Occupational and social impairment with reduced 50
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...........
Occupational and social impairment with occasional 30
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)...........................................
Occupational and social impairment due to mild or 10
transient symptoms which decrease work efficiency
and ability to perform occupational tasks only
during periods of significant stress, or; symptoms
controlled by continuous medication...............
A mental condition has been formally diagnosed, but 0
symptoms are not severe enough either to interfere
with occupational and social functioning or to
require continuous medication.....................
What your doctor writes down puts you in one of these categories. You can see by your treatment where you expect to fit in. Read the criteria for each rating and put yourself in it. You should expect, in your mind, nothing more and nothing less that where you fit in. This will help you, believe me, in the stress of waiting though the process of the claim.
A note on these ratings as it applies to your employment:
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Quote:
If you are unable to work due to your service connected PTSD or mental disorder you will be granted 100% SC disability
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38 CFR 4.16
There are 3 ways the VA may choose to set your 100% rating.
IU...Individual unemployability. This means you are really a 70% rating but you cannot work so they grant you 100% based on that.
IU is a tough rating for PTSD. A letter sent to rating officials in the VA states:
Quote:
Don’t go through the I.U. process if there is clear evidence on the examination that the veteran is unable to work because of PTSD. A 100% evaluation would be more appropriate in such cases, and a future exam can be requested when indicated.
The same letter gives more information to raters on a study conducted on PTSD ratings. Remember me mentioning that "Saving Private Ryan" guy. well here it is:
Reluctance to grant 100%
Many cases of PTSD were rated at 70% even when there were clear indications on the examination that the veteran had severe symptoms and had total occupational impairment because of PTSD symptoms.
Examples: One veteran had not been working for 2 years because of PTSD symptoms; one was reported as unable to work and getting progressively worse; one had not worked for 7 or 8 months since seeing “Saving Private Ryan”; one was complying with his treatment plan but was said not to be sufficiently stable (e.g., had suicidal ideation) to maintain competitive employment; one was said to have an inability to function in almost all areas; and one had impairment of reality testing, active flashbacks, depression, hopeless mood, etc.
Each of these was rated at 70% but could have been rated at 100%. GAF scores in these cases ranged from 30 to 45. (30 was the lowest GAF score given for any case in this review.) Most were eventually given I.U., but there seemed to be great reluctance to grant a schedular 100-percent evaluation even when there was ample medical evidence of severe disability due to PTSD, and a clear indication of impaired functioning sufficient for a schedular 100-percent evaluation.
The old Physician’s Guide stated in the chapter on mental disorders: “In the case of anxiety disorders, except for severe phobias, it is unusual for a person to be completely incapacitated.” However, VA’s National PTSD Center states that anxiety disorders, severe phobias, PTSD, OCD (obsessive-compulsive disorder), panic disorder (esp. with agoraphobia), and social phobia all can be debilitating, sometimes to the point of complete incapacitation. Currently, over 29,000 veterans with PTSD are rated at 100% and over 6000 with generalized anxiety disorder are rated at 100%. Therefore, it is no longer correct to say that total incapacitation for anxiety disorders is unusual.
Another rating is schedular: Schedular is the rating that says you are 100% and under the CFR. You fit into that rating criteria.
The last is Permanent and Total or P&T:
This means that rating board feels that you will not improve during your lifetime and you are permanently disabled for life in their eyes. If you haven't done so, file for SSDI if you get this rating.
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VII. I did drugs and drank while during the period after i left the Military. Should i tell them that?
Always be honest!.... Tell your physician that because many people did the alcohol and drug thing because they were trying to escape the pain and the symptoms they were experiencing. The Rating board knows this. Most of the time they will not hold it against you. I myself drank quite a bit because I had very disturbing episodes when trying to fall asleep. I drank alot so i could pass out. I was honest and i am rated at 100%.
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VIII. What is the Compensation and Pension exam or C&P exam and what should I expect out of it?
When you have submitted your evidence the VA will ask you to take a compensation and pension exam or C&P exam. This exam is not conducted by your treating physician but rather conducted by a different qualified examiner who specializes in mental disabilities.
This exam is crucial to your rating and is centralized on your health rather than all that evidence you gathered. I call the exam BAD (before, after, and during). The exam will focus on your life before the military where they ask you personal questions about your family life and childhood. The during part, which is the toughest focuses on your stressor. this will be the part where you explain what happened to you and why you believe you have PTSD. This part is very emotional at times. The after part focuses on your life outside the military. It looks into your behavior and mental well being. There are also parts of the exam where you will common Psych tests like remembering three words after 5 minutes and drawing shapes and figures to test your memory and focus. You may have already taken these type of tests when you enrolled in the Psych clinic.
