MilConnect records for PTSD Stressor Verification

[Usaf9498]

First off thank you for this site and any help I can get.

I was USAF and deployed to Saudi and was barracked at Khobar Towers when it was bombed in 96. For the last couple of years, I have started to show a lot of signs of PTSD. I recently went and talked to my Primary Care doc at the VA and she referred me to mental health. I sat and talked to a doctor for over an hour and a half and he diagnosed me with PTSD, depression and anxiety. I also have tinnitus and sleep apnea. I am going to go about starting a PTSD claim and filed my intent to file yesterday. I got on Milconnect and ordered my OMPF files. What I got back in a pdf is my seperation file, my DD214, my enlistment papers etc. No medical records and no copies of orders which I could then use to show I was there. I am sure it would be helpful to have those. What channels do I need to start looking into for my TDY orders? 

Thank you!

Edited July 26, 2019 by Usaf9498

[GeekySquid]

10 hours ago, broncovet said:

I think the ITF may have been eliminated or is being eliminated, so go ahead and

it isn't .... in that same thread are the screen shots I took of initiating a new claim once AMA started

Like the third screen says YOUR INTENT TO FILE HAS BEEN SAVED...or such wording.

I have an active ITF sitting on VA.Gov right now.

10 hours ago, Usaf9498 said:

I was literally just diagnosed at the VA by the doctor Monday. I keep reading that you should wait for at least a month to 6  months to show that it is a continuous problem. 

no.

The va will send you to a C&P and it will be done by a VA authorized C&P doctor. Your history in your medical record helps, but your Nexus and other Caluzza elements must be from service. VA knows that frequently PTSD is a creeper condition.

Screw MilConnect. Order your C-File from Janesville.

When you file the VA will order all the documents and Service Records and Treatment records. you want to have your own copy so order the damn c-file ASAP. it can take a while to get. instructions on here and on VA.GOV

I don't know if you have a VSO yet. They can be helpful in filing an initial claim though are frequently useless for much more.

You will want to handwrite (not type) your stressor events statement. The worse your handwriting the better. The more disjointed, as long as your thinking is disjointed, the better.

If you come across as having it all together and wrapped up in a bow you undercut your own claim.

you never talk about "today" you always talk about your "worst day" when speaking to a VA shrink or C&P.

As for other things.

What was your job in the military, do you have any trouble hearing...file the claim make them prove your hearing is good.

Ever hit your head, even in a mild car crash while on AD? have yourself checked for TBI and specifically for  Empty Sella Syndrome. takes an MRI to find or an autopsy.

Ever get dizzy, world spin, fall down, vomit... do you have the DRUNK GAIT? after your in service events? tell the VA and get checked for Vertigo.

Not being personal but do you have ED? since your in-service events have you had continence problems? both had a tie to PTSD as well as the Sella.

anxiety, fear, any strong emotional swings...one possible culprit making it worse is the Sella. The Sella covers the Pituitary and that controls almost all your body systems including hormones.

Besides the MRI most tests are blood tests.

The one big exception is if you do have Vertigo . You will have a VNG... amounts to being blind folded, spun around in all sorts of directions, flipped around adn then having warm water gushed into your ears.... to stimulate your vertigo so the cameras in your goggles record your eye movements.

I know this test...on Aug 1 I have another one.. the VA "lost" the last one... yeah waterboarding... UGH.

These are all important things and very common.

You need to become an expert on your issues. Read the DBQ's. Read 38 USC about the different rated conditions. Read the MR21.  at least know how to access and use the last two..

you have 8 million things to learn and to learn to watch for with the VA... start running NOW>...

[Berta]

There is quite a bit on Google on the bombings:

https://www.google.com/search?q=what+military+units+were+present+in+the+1996+bombing+of+the+Khobar+Towers&rlz=1C1CHBF_enUS695US695&oq=what+military+units+were+present+in+the+1996+bombing+of+the+Khobar+Towers&aqs=chrome..69i57.50039j0j8&sourceid=chrome&ie=UTF-8

Also a few cases at the BVA:

Here's one of them:

DOCKET NO. 14-24 959 DATE: August 6, 2018 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT The Veteran has PTSD that is related to his active service. CONCLUSION OF LAW

Here, during the February 2018 Board hearing, the Veteran and his representative reported that the Veteran was present at the Khobar Tower explosion, a 1996 terrorist attack in Saudi Arabia, as part of the search and recovery team and he personally knew two of the victims of the attack. It was reported that he demonstrated changes in his personality thereafter. See generally February 2018 Board hearing. In November 1996, the Veteran was awarded The Air Force Achievement Medal with Valor Device for outstanding achievement in Saudi Arabia in June 1996. The award certificate indicates that the Veteran helped evacuate injured personnel from a bomb-damaged building and assisted the injured with first aid and buddy care."

https://www.va.gov/vetapp18/files8/18124250.txt

The BVA considered the AF Achievement medal as well as his MOS-

sorry my daughter, veteran, USAF Intel ,always chastises me for saying MOS  regarding USAF-- I forget the AF lingo for any airman's inservice occupation.

