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ArmyMajor

C and P Exam PTSD/MST Update

Question

 

I currently have a pending claim for PTSD related to MST, any feedback would be appreciated.  I have included information from the original post that includes in my opinion conflicting information from the C &P examiner versus that of the psychologist that saw me a few days later in March 2018.  The first set of notes is from my most recent visit with my VA therapist.  I have been seeing the therapist since April 2018 and have been diagnosed with PTSD.

 

 

Therapist Notes (December 2018)


PTSD SCREEN PC-PTSD-5+I9 PTSD Screening Score: 5 The score for this administration is 5, which indicates a POSITIVE screen for PTSD in the past month.

 PC-PTSD-5+I9 Suicide Screening Score: 1 The results of this administration revealed suicidal ideation over the last 2 weeks, which indicates a POSITIVE primary screen for Risk of Suicide.

PHQ-2+I9 PHQ-2+I9 Depression Screening Score: 2 The score on this administration is 2, which indicates a negative screen on the Depression Scale over the past two weeks.

 PHQ-2+I9 Suicide Screening Score: 1  The results of this administration revealed suicidal ideation over the last 2 weeks, which indicates a POSITIVE primary screen for Risk of Suicide.

AUDIT-C An alcohol screening test (AUDIT-C) was positive (score=9).

 

Posted March 24, 2018 (edited)

 

I was scheduled for an appointment with a VA psychologist and the below are her results, which is seems to conflict the C and P examiner ...... any feedback is appreciated

 VA Psychologist Notes (March 2018)

Military History

Branch (years of service): MST: yes
 

MEASUREMENT BASED CARE:
PHQ-9: 19 (moderate)
GAD-7: 16 (severe)
PCL-5:
AUDIT-C: 5 (above threshold)

 

DIAGNOSTIC IMPRESSIONS:
Anxiety Disorder, unsp
MDD, recurrent, moderate

 

Depression Monitoring (PHQ-9) 2017:
Depression Screen:
PHQ9 Screening
PHQ-9
A PHQ-9 screen was performed. The score was 19 which is suggestive
of moderately severe depression.

 

PTSD Screening:
PTSD Screen:
PTSD Screening
PC PTSD
A PTSD screening test (PC-PTSD) was positive (score=4).

 

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

 

C & P Examiners Notes (March 2018)

 

SECTION I:
----------
1. Diagnostic Summary
---------------------
Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria
based on today's evaluation?
[ ] Yes [X] No
If no diagnosis of PTSD, check all that apply:
[X] Veteran's symptoms do not meet the diagnostic criteria for PTSD under
DSM-5 criteria
[X] Veteran has another Mental Disorder diagnosis. Continue to complete
this Questionnaire and/or the Eating Disorder Questionnaire:
2. Current Diagnoses
--------------------
a. Mental Disorder Diagnosis #1: UNSPECIFIED DEPRESSIVE DISORDER
b. Medical diagnoses relevant to the understanding or management of the
Mental Health Disorder (to include TBI): SEE MEDICAL CHART
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 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 medication

TYPE OF MEDICAL OPINION REQUESTED: Military Sexual Trauma (MST)
OPINION: Military Sexual Trauma (MST)
This examination is being conducted to assist with determining whether the
Veteran experienced an in-service personal assault stressor related to
military sexual trauma (MST) that has resulted in a current PTSD diagnosis.
Please review the claims file and state in your report that it was reviewed.
In your review of the claims file, please pay special attention to signs,
events, or circumstances that may represent markers for the MST stressor
described by the Veteran. Your review is not limited to the evidence
identified on this request form, or tabbed in the claims folder. If
additional testing is required, please obtain it prior to rendering your
opinion.
Based upon your review of the evidence, please provide a medical opinion as
to whether the MST stressor event described by the Veteran is at least as
likely as not (50 percent or greater probability) supported by and consistent
with the in-service marker evidence. Please provide a rationale for the
opinion and list the marker evidence used to arrive at your decision.
NO MARKERS IDENTIFIED. MEDICAL OPINION DOES NOT APPEAR WARRANTED.


In addition:
1. IF YOUR EXAMINATION DETERMINES THE VETERAN HAS A CURRENT DIAGNOSIS OF
PTSD, please provide an opinion as to whether the current PTSD diagnosis is
at least as likely as not (50 percent or greater probability) caused by or a
result of the in-service MST-related marker(s), and provide a rationale.
Please note that only PTSD can be service connected based on circumstantial
marker evidence (38 CFR 3.304(f) (5)).
VETERAN'S SYMPTOMS APPEAR TO BE BEST ACCOUNTED FOR BY A DIAGNOSIS OF
UNSPECIFIED DEPRESSIVE DISORDER. MEDICAL OPINION DOES NOT APPEAR WARRANTED.

