ptsd Nearly 3 Hour PTSD C&P Exam

[Rakkasan]

Little History: This was my second C&P Exam. The first one granted me 30% about 2 years ago. That exam was only like 20 minutes so this one caught me off guard. I have been getting worse the past year. I got time on the street from my job for about 5 days  to recover from a panic attack I had at work. I get into fights with coworkers so now I work in a tower by myself away from everyone and about a month ago, I nearly committed suicide. I had called the suicide hotline and made an appointment with the Mental Health and now I am doing weekly group therapy, monthly individual therapy and they have me on a couple different medications for the panic attacks and anxiety. I recently applied for an increase in PTSD and added anxiety and panic attacks as a secondary. Couple of questions: I was only scheduled a C&P exam for the PTSD, will I need to do another one for the anxiety or panic attacks? Also, here is my C&P Exam results and was wondering if someone with more experience can take a look at it and tell me what you think. It looks like a 50% possibility but not for sure. Thanks.

 

 LOCAL TITLE: PSYCH C&P EXAM MA                                  
STANDARD TITLE: C & P EXAMINATION NOTE                          
DATE OF NOTE: JUN 27, 2016@12:00     ENTRY DATE: JUN 27, 2016@14:39:27      
      AUTHOR:       EXP COSIGNER:                           
     URGENCY:                            STATUS: COMPLETED                     

                  Review Post Traumatic Stress Disorder (PTSD)
                        Disability Benefits Questionnaire

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

    2. Current Diagnoses
    --------------------
    a. Mental Disorder Diagnosis #1: PTSD
         Comments, if any: SC 30%

    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?
       [ ] Yes[X] No
       
    c. Does the Veteran have a diagnosed traumatic brain injury 
    (TBI)?
       [ ] Yes[ ] No[X] 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[ ] 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?
       No response provided.
       
                                   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[ ] 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
        [ ] 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. Recent History (since prior exam)
    ------------------------------------
    a. Relevant Social/Marital/Family history:
                         E. Social Functioning:

          The veteran is currently married to second wife. 9 years. 
          They
          separated for 6 weeks due to his anger and other PTSD like 
          behaviors
          late Sept 2015.    

          He describes his current relationships as: "since the
          suicide thing. It has picked up. I have started talking to 
          her more. My
          anger, outbursts. I would nitpick everything. We fight 
          about not going
          out more.
          Four kids in today (two from first marriage ages 13, 11) 
          and second
          marriage two kids (6,3). All the kids live with them. 
          He noted he has many outbursts with the kids because he 
          expects too
          much, he is more like a drill sgt than a father. Overall 
          the thinks
          their relationship is "good"
          He may not physically isolate himself from family but does 
          emotional
          isolate himself (does not want to be vulnerable)
                  
          Friends and Hobbies: no friends; does not trust people.
          He started gardening. He and his wife watch movies. 
          
          
    b. Relevant Occupational and Educational history:
          Occupation:  Prison guard in XXXXX. Has been there 1.5 
          years. Works in
          tower alone
              
          Has the veteran lost time from work due to mental health 
          issues? 5 days
          of paid leave for anxiety attack at work; estimates he 
          misses an hour a
          day at work due to "zoning out" (dissociation or intrusive 
          thoughts)
          Any difficulties at work? yes
          What causes difficulties? Anxiety, he has ad anger 
          outbursts at work
          (he was transferred to the tower)
          Are these difficulties mild/moderate/severe? Mild to 
          moderate
          How is your  efficiency/reliability/productivity at work? 
          good
          How do you get along with supervisor/coworkers?depends on 
          the person
          Does your problems only occur during times of significant 
          stress?yes

          Current Financial Status:
          Income:job, disability from VA
          Basic needs being met:yes
          
          
    c. Relevant Mental Health history, to include prescribed 
    medications and
       family mental health:
          ACTIVE PROBLEM LIST
          1)  Annual Physical-No Problem (P)
          2)  Psoriasis vulgaris
          3)  Chronic post-traumatic stress disorder
          4)  Suicidal thoughts

