C&P for PTSD

Discussion in 'PTSD' started by jkimsr, Mar 11, 2005.

  1. jkimsr

    jkimsr New Member

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    Hi everyone,

    I am a returning Iraqi war vet that is going for my C&P in a few days.
    I am very nervous and don't know exactly how it works. I got a few letters from my pshchariast and psychologist and i think my gaf is 40. What happens at the exam and what will happen after.
    Thanks
  2. rainvet

    rainvet New Member

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  3. Terry McGee

    Terry McGee New Member

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    C&P Exam

    In my C&P exam for PTSD I met with the shrink and she asked a bunch of questions. I told her up front that I would not go into any great details because of the reaction I have when I do. She said it wasn't necessary because she had all my records and could see what I had gone through.

    Now that was my experience. But I'm sure that yours will be different. Just be prepared to do some talking and explaining things if it is necessary.

    Good Luck!
  4. jkimsr

    jkimsr New Member

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    Thank You Terry,

    I hope you feel better :)
  5. jkimsr

    jkimsr New Member

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  6. babyduck16r

    babyduck16r New Member

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    Hello jkimsr
    I am 100% ptsd service connected Vietnam veteran. I will try and give you some pointers.When you go for C&P take your letters that, you got from psychiatrist and psychologist and give copy's to your C&P examiner and don't tell he/she that you don,t want to talk about your problems, let examiner know how you feel and that you had a normal healthy life before your military experience and your post truamatic stress disorder(ptsd) happen during your combat tour in Iraqi.Make sure this is one of your worst days,dress like you would on a normal day,no tie.I don't know you but with a gaf of 40 you have to have nitemares,panic attacks,intrusive thoughts,suicidal thoughts,if you do, let the examiner know, with no intents to comitte suicide.Its very hard to talk about combat, but if you want to get good gaf from examiner let it all out. I hope this helps and Welcome Home.
    babyduck
    !00% PTSD
  7. jkimsr

    jkimsr New Member

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    thank you :)
  8. joeblowj0

    joeblowj0 New Member

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    You got good information from the other guys. Be yourself and do not volunteer any information. Don't go in there looking like you you gave up on life. That examiner will read things into this appearance that is not there.
    I was able to show pictures of what I was involved in when I was in Khe Sanh. The examiner said she could not believe I took part in this act. I do not want to go into details, but I did tell her I was 19 years old and only doing what I was trained to do.
    A lot of time it's the luck of the draw. The end result layes with the examiner. Don't lie and you can always remember what you said before. By the way I to, have made the 100% mark. Good luck !!!!!!!!
  9. jkimsr

    jkimsr New Member

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    thanks Joe !! :)
  10. nurseflo

    nurseflo Member

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    Welcome home.Thank you for sacrificing everything to keep the citizens of the USA including my family safe and free.I'm so sorry that you came home with problems.Good luck getting the help that you need.Seems to me you've earned it.
  11. jkimsr

    jkimsr New Member

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    Thank you very much
  12. rainvet

    rainvet New Member

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    to all ; GOD Bless the Great USA and all those who gave its all to defended our Freedom, and Rights and Died in that great cause for you and me. GOD Bless each and and everyone of them Brave Soliders and we love them for it !
  13. rainvet

    rainvet New Member

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    jkimsr ; I just hope all come out well for you and you get the help and the benefits that you deserved. GOD Bless you and the Great USA and for all on this board and for the Brave Soliders that gave there Life for our defence of our Freedom, and Rights to be a free Nation With GOD Help for us all ! Thanks
  14. rainvet

    rainvet New Member

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    Complex PTSD for DVA and DSM-V

    Complex PTSD for DVA and DSM-V
    ------------------------------------------------------------------------
    This is a new PTSD criteria that will be admitted to DSM-V and will be used by the VA for future PTSD claims. It is long overdue and is needed to distinguish different types of PTSD issues. This is not a replacement of PTSD as it related to experiences beyond human experience or war relted trauma. There is a possibility that PTSD in DSM will be divided into different categories much like depression. Complex PTSD is one, and the liklihood of Combat PTSD is another.

    www.rattler-firebird.org/va/ptsd/

    Complex PTSD

    A National Center for PTSD Fact Sheet
    By Julia M. Whealin, Ph.D.

