Quick back drop I've filed for increase for ptsd Oct. 2017 and had my exam the following month. Awarded 70 percent with retro pay included, right after i filed for IU in Dec. 2017 and they just gave me another ptsd C&P exam(Feb. 17, 2018).
3 months apart from each other for the same exam i thought was kind of strange. But none the less I would like any feed back on whether this new exam remains at 70 percent???(My gut feeling is saying 100).....
SECTION I:
----------
1. Diagnostic Summary
---------------------
Does the Veteran now have or has he/she ever been diagnosed with PTSD?
[X] Yes [ ] No
ICD Code: F43.10
2. Current Diagnoses
--------------------
a. Mental Disorder Diagnosis #1: Posttraumatic Stress Disorder
ICD Code: F43.10
Comments, if any:
The Veteran reported that he continues to experience trauma disorder
symptoms consistent with identified criteria for PTSD including having
witnessed/endured a series of traumatic events while serving two
deployments to Iraq (2006) and 2008), chronic severe intrusive
ideations
involving these traumas, avoidance of stimuli associated with traumatic
events, negative alterations in cognitions and mood, and significant
emotional arousal on a daily basis. He reported that these
self-identified index military traumas, including his having been
wounded by an IED causing damage to his head, neck, and left leg;
witnessing other Marines become wounded, observing the bodies of dead
Iraqis, and fearing for his life on a regular basis secondary to
frequent attacks on his base and IEDs while on mounted patrol fearing
that the vehicles he rode in would be destroyed by an IED and he would
be killed in action. These symptoms reportedly cause him significant
impairment in most areas of his functioning on an almost daily basis.
Current PTSD-related symptoms reported by the veteran include severe
anxiety, suspiciousness, chronic middle insomnia, mild memory
impairment
particularly immediate memory functioning, intrusive recollections of
military service based traumas, recurrent nightmares of index military
traumas, avoidance of activities, person, and places that resemble
aspects of identified traumatic experiences, diminished interest in
participation in most daily activities, feeling detached/estranged
from
family and friends, frequent irritability resulting in occasional
displays of verbal aggression, frequent hypervigilance, and chronic
difficulty initiating and maintaining certain interpersonal
relationships. He reported that the frequency and severity of
PTSD-related symptoms continue to increase in frequency and severity
and
do result in significant impairment in his daily functioning on more
days than not at present. Veteran provided self-assessment of severity
of current symptoms consistent with PTSD as "getting worse and since I
am not working I have time to think about things that I saw in the
military" and that it is his subjective opinion that he has experienced
a generally mild increase in specific symptoms consistent with
diagnosed
PTSD during the 3-month interim between the date of the prior Review
PTSD C&P examination completed by Dr. XXXX and the date of this
Review PTSD examination both of which was completed at the Corporal
XXXX VAMC. He reported that the frequency and severity of
PTSD-related symptoms have continued to increase in terms of frequency
and severity since his military discharge during 2009 and currently
cause significant impairment his daily functioning on more days than
not. Veteran provided self-assessment of severity of current symptoms
consistent with PTSD as "under okay control usually but if something
makes me think of something I saw in Iraq or that I am back in Iraq
again things gets worse". He noted having experienced continued
increases in level of hypervigilance at home and in the community as
well as increased frequency of distressing ideations and nightmares of
index traumas Veteran is currently awarded 70% disability rating by the
VA Regional Office and Insurance Center in light of reported functional
impairment caused by chronic PTSD symptoms.
b. Medical diagnoses relevant to the understanding or management of the
Mental Health Disorder (to include TBI): Service-connected for migraine
headaches, flat feet, limited motion of left arm, and limited motion of
left ankle.
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
Comments, if any: No formal asessment for the presence of symptoms
consistent with a diagnosis of traumatic brain injury had been
completed based on a review of the Veteran's clinical files.
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?
[ ] 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
2. Recent History (since prior exam)
------------------------------------
a. Relevant Social/Marital/Family history:
Veteran served in the US Marine Corps (USMC) and his period of active
duty began during June 2005 and ended 4 years later during June 2009.
He completed his course of basic training at the Parris Island USMC
Base in South Carolina. He the completed infantry school at the North
Carolina. His primary military specialty was a 0311 Rifleman. He was
deployed twice, Iraq (2006-07) and Iraq (2008). He suffered injuries
to his head and neck as the result of an IED blast during initial
deployment as a turret gunner. He stated that there was a bright
flash
as the IED exploded and suffered a laceration othis head and bried
loss
of consciousness. He denied having been the
focus of any significant
action of military discipline. He was assessed a Page 11 violation
and
was charged with failure to supervise a fellow Marine under his
command
and that other Marine accidentally discharged his weapon which
fortunately did not result in personal injury or property damage. He
believes that it was that incident that prevented him from achieving
the rank of Sergeant. He was awarded an Honorable Discharge at the
rank of Corporal (E-4) during June 2009.
Veteran reported that he has not experienced any significant changes
in
his social, marital, or family history during the 3-month interim
between the last Review PTSD C&P examination and the date of this
examination. Veteran continues to reside with his mother near
Xxxx,
XX and reports a successful relationship with his mother. He has an
emotionally detached relationship with his father currently and that
has been the status of their relationship for the past few years.