          ACTIVE MEDICATIONS:
          Active Outpatient Medications (including Supplies):
           
          SERTRALINE HCL 100MG TAB TAKE ONE-HALF TABLET BY MOUTH      
          ACTIVE
            EVERY MORNING FOR MOOD
          TRAZODONE HCL 100MG TAB TAKE ONE-HALF TABLET BY MOUTH AT    
          ACTIVE
            BEDTIME FOR MOOD OR SLEEP.               
          PRE-MILITARY MENTAL HEALTH HISTORY:

          POST-MILITARY MENTAL HEALTH HISTORY:

          History of Psychiatric care: 

          His history of psychiatric care has included:

          PSYCHOTROPIC MEDICATIONS: trazodone, sertraline
           
          a.      Side effects of medication: not taking them as 
          they make him
          feel "strange". He noted he has talked to his provider. 

          PSYCHIATRIC INPATIENT TREATMENTS:  none

          PSYCHIATRIC OUTPATIENT CARE: Received 4 to 6 sessions in 
          KY Vet
          center about 2014.  Had received medications from KY VA. 
          He had no had
          therapy until coming back to the Marion VAMC and he has 
          had interaction
          with a NP for medication and the PTSD clinical team. He is 
          scheduled to
          start group therapy. 

          individual therapy/ symptoms and medicati
on monitoring

           Suicidal Thoughts, intentions, plans or intent
           a.    
          Presence of SI: called hotline june 2015. Occasional 
          thoughts mostly
          passive. Was going to run car into wall or ditch.
           b.      Comments

                
           SUICIDE RISK ASSESSMENT COMPLETED 

          Suicide Risk Screening Questions Are you feeling hopeless 
          about the  present or future? 
           
                  
          Homicidal thoughts, intentions, plans, intent

           a.      Presence of HI: No
           b.      Comments: 

                  
          Subjective Complaints:  a. Describe fully.

          HOW DO YOU SEE YOUR SYMPTOMS AFFECTING YOUR DAILY LIVING? 
          "Anger
          affects everything. It ruins everything. I don't' go 
          anywhere and my
          wife wants to. If we go out I am good for an hour then I 
          have to go, I
          feel closed in. I yell at the kids too much."
          ANY REMISSION FROM SYMPTOMS?  No have become worse
          IMPAIRMENT IN THOUGHT?  no
          CURRENT STRESSORS? Increase in MH symptoms, SI, 
          relationships, kids
          causing more anxiety and depression

          SPONTANEOUS REPORTING OF SYMPTOMS: "Suicidal thoughts, I 
          see things
          that are not there but I think they are there; I smell 
          thinks that
          makes me think I am there. I hallucinate about stuff and I 
          cry over it,
          I get angry so easily and I take it out on my kids. I 
          don't like being
          around people, even at work. I keep a tight group I guess. 
          I stare off
          into space sometimes and it seems like a long time. I try 
          to have my
          wife drive more often. The suicidal stuff started 
          happening more."
          END OF SPONTANEOUS REPORTING. 
          "some days I feel I am doing good, other days I am crying 
          and sobbing
          the entire time. I keep getting better but I am not. My 
          wife left me
          for 6 weeks. We patched things up. My first wife left me. 
          I don't
          know." 
          "I feel there is no escape. The day of the suicide 
          hotline. I saw her.
          I felt there was no escape, ever" 
          He cannot understand why his symptoms are much worse than 
          in 2012. 
          He noted memory loss for childhood events in the past few 
          years. He
          noted poor short term memory. 
          CRITERION B:RE-EXPERIENCING PHENOMENA
          INTRUSIVE THOUGHTS: explained and gave description of 
          intrusive
          thoughts.  "I will have a week where I don't have anything  
          and then a
          week where it is 4 to 5 times a week or day"
          FLASHBACKS:  he noted dissociative periods throughout the 
          day.
          Flashbacks upon waking in the morning. Flashback 
          occurrence varies
          greatly.
          NIGHTMARES: "my wife's says I am screaming and yelling in 
          my sleep. I
          speak Arabic in my sleep, My heart is pounding."   He 
          noted waking up
          sweating profusely daily. Only vaguely remembers the 
          nightmares. Wife
          tells him in the morning about his behaviors. 
          Does not endorse depersonalization, derealization. 
          PHYSIOLOGICAL/PSYCHOLOGICAL REACTIVITY: anger, depression, 
          tears, heart
          pounding, increased sweating. 