    What are the differences between the effects of short-term trauma and the effects of chronic trauma?

    The diagnosis of PTSD accurately describes the symptoms that result when a person experiences a short-lived trauma. For example, car accidents, natural disasters, and rape are considered traumatic events of time-limited duration.

    However, chronic traumas continue for months or years at a time. Clinicians and researchers have found that the current PTSD diagnosis often does not capture the severe psychological harm that occurs with such prolonged, repeated trauma. For example, ordinary, healthy people who experience chronic trauma can experience changes in their self-concept and the way they adapt to stressful events. Dr. Judith Herman of Harvard University suggests that a new diagnosis, called Complex PTSD, is needed to describe the symptoms of long-term trauma.

    What are examples of captivity that are associated with chronic trauma?

    Judith Herman notes that during long-term traumas, the victim is generally held in a state of captivity. In these situations the victim is under the control of the perpetrator and unable to flee.

    Examples of captivity include:

    Concentration camps
    Prisoner of War camps
    Prostitution brothels
    Long-term domestic violence
    Long-term, severe physical abuse
    Child sexual abuse
    Organized child exploitation rings

    What are the symptoms of Complex PTSD?

    The first requirement for the diagnosis is that the individual experienced a prolonged period (months to years) of total control by another. The other criteria are symptoms that tend to result from chronic victimization. Those symptoms include:

    * Alterations in emotional regulation, which may include symptoms such as persistent sadness, suicidal thoughts, explosive anger, or inhibited anger

    * Alterations in consciousness, such as forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one's mental processes or body

    * Alterations in self-perception, which may include a sense of helplessness, shame, guilt, stigma, and a sense of being completely different than other human beings

    * Alterations in the perception of the perpetrator, such as attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge

    * Alterations in relations with others, including isolation, distrust, or a repeated search for a rescuer

    * Alterations in one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair

    What other difficulties do those with Complex PTSD tend to experience?

    Survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming.

    Survivors may use alcohol and substance abuse as a way to avoid and numb feelings and thoughts related to the trauma.

    Survivors may also engage in self-mutilation and other forms of self-harm.

    There is a tendency to blame the victim.
    A person who has been abused repeatedly is sometimes mistaken as someone who has a "weak character."

    Because of their chronic victimization, in the past, survivors have been misdiagnosed by mental-health providers as having Borderline, Dependent, or Masochistic Personality Disorder. When survivors are faulted for the symptoms they experience as a result of victimization, they are being unjustly blamed.

    Researchers hope that a new diagnosis will prevent clinicians, the public, and those who suffer from trauma from mistakenly blaming survivors for their symptoms.

    Summary

    The current PTSD diagnosis often does not capture the severe psychological harm that occurs with prolonged, repeated trauma. For example, long-term trauma may impact a healthy person's self-concept and adaptation. The symptoms of such prolonged trauma have been mistaken for character weakness. Research is currently underway to determine if the Complex PTSD diagnosis is the best way to categorize the symptoms of patients who have suffered prolonged trauma.

    AXIS I: MAJOR PSYCHIATRIC ILLNESSES, INCLUDING SUBSTANCE ABUSE.

    AXIS II: PERSONALITY DISORDERS/FEATURES

    AXIS III: PHYSICAL PROBLEMS (MEDICAL DIAGNOSIS-AS OPPOSED TO A PSYCH DIAGNOSIS)

    AXIS IV: PSYCHOSOCIAL STRESSORS (homeless, unemployment, marital conflict, etc.)

    AXIS V: 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. (0 is a drooling brain dead person, 100 is a perfectly functioning individual.)

