Generalized Anxiety disorder

tidus955

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Hey I am in the Air Force and was an air crew member for 6 years before I had an anxiety attack on a flight preparing me for instructor school. About a year of trying different medications to make it better the military has decided im not suited to fly anymore. After having a phyc test It looks like I will be diagnosed with generalized anxiety disorder social anxiety disorder and Schizoid personality disorder. I looked over the Vsrad and feel I fit under the 30% but I dont know if they will try to hit me with it being pre existing even though I have never had any anxiety attacks in my past. The social anxiety was mainly pre existing but never really effected me. I have been told the schizoid personality disorder is not being mentioned to being the root cause. Any idea how this will go down for me. My leadership only thinks im trying to get myself out of the military with a lump sum which seems to be effecting my work conditions.
 

scoutCC

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First, they'd have to show that the condition clearly pre-existed service. This is very difficult if not noted on your entrance physical and no treatment for it pre-service.

Second, they'd have to show that the condition was not aggravated by service.

Both things have to be proven by the military before they can say it was EPTS and not compensate you. That's not to say they won't make a mistake and you'll have to point out to them they're doing it wrong, but its a pretty high standard they have to meet and likely you'll prevail in the end. Even if they decide it was EPTS, they have to judge at what level it was before service and then compensate you for the increase.
 

tidus955

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Ok I just got to review my NARSUM that will be sent to the board. It looks the I am getting put as unspecified anxiety disorder because I fit criteria for 5 different disorders. It sounds like it is mentioning a lot of the facts that I had social anxiety as a kid and didn't do well working in groups which is true but I never had a diagnosis while I was younger. It does state that I didn't start having panic attacks until I about a year ago when I started the process of becoming an instructor for my job. Will they be able to pin this as being pre existing do to my previous issues? While it does say I had issues through the military process like basic training and tech school I passed everything to becoming an aircrew member and had 9 deployments without any issues.
 

scoutCC

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I think it'd be fair to say it wasn't disabling before the military, that the military aggravated it and that created the current disability picture. What you have said seems to clearly paints that picture, I don't think they will consider it EPTS.

I will put a note however. If the info wasn't pertinent, why would the doc know about it? Either you answered one of his questions with the info, so it was pertinent, or you have medical records about it, which definitely makes it pertinent. I think sometimes when they make a wrong determination about EPTS people make the mistake of trying to bury that information. There's nothing wrong with saying, yes, I had some minor anxiety as a kid, but it wasn't disabling by any means. Then after this event and this event and these others, well, that severely aggravated my anxiety, and now it is disabling. Service aggravation is just as valid as service caused.
 

tidus955

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One more questions. When it comes to medication I tried many different medications for this issue with no effect from any of them. Currently I am a use as needed medication which doesn't really do anything either. Would the VA take this as not needing medication even though there is none that works. Basically Medication would make my life much easier but currently nothing works. I don't want to get a lower rating cause my condition basically cant be rectified with medicine.
 

Freightliner6

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I believe I was given 70% (after a sneak peek of my 199) for my MH conditions, I refilled my meds even if they didnt work until they gave my something that actually helps. To my knowledge, if you aren't taking meds or dont need them it may lower your rating because they assume your condition isn't severe enough and you're able to function without it.
 

tidus955

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well the VA is trying to screw me. My C&P results they are taking all my issues and throwing them under my schizoid personality disorder. Anyway to fight this before it goes to the board for ratings.


LOCAL TITLE: WI-C&P

STANDARD TITLE: C & P EXAMINATION NOTE

DATE OF NOTE: JUL 22, [email protected]:00 ENTRY DATE: AUG 02, [email protected]:39:40

AUTHOR: ALEXANDER,SHIRLEY EXP COSIGNER:

URGENCY: STATUS: COMPLETED

Mental Disorders (other than PTSD and Eating Disorders)

Disability Benefits Questionnaire

Name of patient/Veteran: BOWDICH, STEVEN JAMES

SECTION I:

----------

1. Diagnosis

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

a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)?

