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  • 14 Questions about VA Disability Compensation Benefits Claims

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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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mrthing2000

New to the process

Question

Hello all.


I am new to the disability comp process, and I'll be the first to admit--it sort of freaks me out.  There is a lot of complexity to it, and I consider myself fairly learned and understanding of science and causation.  Years ago I interned at the local VA hospital, and my dad retired from 20+ years in the VA civil service.  Its a bit different walking in the door as a patient.

Okay, I had a book practically written below, but I'll keep it short:

  • Really didn't expect basic training to be as hard as it was--the constant screaming, lack of sleep, etc.  It WAS NOT like 'Scout Camp' like my recruiter and retired USAF neighbor said.  I never had more than 1-2 anxiety attacks before this.  It was a struggle.
  • Took a psych eval maybe 2-3 days into basic training.  I was referred to Behavioral Health for a followup.  They were concerned about stupid things like "I weight myself often".  Um yep, I was a bit chunky.  Whatever.  Released to duty no problem.
  • Tore the heck out of my feet in basic training, had PT waivers, missing big toenails and a lot of pain for months, bled through my shoes, horrible.
  • Post-basic training, tore hamstrings in PT session--put on about a monthlong PT waiver
  • Developed severe bronchitis.  USAF docs treated me like I was faking it.  It wasn't 'a cold'.  I got really bad.  Nearly hospitalized.  Took 3 weeks+ to recover

Had an uneventful year in the Air Guard, then ran into some older guys who basically hazed me.  I was about 3 paygrades lower, and 20 years younger.  It was awful

  • Broke up with a girlfriend after getting ready to move across country--my unit 'was concerned I was depressed'
  • Had a field exercise that didn't go well.  They asked for feedback in an email. Was a little 'too honest'.  Nothing I said was wrong, but I clearly did not like where I was, who I was with, and did not trust them.  Probably shouldn't put that in an email.  To this day I stand by what I said.  Some good guys, some idiots.  Was sent for a psych eval for 'erratic behavior'.  Initially cleared.  Nope--sent for another one.

I said screw that, these people are jerks, and I transferred into the Navy Reserve.  Had 2 good years there.  Enjoyed it thoroughly.

Graduated college, moved across country.  Wasn't enthusisatic about the hassle of drill weekends.  Wasn't making anything as an E-4.  Prospective employers were always wary 'so you can get called up', and 'oh, so when do you get out.'  I realized I needed to cut ties.  I was out of college.  Did what I came to do.  See ya.

9/11 happened and I was nearly recalled to Active Duty.  But I lucked out, stayed in my civil service job, and was transferred to the IRR per my request.  I kept up pooints for good years in the IRR, but had no real intention of going back.

Had a change of heart, and economics were getting tight.  Re-enlisted and went back to the drilling reserve.  Found a loophole in my previous contract, and intentionally took a demotion to change career fields.  Muhahaha.  Then advanced first cycle each time.  A year later, was an E-5.  Took all the extra orders I could.  Did pretty well.  Spent a year on and off active duty orders in the reserve.  Job market sucked and I liked traveling to new places.  New York City was a highlight.  Went twice.  

But wife got into nursing school.  We'd have to move.  You go where you have to.  And she was busy as hell.  Loans were piling up.  I figured--take a deployment.  In the meantime, I volunteered to go to New Orleans to help with Hurricane Katrina relief efforts.  And en route, got hammered by Hurricane Rita there (anybody remember that?).  

  • Started having sinus issues from the mold that was now everywhere (not in my service record)
  • Started feeling extremely depressed, slept every free moment I could (the post-deployment questionnaire shows that somewhere)

A few months later, got the magic phone call.  Deploy now if I wanted, but not with my unit.  Or not.  But I knew I would probably get yanked to go to Iraq with the Seabees (now I was one), Korea with the Coastal Warfare unit I was now in, or maybe not get yanked for a year.  But eventually I would.

Economics rule.  I opted for NOW.  But the catch was--it was with the ARMY.  And it was a year-long.  And it was Afghanistan.  

