PTSD rating advise needed please

[PTSD78]

Does the Veteran have a diagnosis of PTSD DSM-5 criteria on today's eval?
 [X] Yes [ ] No
 2. Current Diagnoses,1PTSD 2Panic Disorder 3Agorophobia 4Major Depressive Disorder
 b. Medical diagnoses relevant. obstructive sleep apnea, fibromyalgia, hypothyroidism.
3. Differential
 a. Does the Veteran have more than one mental disorder diagnosed?
 [X] Yes [ ] No
 4. Occupational and social impairment
 [X] Occupational and social impairment with reduced reliability and productivity
 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)
 Vet has multiple co-morbid psych dx and therefore cannot differentiate level of impairment due to each mental disorder due to overlap in symptoms.
Does stressor meet Criterion diagnosis of PTSD)?
 [X] Yes [ ] No
 Is the stressor related to the Veteran's fear of hostile military terrorist activity?
 [X] Yes [ ] No
 Is the stressor related to personal assault, e.g. military sexual trauma?
 [X] Yes [ ] No
 Criterion A: Exposure to
  [X] Directly experiencing the traumatic event(s)
 Criterion B: Presence of
  [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
 [X] Recurrent distressing dreams
[X] Dissociative reactions
[X] Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic
 [X] Marked physiological reactions to internal or externalcues that symbolize or resemble an aspect of the traumatic
Criterion Persistent avoidance of
 [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated
 traumatic event(s).
 [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects,
Criterion Negative alterations
 [X] Persistent and exaggerated negative beliefs or expectations about oneself, others
 [X] Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the
 individual to blameherself others.
 [X] Persistent negative emotional state
 [X] Markedly diminished interest or participation in significant activities.
 [X] FeelingsofdetachmentEstrangement
 [X] Persistent inability positive emotions
 Criterion E: Marked alterations  arousal
 [X] Irritable behavior angry outbursts
 [X] Hypervigilance.
 [X] Exaggerated startle response.
 [X] Problems with concentration.
 [X] Sleep disturbance
 Criterion F:
 [X] Duration disturbis more than month.
Criterion G:
 [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important
Criterion H:
 [X] The disturbance is not attributable to the physiologicaleffects of a substance
Criterion I: Which stressor contributed to the Veteran's PTSD diagnosis?:
 X] Stressor #1
 5. Symptoms
 [X] Depressed mood
 [X] Anxiety
 [X] Suspiciousness
 [X] Panic attacks more than once aweek
 [X] Chronic sleep impairment
 [X] Mild memory loss, such as forgetting names, directions or recentevents
 [X] Flattened affect
 [X] Impaired judgment
 [X] Disturbances of motivation a
 [X] Difficulty in establishing and maintaining effective work and social
 [X] Difficulty in adapting to stressful circumstances,including worklike setting
 [X] Obsessional ritualsInterfereActivities
 [X] Neglect personalAppearance hygiene
 DSM 5 Diagnosis:PTSD-Panic d/o with agoraphobia-Generalized Anxiety D/o
Vet meets the DSM-5 diagnostic criteria for PTSD as level of severity - severe. Relationship of mental disorders to each other Vet's MDD, recurrent,moderate is secondary to her PTSD.HerPanicDisorder, Agorophobia and FSAD are also secondary to her PTSD. It is my medical opinion that vet's MST stressor is as least as likely as not suppported by and consistent with the in service marker evidence. Her agorophobia preclude her from functioning satisfactorily in work environments.

 

[PTSD78]

7 hours ago, Berta said:

I agree- at least 70% but also possibly 100%.

I do not view the " Negative alterations" as anything that could go against your claim.They are consistent with PTSD.

Do you get SSDI- and if so, is it solely for PTSD?

and if so, does VA know of the SSA award for PTSD?