This vet however is on remand, for a new PTSD C & P exam but also his statements on Khobar Tower were inconsistent with the record.

https://www.va.gov/vetapp10/files4/1039132.txt

This vet's claim was not as strong as the first one, regarding Khobar Tower and other stressors but the BVA did award him for PTSD.

https://www.va.gov/vetapp02/files03/0213687.txt

This claim too ,mentions Khobar Towers but the veteran could not prove the stressor and was denied:

https://www.va.gov/vetapp15/files2/1513059.txt

It is possible that your DD 214 does not reveal all of the decorations, medals, you should have.

I hope you apply for a corrected version.

The form , a DD 149 is here under a search and also at the VA web site.

Just put "Inapplicable" to the "Injustice " part, unless you feel you do have the proper medals etc on your DD 214.

Make sure you use the exact address on the instructions on the form, page 2.

Edited July 27, 2019 by Berta

[Usaf9498]

 My DD214 shows I received the Armed Forces Expeditionary medal with 1 oak leaf cluster. That should show them that I was at least in theater during my enlisted dates. 

I am trying to figure out how to upload a scan of it and of the psychiatrist report but I am not having any luck figuring out how to attach it so that you can read it on here.  

[Berta]

Cover your C file #, name, prior to scanning it.

Scan it and save as a pdf file.

The file should pop up in your "library" right away with any other  pdf files you have.You can name the file.

Under Choose files, here ,click on the pdf after you name it and it should pop up here as an attachment. 

I have Windows 10- maybe others use a different program.

Or you can save it as a regular docx file, and then copy and paste it here. or choose the doc .or doc x file to attach.

I have never dragged a file to attach.....others can help with that.

 

 

Edited July 28, 2019 by Berta
added more

[Usaf9498]

 

Here is the Psychiatrist report from when I went in to get screened. This is not my C and P, which I have not had yet since I am still in the process of filing my claim. My DD 214 does show my Armed Forces Expeditionary Medal with 1 oak leaf cluster as well.  

 

 

 

 

PARRATT, JEREMY L CONFIDENTIAL Page 18 of 85 

VA Problem List 

Source: VA Last Updated: 25 Jul 2019 @ 1152 

Sorted By: Date/Time Entered (Descending) then alphabetically by Problem Your VA Problem List contains active health problems your VA providers are helping you to manage. This information is available 3 calendar days after it has been entered. It may not contain active problems managed by non-VA health care providers. If you have any questions about your information, visit the FAQs or contact your VA health care team. 

Problem: Anxiety (SCT 48694002) Date/Time Entered: 08 Jul 

2019 @ 1200 Provider: ANYANIKE,TISHA D Location: VA Heartland-West VISN 15 

Status: ACTIVE Comments: -- 

Problem: Bilateral tinnitus (SCT 4831000119102) Date/Time Entered: 08 Jul 

2019 @ 1200 Provider: ANYANIKE,TISHA D Location: VA Heartland-West VISN 15 

Status: ACTIVE Comments: -- 

Problem: Hearing loss (SCT 15188001) Date/Time Entered: 08 Jul 

2019 @ 1200 Provider: ANYANIKE,TISHA D Location: VA Heartland-West VISN 15 

Status: ACTIVE Comments: -- 

Problem: Major depression (SCT 370143000) Date/Time Entered: 08 Jul 

2019 @ 1200 Provider: ANYANIKE,TISHA D Location: VA Heartland-West VISN 15 

Status: ACTIVE Comments: -- 

Problem: Obesity (SCT 414916001) Date/Time Entered: 08 Jul 

2019 @ 1200 Provider: ANYANIKE,TISHA D Location: VA Heartland-West VISN 15 

Status: ACTIVE 

, JEREMYPARRATT L CONFIDENTIAL Page 19 of 85 

Comments: -- 

Problem: Sleep apnea (SCT 73430006) Date/Time Entered: 08 Jul 

2019 @ 1200 Provider: ANYANIKE,TISHA D Location: VA Heartland-West VISN 15 

Status: ACTIVE Comments: -- 

PARRATT, JEREMY L CONFIDENTIAL Page 20 of 85 

VA Admissions and Discharges 

Source: VA Last Updated: 25 Jul 2019 @ 1152 No information was available that matched your selection. However if you were recently discharged, your summary may be available 3 calendar days after it is completed. 

PARRATT, JEREMY L CONFIDENTIAL Page 21 of 85 

VA Notes 

Source: VA Last Updated: 25 Jul 2019 @ 1152 

Sorted By: Date/Time (Descending) VA Notes from January 1, 2013 forward are available 3 calendar days after they have been completed and signed by all required members of your VA health care team. If you have any questions about your information please visit the FAQs or contact your VA health care team. 

Date/Time: 22 Jul 2019 @ 1417 

Note Title: KC-MH PTSD STATUS FORM Location: VA Heartland-West VISN 15 Signed By: REDD,MICHAEL JOHN Co-signed By: REDD,MICHAEL JOHN Date/Time Signed: 22 Jul 2019 @ 1423 

Note LOCAL TITLE: KC-MH PTSD STATUS FORM STANDARD TITLE: MENTAL HEALTH INITIAL EVALUATION NOTE DATE OF NOTE: JUL 22, 2019@14:17 ENTRY DATE: JUL 22, 2019@14:17:41 

AUTHOR: REDD,MICHAEL JOHN EXP COSIGNER: URGENCY: STATUS: COMPLETED 

PTSD STATUS FORM 

Mr.PARRATT is a 43 year old Veteran presenting to PTSD specialty care for treatment. The Veterane provided the following background information: 