The deployment sucked--why would you expect different?  I enjoyed a lot of it.  But the issues I felt during Katrina got intense.  The isolation from the real world sucked.  I was fighting the 'just war'.  But we didn't do much anything most of the time.  We were ON the front lines.  Basically not doing anything all day.  I was trained for all this combat stuff, and was stuck all day on the tiny FOB.  And if you don't engage the enemy, they come to you.  First night of tower guard, gunfire.  Turns out if was a runaway 50cal on a Humvee.  Tracers into the sky.  An accident.  And accidents, more than anything else, were to mar the deployment over and over.

In short:

  • Stationed with ABSOLUTELY IDIOT medical types who didn't document anything.  Totally worthless people.  And now it matters more than ever.
  • Broke a toe on my right foot (have the x-ray for that)
  • Howitzers are loud.  Mortars 40 feet from your tent are louder (tinnitus really sucks--but need formal diagnosis)
  • Body armor and Humvees don't mix well off-road (2-3 weeks in physical therapy)
  • Anxiety sucks.  Got demoted with a feud with my CO, and he ended up relieved of command a couple of weeks later.  But anxiety was worsening, and now I was having up to 15 attacks PER DAY.  Son of a bitch tried to ruin me.  
  • Had a former co-worker I knew in my civilian days, take a mortar shell to the helmet.  He woke up in Germany.  9 people didn't
  • Had to go to a funeral for 2 fallen airman.  They died in a suicide bombing--getting MAIL in Kabul--and if they waited 1 day, it came by helo.  Some COs don't understand that's an idiot risk. Made a quick enemy with my CO over the issue.  And then it spiraled.  He demoted me, but then was relieved of command.  LONG LONG story.
  • Smashed in the face with a Humvee door (not in service record)
  • Finally got tired of anxiety attacks, saw an Army psychiatrist.  Guy basically said 'too bad, deal with it, and sent me back to the front lines'.  Anxiety attacks now were almost continuous.  
  • Was deprived of sleep constantly because a few CO-loyalists though it fitting to assign me extra duty whenever possible.  No joke--sleeping maybe 2 hours a night for days/weeks on end.  Was sleeping instead of eating lunch.  Slept every free moment I had.
  • Base was attacked a few times.  That sucked.  But I was more upset about missing lunch--serious.  Started to notice I was detached from my surroundings.  Sort of felt invincible in terms of the war around me, but extremely vulnerable too.  Was more suspicious of people.  Feared my own people more than the Taliban--absolutely dead serious.
  • Was stuck for months hosting the Local National Detail--basically locals who could work on the base doing menial tasks.  They got paid for janitorial stuff mostly.  And I had to drive and escort them to the BURN PIT.  Sometimes 5 times a day.  It was awful.  And some Army guys threw ammunition into the trashcan.  Nothing like rounds going off when you drive down there. Seriously.  A car battery sounds like a car bomb.  Crazy.  
  • Could have been killed by a mortar that blew up just feet out of the tube.  Had it not been an illuminating round...
  • Had many suicidal thoughts during the deployment.  Instead, just volunteered for crazy stuff.  Figured result would be the same.
  • If we had any medical issues at all, the Navy tried to hold us hostage at Norfolk.  I had to sign out AMA (Against Medical Advice) so I could finally go home after being gone 13 months.  

Post deployment:

  • Had extremely strong irritable bowel symptoms 1-2 months later.  This had plagued me at Fort Bragg and intermittently throughout the deployment.  Had a barium exam.  Horrible.  Results: inconclusive.  Something has plagued me since, and it has been 10 years.
  • Very strong anxiety, PTSD, and particularly depression.  Formally diagnosed at the VA hospital.  Finally had something.  Meds: Prozac.
  • Moved across country for Graduate School: may have experienced a manic episode.  Adjusted meds.  Felt better.
  • Diagnosed with SEVERE chronic obstructive sleep apnea by the VA.  Been on a CPAP now for 7 years.
  • Struggled with a lot of change.  Medications had side effects, things were rough.  Been on a mental health see-saw for years.
  • Changed meds to Cymbalta.  Bad idea--if I took it an hour later than usual, I started to feel withdrawal 
  • Changed meds to Wellbutrin to address worsening anxiety.  It did not work.  Had almost immediate depression severity.  Had to discontinue after 3 weeks--was literally suicidal.  Scary as hell.
  • Change to Pristiq.  Seemed better than other choices.  Took that for 2 years.
  • Moved again, new doc prescribed Lamotrigine as a mood stabilizer.  Took for 1 year
  • Recently, sleep really got bad.  Prescribed Ambien
  • Anxiety attacks nearly daily.  Prescribed Adivan.  Eventually doubled the dose just to sleep.  Having recurrent dreams of being isolated, stuck in the Navy, in trouble, etc.
  • Finally fed up with the doc, transferred to the VA.  Initially thought the pyschiatrist was a bit weird.  But she said a few things that amazed me.  And unlike the previous psych doc, she listened to my concerns.  Changed sleep meds to Tramadol.  Changed meds to Clonipin for PTSD, anxiety.  Still taking Pristiq and Lamotrigine. Feeling somewhat better but not where I want to be, but closer than before
  • Oh yes, and my feet are killing me now.  I wonder if my foot geometry shifted after the broken foot and basic training injuries

Overall, its been a real struggle.  Survivors guilt, being abused by some peers and superiors, some issues from PTSD, and a propensity to want to talk about things, but nobody wants to hear your story.  No one.  Everyone wants to believe the Afghan campaign was the 'right war'.  And they don't want to know we tried but basically failed.

There were no war heros in my FOB.  One purple heart.  A LOT of close calls.  And tons of accidents.  Tons.

It took me almost 10 years to finally march myself into the VA and say 'finally, let's do this'.  I have pain, nightmares, anxiety attacks, and I've not tackled them.  I go to the VA and feel out of place--30 years younger than everyone else there.  And 'I'm not as bad as that guy' feeling.  And especially thinking someday about re-enlisting, and not wanting a foot of paper to need a waiver for everything.

But then I realized, its very unlikely I would re-enlist.  And I was getting older.  I had the time.  Let's roll.

I am wary of the VA, just as I was wary of the medical departments all along.  There is so much missing in my service records.  Our unit corpsman didn't write anything down.  It will be a struggle to argue service connectivity for many things, being that its been 9 years since I came 'home'.  It sucks.  I remember times/dates/places vividly.  That may not matter.

But its a fight many of you know all too well.  I have questions.  Many.  And truly, thank you for your service.  

We weren't all patriots.  Some needed money for college, others to feed their families.  And many drafted without a choice.  Most old, and a few young ones.  But we are all veterans.

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Welcome to Hadit!

 

To become service connected (SC) for a disability, for the most part, you'll need:
1. Event/Issue in service
2. Current diagnosis
3. Doctor connecting 1 and 2

There are other avenues which include presumptive conditions, like if you were deployed under certain circumstances (like Vietnam, OEF/IEF, etc...), or if a chronic condition appeared within a year after you got out.

There are also secondary claims, where a SC disability, or medication used to treat a SC disability, caused another disability.

For Guard/Reserve, there are special line of duty (LOD) requirements which may apply.


Evidence is very important, so try to get all that you can. When you have it, compare it to what you may already have.

1. Make sure you have an account setup with www.myhealth.va.gov. After additional authentication, you can pull your personnel file and VA medical records.

2. Do the same for Ebenefits at http://ebenefits.va.gov

3. Request a copy of your personnel record via www.archives.gov/veterans/military-service-records

4. Request a copy of your claims file (c-file) from the VA. This could take weeks to months (most likely) to arrive

5. Request a copy of your service medical records from the VA. These are often available by contacting the Release of Information Office at your VAMC. They claim it will take 4 business weeks or so, but in reality it likely will take longer.

6. If you had medical treatment at a civilian facility, try to get those records too. Please bear in mind that they may have destroyed copies and/or might charge you money for copies, which can add up. Only get what you deem potentially relevant to current or future claims.  