[X] Yes[ ] No

If the Veteran currently has one or more mental disorders that conform to DSM-5 criteria, provide all diagnoses:

Mental Disorder Diagnosis #1: Schizoid Personality Disorder

ICD code: 301.20

Comments, if any:

The SM described a lifelong history of symptoms that meet DSM 5 criteria for Schizoid Personality Disorder. This personality disorder, per DSM 5, is "a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in

interpersonal settings, beginning by early adulthood, and present in a variety of contexts..."

He has never desired nor enjoyed close social relationships, has almost always chosen solitary activities, has been detached from others and had difficulty experiencing pleasure in activities
since his early childhood. As a result, he has struggled with anxiety/adjustment issues whenever he has been forced to interact with other people and unable to

BOWDICH, STEVEN JAMESCONFIDENTIALPage 23 of 157

avoid such situations as would be his usual preference, and he has especially had anxiety with increasing rank and leadership roles since this has meant increased social interactions which is something he has never been interested in, nor comfortable with, and has always avoided
as much as all possible. In such a situation while in a mid-air exercise last year, being questioned by instructors, he had an anxiety attack and "froze up," and that incident led him
to mental health evaluation/treatment on base. His current situation with pending MEB
and unknown future (job, financial security) appears to be causing most of the anxiety that he reports today and is also causing a little depression; these symptoms should resolve once
he is out of service and back to his usual routine where he is better able to control any social interactions, and are thus not considered by this examiner as a separate diagnosis (such as an adjustment disorder, unspecified anxiety disorder, or GAD) but rather to be expected as part of
Schizoid Personality Disorder under such stressful circumstances (in a personality disorder, the individual manifests difficulties with cognitive patterns, emotional responses, interpersonal unctioning, and sometimes impulse control, problems which lead to significant distress and/or impairment in psychosocial and occupational functioning). If this SM's anxiety should persist beyond the transitional period back to civilian life and further interfere with his psychosocial or occupational functioning, he should be reevaluated for the possibility of a comorbid major psychiatric disorder. The SM reported having had some counseling in middle school for behavioral problems which he said became an issue after his parents divorced. SM also said that someone had suggested to his parents that

BOWDICH, STEVEN JAMESCONFIDENTIALPage 24 of 157

he might have an autism spectrum disorder (Asperger's), which was also suggested by base mental health professionals and should be considered in the differential diagnosis, since he reports features today (and noted in treatment records) that are consistent with Asperger's;
however, it should be noted that this is beyond the scope of today's exam and requires more developmental history which is not known at this point, and even if this were to be formally
diagnosed, it would be considered a pre-existing condition, the same as Schizoid Personality
Disorder. He denies any further psychiatric treatment beyond adolescence until the mid-air anxiety attack last year when there was too much social interaction and other things going on while he was trying to focus on his job in what he says was a dangerous situation.

After that incident, he saw a therapist on base until the recent past; he also had psych testing done, the results of which were consistent with Schizoid Personality Disorder and also showed anxiety symptoms which would be expected whenever he is stressed since personality disorders tend to be pervasive and maladaptive patterns which lead to
 

chaplaincharlie

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What are the credentials of your VA examiner? In every career field/vocation there is a pecking order. Psychiatrist are at the top of the pecking order in the mental health field. I'd suggest you finding a psychiatrist with a different opinion and request the VA reconsider their decision.
 

tidus955

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Field: Primary Care
Board Certifications: Family Nurse Practitioner
Education: MSN, WICHITA STATE UNIVERSITY
Licensed In: Kansas
Provider Type: Nurse Practitioner
Gender: Female
Location: Robert J. Dole Department of Veterans Affairs Medical and Regional Office Center
5500 E. Kellogg
Wichita, KS 67218
316-685-2221

is there any details would anyone trump this. I don't know much about these degrees What should I look for. I am tired of getting screwed by the military in every way possible. I was a boom operator for 6 years before all these incidents. These is a job with very stringent requirements in the Air Force. I had never had an anxiety attack before I joined the military nor really any depression. The documents say I will be back to normal basically once I am out but right now I basically am doing a job that has nothing to do with the military. I work at our outdoor rec doing various basic tasks which I still am having problems and anxiety attacks with. My depression is through the roof now as I really don't trust anyone anymore. my top secret clearance is being taken away even though I have never had an incident and its states I should not have access to weapons in my records. I am not trying to deny that I had social issues before joining but I was generally happy and never had a single panic attack. But the fact they are lumping it all under schizoid personality disorder is just a way to screw me. Id given up all my hope in my future because of this as I really don't know who to go to.
 