ETHNICITY: NOT HISPANIC OR LATINO 

RACE 

White not Latino(a) 

HOUSING 

Residence 

CURRENTLY WORKING FOR PAY 

Yes 

IF NOT WORKING, PRIMARY REASON IS 

CURRENTLY APPLYING FOR VA DISABILITY BENEFITS 

No 

PERIOD(S) OF SERVICE 

PARRATT, JEREMY L CONFIDENTIAL Page 22 of 85 

Persian Gulf War 

SOCIAL SUPPORT The Veteran rated their perception of social support as: Someone who understand my problems: 

Never 

Someone I trust to talk with about my problems: 

Never 

Someone is around to help me if I need it: 

Usually 

CURRENT BARRIERS TO TREATMENT 

None 

TRAUMA EXPERIENCES TREATED IN PCT Military related trauma: 

Yes Non-military related trauma: 

No 

PROBLEM WITH PAIN FOR MORE THAN THREE MONTHS 

No 

PAIN RATING-PAST WEEK 

Score: 0 

PAIN INTERFERENCE-PAST WEEK 

Score: 0 

CURRENTLY RECEIVING VET CENTER SERVICES 

No 

CURRENTLY RECEIVING MENTAL HEALTH CARE FROM NON-VA 

Yes 

VETERAN WILLING TO HAVE FAMILY INVOLVED IN TREATMENT 

No 

ASSESSMENT PCL-5 (PTSD Symptom Checklist for DSM 5) was administered at this encounter. 

A PCL-5 was performed and was positive. The score was 75. 

The event you experienced was: Bombing of Kobar Towers in 1996 

The event happened: more than 10 years ago 

1. Repeated, disturbing, and unwanted memories of the stressful 

PARRATT, JEREMY L CONFIDENTIAL Page 23 of 85 

experience? Extremely 

2. Repeated, disturbing dreams of the stressful experience? Moderately 

3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)? Extremely 

4. Feeling very upset when something reminded you of the stressful experience? Extremely 

5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)? Extremely 

6. Avoiding memories, thoughts, or feelings related to the stressful experience? Extremely 

7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)? Extremely 

8. Trouble remembering important parts of the stressful experience? Extremely 

9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)? Extremely 

10. Blaming yourself or someone else for the stressful experience or what happened after it? Extremely 

11. Having strong negative feelings such as fear, horror, anger, guilt, or shame? Extremely 

12. Loss of interest in activities that you used to enjoy? Extremely 

13. Feeling distant or cut off from other people? Extremely 

14. Trouble experiencing positive feelings (for example, being unable to 

PARRATT, JEREMY L CONFIDENTIAL Page 24 of 85 

feel happiness or have loving feelings for people close to you)? Quite a bit 

15. Irritable behavior, angry outbursts, or acting aggressively? Extremely 

16. Taking too many risks or doing things that could cause you harm? Moderately 

17. Being "superalert" or watchful or on guard? Extremely 

18. Feeling jumpy or easily startled? Extremely 

19. Having difficulty concentrating? Extremely 

20. Trouble falling or staying asleep? Extremely PHQ-9 was adminstered at this encounter. 

A PHQ-9 screen was performed. The score was 22 which is suggestive of severe depression. 

1. Little interest or pleasure in doing things More than half the days 

2. Feeling down, depressed, or hopeless More than half the days 

3. Trouble falling or staying asleep, or sleeping too much Nearly every day 

4. Feeling tired or having little energy Nearly every day 

5. Poor appetite or overeating Nearly every day 

6. Feeling bad about yourself or that you are a failure or have let yourself or your family down More than half the days 

7. Trouble concentrating on things, such as reading the newspaper or watching television Nearly every day 

8. Moving or speaking so slowly that other people could have noticed. Or the opposite being so fidgety or restless that you have been moving around a lot more than usual Nearly every day 

PARRATT, JEREMY L CONFIDENTIAL Page 25 of 85 

9. Thoughts that you would be better off dead or of hurting yourself in some way Several days 

10. If you checked off any problems, how DIFFICULT have these problems made it for you to do your work, take care of things at home or get along with other people? Very difficult 

Based on initial assessment and/or detailed chart review the following are relevant presenting problems for the Veteran: 

Need for PTSD specialty tx 

/es/ MICHAEL REDD, PH.D. Licensed Marriage and Family Therapist Signed: 07/22/2019 14:23 

Date/Time: 22 Jul 2019 @ 0830 

Note Title: KC-MH BIOPSYCHOSOCIAL ASSESSMENT CONSULT 

Location: VA Heartland-West VISN 15 Signed By: REDD,MICHAEL JOHN Co-signed By: REDD,MICHAEL JOHN Date/Time Signed: 22 Jul 2019 @ 1441 

Note LOCAL TITLE: KC-MH BIOPSYCHOSOCIAL ASSESSMENT CONSULT STANDARD TITLE: MENTAL HEALTH CONSULT DATE OF NOTE: JUL 22, 2019@08:30 ENTRY DATE: JUL 22, 2019@08:30:17 

AUTHOR: REDD,MICHAEL JOHN EXP COSIGNER: URGENCY: STATUS: COMPLETED 

*** KC-MH BIOPSYCHOSOCIAL ASSESSMENT CONSULT Has ADDENDA *** 

Date of Visit: 7/22/19 @ 0840 

Veteran was seen for a 120 minute PTSD consult to assess trauma related symptoms following referral from PCHMI. Veteran's identity was confirmed with name and last 4. He was educated regarding the purpose of the consult and limits 

to confidentiality. Veteran provided verbal consent to continue. 

