C&P Gad Mdd

[ferriswheel]

Hello,

I recently completed a c&p exam which concluded two mental disorders (MDD and GAD). I'm currently rated at 30% for mental health for about 6 years now (total of 40%).

I can't stop thinking about what the results will be for this exam and would appreciate some insight on some seemingly "scattered" results in regards to severity.

Some things appear to have been omitted while other details appear to be input incorrectly.

Thanks for the help.

Here's what I have. It's not the entire thing...I'm just really hesitant on posting certain things online that shows any kind of PII (even though this is anonymous.)

 

1. Diagnosis
------------
a. Does the Veteran now have or has he/she ever been diagnosed with a mental
disorder(s)?
[X] Yes [ ] No
ICD code: F41.1
If the Veteran currently has one or more mental disorders that conform to
DSM-5 criteria, provide all diagnoses:

Mental Disorder Diagnosis #1: Generalized anxiety disorder with panic
attacks, severe
ICD code: F41.1
Comments, if any:
The veteran is service connected for social phobia which is now
diagnosed as generalized anxiety disorder with panic attacks, which is
considered to be a progression of his previous diagnosis of social
phobia. The veteran's current diagnosis of generalized anxiety disorder
with panic attacks subsumes his anxiety condition and sleep
disturbances, as well as his symptoms of social phobia.

Mental Disorder Diagnosis #2: Major depressive disorder, severe
ICD code: F33.2
Comments, if any:
Major depressive disorder is a new diagnosis for compensation purposes,
and is at least as likely as not (greater than 50/50 probability)
related to his diagnosis of generalized anxiety disorder. The veteran's
major depressive disorder symptoms of helplessness, hopelessness and
worthlessness are all related to his severe level of anxiety. The
veteran's diagnosis of major depressive disorder subsumes his major
depression and depressive neurosis.

b. Medical diagnoses relevant to the understanding or management of the
Mental Health Disorder (to include TBI): Chronic back issues interefere
with his level of sleep.

 

 

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] Total occupational and social impairment

b. For the indicated occupational and social impairment, is it possible to
differentiate which impairment is caused by each mental disorder?
[ ] Yes [X] No [ ] Not Applicable (N/A)

If no, provide reason
Both diagnoses are comorbid and both equally affect functioning.

 

 

3. Symptoms
-----------
For VA rating purposes, check all symptoms that actively apply to the
Veteran's diagnoses:
[X] Depressed mood
[X] Anxiety
[X] Near-continuous panic or depression affecting the ability to function
independently, appropriately and effectively
[X] Chronic sleep impairment
[X] Mild memory loss, such as forgetting names, directions or recent
events
[X] Gross impairment in thought processes or communication
[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

 

6. Competency
-------------
Is the Veteran capable of managing his or her financial affairs?
[X] Yes [ ] No

7. Remarks (including any testing results), if any:
---------------------------------------------------
The diagnoses obtained were based on the criteria contained in DSM-5. The
veteran's psychological testing was valid and consistent with his report
today. He does report passive suicidal ideation, and stated he has no intent
to harm himself. He stated that several years ago he pawned his handgun. No
other weapons at home. He cited his daughter as a protective factor, even
though his ex-wife does not allow him to see her (and it may be that his
ex-wife is using the veteran's anxiety to deny him his right to see his
daughter as it is difficult for him to effectively communicate within a
public setting such as a court hearing and to a judge given his significant
level of anxiety and panic). No current active suicidal or homicidal ideation
was noted. The veteran has the national suicide hotline number for the VA.
Treatment options were specifically discussed, and he stated he would contact
<blank> for medication management. Given the veteran's level of anxiety
which impairs his ability to communicate by phone, I also contacted <blank>
and she f/u with me, stating she made an apt. for the veteran and he would be
contacted as to the time of this apt. She also noted his difficulty with
phone communication. The veteran's "intermittent inability to perform the
activities of daily living" noted above, as well as the "gross impairment of
communication" refers to the issue he has with effective communication given
his level of anxiety. These symptoms, along with his near continuous level of
panic which impairs his ability to function effectively, indicates
significant impairment for the veteran, even though he is managing to work
full time at this point. His ability to be effective at his job or at school
is considered to be impaired given his level of generalized anxiety disorder.
Application for vocational rehabilitation is noted in VBMS. He did have to
drop out a college due to his inability to perform public speaking. Given the
severity of his anxiety and now major depressive disorder as well, with the
addition of mental health treatment and continued medication management, his
prognosis for improvement is likely oonly fair. 

 

[broncovet]

After reviewing this exam, I think this c and p exam is positive for you.  I have 5 reasons:

"Total Occupational and Social Impairment".  

This is the exact language contained in the "100 percent " category, as follows:

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

 

Now, this does not mean the decision maker will agree and that you will get 100 percent.  But, based on this exam, you likely should.  Im puzzled by the examiner stating that you are working yet, you have "total occupational impairment".  The VA may just deny an increase because the doc probably did not explain why he said this when you are working.  

[ferriswheel]

That's what was confusing to me. Total occupational impairment but...I work? Granted I work a federal position that would make any accommodations that I needed and it's almost impossible to be fired (especially for disabled vets).  That part was really bugging me though. My career is noted in the full text - maybe that will have some merit towards the rating?

I appreciate the response.

[vetquest]

"Total occupational and social impairment" would lend itself to a 100% examination but I believe the line that "he is managing to work full time at this point" will hurt you and get you 70%.  I could be wrong, we never know how the VA rates things sometimes.  I am surprised you are marked as fit to handle your finances looking at the rest of the examiner's report. 

Edited August 8, 2018 by vetquest