The examiner does work with a pre-determined set of written questions. You will tell them the story of your life, basically. This story is probably the same story you told your regular physician. The examiner already knows from reading your medical record what you have already said about this stuff. This is why you MUST be as honest as possible in this exam. This exam is also a test on your truthfulness. The exam may run up to two hours and it is most definitely the longest C&P exam you could take in the VA system. you may be asked to retell the same things two or three times during the same exam.
What the C&P examiner fills out:
www.hughcox.com/v_ptsdform.htm
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IX. Can i get a copy of my C&P exam?
Yes. About three to four weeks after the exam you can go to the freedom of information desk or records section of your VA clinic to get a copy of this exam.
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X. I got a copy of my C&P exam but don't understand alot of the phrasing.
here is an explanation of a C&P report:
Name:
SSN:
Date of Exam:
C-number
Place of Exam:
Narrative: Service connection for post-traumatic stress disorder (PTSD) requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. It is the responsibility of the examiner to indicate the extreme traumatic stressor leading to PTSD, if he or she make the diagnosis of
PTSD. It is the responsibility of the rating specialist to confirm that the cited stressor occurred during active duty. A diagnosis of PTSD cannot be adequately documented or ruled out without obtaining a detailed military history and reviewing the claims folder. This means that
initial review of the folder prior to examination, the history and examinations itself, and the dictation for an examination initially establishing PTSD will often require more time than for examinations of other disorders. Ninety minutes to two hours on an initial exam in normal.
A. Review of Medical Records:
B. Medical History (Subjective Complaints):
Comment on:
1. Past Medical History:
a. Previous hospitalizations and outpatient care.
b. Medical and occupational history (from the time between last rating
examination and the present need be accounted for, UNLESS the purpose of this examination is to ESTABLISH service connection, then complete medical history including description of stressors and history since discharge from military service is required.
c. Review of Claims Folder is also required on initial exams to establish or rule out the diagnosis.
2. Present Medical, occupational and social history - over the past one year.
a. Frequency, severity and duration of psychiatric symptoms.
b. Length of remissions, to include capacity for adjustment during periods of remissions.
c. Extent of social impairment and time lost from work over the past 12 month period. If employed, identify current occupation and length of time at this job.
If unemployed, note in complaints whether veteran contends it is due to the effects of a mental disorder. Further discuss in DIAGNOSIS what factors, and objective findings support or rebut that contention.
3. Subjective complaints:
a. Describe fully.
C. Examination (Objective Findings):
================================================== =====
Address each of the following and fully describe:
1. Stressor information: Clearly describe the stressor. Particularly if the stressor is a type of personal assault, including sexual assault, provide information, with examples, if possible, on behavioral, cognitive, social, or affective changes that the veteran links to the stressor. Include information on related somatic symptoms. If there is a history of multiple stressor, assess the impact of each, to the extent possible.
2. Mental status exam to confirm or establish diagnosis in accordance with DSM-IV:
a. Are all diagnostic criteria to establish a diagnosis for 309.81 Post=traumatic Stress Disorder, as specified in DSM-IV, fully met?
b.. For initial examination to establish service connection, fully discuss the criteria in steps A through F supporting or ruling out the diagnosis.
c. Describe any associated symptoms.
d. Specify onset and duration of symptoms as acute, chronic, or with delayed onset.
3. Describe in detail the linkage between the stressor and the current symptoms and clinical findings.
4. Describe and fully explain the existence, frequency and extend of the following signs and symptoms, or any others present, and relate how they interfere with employment and social functioning:
a. Impairment of thought process or communication.
b. Delusions, hallucinations and their persistence.
c. Inappropriate behavior cited with examples.
d. Suicidal or homicidal thoughts, ideation or plans or intent.
e. Ability to maintain minimal personal hygiene and other basis activities of daily living.
f. Orientation to person, place and time.
g. Memory loss, or impairment (both short and long-term).
h. Obsessive or ritualistic behavior which interferes with routine activities and describe any found.
i. Rate and flow of speech and note any irrelevant, illogical, or obscure speech patterns and whether constant or intermittent.
j. Panic attacks noting the severity, duration, frequency and affect on
independent functioning and whether clinically observed or good evidence of prior clinical or equivalent observation is shown.
k. Depression, depressed mood or anxiety.
l. Impaired impulse control and its effect on motivation or mood.
m. Sleep impairment and describe extent it interferes with daytime activities.
n. Other symptoms and the extent they interfere with activities.
