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PTSD Exams Being Re-rated As Another Mental Issue

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I'm seeing a LOT of veterans recently having their PTSD ratings re-evaluated and moved into another mental issue such as Major Depressive Disorder, Adjustment Disorder, etc.  The ramifications of this to the veteran is not clear, but it looks like it is a bid to remove them from a service-connected rating.  PTSD is the only mental rating that I know that can be diagnosed more than a year out of service. 

There are many PTSD claims that are getting denied because they fail to get Criterion F - "symptoms more than one month in duration."  That seems like utter horse hockey because it takes more than one month to get into the system for a C&P exam.  It's a 2-3 yr wait for most of us to get to the diagnostic exam phase.

If you don't have something in every Criterion in the VA's PTSD and DSM-5 guidelines, it's not PTSD it's something else.  I've talked to one woman who requested a female examiner and got a male examiner that got negative marks on Criterion C - Avoidance.  So, she's coming in for PTSD due to MST and the VA rattles her with a male examiner instead of the female she requested.  And somehow that very fact does not get marked as Avoidance?     It's the very definition of Avoidance!!

I'm putting the text from the VA web page on PTSD Criterion here, because they may make that page unavailable if the VA thinks veterans are actually reading it.

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PTSD and DSM-5

In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 1). PTSD is included in a new category in DSM-5, Trauma- and Stressor-Related Disorders. All of the conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion. For a review of the DSM-5 changes to the criteria for PTSD, see the American Psychiatric Association website on Posttraumatic Stress DisorderLink will take you outside the VA website. VA is not responsible for the content of the linked site..

DSM-5 Criteria for PTSD

Full copyrighted criteria are available from the American Psychiatric Association (1). All of the criteria are required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria:

Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

  • Direct exposure
  • Witnessing the trauma
  • Learning that a relative or close friend was exposed to a trauma
  • Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B (one required): The traumatic event is persistently re-experienced, in the following way(s):

  • Intrusive thoughts
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

Criterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the following way(s):

  • Trauma-related thoughts or feelings
  • Trauma-related reminders

Criterion D (two required): Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

  • Irritability or aggression
  • Risky or destructive behavior
  • Hypervigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

Criterion F (required): Symptoms last for more than 1 month.

Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H (required): Symptoms are not due to medication, substance use, or other illness.

Two specifications:

  • Dissociative Specification. In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
    • Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).
    • Derealization. Experience of unreality, distance, or distortion (e.g., "things are not real").
  • Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.

Note: DSM-5 introduced a preschool subtype of PTSD for children ages six years and younger.

How Do the DSM-5 PTSD Symptoms Compare to DSM-IV Symptoms?

Overall, the symptoms of PTSD are generally comparable between DSM-5 and DSM-IV. A few key alterations include:

  • The revision of Criterion A1 in DSM-5 narrowed qualifying traumatic events such that the unexpected death of family or a close friend due to natural causes is no longer included.
  • Criterion A2, requiring that the response to a traumatic event involved intense fear, hopelessness, or horror, was removed from DSM-5. Research suggests that Criterion A2 did not improve diagnostic accuracy (2).
  • The avoidance and numbing cluster (Criterion C) in DSM-IV was separated into two criteria in DSM-5: Criterion C (avoidance) and Criterion D (negative alterations in cognitions and mood). This results in a requirement that a PTSD diagnosis includes at least one avoidance symptom.
  • Three new symptoms were added:
    • Criterion D (Negative thoughts or feelings that began or worsened after the trauma): Overly negative thoughts and assumptions about oneself or the world; and, negative affect
    • Criterion E (Trauma-related arousal and reactivity that began or worsened after the trauma): Reckless or destructive behavior

What Are the Implications of the DSM-5 Revisions on PTSD Prevalence?

Changes in the diagnostic criteria have minimal impact on prevalence. National estimates of PTSD prevalence suggest that DSM-5 rates were only slightly lower (typically about 1%) than DSM-IV for both lifetime and past-12 month (3). When cases met criteria for DSM-IV, but not DSM-5, this was primarily due the revision excluding sudden unexpected death of a loved one from Criterion A in the DSM-5. The other reason was a failure to have one avoidance symptom. When cases met criteria for DSM-5, but not DSM-IV, this was primarily due to not meeting DSM-IV avoidance/numbing and/or arousal criteria (3). Research also suggests that similarly to DSM-IV, prevalence of PTSD for DSM-5 was higher among women than men, and increased with multiple traumatic event exposure (3).

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Thanks for the information.  I now understand what my last PTSD exam was all about now.

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My advice is to get the highest rating any way you can get it.  If it is depression or PTSD just max out your rating and take the money because that is all you will get.   I know this because the VA DX'ed me with schizophrenia after Vietnam because they did not have a PTSD DX.  What does it matter if you get the money?  Get the 100% or TDIU and start building time at that rating so you can one day tell them all to go to hell where they belong. 

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