S: The majority of the session was spent reviewing the Veteran's history and 

current symptoms. Veteran reported that the index traumatic event was the bombing of the Kobar towers that occurred during his deployment to Saudi Arabia in 1996. 

PARRATT, JEREMY L CONFIDENTIAL Page 26 of 85 

FULL REPORT TO FOLLOW 

O: Veteran presented to his consult appointment on time. He was casually dressed 

and appropriately groomed. Mood appeared moderately depressed and affect was mood congruent. Veteran became tearful during questions about PTSD symptoms and in recounting the index trauma. Veteran was cooperative throughout the evaluation procedures. Eye contact was okay. Thought processes were logical, linear, and goal-directed. Thought content was relevant to topic. Speech was normal as to rate, tone, and prosody. Memory and concentration were adequate for 

the current session. Judgment and insight were fair. 

CURRENT SUICIDALITY/HOMICIDALITY: Upon direct questioning, Veteran denied current suicidal and homicidal ideation, 

plan and intent. Veteran acknowledged that he has occasional thoughts of dying but denied any thoughts about killing himself, or any plan or intent to carry out any thoughts. 

See suicide screening results below (C-SSRS) 

CLINICAL REMINDER ACTIVITY: 

Depression Screening: 

PHQ-2+I9 

Depression Screening Score: 5 

The score on this administration is 5, which indicates a POSITIVE screen on the Depression Scale over the past two weeks. 

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. 

Over the past two weeks, how often have you been bothered by the following problems? 

1. Little interest or pleasure in doing things More than half the days 

2. Feeling down, depressed, or hopeless Nearly every day 

3. Thoughts that you would be better off dead or of hurting yourself in some way Several days 

Columbia Suicide Severity Rating Scale (C-SSRS) 

PARRATT, JEREMY L CONFIDENTIAL Page 27 of 85 

Date Given: 07/22/2019 Clinician: Redd,Michael John Location: Kc-Bh-Honor-Pct-Eval/Redd 

Veteran: Parratt, Jeremy L SSN: xxx-xx-3926 DOB: Dec 9,1975 (43) Gender: Male 

Suicidal Ideation in Past Month: None endorsed 

Method/Plan/Intent in Past Month: No method, no specific plan, and no intent 

Suicidal Behavior: No Past Suicidal Behavior Reported 

KEY INDICATORS: None 

Questions and Answers: 

1. Over the past month, have you wished you were dead or wished you could go to sleep and not wake up? 

No 2. Over the past month, have you had any actual thoughts of killing yourself? 

No 3. Over the past month, have you been thinking about how you might do this? 

Not asked (due to responses to other questions) 4. Over the past month, have you had these thoughts and had some intention of 

acting on them? 

Not asked (due to responses to other questions) 5. Over the past month, have you started to work out or worked out the details of how to kill yourself? 

Not asked (due to responses to other questions) 6. If yes, at any time in the past month did you intend to carry out this plan? 

Not asked (due to responses to other questions) 7. In your lifetime, have you ever done anything, started to do anything, or prepared to do anything to end your life (for example, collected pills, obtained 

a gun, gave away valuables, went to the roof but didn't jump)? 

No 8. If yes, was this within the past 3 months? 

Not asked (due to responses to other questions) 

Columbia-Suicide Severity Rating Scale (C-SSRS) ? 2016 The Columbia Lighthouse 

PARRATT, JEREMY L CONFIDENTIAL Page 28 of 85 

Project. Scale may be reproduced without permission. 

Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic purposes. Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities. 

Follow-Up Pos PTSD/Depression/SI: 

I have reviewed the results of the Mental Health screens and have evaluated the patient. Based on the evaluation, the following disposition plan will be implemented: 

Other 

Comment: Patient to be evaluated for further Mental Health options for treatment 

Additional risk factors: 

Risk Factors: Male Sex Chronic PTSD symptoms Access to firearms (hunting firearms) Lacks Social Support, lack of people to confide in 

Protective Factors: Absence of Psychosis Access to Healthcare Advice/Help Seeking Resourcefulness/Survival Skills Guilt About Impact on Loved Ones Children Positive relationship with current partner Sense of responsibility to others Future oriented 

Any family history of suicide? No 

Are you currently having thoughts about hurting or killing someone else? No. 

Current assessed risk of harming self: Low Current assessed risk of harming others: Low Safety Plan (if risk is moderate or high): Current risk assessed as low. 

A: Post Traumatic Stress Disorder, chronic 

P: Veteran and provider discussed the diagnsis of PTSD as well as evidenced based treatment options which included individual trauma focused therapy treatments (Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). Also 

PARRATT, JEREMY L CONFIDENTIAL Page 29 of 85 

discussed group options, though Veteran indicated his preference for individual treatments at this time and that he was nervous just thinking about doing group therapy. He also indicated his preference for individual treatment and that he did not think that family involvement was needed at this time. After the discussion of treatment options Veteran indicated that he was most interested in 

CPT. He indicated his preference for Monday or Tuesday appointments and for morning appointments if possible. 

Veteran is currently stable and there is no evidence of imminent harm to self or 

others. 

