Anxiety (Secondary to IBS/Fibro) C&P Results...Thoughts???

[IMEF-Gunny]

Here is my recent C&P results for anxiety secondary to SC IBS and Fibromyalgia. Thoughts or opinions on SC rating?

 

LOCAL TITLE: PSYCH C&P EXAM MA

STANDARD TITLE: C & P EXAMINATION NOTE

 

Mental Disorders

(other than PTSD and Eating Disorders)

Disability Benefits Questionnaire

Name of patient/Veteran: Is this DBQ being completed in conjunction with a VA 21-2507,

C&P Examination

Request?

[X] Yes [ ] No

SECTION I:

----------

1. Diagnosis

------------

a. Does the Veteran now have or has he/she ever been diagnosed

with a mental

disorder(s)?

[X] Yes [ ] No

If the Veteran currently has one or more mental disorders

that conform to

DSM-5 criteria, provide all diagnoses:

Mental Disorder Diagnosis #1: Anxiety Disorder due to another

medical

condition (IBS, fibromyalgia)

b. Medical diagnoses relevant to the understanding or management

of the

Mental Health Disorder (to include TBI):

No response provided.

2. 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

3. 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

------------------

Evidence reviewed (check all that apply):

[X] VA e-folder (VBMS or Virtual VA)

[X] CPRS

2. History

----------

a. Relevant Social/Marital/Family history (pre-military,

military, and

post-military):

PRE-MILITARY SOCIAL/MARITAL/FAMILY HISTORY:

Please see previous C&P exams

POST - MILITARY SOCIAL/MARITAL/FAMILY HISTORY:

E. Social Functioning:

The veteran is currently married to second wife since 1999

Current relationship description: "my wife is a great

support. We get along okay, I pretend to give a shit about a lot of things.

I don't have emotional connections with others. My wife can leave

tomorrow and take the kids and I won't give a shit. I mean I love them but I

don't I don't have the emotional connection. We have not slept in same

bed in 7/8 years because she says I shake so my in bed. I sweat a lot

in bed."

Children: 7 children (23 through 1.5). 5 still live

in the home.

Oldest daughter thinks her father is distant from her. He

Believes relationship with others children is good. He is supportive

of them.

Older son is autistic and lives in a home.

He has one grandson (1 year old)

Friends and Hobbies: no friends. talks to two military

Buddies occasionally.

Structure of day: work structures his day. When he is not

working "I tries to stay busy but winter time is boring and gives me

more time to think"

b. Relevant Occupational and Educational history (pre-military,

military, and

post-military):

PRE-MILITARY OCCUPATIONAL and EDUCATIONAL HISTORY:

See previous C&P

POST-MILITARY OCCUPATIONAL and EDUCATIONAL HISTORY:

Education: none

Occupation: refinery- maintenance coordinator; 11 years

Has the veteran lost time from work due to mental health

issues? He missed about 5 or 6 days a year due to anxiety. However,

when at work he is missing time from work because of anxiety- for the

days he must put on SCBA (similar to the MACH 4) this is highly anxiety

provoking. He noted about 20 hours a week he is anxious, about 10 of

those hours he is not as efficient, reliability due to the anxiety.

Difficulties at work? Anxiety. Dangerous work, needing to

don SCBA (similar to MACH 4) Causes difficulties? See above

Are these difficulties mild/moderate/severe: ranges mild to

Severe Efficiency/reliability/productivity at work: usually good

except for those 10 hours a week

Quality of interactions with supervisor/coworkers: poorly.

2016 almost lost job because a woman at work stated she was

So intimidated by him she could not bring herself to come to

work. "I have to be very careful the way I act, what I say. I

walk on eggshells. I am very blunt, very honest and other people

don't like it. I don't relate to them. I think differently than them"

Does your problems only occur during times of significant

stress? usually

c. Relevant Mental Health history, to include prescribed

medications and family mental health (pre-military, military, and post-

PRE-MILITARY MENTAL HEALTH HISTORY:

See prior C&P

General Health:

Active Outpatient Medications (including Supplies):

Active Outpatient Medications

Status

===========================================================

=============

=

1) ARIPIPRAZOLE 20MG TAB TAKE ONE-HALF TABLET BY MOUTH

ACTIVE

ONCE A DAY

2) HCTZ 12.5/LISINOPRIL 20MG TAB TAKE 1 TABLET BY MOUTH

ACTIVE

EVERY MORNING FOR HEART OR BLOOD PRESSURE

3) PRAVASTATIN NA 20MG TAB TAKE ONE-HALF TABLET BY MOUTH

ACTIVE

EVERY EVENING TO LOWER CHOLESTEROL (REPORT ANY

MUSCLE PAIN OR WEAKNESS)