7. Please bear in mind that some facilities (VA, military, and civilian) may keep dental and/or imaging (X-ray, CAT scan, MRI, etc...) records apart from regular records and they may need to be obtained separately. Some VAMC's keep these at their Radiology department, but they will make you fill out a release of information form first.

8. Try to obtain copies of Monday Morning Reports (MMR's) and unit records from units with which you served.

9. If you are or can get in contact with people who knew you before/during/after service, and who could attest to observing your condition, then they may be able to write a "buddy letter" on your behalf. These are not guaranteed, but may help when other evidence is unavailable. If you or them kept any journals, diaries, etc.., they may become helpful.

10. If you send anything via the mail to the VA, keep copies of everything. Don't send originals. Use certified mail so you can prove they received it.

11. Keep a log of activity between you and the VA, more or less like a diary. It can help if you need to see what was done and when.

12. Check out the links on the main www.hadit.com web site. There is a lot of good information and helpful links.

 

It is important to know that you might be able to obtain digital copies of the records on CD and/or DVD.

It is important to know that any paper documents may contain information on both sides. If you can't understand any medical symbols, look them up, and/or ask a medical person to help decipher them and/or chicken scratch handwriting.

 

1. In your service treatment records, look at your entrance/exit exams. They will typically entail two parts: you telling what you remember having (subjective/personal history) and what the doctor found (objective) at the time of each exam.
  With respect to the entrance exam, it is used to determine if you were medically sound when you joined up. If the doctor did not find anything, then you should be ok in most situations. If you had a pre-existing condition that was made worse by service, that might be able to be claimed.
  With respect to the exit exam, that is used to determine what was left of you when you left the service. In some cases, an exit physical may have been declined or the doc might have just checked off things as normal. It happens.

2. Go through all of the medical records, sort and catalog them. If you were diagnosed with anything being described as "chonic", such as "chronic bronchitis", then that can help with that condition.
  If you currently have a diagnosis that was found to be "normal" during the exit exam, but was diagnosed as "chronic" during service, that can really help.
  If you had a lot of treatment visits for the same problem, that can also help.


9/10 Years
The VA will likely try to use the amount of time between service and when you claimed against you. If you can show that the problems continued over the duration, it can be helpful.

 

Medical Nexus
This is where a medical professional ties your current disability directly to your service or secondary to another SC disability or its treatment. For disability claims, the VA prefers to have one of their C&P examiners do it. Many VA and civilian docs will refuse to write a statement. They may be too busy or not know anything about it.
  Doctors should have to have reviewed the records in question, performed an exam/labs/imaging, and then write a nexus statement containing strong medical rationale. Some docs might state "may be", "possibly", or "probably", but the VA will discount those phrases. The minimum threshold is "at least as likely as not" 50%, "more/most likely" 75%, and "caused by/due to" 100%. This site contains lots of good information about medical nexus statements. Check out the DBQ link below.


PTSD/Mental Health
It sounds like you stayed in treatment and let them know when things didn't work, which is good. MH meds are known to have unusual side effects.
  A few years back, the VA relaxed some of its rules about PTSD regarding combat veterans and also those who were personally assaulted. If you file for PTSD, a VA C&P examiner will need to handle the nexus part. This site contains lots of good information about filing PTSD claims here on this site.


Burn Pits
If you have not singed up yet, the VA as a burn pit registry at: http://www.va.gov/HEALTH/NewsFeatures/2014/October/Burn-pit-exposure-Signup-now-in-VA-Registry.asp


 

Don't just send in several reams of paper and expect the VA to connect the dots. Spoon feed them what is specific to each claim.

 

Get to know the VA rating criteria relating to your issues:
http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5

And do the same with the DBQ's:
http://www.benefits.va.gov/compensation/dbq_ListByDBQFormName.asp

 

 

If you have questions about specific disabilities, it might be better to break them out into individual topics.

Good luck!

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Great Information from Vync!

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Thanks so much.  Its a daunting task and beyond complex!