          CRITERION C:AVOIDANCE
          He avoids being around blood; crowds (this is more about
          hypervigilance); 4th of july and fireworks; talking and 
          thinking about
          trauma. 
          CRITERION D:ALERTATIONS IN 
          COGNITION/DETACHMENT/BLAME/INABILITY FOR
          POSITIVE 
          EMOTIONS
          "I try to keep everyone close, my circle of people is 
          small; I have
          major trust issues; I don't go out and do anything with 
          anyone. We have
          had arguments over this (going out); I talk to people even 
          coworkers
          like they are dumb. I get pissed off very easily.  If they 
          do something
          wrong, I get so angry. My kids, if they don't do what I 
          tell them I get
          so mad, I am throwing stuff, yelling. They will do stuff 
          they don't
          know they are doing and it will bother me like startling. 
          I think I am
          getting shot at in the moment." 
          Trusts wife. No one else. Feels no one is trustworthy. 
          Feels this way
          100% of the time. "Constant patrols and talking to people, 
          there was no
          one to trust them." This how he relates this to combat.
          He feels damaged; there is no trust in people; the world 
          and people are
          unsafe. 
          "I have not talked to my parents in months. My brother 
          came out last
          week to check on me. They act like I am secluding them. I 
          don't pick up
          the phone and call people. My wife called my brother and 
          told him I was
          having problems. He flew out here."
          Feels anger the most; does not have ability to feel peace, 
          joy and
          love; no positive feelings. 
          He keeps people at a distance. "I don't think everyone is 
          out to get
          me. I don't trust them.  I will not be vulnerable"  
          He describes some "blank spots" in his memory during 
          certain trauma. 
          Believes himself to have been a person who could help 
          anyone. This
          trauma with the woman who had her intestines outside of 
          her body; first
          of all it was a woman, second of all he felt utterly 
          helpless which
          decimated his thoughts about his core self. 
          Lack of interest in playing guitar; used to play golf.  
          (he noted lack
          of motivation, not really trauma based) 
          Has to be in control.  "everything goes my way I know 
          every one will be
          safe" Control represents safety
          CRITERION E: INCREASED AUTONOMIC AROUSAL
          IRRITABILITY/ANGER: themes of anger not being in control.  
          Control,
          stupidity, disrespectful, poor work ethic are all themes 
          of anger.
          "Anger, I have to let out. Irritability, I don't have to 
          express." He
          yells, screams and throws things. Has outbursts a few 
          times a week. 
          RECKLESS BEHAVIOR:
          HYPERVIGLANCES: "I always have my back against the wall, I 
          will not be
          vulnerable. I will wait 20 + min at a restaurant for table 
          with my back
          at the wall." Noted when not against wall, very 
          uncomfortable "I can't
          do it, I will be moving around constantly looking around. 
          I can't have
          people behind me." He is even hypervigilant with staff he 
          works with.
          He feels this way 100% of the time. Relates to the 
          deployment "I guess
          the waiting for something to happen all the time. Every 
          day, take out a
          vehicle, get blown up, get another vechile and do it 
          again."
          EXAGGERATED STARTLE RESPONSE: fire works, people behind 
          him; when
          startled acts defensively 100% of the time/. 
          IMPAIRED CONCENTRATION: poor at times other times "okay" 
          poor sleep,
          intrusive thoughts, flashbacks take away from 
          concentrating. "I work in
          the tower I will see her, I will see a Humvee. I see a 
          cloud over the

          rocks I think a Humvee is coming. When people are on the 
          radio and they
          yell and I get startled."
          SLEEP DISTURBANCES: on average goes to bed 10pm; no sleep 
          until 1230- 1
          am; out of bed 6 to 630am.  "If I don't have anything 
          bothers me, I
          will sleep fine. If something wakes me up at 3am, my 
          adrenaline is
          going, I just stay away (this occurs multiple times a 
          week). Never
          feels rested. Poor sleep quality and quantity. 
          