/es/ MICHAEL REDD, PH.D. Licensed Marriage and Family Therapist Signed: 07/22/2019 14:41 

Receipt Acknowledged By: * AWAITING SIGNATURE * HEINECKE,NICHOLAS B 

07/23/2019 ADDENDUM STATUS: COMPLETED BEHAVIORAL HEALTH BIOPSYCHOSOCIAL ASSESSMENT 

Service-connected: Vet is a NSC, 43-year-old, Caucasian, married, employed, Persian Gulf War Air Force Veteran. 

Referred by: PCMHI; Dr. Niki Knight 

The Veteran's identity was confirmed using the following two identifiers: Name and SS#. Veteran was informed of the purpose of the assessment and the limits of confidentiality and agrees to proceed. 

PRESENTING PROBLEM: Veteran reports that he went to see his private PCP in February for anxiety symptoms, "felt like it was getting out of control". "I kept dwelling on it until couldn't think of anything else". He rep orted anxiety thoughts about work, relationships with friends, "everything was a panic". 

He reports that in the last year or two, he started to get a lot of anxiety. He 

reported an index trauma related to the Kobar towers bombing in 1996 where he 

PARRATT, JEREMY L CONFIDENTIAL Page 30 of 85 

was deployed. He notes that especially around July 4th every year, the fireworks 

trigger him. "Gets tough." 

Now, he notes that he is irritable "a lot more than should be", and anxiety (within the last couple of years). "Always hyper alert when out with family", aware of surroundings. "Don't like to be in large crowds anymore" (since deployment). "Don't like to be in situations that I can't control so don't like to be around that many people." He reports having some level of hypervigilance and being jumpy (last 10-15 years) consistently since the trauma but denies that it was there before that. He notes it is worse in the past couple of years. He also reports having significant difficulty sleeping at night and trouble with work due to not wanting to be around people for long. Having more trouble in last several years having conversations with people, feeling more and more uncomfortable, one-on- one, carrying on long conversations. Used to be easy to interact with customers, 

really enjoyed it before. Now feel more comfortable back in the brewery doing his own thing, not having to interact as much. Now avoiding those interactions and related people on almost a daily basis. More anxious about the talking than just being around them (that they might bring up conversations about his military service which might bring up combat experience). 

He reports taking escitalopram since February of this year and that it "takes the edge off of the anxiety." He notes that his anxiety is a 6 out of 10 on 

typical day (10 being the worst). He reports that prior to the last several years it used to be 2-3 out of 10, "didn't really remember having anxiety issues". 

Out of the symptoms described he notes that the anxiety and irritability are bothering him the most. "Would be nice to not jump out of my skin every time I am startled." "Would like to enjoy spending time with family around July 4th. I normally go inside, and spend time by myself." "I used to really enjoy shooting but I don't anymore. Everything kind of reminds me of that now." 

Not currently pursuing new claim for PTSD SC. May pursue in the future if it makes sense, but "at this point I just want to be better". 

RELEVANT BACKGROUND & CURRENT PSYCHOSOCIAL ASSESSMENT Early childhood: He describes his childhood as "Awesome". He reports having one 

PARRATT, JEREMY L CONFIDENTIAL Page 31 of 85 

sister growing up and that his Mom and Dad divorced after he became an adult. He 

reports that there was not a lot of conflict in the home and denied any childhood trauma or abuse. Parents rarely ever drank, no drug/alcohol abuse in the home. Grew up in a small town, played sports, hunted and fished with Dad and 

grandfather. 

Current contact with parents/siblings: Sees sister about once every two years, lives in Texas. Father died three years ago. See Mom when he sees his sister. Talks on the phone, or texts usually about once a week. 

Current relationship/history: Married, 17 years. Relationship is "great". No real issues, get along great. Irritability (snapping) can cause friction, she gets frustrated with that and wants him to control it more. He notes that she also gets frustrated with his triggering around July 4th and her expressed concerns about his anxiety led him to reaching out to his PCP this last Feb. He notes that he has never been a violent person/fighter. Denies escalated arguments/conflict due to it these problems. 

Current environment and home/family situation: "good". Spend a lot of time in pool together. He notes that he is spending more time at home with them, stepping away from work responsibilities (though later in the interview information the Veteran shared indicated that this may be because he is trending 

towards more and more isolation and avoidance of interactions with people). Went 

on vacation to Florida in April. Noticed irritability, but not anxiety so much. Was on medication for several months by that point so was doing okay. 

Is family involvement assessed to be appropriate in this episode of care? Not at this time. Would like to "figure this out on my own at this time". 

Current bereavement issues: Not at this time. 

Financial History (stress): Self-employed, brewery and retail store, no significant financial stressors reported. 

Social Support: Have wife to talk to, she is very supportive about talking about things. She urged him to go to PCP to talk about his anxiety. Outside of wife, he reports he doesn't have anyone to confide in or talk to. Can't talk to those he works with (his employees), not really any social interactions outside of work. Have had trouble keeping friends (been more recently). Don't have any currently close friends. 

PARRATT, JEREMY L CONFIDENTIAL Page 32 of 85 

Legal Problems (history and current problems): denied 

Influence of Veteran's legal situation on progress in care, treatment, or services: N/A 

Relationship between the presenting conditions and legal involvement: N/A 

Is a referral to VJO or other legal assistance needed? Not at this time 

Leisure/Recreation: Swim, fish, bow hunt (do as work permits, "I work a lot"). He reports that he needs to keep very busy all of the time, which he notes is a significant difference from before the index trauma. "I don't do well with not having something to do, used to be able to relax more". Sundays try to spend as a family. 