    Re: Axis I-V Explanation

    Axis I: Clinical Disorders and Syndromes or other conditions that may be the focus of clinical attention (in other words any future disorders under study or yet to be named)

    Axis II: Personality Disorders, Developmental Disorders, and Mental Retardation.

    Axis III: Medical Conditions that influence or exacerbate your mental problems.

    Axis IV: Psychosocial and Environmental Problems.

    Axis V: Global Assessment of Functioning.

    Your Axis V of 65 means: 61-70 shows: Some mild symptoms (e.g, depressed mood and mild insomnia) OR Some difficulty in occupational, social or school functioning (e.g.,occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships (p.32 DSM-IV).

    http://p203.ezboard.com/fvetbenefitsfrm143.showMessage?topicID=33.topic

    Filing A Claim with the VA-What To Do

    If you do the following you will have a better than average chance of winning your claim.

    A. General Filing Information

    1. Gather All Military, Private and VA Medical Records

    http://p203.ezboard.com/fvetbenefitsfrm143.showMessage?topicID=33.topic


    ------------------------------------------------------------------------
    PTSD CLAIMS======{ FAQ }

    The claims process can be difficult for some. When you bring the illness of PTSD into the mix it can be especially difficult. The illness effects your mental ability to handle certain situations.

    All of the pinned upped material previously here is included at the bottom of the page and is also located in the PTSD archives. If anyone has any comments or questions about additions that can me made here, please send me a message.


    I. - What is PTSD
    II. - should I file a claim
    III.- whats the next step?
    IV.- Proof of claim
    V. - PTSD Treatment
    VI.- Treatment and claims
    VII.- Alcohol and drug abuse
    VIII.- Compensation and pension exam.
    IX.- Copy of C&P exams.
    X. - How to read C&P exam
    XI.- GAF and Axis
    XII.- Timetable for claims
    XIII.- Compensation table.
    XIV.- Appealing a disappointing claim.
    XV.- Summary and links.
    ---------------------------------------------------------

    I. But what is PTSD? (POST TRAUMATIC STRESS DISORDER)

    There is a short answer to this question, but people who suffer from it may be able to write novels to answer this question.

    -----------------------------------------------------------------------
    Quote:
    When an individual who has been exposed to a traumatic event develops anxiety symptoms, re-experiencing of the event, and avoidance of stimuli related to the event lasting more than four weeks, they may be suffering from this Anxiety Disorder.
    ------------------------------------------------------------------------

    Truth be known, individuals may respond different to stressors, especially on the battlefield. Some show immediate reactions to trauma and some may take years to show it.

    There is the story of the WWII veteran who became suddenly unable to function in life after seeing the movie "Saving Private Ryan".
    --------------------------------------------------------

    II. I believe I have PTSD, should I file a claim?

    The answer is yes, but there are some things to be aware of when filing a claim. The first thing to do is to get a service representative to help you through the process. VFW, AMVETS, DAV, and VVA are examples of service organizations that can help you through the process. They don't charge you money and are very knowledgeable about the claims process.
    ---------------------------------------------------------

    III. Whats next?

    There is 1 major thing that you need in order to get a PTSD claim approved. This is a diagnosis of Post Traumatic stress disorder from a medical professional. The diagnosis can come from a private physician or from a VA physician.

    Your service officer can help you to make a decision to file the claim before receiving an official diagnosis or after receiving a diagnosis. One reason to file before receiving a diagnosis is that claims are granted from the date you file the claim. any monetary award will be paid retroactively from the date of file. I would suggest that if you truly believe you have PTSD and and are certain to receive a diagnosis of the illness, go ahead and file for PTSD.

    A warning would be that it is more difficult to re-open your claim if denied. It does not matter how many people believe you have PTSD, a diagnosis from a medical professional is the only thing the VA accepts as proof of illness. Again, ask the opinion of your service representative.

