PTSD increase request 70% to 100% comment from pyschatirst "severity reamins the same" and "character pathology issues"

[75HotelCalifornia]

will actually review my uploaded statements I did at the last minute. The claim is currently in Preparation for decision and has been that way since the 11th. 

Does it normally close out faster for a denial or approval? I know my previous claims closed out within days, though not sure the process for 100% P&T. I did not clam UI as my job works from home and solving technology issues is truly the only thing I enjoy at times. On the other hand I am really worried due to the depression and stress along with my temper I make a fatal mistep and lose it as I have in the past which almost got me fired from the job. Though by a stroke of luck, and because my  personality at times works to motivate large groups of teams to resolve issues quicker and due to my ability tto push others to move forward and "encourage" folks to do their job I got promoted by saving an aboslute charlie foxrot of a situation and saving my company 2 million dollars. Though now the lack of sleep and stress I am having probems meetiing my new obligations and things are just crazy..

So I guess thoughts anyone? Odds of getting an increase to 100% without UI based on the notes below? Let me know if you need more information.

Quote

DBQ NOTES 07/10/2018
This pt continues to meet DSM V criteria for diagnoses of Bipolar I
Disorder most recent episode mixed, PTSD, ADHD, and Alcohol Use Disorder.
It is very likely, judging from the treatment record in CPRS that this ptalso has some character pathology that contributes to the overall
picture. The pt has poor coping methods due to his conditions and he continues to
have difficulty dealing with psychosocial stressors. His current level
of severity is as above and remains unchaged from his last evaluation of
06/19/2017.

Quote

DBQ DATE 11/07/2016
-----------
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] Mild memory loss, such as forgetting names, directions or recent
events
[X] Disturbances of motivation and mood
[X] Difficulty in adapting to stressful circumstances, including work or a
worklike setting
[X] Suicidal ideation
[X] Impaired impulse control, such as unprovoked irritability with periods
of violence

Quote

DBQ 06/19/2017
[X] Depressed mood
[X] Anxiety
[X] Suspiciousness
[X] Panic attacks that occur weekly or less often
[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 work like setting
[X] Impaired impulse control, such as unprovoked irritability with periods of violence
[X] Neglect of personal appearance and hygiene
[X] Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene

Quote

 

DBQ 07/10/2018ma

[X] Depressed mood

[X] Anxiety
[X] Suspiciousness
[X] Panic attacks that occur weekly or less often
[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] Inability to establish and maintain effective relationships
[X] Suicidal ideation
[X] Impaired impulse control, such as unprovoked irritability with
periods
of violence
[X] Neglect of personal appearance and hygiene
[X] Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene

 

 

1. Diagnostic Summary
---------------------
Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria
based on today's evaluation?
[X] Yes [ ] No
ICD code: F43.10
2. Current Diagnoses
--------------------
a. Mental Disorder Diagnosis #1: Bipolar I Disorder, most recent episode
depressed, moderate
ICD code: F31.32
Mental Disorder Diagnosis #2: PTSD
ICD code: F43.10
b. Medical diagnoses relevant to the understanding or management of the
Mental Health Disorder (to include TBI): See medical record
3. Differentiation of symptoms
------------------------------
a. Does the Veteran have more than one mental disorder diagnosed?
[X] Yes [ ] No
b. Is it possible to differentiate what symptom(s) is/are attributable to
each diagnosis?

[ ] Yes [X] No [ ] Not applicable (N/A)
If no, provide reason that it is not possible to differentiate what
portion of each symptom is attributable to each diagnosis and discuss
whether there is any clinical association between these diagnoses:
The pt has current diagnoses of Bipolar I Disorder, most recent
episode depressed, moderate and PTSD. They have many overlapping
symptoms and cannot be adequately seperated out.

c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?
[ ] Yes [X] No [ ] Not shown in records reviewed

4. Occupational and social impairment
-------------------------------------
a. Which of the following best summarizes the Veteran's level of occupational
COPY MADE BY VARMC, ST. LOUIS FROM A RECORD IN VA'S POSSESSION
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 [X] No [ ] No other mental disorder has been diagnosed
If no, provide reason that it is not possible to differentiate what
portion of the indicated level of occupational and social impairment
is attributable to each diagnosis:
Both the pt's conditions cause his current level of social and
occupational dysfuntion.
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

