Tabletop C and P exam for Increase.. Please read

[Austin]

Yesterday when reviewing my medical records I noticed an examiner did a C and P/DBQ addendum. Im currently 70 percent and submitted for an increase(12 months ago) and also filed for IU(2 months ago). I don't know what this nexus means and would like to know if the exam was for the IU or increase claim. This examiner did a table top review as I wasn't present for it. See below:

Please utilize this form when responding to VBA requests for either addendums    or clarifications of prior VHA examination reports.        This Veteran was seen for a C&P examination in December, 2017. At that time    it was felt that the most appropriate diagnosis was that of a mood disorder,    which was considered to be severe. At that time it was noted that the Veteran    had been able to complete a college degree.
    In July of this year the Veteran was admitted to inpatient treatment, which    he successfully completed, and he continued in treatment throught the    remainder of this year. Treatment notes reference some improvement in
    functioning, with the Veteran reporting boredom.
    At this point, given the available information, I believe it is as likely as    not that the Veteran's severe mood disorder would make it impossible for him    to maintain employment over an extended period of time. 
    Perhaps vocational rehabilitation, combined with his continuing in treatment    might make it possible for him to obtain and maintain employment at a later 

So my question is.. Does the nexus look favorable? What was this exam for(IU or my increase)? My increase is in front of the DRO and was filed in December of last year after my initial award. The IU claim was only filled a month or two ago. The C and P exam was done 15 days ago. Any assistance would be greatly appreciated 

 

[vetquest]

Can you redact and post the entire information?  It would be hard with only what you have provided.

[Austin]

Thank you for the feedback. I posted my original C and P exam that he did the addendum on. He did the original C and P in 2017, which granted me 70 percent. See below:

 

2. Current Diagnoses    -------------------    a. Mental Disorder Diagnosis #1: unspecified bipolar disorder           ICD code: F31.9
    b. Medical diagnoses relevant to the understanding or management of the       Mental Health Disorder (to include TBI): none
    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           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 deficiencies in most areas,           such as work, school, family relations, judgment, thinking and/or mood    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. History    ---------
 Page 26 of 139
    a. Relevant Social/Marital/Family history (pre-military, military, and       post-military):          The Veteran has been married for approximately one year; he said lately          their relationship has had problems because he feels his wife has not          understood his problems.              b. Relevant Occupational and Educational history (pre-military, military, and       post-military):          The Veteran said he had had eight jobs in the past year. He completed a          bachelor's degree in psychology at UCA a year ago.              c. Relevant Mental Health history, to include prescribed medications and       family mental health (pre-military, military, and post-military):          The Veteran is followed in mental health at CAVHS. He takes lamictal,          prazosin, and lithium carbonate. He also sees a private counselor.              d. Relevant Legal and Behavioral history (pre-military, military, and       post-military):          n/a              e. Relevant Substance abuse history (pre-military, military, and       post-military):          The Veteran reports drinking every day, having two 30-packs over the          course of a week. His last marijuana use was about two and a half years          ago.              f. Other, if any:          n/a              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: hearing a soldier getting raped              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
 Page 27 of 139
              4. PTSD Diagnostic Criteria    --------------------------    No response provided.
    5. Symptoms    ----------    For VA rating purposes, check all symptoms that actively apply to the    Veteran's diagnoses:           [X] Depressed mood       [X] Anxiety       [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] Inability to establish and maintain effective relationships       [X] Suicidal ideation
    6. Behavioral Observations    -------------------------    The Veteran was cooperative. He displayed some dysphoria.
    7. Other symptoms    ----------------    Does the Veteran have any other symptoms attributable to PTSD (and other    mental disorders) that are not listed above?       [ ] Yes   [X] No           8. Competency    ------------    Is the Veteran capable of managing his or her financial affairs?       [X] Yes   [ ] No           9. Remarks, (including any testing results) if any    -------------------------------------------------       The Veteran's symptoms appear to be more consistent with a mood disorder       than with those of PTSD. He reported depression while still in the       military, but also reported he had been treated for depression prior to       the military. In today's examination the Veteran denied depression prior       to the military but then conceded it was possible he had been depressed as       a teenage, but could not recall details of his depression or the treatment       he received. However, the same note indicated that in 2007 the Veteran       reported that he had responded well to medication, suggesting that it was       possible that his depression was relatively mild.
 Page 28 of 139
       The Veteran's current bipolar disorder is severe. Therefore, it is more       likely than not that any mood disorder present before the Veteran's       military service was exacerbated by his time in the military.
       Given the Veteran's ability to complete a bachelor's degree, I did not       find evidence that his bipolar disorder precluded all employment; however,       it definitely makes it difficult for him to sustain employment.           NOTE: VA may request additional medical information, including additional    examinations if necessary to complete VA's review of the Veteran's

[vetquest]

I hate to say it but it does not look like a 100% rating.  You should have a strong chance for 70% and IU.  What is killing you is getting the degree, if you are able to get a degree the VA sees you as most likely able to work.

 General Rating Formula for Mental Disorders:
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

[Austin]

The crappy part about My IU claim is that I have very strong medical evidence. But my attorney told me if we can’t get my previous employer to fill out that form... it would be denied.

[vetquest]

Your previous employer will not fill out the form?  When I requested IU the VA contacted my previous employer to fill out the form.

[Austin]

I contacted the employer to give them notice. The VA hasn’t got the form yet.My attorney said they haven’t got the form. They wanted her full contact info to get intouch with her...10 days down to the wire. It’s frustrating.