    When filing a claim the VA will ask for any or all medical evidence regarding you in-service health and health after leaving the military. This includes any medical treatment from private physicians, military physicians, or VA treatment centers. Your service officer will give you a form to fill out that will ask you for all the doctors you have seen. The VA will take care of requesting the information from these physicians. But, it may be important for you to have copies of these documents just in case any information is not received by the VA.

    Helpful information on how to get your medical records from various physicians. remember the important reason to get a service rep. is so you would not have to do all of this work by yourself. It is simply much easier to use a service representative.

    www.kfvn.com/ptsd/chapter10.htm

    ---------------------------------------------------------

    IV. What evidence do I need to prove my claim?

    The second most important thing to get your PTSD claim approved is to prove the stressor occurred. The first thing to do is to get copies of you military records if you do not have it already.

    VA for SF-180 is a form that requests medical records. Your service officer may already have this form. If not you may download the form from here:

    www.vba.va.gov/pubs/otherforms.htm

    Information on how to fill out the form can be seen here:

    www.kfvn.com/ptsd/chapter11.htm

    This is the mailing address on where to send the form:

    National Personnel Records Center
    14 (Military Personnel Records)
    9700 page Boulevard
    St. Louis, Mo 63132

    Other evidence to support your claim would be:

    military decorations:

    Purple Heart, CIB, CAR and Valor Medals can be helpful but are certainly not needed.

    Incident reports:

    These are reports of the incident that you have filed for. they can be included in unit logs as well. If you believe there may be evidence that a record of the incident exists your service officer may be able to help you locate these records. If you wish to find them here is some info on this:

    members.aol.com/vetcenter1/untrcrds.htm

    Incident reports will help you provide further evidence for your claim.

    Buddy letters and stressor letters

    Buddy letters are highly regarded among raters. If you know of someone you served with that may have been there with you and witnessed the same thing you did, a simple note from him or her would be great. Just ask the person to include the incident as he or she remembers it in the note.

    If you can't find a buddy do not spend too much money trying to find them on investigative searches. some of these sites are leaches.

    Letters from family and friends, co-workers or ex co-workers describing hop the illness has affected you is also very helpful. You may even ask you psychiatrist or psychologist for a letter describing how your PTSD is affecting your ability to work and act socially. All the evidence you are gathering just strengthens your case.

    A stressor letter is something you will be asked to write during the evidence gathering process. Your service representative may help you with this. the letter will, however be written by you. I know it may be painful to put down in words what happened. I may also take you a while to write it.

    A stressor letter is one that gets included with you claim that explains in your own words what happened. date, times, location and unit should be included in this letter as well.

    here is an example of a stressor letter for your own peace of mind:

    www.kfvn.com/ptsd/ptsdima...ircav1.jpg
    page 1

    www.kfvn.com/ptsd/ptsdima...ircav2.jpg
    page 2

    If your stressor is well known, you may want to include news reports or articles concerning the incident. all this evidence is helpful.
    ----------------------------------------------------------
    V. Medically speaking, how should I be treated?

    During the process of gathering evidence you should start or continue to be treated at a VA facility or a private physician for your PTSD. Remember, you need that diagnosis for your claim and possibly the medication to help you cope with your illness.

    below is a list of medications used to treat your illness. PTSD affects everyone in different ways and there are many symptoms that affect us. Your physician may choose to provide medication to you. Make sure you are incredibly honest with your physician about your problems. don't hold back, because honesty is the best policy.

    always updated list of medications for PTSD and symptoms.

    www.ptsdsupport.net/pills.html

    Also, medications are strong. They may affect you in ways that you might not like. You and your doctor should work together so you are receiving the best treatment for you. In the beginning it will be trial and error with medication. You are really in control of your own treatment. The honesty with your physician is important because he needs to know that you want to try to feel as good as possible with what you are experiencing. No matter what horror stories you may have hear, most physicians are really willing to work for what's best for YOU.
    -------------------------------------------------------
    VI. What does my treatment have to do with my claim?

    Your health is the basis for your rating. By now you are in the process of gathering all your evidence. You will be confident that you have proved your stressor and are now being treated for it. You have been honest with your physician and controlling your own health-care.