 

Thank you beta for all your help. I was advised not to apply for said until after receiving VA rating letter so I can be expedite the process. I also had sent a tdiu form per my county vet rep. Will they rate my secondary conditions as well? This has been a very difficult process to go through and God bless you all for your guidance.

[vetquest]

Well, it states your PTSD is creating occupational impairment with reduced reliability and productivity.  That would usually be a 70% rating.  At the end they state your conditions preclude her from functions satisfactorily in work environments.  That looks like a rating of 100%.  It is anybody's guess at which one will be awarded.

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 shortand
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

[Berta]

I agree- at least 70% but also possibly 100%.

I do not view the " Negative alterations" as anything that could go against your claim.They are consistent with PTSD.

Do you get SSDI- and if so, is it solely for PTSD?

and if so, does VA know of the SSA award for PTSD?

 

[Berta]

To add, if they award 70% they should enclose a TDIU form ( 21-8940):

"Forward a VA Form 21-8940, Veteran’s Application for Increased Compensation based on Unemployability, to the Veteran if a request for IU is

·  expressly raised by the Veteran, or

·  reasonably raised by the evidence of record.   (*) 

Change Date

September 24, 2015 November 9, 2015" www.benefits.va.gov..._key changes_m21-1iv_ii_2_secf.docx   (*) - my note- I feel your claim has evidence of record to make the TDU consideration mandatory- thus they should send the form if you get 70% and not 100%.  TDIU is paid at the 100% rate.

The change to this part of M21 has nothing to do with the info above.

 

Edited November 14, 2018 by Berta

[Berta]

one more point:

You certainly might be entitled to SMC S if they award 100%.

 

“With respect to the claim for entitlement to a TDIU, in a March 2016 rating decision, the RO in Nashville, Tennessee granted entitlement to special monthly compensation (SMC) based on the housebound criteria under 38 U.S.C.A. § 1114 (s) (West 2014), effective August 20, 2014. This award was based on the 100 percent rating for PTSD with agoraphobia, effective August 20, 2014, and additional disabilities independently ratable at 60 percent or more, and is the maximum benefit allowable under the law for the appeal period beginning on August 20, 2014. Because a total rating is in effect for a service-connected disorder and SMC has been awarded at the housebound rate, the TDIU issue is moot from August 20, 2014. See Bradley v. Peake, 22 Vet. App. 280, 294 (2008); DVA Sum. Op. Gen. Counsel Prec., 75 Fed. Reg. 11229-04 (Mar. 10, 2010) (withdrawing VAOPGCPREC 6-99, 64 Fed. Reg. 52375 (1999)). As a total rating and SMC at the housebound rate is not in effect prior to August 20, 2014, the issue of entitlement to TDIU remains on appeal prior to that date.”

https://www.va.gov/vetapp17/files1/1704948.txt

The statement above is confusing, and VA made the same statement when the awarded my SMC CUE-

they based it on both theories of entitlement.

 

It seems however that BVA held with the Housebound theory above- due to the PTSD with agoraphobia.

 

 

[GeekySquid]

17 hours ago, PTSD78 said:

It is my medical opinion that vet's MST stressor is as least as likely as not suppported by and consistent with the in service marker evidence.

@Berta, @vetquest

this is the one question in the mix. the connection statement says specifically MST but I don't see an explicit connection statement to PTSD.

I am not sure it is an automatic assumption that because you have an MST event that is SC that you have a PTSD event that is SC. clinically you can have both a non-service connected PTSD nexus and a service connected MST event that makes your PTSD worse, or even that one is not affecting the other (which is a logic pretzel but it is possible). If one of you has a link directing an automatic connection that would be useful to the OP. 

I just hope she does not have to argue about that with some faceless rater.

1 hour ago, Berta said:

You certainly might be entitled to SMC S if they award 100%.

she notes that she is diagnosed with OSA as well as the Fibro and the Agoraphobia. It is a strong guess that SMC is a possibility and with that overall eval I would think it obvious that it is required for her but who knows what the raters will do.