Religious/Spiritual Orientation: No. 

Transportation: Veteran has no difficulties arriving to appointments. 

Cultural considerations: denied 

HEALTH ASSESSMENT 

Is the Veteran connected to medical care for relevant medical needs? Yes. 

Has Veteran seen a Primary Care Physician in the last year and/or does Veteran need referral for relevant medical needs? Had first appointment with VA PCP in the last couple of weeks. He reports that they indicated he had a Vitamin D deficiency, no other medical issues. He notes that he went to see a private doctor in Feb. for anxiety issues after urging from his wife, then came to VA to try to get the anxiety figured out. He indicates that he would rather not have to be on medication for the anxiety if he can help it. Last time before that to see a doctor was over 10 years ago. 

Does the Veteran have pain that is impacting their day to day life? (if yes, consider referral to medical care) None reported 

Nutrition screening: *Does the Veteran have food allergies? none *Has the Veteran gained or lost 10 pounds or more in the last three months? Not necessarily in last 3 months. This year has "definitely put on weight". 

*Has the Veteran experiences a decrease in food intake or appetite? No. Last year or two has had increase in appetite/intake. *Does the Veteran have dental problems? None *Does the Veteran have behaviors that may be indicators of an eating disorder (binging or purging)? None *Need for referral to PCP: No 

PARRATT, JEREMY L CONFIDENTIAL Page 33 of 85 

Medical History/Problems and impact on psychological status or treatment planning: 

Veteran reports being pretty healthy physically. When in Air Force he reports having had a back problem that can flare up every once in a while rarely. 

Psychiatric medication evaluation and management provider: 

According to Veteran he is being prescribed escitalopram, still being prescribed through private PCP, but it will be transferred over to his new VA 

PCP after the prescription expires (still have a couple of months). Functional status (assessment of patient's ability to live independently and any limitations/needs regarding ADLs/IADLS and other basic living skills): Denies any problems. 

EDUCATIONAL, VOCATIONAL AND LEARNING ASSESSMENT Highest level of education completed (performance/preferred areas of study/attitude toward education/desire for future education): High School 

Is further educational assessment needed? Not at this time. 

History of head injury/trauma? None 

Employment history: Works at self-owned brewery and retail store for the last 8 

years, before that sold insurance (5 years). Before that, construction and welding jobs after he got out of Air Force. 

Is a referral to vocational rehabilitation or CWT/SEW needed? Not at this time 

MILITARY SERVICE HISTORY Confirmed via the veteran's copy of the DD214? Branch of service: Air Force Dates of service: 1994-1998 Location and Dates in country: Turkey, Bahrain, Saudi Arabia Enlisted: Yes Highest rank: SrA Rank at discharge: SrA Type of discharge: Honorable Disciplinary actions? No Duties, MOS, specialty: Egress 

TRAUMA HISTORY AND SYMPTOMS 

A. Description of Veteran's reported traumatic experiences: a. He reports that he was on deployment in Saudi Arabia in June of 1996 and 

living in the compound at the Kobar towers. He reports that he normally had 

 

worked nights but had switched with someone so he was working at the time. He had just left the parking lot and was on his way to work when a terrorist drove a fertilizer bomb into the tower and exploded it. He reports that 19 people were 

killed and injured 100s more (all military personnel). He reports that he just missed being there where the truck was by about 5 minutes, and that even though his living quarters were farther away from the detonation spot, the glass blew out of the windows throughout the building and shredded his bed that he would have been in. He reports that there was a lock down but that he saw everything when he came back the next day. 

B. RE-EXPERIENCING SYMPTOMS 

(X)INTRUSIVE THOUGHTS: He reports daily. "Not a day goes by 

without thinking about it." He reports more intrusive thoughts around the anniversary date. He says that he thinks about it everyday, about being helpless 

and still very much angry. 

()NIGHTMARES: He reports that he does not have nightmares at least that he remembers. 

(X)FLASHBACKS: He reports flashbacks related to fireworks or gunpowder triggers (less so but can still happen with loud noises). 

(X)EMOTIONAL DISTRESS: He reports significant distress with reminders (10 out of 10). (X)PHYSICAL REACTIONS: breathing heavily, heart pounding, shaking, palms sweaty when reminded of trauma which he reports can last minutes to an hour. 

C. AVOIDANCE SYMPTOMS 

(X)AVOID THOUGHTS: Try to avoid thinking about it but can't. 

Avoids situations where he might have to think about it. 

(X)AVOID THINGS: Try to avoid talking about it. "Proud" of fact that he served and it is on his business Facebook page. People are curious and they often ask about combat experience. Fear that it will come back to that. He notes that he has started to even avoid employees because they might ask about military experience. Avoiding a military friend who rotated out before the bombing, because of likelihood the conversation would be about the event. Lot of 

anxiety about talking about the event. Avoid Friday night Royals games because of fireworks. Avoided talking about it even with wife. Avoid stock car racing (used to enjoy going) because of the loud noise and trigger. Avoid pretty much anywhere there is a crowd. Find himself mostly at home or at work now. 