D. Diagnostic Tests:
1. Provide psychological testing if deemed necessary.
2. If testing is requested, the results must be reported and considered in arriving at the diagnosis.
3. Provide specific evaluation information required by the rating board or on a BVA Remand.
a. Competency: State whether the veteran is capable of managing his or her benefit payments in the individual's own best interest (a physical disability which prevents the veteran from attending to financial matters in person is not a proper basis for a finding of incompetence unless the veteran is, by reason of that disability, incapable of directing someone else in handling the individual's financial affairs).
b. Other Opinion: Furnish any other specific opinion requested by the rating board or BVA remand furnishing the complete rationale and citation of medical texts or treatise supporting opinion, if medical literature review was undertaken. If the requested opinion is medically not ascertainable on exam or testing please state why. If the requested opinion can not be expressed without resorting to speculation or making improbable assumptions say so, and explain why. If the opinion asks "...is it at least as likely as not...", fully explain the clinical findings and rationale for the opinion.
4. Include results of all diagnostic and clinical tests conducted in the
examination report.
E. Diagnosis:
Provide:
1. The Diagnosis must conform to DSM-IV and be supported by the findings on the examination report.
2. If the diagnosis is changed, explain fully whether the new diagnosis
represents a progression of the prior diagnosis or development of a new and separate condition.
3. Is there are multiple mental disorders, delineate to the extent possible the symptoms associated with each and a discussion of relationship.
4. Evaluation is based on the effects of the signs and symptoms on occupational and social functioning.
NOTE: VA is prohibited by statue from paying compensation for a disability that is a result of the veteran's own ALCOHOL OR DRUG ABUSE, whether based on direct service connection, secondary service connection, or aggravation by a service-connected condition. Therefore, when alcohol or drug abuse accompanies or is associated with another mental disorder, separate, to the extent possible, the
effects of the alcohol or drug abuse from the effects of the other mental disorder(s). If it is not possible to separate the effects, explain why.
F. Global Assessment of Functioning (GAF).
NOTE: The complete multi-axial format as specified by DSM-IV may be required by BVA REMAND or specifically requested by the rating specialist. If so, include the GAF score and note whether it refers to current functioning over the past years, etc.
If multiple Axis I or II diagnoses exist, attempt to the extent possible to
provide a GAF score for the service connected conditions alone as well as a separate overall GAF score based on all mental disorders present, and explain and discuss you rationale. (See the above note pertaining to alcohol or drug abuse, the effects of which cannot be used to assess the effects of a service-connected condition). If it is not possible to separate the symptomatology, explain why.
DSM-IV is only for application from 11/7/96 on. Therefore, when applicable note whether the diagnosis of PTSD was supportable under DSM III-R prior to that date. The prior criteria under DSM III-R are provided as an attachment.
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XI. What is the GAF and what does it have to do with my rating?
ah...GAF stands for Global Assessment of Function. It is incredibly nice of the VA to put a numerical value to your mental health. You receive a GAF score every time you visit your mental health professional. It is a value that represents what you are mentally like on that particular day. the higher the number the better you are on that day.
What does the GAF mean to my overall rating?
Well, its subjective. some people get a GAF of 45 and receive a 100% rating and others with a GAF of 45 could end up with a 50% rating. Its really just a guide.
In the letter used earlier to raters the VA explains its position on the GAF score:
Quote:
Do not base a rating solely or mainly on the GAF score. The GAF score does not translate directly to the rating schedule criteria.
If you would like to see a general guide on how the GAF may correspond to ratings here it is:"The rule of thumb for the amounts the VA assigns for psychiatric disabilities is:
GAF Percentage
0-40=100%
41-50=70%
51-60=50%
61-70=30%
71-80=10%
81-100=0%
Raters may choose to ignore this, but it does give you a general idea of where you stand.
what does the Axis mean on my C&P report?
The AXIS I through AXIS V are your evaluation. The most important is AXIS I being the diagnosis, or what was found wrong, and AXIS V is the prognosis, or how it looks for future progress. Also you will find it says, "Competent for VA purposes," don't worry about that it's a good thing. It just means that you don't need to be locked up against your will, or "committed" as the doctors prefer saying.
AXIS 1: MAJOR PSYCHIATRIC ILLNESSES, INCLUDING SUBSTANCE ABUSE.
AXIS 2: PERSONALITY DISORDERS/FEATURES
AXIS 3: PHYSICAL PROBLEMS (MEDICAL DIAGNOSIS-AS OPPOSED TO A PSYCH DIAGNOSIS)
AXIS 4: PSYCHOSOCIAL STRESSORS (homeless, unemployment, marital conflict, etc.)
AXIS 5: GLOBAL ASSESSMENT of FUNCTIONING SCALE, expressed as: none, mild, moderate, severe and then it'll have numbers listed to represent, eye movement, or non-eye contact, tearful, fearful, and these kinds of assessments.
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C&P for PTSD
C&P Exam
Unhappy VVnW life member
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