    Now is the best time to check out the Code of Federal Regulations as it regards to PTSD.

    ecfr.gpoaccess.gov/cgi/t/...77&idno=38

    9440 Chronic adjustment disorder

    General Rating Formula for Mental Disorders:

    Total occupational and social impairment, due to 100
    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.......................


    Occupational and social impairment, with 70
    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 work-like
    setting); inability to establish and maintain
    effective relationships...........................
  15. rainvet

    rainvet New Member

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    Ptsd Occupational and social impairment

    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:
    ------------------------------------------------------------------------
    Quote:
    If you are unable to work due to your service connected PTSD or mental disorder you will be granted 100% SC disability
    -------------------------------------------------------------------------
    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.


    ---------------------------------------------------------
    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%.
    ---------------------------------------------------------

    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

    ---------------------------------------------------------
    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.
    ----------------------------------------------------------
    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.
    ---------------------------------------------------------
    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.
    ==================-=======================------==========
  16. rainvet

    rainvet New Member

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    Ptsd Occupational and social impairment

    XII. I filed the claim, received my C&P and the report. How long do I have to wait before I receive my decision?

    This, as always, depends on the backlog of cases at your regional VA office. The rule of thumb ,I say, is 3-6 months after your C&P exam if and only if the rating board has all the information they need. But remember, especially with PTSD, that it may take longer to hear a reply. Always keep in contact with your service rep for any updates.
    ---------------------------------------------------------
    XIII. I received my decision and it was favorable. How much do i get?

    compensation rate tables.

    www.vba.va.gov/bln/21/Rates/comp01.htm

    members.tripod.com/MrMrsSarge/PTSD.html
    ---------------------------------------------------------
    XIV. I got denied or i did not get the rating i expected, What do I do?

    IF YOU LOSE: APPEAL

    If the VA Regional Office says your disability is not service-connected or if the percentage of disability is lower than what you think is fair, you have the right to appeal to the Board of Veterans' Appeals.

    The first step in appealing is to send the VA Regional Office a "Notice of Disagreement." This Notice is a letter saying that you "disagree" with the denial. Be sure to include in your letter the date of the VA's denial letter and be sure to list the benefits you are still seeking.

    Deadline: The Notice of Disagreement must be mailed to the VA Regional Office within one year of the denial of your claim or you cannot appeal. (You still can reopen your claim if you miss this deadline but you lose an earlier "effective date" for an award of back benefits.)

    If you win, one issue which you should examine carefully with your representative is whether the VA has set the correct effective date for your award. If you think an earlier effective date is appropriate, you can file a Notice of Disagreement on that issue. More help is available in IF YOU LOSE: APPEAL
    If the VA Regional Office says your disability is not service-connected or if the percentage of disability is lower than what you think is fair, you have the right to appeal to the Board of Veterans' Appeals.

    The first step in appealing is to send the VA Regional Office a "Notice of Disagreement." This Notice is a letter saying that you "disagree" with the denial. Be sure to include in your letter the date of the VA's denial letter and be sure to list the benefits you are still seeking.

    Deadline: The Notice of Disagreement must be mailed to the VA Regional Office within one year of the denial of your claim or you cannot appeal. (You still can reopen your claim if you miss this deadline but you lose an earlier "effective date" for an award of back benefits.)

    If you win, one issue which you should examine carefully with your representative is whether the VA has set the correct effective date for your award. If you think an earlier effective date is appropriate, you can file a Notice of Disagreement on that issue. More help is available in www.vva.org/Benefits/vvgvaclaims.htm
    -----------------------------------------------------------
    Here is a basic explanation on what the numbers actually mean:

    GAF

    100-91
    Superior functioning in a wide range of activities. Life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms.

    90-81

    Absent or minimum symptoms (e.g. mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns ("e.g.. an occasional argument with family members)

    80-71

    If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g temporarily falling behind in schoolwork).

    70-61

    Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.

