RECENT C & P EXAM

[t buck]

COULD SOMEONE HELP ME UNDERSTAND WHAT THE RESULTS MAY BE ON THIS REVIEW? I SUBMITTED A REQUEST FOR COMPENSATION FOR ANXIETY AND DEPRESSION AND IT LOOKS LIKE THEY DID A REVIEW OF PTSD THAT ALREADY HAD BEEN AWARDED 50%.. ALL MY VA MED RECORDS HAVE ANXIETY AND DEPRESSION AND I'M BEING TREATED FOR THOSE MORE THAN PTSD... I'M CONFUSED AS TO WHY  SHE SAID WHAT SHE SAID IN THE LAST SENTENCE. LOOKS LIKE I WAS ONLY REVIEWED FOR PTSD NOT ANXIETY OR DEPRESSION.

THANKS,

TBUCK

 

Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire Name of patient/Veteran: XXXXXX Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes [ ] No ICD Code: 309.81 2. Current Diagnoses --------------------  XXXXXXX  CONFIDENTIAL Page 4 of 9 a. Mental Disorder Diagnosis #1: PTSD ICD Code: 309.81 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Hypertension 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 occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation 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? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS Evidence Comments: shows consistent treatment for PTSD XXXXXXXXX CONFIDENTIAL Page 5 of 9 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: The vet is a 51 year-old married for the 3rd x for 11 years caucasian male who lives in XXXXX with his wife; he reportedly grew up in XXXXXX with his mother, stepfather, and 2 siblings; he denied a fam hx of MI but reported a hx of physical abuse by his mother and stepfather; he described the relationship with his wife as fair to poor and suggested that he is irritable and withdrawing; he reported having 4 sons and described the relationships with 2 sons as fair to good and with 2 sons as poor; he reported having no close friends or casual friends; he watches a lot of tv, sits around the house, and runs some errands b. Relevant Occupational and Educational history: he finished high school and joined the navy in 82 and was d/c in 86; his duty was supply, and he denied combat experience; he currently works at XXXXXXXX where he has been employed for 3 years; he reported missing days from work in the past year due to mh issues including a hospitalization at Dorn; he reported being irritable on the job and is sometimes short with co-workers and supervisors; he reported having problems with concentration that slow him down and cause mistakes; prior to this job he worked at XXXXX for 6-7 mos and left because he felt they would fire him; he reported having problems with irritability and concentration on that job as well. c. Relevant Mental Health history, to include prescribed medications and family mental health: He 1st sought mh tx at age 10 or 12 due to problems with concentration and getting in trouble at school; he received mh tx for about 1-2 years; he was seen in the navy in 83 or 84 after plane crashes and received counseling; in 92 he hospitalized at the XXXXXX VAMC for anxiety and alcohol abuse; he reported being seen in XX for counseling and psych meds and continued with these until 7/15 he was hospitalized at Dorn for ptsd and an alcohol use disorder. he is currently prescribed prazosin, mirtazapine, and escitalopram. He reported being on depression medication for the last 30 years. d. Relevant Legal and Behavioral history: He reported being arrested 3-4x for A&B, DUI, Making a False Statement; denied serving time in prison e. Relevant Substance abuse history:  XXXXXXXXX  CONFIDENTIAL Page 6 of 9 Veteran reported that he quit drinking about 2 years ago 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 Criterion 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 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). 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 effor ts 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). XXXXXXXX  CONFIDENTIAL Page 7 of 9 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] 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] 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] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Flattened affect [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social XXXXXX CONFIDENTIAL Page 8 of 9 relationships 5. Behavioral observations -------------------------- Veteran is adequately dressed and groomed; speech is coherent and goal directed although somewhat irritable. he is alert and oriented to time place and person. 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: --------------------------------------------------- Veteran continues to meet hte criteria for PTSD related to previously described stressors; he continues to experience signficant functional impairment from the PTSD. while he does have symptoms of depression and anxiety, these are secondary and a part of the chronic PTSD rather than separate diagnoses.

[Gastone]

The C & P Clinician's Medical Opinion is your Depression & Anxiety Symptoms are not identifiable as separate disability issues.

I doubt there's any chance of a Rater Awarding individual SC's for either condition, based on the recent C & P. Both conditions are usually part and parcel of a PTSD DX.

At 50%, you're not Schedule eligible to file for IU but there is the possibility of the Rater putting you in for an extra-Scheduler IU Rating if your C-File Record of Evidence supports it.

[t buck]

1 hour ago, Gastone said:

The C & P Clinician's Medical Opinion is your Depression & Anxiety Symptoms are not identifiable as separate disability issues.

I doubt there's any chance of a Rater Awarding individual SC's for either condition, based on the recent C & P. Both conditions are usually part and parcel of a PTSD DX.

At 50%, you're not Schedule eligible to file for IU but there is the possibility of the Rater putting you in for an extra-Scheduler IU Rating if your C-File Record of Evidence supports it.

I don't understand " you're not eligible to file IU, but there is the possibility of the rater putting you in for an extra-scheduler IU rating" Please explain, don't mean to be ignorant, but I am..

Do you think my 50% will remain the same??

[broncovet]

There are 2 ways to get TDIU:

1.  Schedular 38 cfr 4.16a

2.  Extra schedular 38 cfr 4.16b.  

     Number 2, is much more difficult to obtain than number 1.  You can read about the schedular requirements, here:  This is what Gastone was referring to, that is, an extra schedular (4.16 b) TDIU

4.16 Total disability ratings for compensation based on unemployability of the individual.

(a) Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided That, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. It is provided further that the existence or degree of nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages referred to in this paragraph for the service-connected disability or disabilities are met and in the judgment of the rating agency such service-connected disabilities render the veteran unemployable. Marginal employment shall not be considered substantially gainful employment. For purposes of this section, marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination.

(Authority: 38 U.S.C. 501)

(b) It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) of this section. The rating board will include a full statement as to the veteran's service-connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue.

[ 40 FR 42535, Sept. 15, 1975, as amended at 54 FR 4281, Jan. 30, 1989; 55 FR 31580, Aug. 3, 1990; 58 FR 39664, July 26, 1993; 61 FR 52700, Oct. 8, 1996; 79 FR 2100, Jan. 13, 2014]