Veteran noted that his relationship has been slightly more amicable
during the past year or so. He has close relationships with his
siblings (2 sisters and 1brother) and interacts with them one monthly
on average. Reported having enjoyed close relationships with all his
family members prior to military service and over time the intimacy of
those relationships diminished to differing degrees. He noted "I
would
like to be closer to my brother but he changed after he was in a car
accident and is hard to get along to get along with".
Veteran reported that he is divorced and had been for 6 years. He
reported that the marriage ended primarily because of irreconcilable
differences including his displaying anxiety, isolation, and frequent
hypervigilance. He has 1 daughter and whom he enjoys a very close,
rewarding relationship. He described his relationship with his
girlfriend in positive terms and described her as his primary source
of
social support. Veteran reported that he has been married only once
and has only one child.
b. Relevant Occupational and Educational history:
Veteran reported that he has not experienced any significant change in
his occupational or social functioning since the date of the prior
Review PTSD C&P examination. He remains unemployed. His last period
of employment ended during 2011 when he resigned from his employment
as
a mechanic at New Jersey Transit in the regional rail division of that
organization. He reported having left that position because he did
not
find the work tasks stimulating and rewarding. As he had during the
interview associated with the prior Review PTSD C&P examination during
November 2017 he perceived that job as "working was killing me, it w
aborning, and I didn't think it was getting me anywhere. I felt like
I
was wasting my life being there".
He reported currently experiencing mild overall impairment in social
functioning. He has close, loving relationships with his mother and
girlfriend. He reported feeling grateful for the support provided him
by his mother and girlfriend. He has a very successful relationship
with his daughter. He has few friends and visits with them on "now
and
then". Reported that he can tolerate most social environments but
prefers to be at home when he can. He generally does not attend
social
occasions hosted by members of his family or his friends and at those
occasions he does attend he often remains at those occasions for an
hour or two and interacts with select attendees based on how
comfortable he feels interacting with them.
c. Relevant Mental Health history, to include prescribed medications and
family mental health:
Veteran reported that he has not participated in any manner of formal
treatment of his reported chronic symptoms consistent with diagnosed
PTSD since the date of the prior Review PTSD C&P examination 3 months
earlier. Reported having last participated in formal mental health
disorder treatment during 2014. Reported currently considering
beginning outpatient mental health disorder treatment at the Lyons
VAMC
in NJ. Veteran denied having ever been prescribed psychotropic
medication.
d. Relevant Legal and Behavioral history:
The Veteran denied any history of significant involvement with
representatives of the legal or criminal justice system prior to,
during, and/or following discharge from military service.
e. Relevant Substance abuse history:
Veteran denied any history of exhibiting behavior consistent with
identified criteria for any substance use disorder listed in the DSM-5
Manual including alcohol, cannabis, cocaine, opiates,
methamphetamines,
or prescription medication. He reported that he generally imbibes
alcohol on an infrequent basis, has never overused cannabis or other
common substances of abuse, and never abused prescription medication.
Veteran reported that he is currently smoking close to a half of a
pack
of cigarettes daily and smoking 1 or 2 joints (cannabis) on 2 or 3
days
per week.
f. Other, if any:
No other mental health disorder symptoms reported by the Veteran
during
the examination interview or noted in his electronic clinical files.
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)
[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] 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] 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] Hypervigilance.
[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] Anxiety
[X] Suspiciousness
[X] Chronic sleep impairment
[X] Mild memory loss, such as forgetting names, directions or recent
events
[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] Intermittent inability to perform activities of daily living,
including maintenance of minimal personal hygiene
5. Behavioral observations
--------------------------
The results of a brief mental status examination found that the Veteran
appeared his stated age, was adequately groomed, and casually attired.
He
displayed anxious affect and stated his mood in positive terms. Veteran
did not display any abnormal or inappropriate behavior during the
60-minute interview. Veteran displayed an open and cooperative attitude
towards this examiner during the course of examination session. His
speech production was within normal limits in terms of pitch, pace, and
volume. Content of his speech indicated reality-based, concise, adaptive
ideations and no evidence of formal thought disorder or frank psychotic
thinking was observed. His skills in insight and judgment were assessed
as intact, his skills in concentration and memory were found to be mildly
impaired in areas assessed. Veteran reported that he had experienced
suicidal ideations and attempted suicide during 2014 (drank bleach) after
experiencing acute psychosocial stressors and was subsequently treated on
an inpatient psychiatry unit of a local hospital. He stated that he has
not experienced active suicidal ideations since he was discharged from
that hospitalization. Denied a history of experiencing homicidal
ideations.
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:
-----------------------
Question
Bluntly
Quick back drop I've filed for increase for ptsd Oct. 2017 and had my exam the following month. Awarded 70 percent with retro pay included, right after i filed for IU in Dec. 2017 and they just gave me another ptsd C&P exam(Feb. 17, 2018).
3 months apart from each other for the same exam i thought was kind of strange. But none the less I would like any feed back on whether this new exam remains at 70 percent???(My gut feeling is saying 100).....
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May 26, 2018 i was approved for tdiu p&t. Effective date was Dec. 12, 2017 the day i applied for it. Thanks to all for listening to me even on my bad days, couldn't have done this alone without th
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