    60-51

    Moderate symptoms (e.g.. flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

    50-41

    Serious symptoms(e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).

    40-31

    Some impairment in reality testing or communication (e.g... speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g depressed man avoids friends, neglects family, and is unable to work: child frequently beats up younger children. Is defiant at home, and is failing at school).

    30-21

    Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communications or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas. (e.g. stays in bed all day; no job, home, or friends).

    20-11

    Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death, frequency violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g smears feces) OR gross impairment in communication (e.g. largely incoherent or mute.)

    10-0

    Persistent danger of severely hurting self or others. (e.g. recurrent violence) OR recurrent inability to maintain minimal personal hygiene OR Serious suicidal act with clear expectation of death.
  17. rainvet

    rainvet New Member

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    Initial Evaluation for Post-Traumatic (PTSD)

    Initial Evaluation for Post-Traumatic Stress Disorder (PTSD)
    # 0910 Worksheet

    Name: SSN:
    Date of Exam: C-number:
    Place of Exam:


    A. Identifying Information:
    age
    ethnic background
    era of military service
    reason for referral (original exam to establish PTSD diagnosis and related psychosocial impairment; re-evaluation of status of existing service-connected PTSD condition)
    B. Sources of Information:
    records reviewed (C-file, DD-214, medical records, other documentation)
    review of social-industrial survey completed by social worker
    statements from collaterals
    administration of psychometric tests and questionnaires (identify here)
    C. Review of Medical Records:
    Past Medical History:
    Previous hospitalizations and outpatient care.
    Complete medical history is required, including history since discharge from military service.
    Review of Claims Folder is required on initial exams to establish or rule out the diagnosis.
    Present Medical History - over the past one year.
    Frequency, severity and duration of medical and psychiatric symptoms.
    Length of remissions, to include capacity for adjustment during periods of remissions.
    D. Examination (Objective Findings):
    Address each of the following and fully describe:
    History (Subjective Complaints):
    Comment on:
    Premilitary History (refer to social-industrial survey if completed)
    describe family structure and environment where raised (identify constellation of family members and quality of relationships)
    quality of peer relationships and social adjustment (e.g., activities, achievements, athletic and/or extracurricular involvement, sexual involvements, etc.)
    education obtained and performance in school · employment
    legal infractions
    delinquency or behavior conduct disturbances
    substance use patterns
    significant medical problems and treatments obtained
    family psychiatric history
    exposure to traumatic stressors (see CAPS trauma assessment checklist)
    summary assessment of psychosocial adjustment and progression through developmental milestones (performance in employment or schooling, routine responsibilities of self-care, family role functioning, physical health, social/interpersonal relationships, recreation/leisure pursuits).
    Military History
    branch of service (enlisted or drafted)
    dates of service
    dates and location of war zone duty and number of months stationed in war zone
    Military Occupational Specialty (describe nature and duration of job(s) in war zone
    highest rank obtained during service (rank at discharge if different)
    type of discharge from military
    describe routine combat stressors veterans was exposed to (refer to Combat Scale)
    combat wounds sustained (describe)
    clearly describe specific stressor event(s) veteran considered particularly traumatic. Clearly describe the stressor. Particularly if the stressor is a type of personal assault, including sexual assault, provide information, with examples, if possible.
    indicate overall level of traumatic stress exposure (high, moderate, low) based on frequency and severity of incident exposure (refer to trauma assessment scale scores described in Appendix B).
    citations or medals received
    disciplinary infractions or other adjustment problems during military
    NOTE: Service connection for post-traumatic stress disorder (PTSD) requires medical evidence establishing a diagnosis of the condition that conforms to the diagnostic criteria of DSM-IV, 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 traumatic stressor leading to PTSD, if he or she makes the diagnosis of PTSD. Crucial in this description are specific details of the stressor, with names, dates, and places linked to the stressor, so that the rating specialist can 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 examination 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 is normal.
    Post-Military Trauma History (refer to social-industrial survey if completed)
    describe post-military traumatic events (see CAPS trauma assessment checklist)
    describe psychosocial consequences of post-military trauma exposure(s) (treatment received, disruption to work, adverse health consequences)
    Post-Military Psychosocial Adjustment (refer to social-industrial survey if completed) · legal history (DWIs, arrests, time spent in jail)
    educational accomplishment
    employment history (describe periods of employment and reasons)