2. IF YOUR EXAMINATION DETERMINES THAT, IN ADDITION TO PTSD, THE VETERAN HAS
ADDITIONAL MENTAL DISORDERS, please state whether the additional mental
disorders are at least as likely as not (50 percent or greater probability)
secondary to the PTSD, and provide a rationale. For each mental disorder

MEDICAL OPINION DOES NOT APPEAR WARRANTED.


3. IF YOUR EXAMINATION DETERMINES THE VETERAN DOES NOT HAVE PTSD, BUT HAS A
DIFFERENT MENTAL DISORDER(S), please review the service treatment records
(STRs) and service personnel records for in-service direct evidence. Direct
evidence is clear, undisputable proof of an event, injury, or disease. Such
evidence includes, but is not limited to, mental health treatment, mental
health symptoms, or a mental health diagnosis. If direct evidence exists in
the STRs or service personnel records, please provide an opinion as to
whether the mental disorder(s) diagnosed on examination is at least as likely
as not (50 percent or greater probability) caused by or a result of the
direct evidence noted in service. Please provide a rationale for the opinion
and list the evidence used to arrive at your decision. (38 CFR 3.303).


NO DIRECT EVIDENCE LOCATED. OPINION DOES NOT APPEAR WARRANTED

 

Edited by ArmyMajor
Additional Information Received

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ArmyMajor

These are Test Scores , they will rate the MST/PTSD on the severity of your symptoms , if you have a C&P Report  we may can give you our opinion on what we think you might be rated ? but that's not a sure thing. 

if you have not been notified or an update from your VSO (IF YOU USE ONE?)  since April 2018 ,YOU need to call the 1-800# or check the status of your claim on e benefits.

Edited by Buck52

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There are likely 2 issues here, and one of those is so important that it renders the second issue rather irrelevant:

1.  Suicidal ideation.

2.  Benefits.  

      Im gonna "go out on a limb" to help you, but ask if my advice does not apply, or even makes things worse you kindly ignore it and get your advice from somone more qualified.  MY OWN SI, hardly qualifies me to advise anyone on their SI.  

     I do think that suicide is NEVER the answer because its a "permanent" non-solution, to an often "temporary" problem.  There have been cases when someone committs suicide, when it was discovered there reason for suicide was quite premature.  

    I committed to my psych doc, that I would "not" commit suicide until AFTER I told him of my intent, to give him a chance to address it.  I think that is fair.  I can see how it awful to have one of your patients take their own life without even giving the doc a chance to help them.  Of course, if you dont like your psych doc, then get a different one, doing yourself in is not a good alternative.  Many people have "crisis" and do stuff they regret in crisis.  

     A chess playing friend of mine (Im also a chess player) suggested you "make the move which leaves you the most options", when you have a choice between 2 or more moves and cant decide.  Suicide would "never" leave you with any options afterward.  Try something else, even if you tried that in the past and it did not work out.  Some football players make great plays in the "second effort" after it looks like they will be tackled.  Or a third, or 4th effort.  Ben FRanklin had to fail 1000 times before he invented the light bulb.   I read where a baby often falls down 10,000 times before he can actually walk.  If a baby can keep trying after 10,000 tries, then you should be able to do so also.  

     There are many good alternatives to suicide, in fact all of these are better than suicide (NOT in this order!!) . 

1.  Contact your psych doc.

2.  Go to your ER and tell them of your intent. 

3.  Call the suicide hotline. 

4.  Dial 911 and report it. 

5.  Contact your pastor, if you dont have one go to church and get one. 

6.  Contact your family or friends.

7.  Do some things on your bucket list. 

8.  Pray, and ask God for help.   

9.  Get into treatment for the REAL problem.  Sometimes you fool yourself and deny the real problem.  

10.  Do anything else you love, as long as its not illegal.  (Its not, however, a good time to get drunk.) . 

     Now that you have prevented your own suicide, you can consider your benefits.  For me, my own suicide would be the "ultimate" denial and let VA win.  And Im not gonna let them win by allowing them to make me think Im worthless and dont deserve my benefits.  In fact, Im not giving "anyone" the right to make me feel worthless.  My self esteem is my decision, and Im not giving up that choice to someone else especially when I am mad at that at that time.  

     In other words, when you say something like, "You made me mad!!!", you are empowering someone to take control over you.   No thanks.  If I decide to get angry, then I will do so.  Im not gonna tell someone "If you do . _________, that makes me angry."  NOPE.  If they choose to be a jerk, then they dont need my help getting angry.  

Edited by broncovet

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Great advice from broncovet.

My doctor gave me his personal phone number and made a pact with me that I would call him if I am ever seriously suicidal.  Doctors hate it when their patients take the easy way out.   

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