4) SERTRALINE HCL 100MG TAB TAKE ONE AND ONE-HALF

ACTIVE

TABLETS BY MOUTH EVERY MORNING FOR MOOD

1)

Essential hypertension

2) Hyperlipidemia

3) Testicular hypofunction

4) Smoker

5) Bloating

6) Sleep disorder

7) Smoker

8) History of noncompliance with medication regimen

9) Posttraumatic stress disorder

10) Erectile dysfunction

11) Irritable bowel syndrome

POST-MILITARY MENTAL HEALTH HISTORY: History of

Psychiatric care:

His history of psychiatric care has included:

PSYCHOTROPIC MEDICATIONS: sertraline

a. Side effects of medication: none noted

PSYCHIATRIC INPATIENT TREATMENTS: none

PSYCHIATRIC OUTPATIENT CARE:

symptoms and medication monitoring: Ronda Bray, nurse

practitioner since 1.6.2017

Suicidal Thoughts, intentions, plans or intent

Presence of SI: rarely (once every three or four months)

SUICIDE RISK ASSESSMENT COMPLETED

Veteran aware of 1-800 number yes

Card handed to veteran no

Homicidal thoughts, intentions, plans, intent

Presence of HI: No

Subjective Complaints:

Describe fully.

How do you see your symptoms affecting your daily living?

"I can't go anywhere, I can't relax, I am always worried about the

bathroom, if I am going to have an accident. I stay away from everyone. I am

embarrassed"

Any remission from symptoms? Veteran says no

Stressors: Health, Family, Significant other, MH problems

causing more MH problems

Impairment in thought: none

Spontaneous Reporting of Symptoms: "I never know when I

have to go to the bathroom. I must carry close with me. You can't go

anywhere or do anything. I have had incidents in public, work, home. I

never have a good time. I don't like to go out. Its horrifying. It

effects intimacy with my wife."

End of Spontaneous Report:

Anxiety: jittery, worry, jumpy, mind races, unable to shut

Down thoughts. Inter turmoil. He paces and fidgets. Used to

drink but no longer. Does not like crowds, noise, being out, being

around people.

Sometimes heart races, hands sweat other times it is

feeling of uneasy.

He noted when he is home he "gets a break" from the

anxiety.

He likes to grill and that helps him relax.

He noted the IBS accidents : "its anywhere, anytime, there

is no method, it can be morning, noon or night. I can go (to the

bathroom) several times a day, I can go once a day" He noted incontinence of

bowel at least once every two weeks.

He noted IBS can "go away" for a week and he then obtains a

false sense of security that he is better. Unfortunately then IBS

returns.

Mild anxiety: fidgety, overly watchful

Moderate anxiety; somewhere in the middle of the two

Severe anxiety: pacing "like crazy" he cannot sit still.

Hands sweating, increased heart rate. His body aches.

More anxiety he has the more he is eating, more sleep

Problems He feels on most days he is moderately anxious. He notes he

spends equal amount of time in mild and severe anxiety

He does not endorse symptoms of Generalized Anxiety

Disorder.

Consequence of anxiety: he cannot relax, he cannot enjoy

being around family, Big public stuff is worse.

Fibromyalgia: body aches all the time, interrupts sleep. "I

don't think it increases my anxiety but fibro effects everything. You

know every day is going to be a shitty day"

He has 7 children. 2 from his first marriage (wife adopted

his oldest two children).

Poor impulse control when feels disrespected, unsafe. Last

Physical altercation 3 months ago. Beat the heck out of a man who

was threatening him and was trying to get violent with the veteran. He has

been in very violent altercations (stabbed three times). Medications

help to mellow him out. Themes that will incite violence is when he is

threatened, disrespected (but this will incite angry but not

necessarily physical violence).

He carries a firearm when not working. He noted he has bene

carrying a firearm since age 18.

Anxiety makes it difficult for him to recall information.

d. Relevant Legal and Behavioral history (pre-military, military, and

post-military):

POST MILITARY LEGAL HISTORY:

Veteran denied any legal entanglements since discharge/last

exam.

e. Relevant Substance abuse history (pre-military, military, and

post-military):

PRE-MILITARY SUBSTANCE USAGE HISTORY:

See past C&P exam

POST MILITARY SUBSTANCE USAGE HISTORY:

Substance abuse problems/treatment: denied "I might have

one glass of wine a week. I just don't drink" Use or abusing illicit drugs: denied

Use and abuse of prescription drugs: Denied

f. Other, if any:

No response provided.