    marital and family relationships (including quality of relationships with children)
    degree and quality of social relationships
    activities and leisure pursuits
    problematic substance abuse (lifetime and current)
    significant medical disorders (resulting pain or disability; current medications)
    treatment history for significant medical conditions, including hospitalizations
    history of inpatient and/or outpatient psychiatric care (dates and conditions treated)
    history of assaultiveness
    history of suicide attempts
    summary statement of current psychosocial functional status (performance in employment or schooling, routine responsibilities of self care, family role functioning, physical health, social/interpersonal relationships, recreation/leisure pursuits)
    E. Mental Status Examination
    Conduct a brief mental status examination aimed at screening for DSM-IV mental disorders. Describe and fully explain the existence, frequency and extent of the following signs and symptoms, or any others present, and relate how they interfere with employment and social functioning:
    Impairment of thought process or communication.
    Delusions, hallucinations and their persistence.
    Eye Contact, interaction in session, and inappropriate behavior cited with examples.
    Suicidal or homicidal thoughts, ideations or plans or intent.
    Ability to maintain minimal personal hygiene and other basic activities of daily living.
    Orientation to person, place and time.
    Memory loss, or impairment (both short and long-term).
    Obsessive or ritualistic behavior which interferes with routine activities and describe any found.
    Rate and flow of speech and note any irrelevant, illogical, or obscure speech patterns and whether constant or intermittent.
    Panic attacks noting the severity, duration, frequency and effect on independent functioning and whether clinically observed or good evidence of prior clinical or equivalent observation is shown.
    Depression, depressed mood or anxiety.
    Impaired impulse control and its effect on motivation or mood.
    Sleep impairment and describe extent it interferes with daytime activities.
    Other disorders or symptoms and the extent they interfere with activities, particularly:
    mood disorders (especially major depression and dysthymia)
    substance use disorders (especially alcohol use disorders)
    anxiety disorders (especially panic disorder, obsessive-compulsive disorder, generalized anxiety disorder)
    somatoform disorders
    personality disorders (especially antisocial personality disorder and borderline personality disorder)
    Specify onset and duration of symptoms as acute, chronic, or with delayed onset.
    F. Assessment of PTSD
    state whether or not the veteran meets the DSM-IV stressor criterion
    identify behavioral, cognitive, social, affective, or somatic change veteran attributes to stress exposure
    describe specific PTSD symptoms present (symptoms of trauma re-experiencing, avoidance/numbing, heightened physiological arousal, and associated features [e.g., disillusionment and demoralization])
    specify onset, duration, typical frequency, and severity of symptoms
    G. Psychometric Testing Results
    provide psychological testing if deemed necessary
    provide specific evaluation information required by the rating board or on a BVA Remand.
    comment on validity of psychological test results
    provide scores for PTSD psychometric assessments administered
    state whether PTSD psychometric measures are consistent or inconsistent with a diagnosis of PTSD, based on normative data and established "cutting scores" (cutting scores that are consistent with or supportive of a PTSD diagnosis are as follows: PCL > 50; Mississippi Scale > 107; MMPI PTSD subscale a score > 28; MMPI code type: 2-8 or 2-7-8)
    state degree of severity of PTSD symptoms based on psychometric data (mild, moderate, or severe)
    describe findings from psychological tests measuring problems other than PTSD (MMPI, etc.)
    H. Diagnosis:
    The Diagnosis must conform to DSM-IV and be supported by the findings on the examination report.
    If there are multiple mental disorders, delineate to the extent possible the symptoms associated with each and a discussion of relationship.
    Evaluation is based on the effects of the signs and symptoms on occupational and social functioning.
    NOTE: VA is prohibited by statute, 38 U.S.C. 1110, from paying compensation for a disability that is a result of the veteran's own ALCOHOL OR DRUG ABUSE. However, when a veteran's alcohol or drug abuse disability is secondary to or is caused or aggravated by a primary service-connected disorder, the veteran may be entitled to compensation. See Allen v. Principi, 237 F.3d 1368, 1381 (Fed. Cir. 2001). Therefore, it is important to determine the relationship, if any, between a service-connected disorder and a disability resulting from the veteran's alcohol or drug abuse. Unless alcohol or drug abuse is secondary to or is caused or aggravated by another mental disorder, you should 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 in such cases, please explain why.
    I. Diagnostic Status
    Axis I disorders
    Axis II disorders
    Axis III disorders
    Axis IV (psychosocial and environmental problems)
    Axis V (GAF score - current)
    J. 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. A BVA REMAND may also request, in addition to an overall GAF score, that a separate GAF score be provided for each mental disorder present when there are multiple Axis I or Axis II diagnoses and not all are service-connected. If separate GAF scores can be given, an explanation and discussion of the rationale is needed. If it is not possible, an explanation as to why not is needed. (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.)