D. NEGATIVE THOUGHTS & EMOTIONS 

()DISSOCIATION: (X)COGNITIVE DISTORTIONS (view of self, others, world): "The 

world is pretty scary". First time this kind of thing had happened to him, had never been exposed to anything like that. From small town USA before that. 

(X)EXCESSIVE RESPONSIBIILTY: Denies 

PARRATT, JEREMY L CONFIDENTIAL Page 35 of 85 

(X)PRESISTENT NEGATIVE EMOTIONS: Anger, Sadness for people's 

families, Fear, (X)LOSS OF INTEREST: yes, especially related to triggers. Strictly bow hunt now instead of shooting firearms like he used to enjoy doing. (X)DETACHED/DISTANT: Confirms 

()EMOTIONAL NUMBING: denies 

E. AROUSAL SYMPTOMS 

(X)IRRITABILITY/ANGER: 6 out of 10 daily. "It is always right there. Any little thing can set it off." ()RECKLESS BEHAVIOR: No (X)HYPERVIGILANCE: Daily; will have to argue with his wife for "back to wall" position when go out to eat. Will avoid going out because of that. (X)EXAGGERATED STARTLE: Daily. People at work try to scare him (walk up behind him). Have a pretty strong reaction to people walking up behind him. (X)CONCENTRATION: Read a lot in spare time and finds himself re-reading over and 

over, can't focus. Really bad at work, forgetting to do things at work. (X)SLEEP DISTURBANCE: Can fall asleep very easily. Usually wake up every night at 3pm. After a couple of hours can typically go back to sleep. 5-6 hours a night. Wake up exhausted daily. 

F. Veteran's duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. 

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. 

Veteran reported symptoms following his service and the condition appears to be chronic. 

Other trauma history? Any traumas during developmental years? History of Neglect/Abuse/Exploitation/ Adult IPV etc): Veteran denies 

INCIDENCES/RISKS OF DOMESTIC VIOLENCE: Veteran denies any past history. 

ADDITIONAL PSYCHIATRIC AND SUBSTANCE USE ASSESSMENT REVIEW OF POSSIBLE COMORBID CONDITIONS: DEPRESSION: Current and past depressive symptoms seems to be a sequalae from PTSD rather than a distinct disorder, though more history may be needed to rule this out. 

MANIA: denied PANIC: None AUDITORY HALLUCINATIONS: denied 

PARRATT, JEREMY L CONFIDENTIAL Page 36 of 85 

VISUAL HALLUCINATIONS: denied 

History of MH treatment: No prior history of counseling or therapy. No history of inpatient mental health treatment. 

Substance abuse history: No abuse treatment in the past. 

Current substance use: Alcohol: Veteran reports that on rare social occasions, such as family get togethers, he might have 5 or more drinks. He notes that right after he got out of the Air Force, he drank more heavily for a couple of years. He reports currently drinking socially and about 4 times a week, 3-4 beers related to his job as a brewer. Drugs: He reports that he has tried marijuana before as an attempt to deal with his anxiety symptoms, but reported that it made him more anxious when under the influence, "didn't agree with me". Synthetic marijuana or other "designer drugs": Denied Prescribed medication abuse: Never really taken prescriptions before until recently. No history of overuse. Tobacco: Not presently. Pack a day smoker for whole adult life until first child 

(13 years ago). Parents smoked while he was growing up. Smoked more after got out of military. Went from a pack every two to three days to a pack ? pack and a 

half a day. Caffeine: Drink coffee in the mornings, drink diet coke, a couple a day. Pattern of use: Veteran denies drinking more heavily now than before. 

Consequences of use: He denies any significant negative consequences from substance use. 

Family history of substance abuse and MH problems: denied 

MEDICAL &/OR PSYCHIATRIC ADVANCED DIRECTIVE *Does Veteran have one or both? No *If so, does Veteran need help completing or updating it? (If so, please complete or refer to SW) Veteran does not want advance directive assistance at this time 

MENTAL STATUS Appearance: casually dressed and groomed Behavior: cooperative Eye contact: established and maintained Mood: Moderately depressed and anxious Affect: congruent with mood Speech: fluent, normal production 

CONFIDENTIAL Page 37 of 85 

Thought process: organized, goal-directed Thought content: appropriate to the topic Delusions: none noted or reported Hallucinations: does not appear to attend to internal stimuli Orientation: intact, x4, all spheres Memory/Concentration: not formally assessed, but grossly intact Fund of knowledge: within normal limits Judgment: fair Insight: fair 

SNAP Assessment: Strengths: Very motivated, determined when there is something to be done. Needs: None reported Abilities: Sense of humor, pretty easy to talk to. Preferences: Would prefer individual over group treatment at this time. Thinking about group treatment makes him anxious but he would be open to considering it. Mondays and Tuesdays, mornings if possible. 

PATIENT IDENTIFIED GOALS/PROBLEMS TO BE ADDRESSED IN TREATMENT 

"Would like to get over it. To get better. Things are escalating as far as the anxiety and avoidance and would like to not have to do that." USE OF COMMUNITY RESOURCES AND NEED FOR ADDITIONAL REFERRALS What resources do you use in your community? (e.g. Vet Center, Community Mental Health, Veteran organizations, etc) None at this time. 

QUESTIONNAIRES: Vet completed the PTSD symptom Check List (PCL5) and scored 75 out of 80 points. A score above 38 indicates possible PTSD. The Veteran obtained 

a score of 22 on the PHQ9 which suggests a severely depressed mood. 