The VSO here was completely unhelpful, almost hostile to me.  I'm looking at going to another VSO to see if I have a better fit.  Or maybe just work without them.  

I'm spending a lot of time reading the Hadit site.  Good info, though I come up with some very specific questions that don't lend themselves to easy answers.

If I knew the answer to these 3, I'd be way ahead on the process:

  • Say I broke my right foot in-service.  But then my left feet had problems also.  Do I file a separate claim for EACH foot?  If I have several different issues for 'a system' (as I understand it), are each issue a separate claim?  Or am I claiming the 'whole system' that could have 7 issues in it, rather than 7 separate claims?
  • Say I claim sleep apnea--but they gave me a CPAP and it works well.  In my head I still have sleep apnea.  But the CPAP is effectively treating it.  Is the fact the intervention is working, negating the rating % until it becomes uncontrolled/unmigitated/ineffective?  Something like, you claim it, but they say your intervention is working great--so 0%?  I could see this true with a hearing aid for hearing loss, etc. Hopefully you can tell what I'm asking here.
  • Final question: is there a list of what conditions are under what system?  Quite possibly I have no idea that something is claimable.  I expect the VA to fight me on several things.  I spent more time fighting the system than the purported enemy.  At least I know the intentions of the enemy (!).

So far my dealings with QTC have been idiotic.  One appointment here at 10am, but at 11am I have to drive 350 miles for a x-ray?  Seriously stupid stuff.

Thanks for the support, and I hope to pass it on too.

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You should read some of Navy4life post  she had  feet/Ankle problems and got S.C. for both  one aggravated the other so-to -speak,

Interesting as how she got it Service connected and rated for..she work hard on her claims and prevailed.

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Also as for as intervention help

VA is not suppose to use a medication or device that helps in your disability as for as releif...If your hard of hearing  and use  hearing aids to hear better..so what? the test are done without Hearing Aide's

Same with sleep apnea Test  they watch you sleep then put on a c-pap or bi-pap   and watch you  and record the apneas and the degree % and how many episodes...then recommend a C-PAP Machine  that helps your air passages ways clear so you sleep better, this still does not stop your apneas  even with the c-pap machine.

Once your Diagnosed with a long lasting disability your rated as to the Degree and severity of it  without the meds or the devise's