    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.
    K. Capacity to Manage Financial Affairs: Mental competency, for VA benefits purposes, refers only to the ability of the veteran to manage VA benefit payments in his or her own best interest, and not to any other subject. Mental incompetency, for VA benefits purposes, means that the veteran, because of injury or disease, is not capable of managing benefit payments in his or her best interest. In order to assist raters in making a legal determination as to competency, please address the following:
    What is the impact of injury or disease on the veteran's ability to manage his or her financial affairs, including consideration of such things as knowing the amount of his or her VA benefit payment, knowing the amounts and types of bills owed monthly, and handling the payment prudently? Does the veteran handle the money and pay the bills himself or herself?

    Based on your examination, do you believe that the veteran is capable of managing his or her financial affairs? Please provide examples to support your conclusion.

    If you believe a Social Work Service assessment is needed before you can give your opinion on the veteran's ability to manage his or her financial affairs, please explain why.
    L. Other Opinion: Furnish any other specific opinion requested by the rating board or BVA remand (furnish 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. M. Integrated Summary and Conclusions
    Describe changes in psychosocial functional status and quality of life following trauma exposure (performance in employment or schooling, routine responsibilities of self care, family role functioning, physical health, social/interpersonal relationships, recreation/leisure pursuits)
    Describe linkage between PTSD symptoms and aforementioned changes in impairment in functional status and quality of life. Particularly in cases where a veteran is unemployed, specific details about the effects of PTSD and its symptoms on employment are especially important.
    If possible, describe extent to which disorders other than PTSD (e.g., substance use disorders) are independently responsible for impairment in psychosocial adjustment and quality of life. If this is not possible, explain why (e.g., substance use had onset after PTSD and clearly is a means of coping with PTSD symptoms).
    If possible, describe pre-trauma risk factors or characteristics than may have rendered the veteran vulnerable to developing PTSD subsequent to trauma exposure.
    If possible, state prognosis for improvement of psychiatric condition and impairments in functional status.
    Comment on whether veteran is capable of managing his or her financial affairs.
    Signature: Date:

    Original located at: http://www.vba.va.gov/bln/21/Benefits/exams/disexm43.htm

    The PTSD Help Network VA Compensation
    http://ptsdhelp.net/id9.html
  18. jcdanner

    jcdanner New Member

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    I am in the process of filing for PTSD and Tinnits I dont know if I am doing this right or not
  19. rainvet

    rainvet New Member

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    jcdanner, can you expand on your post about not knowing if you are doing the right thing. I come and go but will watch for your respond and then I maybe of some uses to you. GOD Bless you and thanks for your service, I'm 100% Ptsd and have been service connected for if since 1970 ! RainVet!
  20. Walter H Adkins

    Walter H Adkins New Member

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