSED TO GO. HE WAS DISCHARGED FROM THE COMMUNITY HOSPITAL AFTER
          A FEW HOURS OF OBSERVATION.

          VET CLEARLY DID BETTER WITH PTSD SYMPTOMS WHEN HE WAS NOT DRINKING,
          ACCORDING TO MULTIPLE MH NOTES. HE HAD GOOD RESPONSE TO MH MEDICATIONS
          BUT STOPPED TAKING THEM OR DIDN'T TAKE THEM AS PRESCRIBED. 

          HE OFTEN SEEKS OUT MH TREATMENT WHEN HE IS IN LEGAL TROUBLE IN ORDER 
TO
          NOT FACE CONSEQUENCES FOR HIS ACTIONS. HE HAS USED HIS PTSD AND 
ALCOHOL
          USE DISORDER DIAGNOSES TO AVOID JAIL TIME.

          HE HAD NO SUICIDE ATTEMPTS OR PSYCHIATRIC HOSPITALIZATIONS IN THE PAST
          YEAR. IN FACT, HE HAD NO PSYCHIATRIC HOSPITALIZATIONS SINCE 3/13.

          IT IS IMPORTANT TO NOTE THAT VET HAS A GREAT DEAL OF MENTAL ILLNESS IN
          HIS FAMILY THAT WAS NOT NOTED ON PRIOR C&P PTSD EXAMS. HIS SISTER WAS
          HOSPITALIZED FOR DEPRESSION IN HIGH SCHOOL AND TAKES ANTIDEPRESSANTS, 
A
          COUSIN COMMITTED SUICIDE A FEW YEARS AGO OF A GSW TO THE HEAD (PER HIS
          8/12 MH INTAKE NOTE), HIS PATERNAL AUNT AND UNCLE HAVE PSYCHIATRIC
          PROBLEMS, AND VET WAS A VICTIM OF PHYSICAL ABUSE ACCORDING TO HIS
          7/6/06 SARP ASSESSMENT.
          
    d. Relevant Legal and Behavioral history:
          SINCE 4/15, VET WAS ARRESTED ON 11/28/15 AND CHARGED WITH BATTERY FOR
          HITTING AMBER'S STEPFATHER BUT THEY DROPPED THE CHARGES. HE WAS
          ARRESTED FOR DRIVING ON A REVOKED LICENSE IN 3/16. VET HAD 3 DUIS AND
          HAS NOT HAD A DRIVER'S LICENSE SINCE 2006. HE HAS A COURT DATE PENDING
          ON 6/30 REGARDING HIS LATEST OFFENSE. HE MAY GO TO JAIL OR MAY BE
          ALLOWED TO ENTER RESIDENTIAL TREATMENT. HE HAS HAD CHRONIC DIFFICULTY
          WITH BEING IN DEBT DUE TO HIS SUBSTANCE ABUSE, IMPULSE CONTROL, CREDIT
          CARDS AND LEGAL EXPENSES.
          
    e. Relevant Substance abuse history:
          SINCE 4/15, VET HAS DRANK EXCESSIVELY. HE WOULD LIKE TO DRINK EVERY
          NIGHT AND TRIES TO MANIPULATE AMBER TO BE ABLE TO DRINK. HE WILL DRINK
          A 6 PACK OR BOTTLE OF WINE PER SITTING. THEIR HOUSE IS 1 BLOCK AWAY


          FROM A BAR AND 2 BLOCKS FROM A CONVENIENT STORE. WHEN AMBER COMES 
HOME
          FROM WORK, THERE WILL BE ALCOHOL IN THE REFRIGERATOR OR EMPTY BOTTLES
          IN THE TRASH. HE STORMS OUT WHEN ARGUING WITH HER AND GOES TO THE BAR
          WHERE HE CONSUMES 6+ DRINKS. ALCOHOL WAS INVOLVED BEFORE VET BECAME
          VIOLENT WITH HER FATHER IN 11/15. HE PUSHED AMBER IN 10/15 WHEN SHE
          CALLED THE POLICE DURING HIS INTOXICATED RAGE.

          CURRENTLY, HE DRANK HEAVILY ON MEMORIAL DAY, BINGE DRINKS, THEN TRIES
          NOT TO DRINK. HE LAST DRANK LAST WEEK WHEN HE HAD 2 GLASSES OF WINE.

          VET SMOKES MARIJUANA OCCASIONALLY, 1-2 TIMES PER MONTH. ON 6/6/16, DR
          LIM REPORTED THAT HE USES IT 2-3 TIMES PER MONTH. HE HAS NOT ACTIVELY
          SOUGHT IT OUT RECENTLY AND LAST USED IT 2 WEEKS AGO. IT UPSETS AMBER 
SO
          HE TRIES NOT TO.