DIAGNOSTIC IMPRESSION (According to the DSM-5): 

Diagnosis: 

Post-traumatic Stress Disorder, chronic CPT code 90791 

RECOMMENDATIONS/PLAN: It is recommended that Veteran engage in trauma focused therapy to address PTSD and related symptoms. Veteran and provider discussed the 

diagnosis of PTSD as well as evidenced based treatment options which included individual trauma focused therapy treatments (Cognitive Processing Therapy (CPT) 

and Prolonged Exposure (PE). Also discussed group options, though Veteran indicated his preference for individual treatments at this time and that he was nervous just thinking about doing group therapy. He also indicated his preference for individual treatment and that he did not think that family 

PARRATT, JEREMY L CONFIDENTIAL Page 38 of 85 

involvement was needed at this time. After the discussion of treatment options Veteran indicated that he was most interested in CPT. He indicated his preference for Monday or Tuesday appointments and for morning appointments if possible. 

-Veteran denies SI/HI. Also discussed how/when to access emergency mental health 

resources, including the emergency room 24 hours a day. Patient agreed to utilize these services as needed. Patient has written information including phone number to his primary care provider, the phone number to the Kansas City VA mental health clinic, and the 24 hour crisis Suicide Prevention Hotline number at 800-273-8255. 

/es/ MICHAEL REDD, PH.D. Licensed Marriage and Family Therapist Signed: 07/23/2019 16:45 

Date/Time: 10 Jul 2019 @ 1456 

Note Title: KC-TELEPHONE CONTACT 

Location: VA Heartland-West VISN 15 Signed By: BATES,TRACEY L Co-signed By: BATES,TRACEY L Date/Time Signed: 10 Jul 2019 @ 1457 

Note LOCAL TITLE: KC-TELEPHONE CONTACT STANDARD TITLE: TELEPHONE ENCOUNTER NOTE DATE OF NOTE: JUL 10, 2019@14:56 ENTRY DATE: JUL 10, 2019@14:57:03 

AUTHOR: BATES,TRACEY L EXP COSIGNER: URGENCY: STATUS: COMPLETED 

Contact Number:Cell: (816)510-1846 

Contacted Veteran regarding 

***************COPIED AND PASTED******************* LOCAL TITLE: Addendum STANDARD TITLE: ADDENDUM DATE OF NOTE: JUL 10, 2019@12:38 ENTRY DATE: JUL 10, 2019@12:38 AUTHOR: ANYANIKE,TISHA D EXP COSIGNER: 

Please alert pt that his labs are all ok except for a low vitamin D at 16.8 (normal 30-96). I want him to take high dose ergocalciferol 50,000 units weekly for 12 weeks then start taking cholecalciferol 2000 units po daily. I will mail this to him. Recheck with next routine labs.

[Buck52]

22 hours ago, Usaf9498 said:

 My DD214 shows I received the Armed Forces Expeditionary medal with 1 oak leaf cluster. That should show them that I was at least in theater during my enlisted dates. 

I am trying to figure out how to upload a scan of it and of the psychiatrist report but I am not having any luck figuring out how to attach it so that you can read it on here.  

yes that should be good enough  and if you were traumatized by the bombings  that's your stressor,  and if you can find any morning reports on the bombing  throw that in as your evidence the event did happen   it will have the dates in it and  you show your IN SERVICE RECORDS that you were there when you said the bombing happen   you may not need all this but its good if you have it all in your file so they can see they they meaning the VA Raters.  The VA HAS Duty to get all your military records to include medical records  to help substantiate your claim  some times they don't get what they need,  so if you have any records putting you at the bombing scene  then send them in as evidence to your trauma.

buddy statements are good to get also   for your evidence.

Main thing now is after you file a claim for MH or PTSD  get in to therapy ASAP and do the weekly sessions. and check the Myhealthevet Notes after 3 days of the sessions  to see what the  therapist is saying about your treatment your responses to it  ect,,ect,,,

it will be a month or two/three for them to set you up a forensic C&P Exam  hopefully from a well trained  state certified license physiatrist  VA or a VA Contractor,   Mine was with QTC and the physiatrist was great! 

if you have any other conditions that would be related to your PTSD  you may want to file on those too when you file now.  CONDITIONS LIKE   like Sleep Apnea CAN BE RELATED TO A SECONDARY CONDITION CAUSED/RELATED TO YOUR PTSD. BUT YOU NEED A QUALIFIED DR TO NEXUS THE TWO. AS LEAST LIKELY AS NOT THAT YOUR PTSD IS RELATED TO YOUR NOW SLEEP APNEA. 

I AM THINKING THAT WITH YOUR PTSD  FROM WHAT YOU MENTION IT WILL BE CLOSE TO A 10% OR 30%RATING DEPENDING ON YOUR SYMPTOMS?   AND A LOT OF THIS DEPENDS ON WHAT THE C&P EXAMINER CHECKS IN THE BOXES.

you could possibly get a 100% rating right off the bat...if your working now then IU is a no go...but if this s.c. condition ever keeps you from working or holding down a job  then you may want to think about filing a IU Claim  but I'd wait and see what they rate you.?

  you have to file for the IU they don't give it to veterans anymore   when they see they can't hold down a job  it use to be mandatory they did but not anymore  now days veterans has to file for the IU.

Edited July 28, 2019 by Buck52