3. Symptoms

-----------

For VA rating purposes, check all symptoms that actively apply

to the

Veteran's diagnoses:

[X] Anxiety

[X] Chronic sleep impairment

[X] Mild memory loss, such as forgetting names, directions or recent

events

[X] Impaired judgment

[X] Disturbances of motivation and mood

[X] Difficulty in establishing and maintaining effective work and social relationships

[X] Difficulty in adapting to stressful circumstances,

including work or a worklike setting

[X] Suicidal ideation

4. Behavioral observations

--------------------------

Confidentiality and lack of discussed and veteran voiced

understanding.

Veteran's response to interview: "I wish you were my therapist:

Cognition- Attention & Concentration: Sufficient

Memory- (ST & LT) average for recent events of last few hours or

days; average for remote events of past year.

Abstraction- able to think abstractly

Insight into illness- both intellectual and emotional

awareness.

Orientation: Time, place and person

Judgement: poor when feeling threatened

Thought Patterns-

Clarity: Coherent

Relevance/logic: Logical

Flow: slow

Content: wnl

Is the thought content consistent with reality? yes

General Appearance

Accessibility- co-operative

Clothing Appropriate to age, season, setting and occasion? yes

Clean, neat, tidy,? yes

Hygiene and grooming: clean

Hair: neat

Odor: NOne

Eye Contact: WNL

Psychomotor Behavior

Gait: Brisk

Handshake: Firm

Abnormal movements: none noted

Mood and affect

Appropriateness of affect: Appropriate to situation.

Congruous

Range of affect: flat

Stability of affect: Stable.

Attitude toward examiner during encounter: Frank.

Specific mood or feelings observed or reported: anxious

Speech

Rate of speech: WNL

Flow of speech: wnl

Intensity of volume: soft.

Clarity: Clear.

Quantity: offers information

Other disorders or symptoms and the extent they interfere with

activities

particularly:

substance abuse disorders: none current

somatoform disorders: no

personality disorders: no

5. Other symptoms

-----------------

Does the Veteran have any other symptoms attributable to mental

disorders

that are not listed above?

[ ] Yes [X] No

6. Competency

-------------

Is the Veteran capable of managing his or her financial affairs?

[X] Yes [ ] No

7. Remarks (including any testing results), if any:

---------------------------------------------------

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 the examiner is not make any personaljudgments 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 of

gathering 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

Did veteran bring documents to interview: no

Interview started: early on time

Testing deemed necessary: no

OPINION:

Anxiety Disorder due to another medical condition (IBS,

fibromyalgia) is at least as likely as not due to or caused by IBS and fibromyalgia.

[Vync]

I'm no expert, but it looks favorable. I expect other members will lend their opinion.

Given the face that you are SC for IBS 30%  and Fibromyalgia 40%, this phrase is the nexus statement which should constitute secondary service-connection:

Quote

Anxiety Disorder due to another medical condition (IBS, fibromyalgia) is at least as likely as not due to or caused by IBS and fibromyalgia.

 

Under 3(a), they checked the box corresponding with reduced reliability and productivity, etc..., which appears to match the 50% criteria. However, the symptoms checked include suicidal ideation, which falls under the 70% criteria. Not sure which rating you might get, but am hoping for the best for you. Good luck!

 

Compared it against the ratings: §4.130   Schedule of ratings—Mental disorders.

 

Quote

 

General Rating Formula for Mental Disorders

	Rating
Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.	100
Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, 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 a worklike setting); inability to establish and maintain effective relationships.	70
Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.	50
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).	30
Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.	10
A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.	0

 

 

[IMEF-Gunny]

Thanks for the reply!

[vetquest]

It looks like a favorable exam with anxiety secondary to your primary diagnosis.  I would go with Vync that you are probably looking at a 50% rating.  Thoughts of suicide might make a 70% rating but it looks like they were not concerned with your suicide thoughts.

I am a 70% veteran for PTSD and anxiety and might I suggest counseling to deal with your aggressive feelings.  You have been lucky so far to not have involvement with the law but luck runs out.  You need a good counselor that knows how to deal with vets.

Good luck and if you are denied be sure to appeal.

[IMEF-Gunny]

Rating came in, 70% anxiety. I do attend therapy and take medication for Depression and anxiety. I am diagnosed with PTSD, major depressive disorder and anxiety secondary to IBS. I am rated only on the anxiety.

Total rating is IBS 30%, Fibromyalgia 40%, Hearing 0%, Tinnitus 10%, Anxiety 70% - Total 90%

[Berta]

Gunny- if you are unemployed the VA should enclose a TDIU form for you.

I dont get their funny math on this????