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      Stressor #1: Early in his tour while stationed in Bagram, the base was attacked with artillery fire. The veteran stated he was terrified and petrified. He was out smoking near the command post when the shells started hitting. He dove between some barriers and other people dove on top of him. He could hear the shells hitting and recalled turning over to see them flying overhead. After the shelling stopped, the veteran was frozen. His Sgt. slapped him. They had taken many incoming that day, and though nobody was killed in his platoon, the veteran doesn't know if others on the base were harmed. After that day, he remained always on alert and tried not to think about it.
      Stressor #2: Later, he was stationed in Salerno, Afghanistan when another artillery strike occurred. Again, the veteran froze.
      Stressor #3: A third incident occurred when he was stationed at COB Zormat - they took incoming artillery and returned artillery in response. Once again, the veteran froze, and was taken aside by his Sgt. who chewed him out, shamed him, and told him to hide his fear. The veteran stated he was afraid to say anything to anyone because he feared he looked like "a xxxxx." While in Afghanistan, the veteran received word from his wife that she wanted a divorce. The veteran stated that his friend helped him through his distress. In 2013, on Christmas day, his friend committed suicide. The veteran stated that when he heard of this, he was angry, including anger at himself for not seeing the warning signs. Veteran stated that his friend's suicide has ruined Christmas for him ever since. Post military occupational functioning: The veteran has been unable to maintain employment since his military discharge. In the first few years post discharge he held 4 to 5 different jobs, the longest being less than a year. Then, he found work as a corrections officer in a prison in Kentucky. However, the
      veteran's depression, drinking, calling off work, anxiety, and irritability, resulted in him being terminated after about 2 years. He got into trouble for losing his temper with the captain and cussing her out. In May 2018, he moved to Ohio having landed another job as a corrections officer with a prison in London. He was there less than 6 months before being terminated. Again, he was having difficulty due to anxiety, irritability, depression, poor attendance, and drinking. He briefly worked at the Post Office as a mail carrier after that, but couldn't get enough sleep, felt depressed, and felt that everyone who worked there was from the military. He couldn't stand it. The veteran has been unemployed for some months now. He wishes to return to school and earned his bachelor's degree. Even at school, he had difficulty because people wanted to ask him about his military service and he always wanted to avoid it.
      c. Relevant mental health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The veteran stated that he was never the same after his deployment. He has felt fearful, depressed, and worthless. He experienced the loss of his grandfather while he was deployed, and the loss of his friend to suicide in 2013. The veteran stated he sleeps poorly, waking up many times throughout the night, and dreaming about artillery attacks. He has intrusive thoughts about his military trauma and other negative military experiences, and at times has physical symptoms including rapid heart rate, shortness of breath, sweating, and trembling. He drinks excessively as an apparent avoidance technique. He has problems with anger outbursts and irritability. He has hypervigilance, problems concentrating, exaggerated startle reflex, feelings of guilt, feelings of inadequacy and worthlessness, inability to connect with others, and wonders if others would be better off if he were dead. The veteran second-guesses his actions in Afghanistan and thinks he could've done better and "I should've manned up." He said he feels worthless. He wonders why he cowered when his base was attacked. He shakes when he hears loud noises, and can't tolerate fireworks. He rarely does activities unless he must, and generally just wants to be by himself. He sees others as threatening, and feels disconnected from everyone including his wife, with the exception of his children, and more recently, his therapist Dr. Ward. The veteran stated he has lost interest in things he used to enjoy, most notably sports. He overeats and drinks excessively. He avoids his friends because he doesn't want to talk about the military. He dropped
      out of school because people kept asking about his military service. He hates going to his parents home because his mother has erected a "shrine" to him in their living room, and he is to fearful of disappointing his parents to tell them how much he hates it. The veteran sought treatment earlier this year, and has now been working with a psychologist in Spring field, Dr. Ward, for 4-5 months. He stated that Dr. Ward is the one person he feels close to. They recently began EMDR therapy. The veteran has been referred for medication, but is awaiting his first appointment.
      d. Relevant legal and behavioral history (pre-military, military, and post-military): The veteran has no history of legal problems.
      e. Relevant substance abuse history (pre-military, military, and post-military): The veteran has been drinking excessively since his return from Afghanistan. He estimates that he was drinking a bottle of hard liquor per day at his peak. It has decreased somewhat recently as he has been engaged in therapy, but he continues to drink quite heavily. f. Other, if any: No response provided.
      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: Artillery attacks at Bagram and Salerno, Afghanistan 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 --------------------------- Note: Please check criteria used for establishing the current PTSD
      diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criterion 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 Criterion 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 violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s)
      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 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 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] 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 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.
      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 