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: Physical harrasment (see mental health history), military
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?
[ ] Yes [X] No
Is the stressor related to personal assault, e.g. military sexual
trauma?
[X] Yes [ ] No
If yes, please describe the markers that may substantiate the
stressor.
The pt's face smashed into a locker, pushed into a wall, shaving
cream in his boots, threatened etc if he told. He ultimately was
dishcarged after a suicide attempt. The wife was physically
abusive to him too
4. PTSD Diagnostic Criteria
---------------------------
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).
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] 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 sleep).
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

[mrstephens11]

I don't have information about the PTSD claim.  However, I would like to offer some advice on the job front.  I work in IT as well and was informed of the Americans with Disabilities Act by my VA neurologist.  The ADA is the goverment's way of forcing companies to make reasonable work accommodations for people with disabilities.  If you work in IT then I grantee you that your Human Resources Department already has a template and intrusions already drafted.  They are accustom to people asking for reasonable work accommodations.

What is a reasonable work accommodation?  You said you need sleep and to reduce your stress.  Think of ways to ask for both. 

Examples:

1. Employee can work nights and weekends to account for times that the disability is flaring up.  Which happens 3-5 times a week.
2. Employee can work from home.  ( I know you already work from home but, get it documented anyway.  Might save you some grief one day.)
3. Employee should have reduced/no on call rotation. ( Being on call is stressful.  If you feel bad about making the team take more on call, ask for some other duty that isn't as stressful to account for the work load.)
4. Employee can leave work for medical appointments.
5. Employee can have daily 2-3 hour breaks, as long as the hours are accounted for.

Process:

1. Tell your HR department "I need to start the ADA process.  Can you tell me where we need to begin?"
2. They shouldn't ask questions about what the disability is, instead they will likely give you some forms to have your doctor fill out.
3. The doctor will fill out the forms listing what the diagnosis is and what work accommodations you need.
4. Send the forms back to HR and they will send you a letter to you and your boss stating the accommodations they have made.
5. Get some rest!

Please take this advise.  It saved my life.  Please let me know if you go this route.

 

[75HotelCalifornia]

4 hours ago, mrstephens11 said:

 

Please take this advise.  It saved my life.  Please let me know if you go this route.

 

I am a high level Executive resource that does account turn arounds, and the sad part is they pay me in excess of 145K a year  total of 190K with bonuses.  So it can be tough as my sole job is to resolve P1 critical incidents and drive a team of 1200 technical resources to have our time to resolution under 2 hours. I finally have it under control we were at 40-50 per month now we were down to literally 4 last month with an average TTR of 1 hour and 35 mins.

Kind of crazy I'm a glutten for punishment, and push the envelope. I can pretty much make my own schdule and accomodations as long as I get the job done. Like this 25 hours of work this weekend, I am now heading to the VA to get my blood work done and pretty much not doing anythign else today. It is just very stressful at times, and my patience gets short at times wit periods of no sleep after a while (trust me it's ugly, but I am still good at keeping composure). The problem is once I get to that point my bark is almost as bad as my bite. Though I shake things up, sometimes I have to wooosaaa get up and go see my counselor before I actually feel like I want to murder people as some engineers and technicians just piss me the xxxx off at their lack of due diligence and carelessness.

 

[broncovet]

Based on the criteria for 100 percent AND that you posted you are working, I suggest its unlikley you are increased to 100 percent for mental health disorders including PTSD.  

Reason:  The Critieria for 100 percent for mental heath disorders states:  "Total occupational and social impairement".  If you are "totally occupationally impaired" it means you are not able to work.  Given that you are working, this does not suggest total occupational impairment. 

However, its possible you could get to 100 percent via something else.  Do you have anything else that you could be service connected for, such as knees, back, etc, etc, sleep apnea, hearing loss, etc?  

My suggestion is you prepare ahead.  If you are making 145k per year, plus VA at 70 percent, then you should sock away a  large percentage of your income in a retirement/IRA/savings/investements etc, for your income is almost certainly likely to drop significantly when you stop working.  

Of course, the trouble is savings accounts earn a very, very low rate of interest. 

For me, that means something more "aggressive". 

[vetquest]

I doubt you will see 100%.  I am at 70% and have been out of work for 14 years due to my disability.  At 100% you are basically a mental mess.  As broncovet pointed out you may reach 100% by other means.

[Gastone]

Why haven't you filed an FDC IU Claim? Your PTSD Rating should have included an "Inferred IU Claim" reference, did it?