          
    d. Relevant Legal and Behavioral history:
          Veteran denied any legal entanglements since 
          discharge/last exam. 
          
          
    e. Relevant Substance abuse history:
          POST MILITARY SUBSTANCE USAGE HISTORY:
          Veteran denied substance abuse problems/treatment
          The veteran  denied use or abusing illicit drugs and abuse 
          of 
          prescription drugs.
          Has not drank in 7 years.
          
          
    f. Other, if any:
       No response provided.
       
    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 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] 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] Flattened affect
       [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] Inability to establish and maintain effective 
       relationships
       [X] Suicidal ideation

    5. Behavioral Observations:
    ---------------------------
       Note 1: Unless otherwise stated, all historical information 
       in this DBQ is 
       based on the veteran's statements during the examination.

       General Appearance: Clean, neatly groomed
       Psychomotor activity: bouncing of legs
       Speech: unremarkable    
       Attitude toward examiner: cooperative

       Affect: flat
       Mood: anxious
           

       Attention: intact
            
       Orientation: The veteran was oriented to person, place and 
       time     

       Thought Processes: unremarkable, logical, goal directed, 
       relevant
       Though Content: unremarkable

       Judgment: partially impaired    

       Intelligence: average as evidenced by vocabulary,  
           grammar, and ability to utilize and understand 
       abstract reasoning.     

       Insight: pt understands he has a problem.    

       Inappropriate Behavior
        a.    Does the pt have inappropriate behavior:  Mild, 
       Moderate (anger)

       Obsessive or Ritualistic Behavior 
           
       a.    Does the pt have obsessive/Ritualistic behaviors: No
       Impulsivity     
       a.    Extend of impulse control: Fair
       b.    Episode of violence: No 

       Problems with ADL's; Yes or No     
       Memory 
           a.    Remote: Normal
            
       b.    Recent: Normal    
       c.    Immediate: Normal
        
       1.    Other disorders or symptoms and the extent they 
       interfere with
       activities  
           
       particularly: 
           a.    substance abuse disorders none
           a.    somatoform disorders none
           b.    personality disorders  deferred
        Testing deemed necessary: no

        Veteran response to interview:  "it went well, detailed"
       
       
    6. Other symptoms
    -----------------
    Does the Veteran have any other symptoms attributable to PTSD 
    (and other
    mental disorders) that are not listed above?
    [ ] Yes[X] No
    
    7. Competency
    -------------
    Is the Veteran capable of managing his or her financial affairs?
    [X] Yes[ ] No
    
    8. Remarks, (including any testing results) if any:
    ---------------------------------------------------
       Interview started: on time

       Explained to veteran: 
       examiner has no decision making capacity regarding the 
       veteran's
       rating; the examiner will be asking numerous questions, some 
       of which will 
       provoke emotional response; the veteran was asked to please 
       understand t
       he examiner is not make any personal judgments regarding the 
       veteran but
       due to the vast amount of 
       questions some might feel they are being judged and the 
       veteran is
       encouraged to 
       understand this is not the case it is simply a matter for 
       trying to gather 
       information for the examination the veteran requested; the 
       veteran was
       informed
       the examiner is not native of this geographical area thus 
       mannerisms are 
       different and no offense is meant if the examiner appears to 
       be abrupt or
       blunt; Veteran 
       was informed of these things at the onset of the interview:  
       the veteran
       voiced understanding 
       of the above statements: yes 
       The veteran brought documents with him/her to interview: no