      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
      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] Chronic sleep impairment [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 his scheduled examination. His identity was confirmed by having him provide his full name and date of birth. The veteran presents as a tall, obese, Caucasian male who appears the stated age. He was dressed casually and exhibited good grooming and hygiene. He had tattoos visible on his lower and upper extremities. His posture, gait, and psychomotor activity were within normal limits. His manner of interaction was cooperative, courteous, and friendly. His speech was normal in rate, rhythm, tone, and volume. His thought processes were clear, logical, coherent, and goal-directed. Veteran reported his mood to be depressed, with affect congruent. He denied suicidal ideation, but admitted to thoughts of death and wondering if others would be better off without him. He denied homicidal ideation as well as auditory and visual hallucinations.
      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 -------------------------------------------------- In my opinion, the veteran meets DSM 5 diagnostic criteria for posttraumatic stress disorder, which is more likely than not secondary to military trauma. In this veteran's case, there is a strong component of shame that is also associated with his military service and is foundationally related to his depressive disorder. His experience of freezing during 3 artillery attacks is something that is associated with feelings of overwhelming shame, worthlessness, helplessness, and inadequacy for the veteran. These thoughts and feelings contribute significantly to his depressive condition, and contribute meaningfully to his PTSD symptoms as well. The veteran also experienced significant losses during military service that have likely aggravated his PTSD and depressive conditions. Notably, the veteran's grandfather died in 2011 when the veteran was deployed to Afghanistan, and his best friend committed suicide on Christmas day in 2013. Both losses were experienced by the veteran as emotionally traumatic and contribute to his symptomatology. The veteran has developed a dysfunctional coping mechanism of excessive alcohol intake in his efforts to suppress negative feelings associated with his traumas. As his excessive alcohol use appears to be largely in the service of avoidance of distress and suppression of intrusive/reexperiencing symptoms, it is my opinion that his alcohol use disorder is secondary to his PTSD and depressive disorders. The veteran's mental health symptoms have severely impaired his functional capacity. He is socially disengaged and avoidant. He has difficulty expressing himself emotionally, showing empathy, or forming emotional bonds with others. Occupationally, the veteran has exhibited significant dysfunction as he has been unable to maintain employment due to anxiety, depression, avoidance, alcohol abuse, irritability, shame. Hs shame about his reactions of freezing during artillery attacks prompts him to avoid interpersonal interactions as much as possible as he fears that the topic of his military service will arise. Recently, the veteran has begun outpatient mental health treatment in the form of individual counseling, and he is awaiting an appointment for trial of medication.
    • By weep4souls
      I'm a Gulf War veteran with 90% S/C for various conditions. Some conditions that have been denied have been frustrating since I'm still suffering with symptoms. How can I create a Nexus for sinusitis and sleep apnea? I'm 30% for asthma and tried to create a relation between sleep apnea and asthma, but that was a no go. I was thinking trying again and tying my PTSD to that. Any thoughts? 
      I was also shot down on sinusitis from the get go, but I thought all I had to do was tie my gulf war time to that condition. I guess I was wrong.
    • By tw4904
      So I pretty much have my statements together. I feel pretty confident especially since I do have a CAB. However, I am already diagnosed with Chronic PTSD by my psychiatrist who works for the VA. I am also being treated by him with medication. And it helps me out alot. Will the doctor who I see during the examination judge me off of how he see's me in my current condition and say I am fine even though I am medication to help with PTSD? I typed up a very lengthy paragraph in the remarks section of the 21-0781 and stated two incidents like directed. Surely they wouldnt judge on my current well being because I am being treated. Also it has been 1 year and 3 months since I got out, and I have been on medication for about 2 and a half months. Also, one of my parents committed suicide a day after I got back from deployment. I was on the fence about bringing this up, but I would be lying through my teeth if I brought up all the things that happened since I was 19 and didnt bring this up. Will this hurt my case in any way?
    • By mikeriggs
      I filed a claim in october of 2018 for ptsd and TDIU, long story short I tried to do everything myself and didn't have the proper diagnosis so I was service connected for anxiety based on having a medical marijuana card diagnosis for anxiety but the rating was 30% and I much worse off then that. So I obtained a referral from the va to a fancy psychiatrist from the university of north florida's behavior health department and was diagnosed with ptsd, bi polar 1 and panic disorder. I used this new medical evidence as my supplemental claim evidence and filed it April 16, 2019 after receiving my letter March 20, 2019. My claim is now at Pending Decision Approval with an estimated completion date of july 2, 2019 which is super fast from all I have read. My question is, Am I going to be awarded tdiu with the evidence I submitted if they adjust me up to 70% which I think it will . Or if they award 70% for ptsd on this new supplemental claim will i have to re-apply for tdiu again? Or would that all be considered in the final review of the entire claim? Thanks for any help.
      1-22 1BCT 4th I.D. "Regulars by God"
    • By J.Robbins
      I’m in final review for about 40 days after spending almost 5 years in legacy. Peggy says almost done but no date. They have everything since 5/1. I thought ramp was quicker .I opted in 5/13.
      I get close then it gets sent back. No one know anything.All you can do is wait
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