          IT IS IMPORTANT TO NOTE THAT VET'S 8/21/12 MH INTAKE NOTE AT HINES
          INDICATED THAT VET DRANK ALCOHOL SINCE 17 IN HIGH SCHOOL AND USED
          MARIJUANA SINCE AGE 16. HE BECOMES AGGRESSIVE AND VIOLENT WHEN HE IS
          INTOXICATED AND IT LEADS TO LEGAL PROBLEMS. HIS 7/1/06 ALCOHOL
          TREATMENT NOTE INDICATED THAT ALCOHOLISM WAS PREVALENT ON BOTH SIDES 
OF
          THE FAMILY, ACCORDING TO VET'S PARENTS. HIS FATHER AND MATERNAL UNCLE
          WERE ALCOHOLIC AND HIS MATERNAL UNCLE ABUSED DRUGS. VET ALSO USED
          COCAINE 10 TIMES, MOST RECENTLY IN 2010, AND USED MUSHROOMS, LSD AND
          ECSTASY SEVERAL TIMES IN 2006, ACCORDING TO HIS 8/12 MH INTAKE NOTE. 
ON
          8/2/06, A BIOPSYCHOSOCIAL ASSESSMENT INDICATED THAT VET'S ALCOHOL AND
          DRUG USE INTERFERED WITH HIS SCHOOL PERFORMANCE.

          VET HAD A HISTORY OF ABUSING PRESCRIPTION NARCOTICS BUT SAID HE HAS 
NOT
          IN THE PAST YEAR.
          
    f. Other, if any:
          VET HAS ANNIVERSARY REACTIONS RELATED TO HIS FRIEND DYING IN IRAQ IN
          APRIL 2004, HIS MOTHER'S DEATH IN 5/08. HIS FIANCEE SAID SOMETHING
          ALWAYS HAPPENS IN THE SPRING WITH VET'S BEHAVIOR.
          
    3. PTSD Diagnostic Criteria
    ---------------------------
    Please check criteria used for establishing the current PTSD diagnosis. The
    diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual
    of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to
    combat, personal trauma, other life threatening situations (non-combat
    related stressors.) 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".
    
       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] 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] The duration of the symptoms described above in Criteria
                       B, C, and D are more than 1 month.

       Criterion G:


                   [X] The PTSD symptoms described above cause 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.

    4. Symptoms
    -----------
    For VA rating purposes, check all symptoms that actively apply to the
       Veteran's diagnoses:
       
       [X] Depressed mood
       [X] Anxiety
       [X] Suspiciousness
       [X] Chronic sleep impairment
       [X] Mild memory loss, such as forgetting names, directions or recent
           events
       [X] Impaired judgment
       [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
       [X] Impaired impulse control, such as unprovoked irritability with 
periods
           of violence

    5. Behavioral Observations:
    ---------------------------
       VET ARRIVED EARLY FOR TODAY'S EXAM AND WAS ACCOMPANIED BY HIS FIANCEE
       AMBER. HE DISPLAYED DEPRESSED AFFECT DURING THE EXAM AND BECAME TEARFUL 
AT
       SEVERAL TIMES. SPEECH, BEHAVIOR, AFFECT, THOUGHT AND EYE CONTACT WERE
       OTHERWISE WITHIN NORMAL LIMITS. APPEARANCE, GROOMING AND HYGIENE WERE
       ACCEPTABLE.
       
    6. Other symptoms
    -----------------
    Does the Veteran have any other symptoms attributable to PTSD (and other
    mental disorders) that are not listed above?
    [X] Yes[ ] No
    
           If yes, describe:
              HE REPORTED PANIC ATTACKS WHERE HE FEELS ANGRY AND CAN'T CONTROL
              THINGS. THESE ARE ANGER ATTACKS, NOT ACTUAL PANIC ATTACKS. HIS
              FIANCEE NOTED THAT HE EATS EXCESSIVELY, EATING 28 WHITE CASTLE
              HAMBURGERS AND AN ENTIRE CAKE IN 2 DAYS. HIS WEIGHT FLUCTUATES AND
              HE EATS DURING THE NIGHT. H AVOIDS WATCHING THE NEWS, 
CONVERSATIONS
              ABOUT THE MILITARY, AND TELLING OTHERS THAT HE WAS A MARINE. HE 
HAS
              LOST INTEREST IN GOING OUT, DOING RECREATIONAL THINGS THAT DON'T
              INVOLVE DRINKING, AND GOING TO STATE PARKS. HE SLEEPS 4-5 HOURS
              WITH MEDICATION.
              