       OPINION:

       After carefully reviewing the C-file, medical records, the 
       clinical
       interview, 
       and medical literature, it is my opinion that:
       PTSD, moderate
       
       

 

 

[flores97]

Rakkasan, I am by no means an expert on ptsd, but I am SC 50% for a mental health issue MDD to account for memory loss, and based on the symptoms reported on your exam, I would say that looks more like a 70% rating, jmo. I do realize the examiner marked the occupational statement that usually coincides with 50, however, the rater is also supposed to look at your symptoms when assigning the rating. For 70%, Occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgement, 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 work-like setting), inability to establish and maintain effective relationships.  Note under .4 on the exam, FOR VA RATING PURPOSES, check all symptoms that actively apply to veterans diagnosis, you have more in the 70% range I believe, such as suicidal ideation, difficulty in establishing and maintaining effective social and work relationships, inability to establish and maintain effective relationships(I had thought those two were the same), difficulty in adapting to stressful circumstances, including work or work-like setting. I wish you the best of luck, and the important issue is to continue receiving treatment and counseling for your ptsd it might even be beneficial to consider an short term inpatient treatment course, I have a few buddies whom the three month inpatient program helped tremendously, hopefully some other members will offer advice as well, but again, best of luck to you and remember, you are not alone, there are people that are going through and have gone through situations very similar and can help.

[Navy04]

Looks like you will be granted 50%. As far as Mental Health exams, I have had quite a few just in the last 3 years, and all have been hours long. All mental health conditions claimed will be in 1 exam. So the VA will not order other exams, as mental health ratings are grouped due to the symptoms over lapping. I have 5 or 6 diagnosed mental conditions but they are all rated as PTSD. Good luck and keep us posted. God bless

[Andyman73]

According to the regs, they must, by law, give you the highest possible rating based on your symptoms.  This tells us that you should be rated at 70% due to the SI. Again, should be, by law.  We all know, however, that the VA defines the laws to suit it's needs on a case by case basis.

Personally, I called the hotline last May. I've been dealing with SI for far too long. Tried it a few times with alcohol, and once got stopped in the act with a knife.

But I get to ride the NOD train to nowhere land, thanks to an examiner who chose to ignore the reason for the exam and all the evidence available.

You should get your sleep issues looked at, since some, like sleep apnea, get their own ratings.

[FormerMember]

Rakkasan. The warrior man who defended the Wounded Warriors Project to the bitter end on the Veterans Today Article that exposed them back in 2013? The one and the same Rakkasan? How are you doin', guy?

[Rakkasan]

Flores97: I never knew that certain symptoms belong in each percentage category.

Navy04: So, I won't have to do any other exams except for my monthly appointments over my anxiety and panic attacks?

Andyman73: I had used alcohol for many years and began going down a path that I did not want to which is why I gave it up. So, if I end up getting rated at 50% then I should just go ahead and file a NOD?

Asknod: No, must be a different guy. Rakkasan is the name of my unit when I was with the 101st Airborne.

[Andyman73]

Rakkasan,

I had an alcohol related incident, which netted me an Article 15/NJP. Out of that I enjoyed a 3 week outpatient treatment program. So I was presented with an opportunity to go a different direction, so I did.

Yes, if you get lowballed at 50%, file that NOD, since SI is in the 70% bracket, the law states the VA must give you that rating.  You may get treated right, and be granted that rating from the get go.

But me, I had a slickster for my MH exam, tried his hardest to avoid talking about the main reason of my claim, which is depression secondary to chronic pain.  I even had talking points all written up, with a few sentences describing each one.  Sent a copy in to be added to my evidence, had a copy for examiner, and one for myself.  Fat lot of good that did.  RO told me, after the fact, that she could not and would not weigh the overwhelming physical evidence against his opinion.  That examiner is one of the few people I ever truly wanted to "share" my pain with, literally.