    7. Competency
    -------------
    Is the Veteran capable of managing his or her financial affairs?
    [X] Yes[ ] No
    
    8. Remarks, (including any testing results) if any:
    ---------------------------------------------------
       MR JUSTIN SOROKA CONTINUES TO MEET CRITERIA FOR PTSD BUT HIS PTSD IS OF
       MODERATE SEVERITY, WHICH INDICATES A DECREASE IN SEVERITY SINCE HIS LAST
       C&P PTSD REVIEW EXAM IN 4/15. HIS PTSD CURRENTLY CAUSES REDUCED
       RELIABILITY AND PRODUCTIVITY IN A WORKPLACE SETTING. THERE WAS NO 
EVIDENCE
       IN TODAY'S EXAM OR IN REVIEW OF VET'S VA TREATMENT RECORDS SINCE 2006,
       THAT HIS PTSD WAS EVER SEVERE ENOUGH TO RENDER HIM UNABLE TO OBTAIN OR
       MAINTAIN SUBSTANTIALLY GAINFUL EMPLOYMENT. HE WAS ABLE TO KEEP THE SAME
       FULL TIME JOB FROM 2/13 TO 4/15 AND WAS PROMOTED TO KEYHOLDER AT GOOD
       WILL. THERE WAS NO EVIDENCE TO DOCUMENT THE REASON THAT HE LOST HIS JOB 
IN
       4/15. HIS MH NOTES INDICATE THAT HE WAS NOT APPLYING FOR OTHER WORK BUT
       PLANNED TO GO TO COLLEGE FULL TIME AND WATCH HIS DAUGHTER WHILE HIS WIFE
       WORKED.

       HIS MOST DISABLING CONDITIONS ARE HIS ALCOHOL USE DISORDER AND ANTISOCIAL
       PERSONALITY DISORDER, WHICH CAUSE SOCIAL AND OCCUPATIONAL IMPAIRMENT IN
       MOST AREAS OF HIS LIFE INCLUDING WORK, SCHOOL, FAMILY RELATIONS,
       INTERPERSONAL RELATIONSHIPS, JUDGMENT, IMPULSE CONTROL, THOUGHT AND MOOD. 


       THERE IS NO EVIDENCE TO SUGGEST THAT VET'S PERSONALITY DISORDER OR 
ALCOHOL
       USE DISORDER ARE RELATED TO THE MILITARY. VET WAS USING ALCOHOL AND
       CANNABIS SINCE AGE 17 AND 16 RESPECTIVELY, AND HAS A STRONG BIOLOGICAL
       PREDISPOSITION FOR A SUBSTANCE USE AND A MH DISORDER. HE HAS MULTIPLE
       FAMILY MEMBERS (INCLUDING HIS FATHER AND SISTER) WITH EITHER SUBSTANCE 
USE
       DISORDERS OR MH DISORDERS AND HAD A COUSIN COMMITTED SUICIDE BY GUNSHOT
       WOUND TO THE HEAD. THERE IS NO EVIDENCE TO SUGGEST THAT EITHER OF VET'S
       CONDITION WORSENED BEYOND THEIR EXPECTED PROGRESSION AS A RESULT OF
       MILITARY EXPERIENCES. 

       ALTHOUGH VET HAS BEEN INVOLVED IN SUBSTANCE ABUSE AND MH TREATMENT AT THE
       VA SINCE 2006, MUCH OF HIS TREATMENT WAS PRECIPITATED BY LEGAL PROBLEMS
       INCLUDING HIS 3 DUIS AND MOST RECENTLY HIS ARREST FOR DRIVING ON A 
REVOKED
       LICENSE. HE ORIGINALLY CAME FOR ALCOHOL TREATMENT AT DANVILLE VA ON
       6/30/06 AFTER GETTING 2 DUIS IN A 5 MONTH PERIOD. AT THE TIME, HE HAD A
       LARGE SOCIAL NETWORK OF FRIENDS WHO ABUSED ALCOHOL AND DRUGS, AND WAS
       EXPERIMENTING WITH COCAINE, ACID, ECSTASY AND MUSHROOMS, BESIDES DRINKING
       12-15 BEERS PER NIGHT AND USING 2 GMS OF CANNABIS PER DAY. HIS 11/2/05 MH
       NOTE INDICATED THAT HE WAS DOING MUCH BETTER ON CELEXA FOR ANXIETY BUT HE
       STOPPED TAKING IT. HIS 10/26/15 PSYCHIATRIST NOTE INDICATED THAT HE ONLY
       GOT AGITATED WHEN INTOXICATED.

       DESPITE URGING FROM HIS SW TO GET RESIDENTIAL SDTU TREATMENT SINCE 8/12,
       VET HAS BEEN UNWILLING TO FOLLOW UP UNTIL NOW WHEN HE FACES JAIL TIME OR
       RESIDENTIAL TREATMENT. HIS MH NOTES INDICATE THAT HE DOES BETTER WHEN HE
       IS SOBER AND WHEN HE IS COMPLIANT WITH MH MEDICATION AND TREATMENT. IT IS
       LIKELY THAT VET WOULD BE ABLE TO MAINTAIN SUBSTANTIALLY GAINFUL FULL TIME
       EMPLOYMENT AND HEALTHIER RELATIONSHIPS IF HE REMAINED SOBER AND 
COOPERATED
       WITH TREATMENT ON A CONSISTENT BASIS.

       TODAY'S DIAGNOSES OF ALCOHOL USE DISORDER, ANTISOCIAL PERSONALITY 
DISORDER
       AND PTSD ARE BASED UPON DSM-5 CRITERIA AND ICD-10 CODING.

       
       

 
/es/ KATHLEEN PARKER, PSY.D.

Signed: 06/10/2016 17:12
-------------------------------------------------------------------------


----------- END OF MY HEALTHEVET PERSONAL INFORMATION REPORT ----------
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