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tidus955

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I am still in the MEB process. I checked the site myheaslthevet to get this information early. SO I havent actually went in for anything yet and still in the waiting process. I am going to talk to my peblo about it Monday to see what they say are my options. I also want to look into a lawyer but I have no idea where to go. I cant really find anything using a google. I think they are technically following the guidelines. The person at our mental health diagnosed me with unspecified anxiety disorder and schizoid personality disorder. She said the personality disorder was secondary to the anxiety disorder and the main cause of the issues was the anxiety disorder. Its the VA that just decided to say that I do not have any anxiety disorder but that it all fall under the personality disorder. are they not following the rules by this as they have told me I have it already and was diagnosed by a physicist. I just think they are trying to save themselves some money. They didn't take into account how I was fine until the last couple years at all and just focused on that I was a social hermit before I joined. Also this isnt the first time they tried screwing me. They tried to force me to volunteer separate before the MEB started. I will be getting legal council but I do feel ill just get stabbed in the back with them as well. Get nothing done or any help but get a large bill.
 
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tidus955

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Now I didn't post the whole thing on here but reading more into it states that all these problems should resolve themselves once im out of the military and that if they persist to be re evaluated for comorbid major psychiatric disorder. I basically am not in military as far as im concerned right now . I work on the other side of the base no longer wear my uniform and do menial tasks to help our outdoor rec. The issues continue to persist even when not around people. Is there anyway to latch onto the statement be re evaluated for comorbid major psychiatric disorder and get it changed.
 

tidus955

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ok well I talk to the VA rep at my base. He said that the personality disorder is rate able based on a small note in the VASRD. it is the note 3.310(a) in this paragraph.

Intellectual disability (intellectual developmental disorder) and personality disorders are not diseases or injuries for compensation purposes, and, except as provided in §3.310(a) of this chapter, disability resulting from them may not be service-connected. However, disability resulting from a mental disorder that is superimposed upon intellectual disability (intellectual developmental disorder) or a personality disorder may be service-connected.


the not is refrenceing this

§3.310 Disabilities that are proximately due to, or aggravated by, service-connected disease

or injury.


(a) General. Except as provided in §3.300(c), disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition

The note 3.300 is just a refrence to tobacco use. Does that mean the schizoid personalty disorder will be rate able even though the VA removed the unspecified anxiety disorder.
 

chaplaincharlie

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Your C&P examiner was a nurse practitioner. If you can get a different opinion from a psychiatrist you can refute the PD finding.
 

scoutCC

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Intellectual disability or personality disorder are not ratable, by definition they are pre-existing service. A mental disorder that is superimposed, basically meaning tied up into the non-ratable problem in a way that can't be separated, can still be rated. The primary point being they need to identify something that is new. This is not the same thing as rating a personality disorder, its only saying that a personality disorder doesn't stop all MH conditions from being rated.

They are saying your personality is prone to these panic attacks, and basically always has been. He's not ruling out that you might have an anxiety disorder, if you continue to have problems he sees that as a ratable comorbid condition, or superimposed. Comorbid and superimposed are essentially the same thing. He just doesn't see the evidence for the anxiety disorder yet.

Making sure the proper process is followed, the ones Jason linked, is hugely important. I maintain this is a shady direction for the examiner to go and you will likely prevail in the end, but you need to argue against the personality disorder, or at a minimum argue that you have an additional condition that is at issue. Why, if this is pre-existing did it only show up as a problem 6 years after being in the military?
 

tony292

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Here is what you need to understand. The stuff you posted was a CP exam note. What you need to see is the entire mental health DBQ, that will give you a picture of your ultimate ratings.

Link to DBQ: http://www.vba.va.gov/pubs/forms/VBA-21-0960P-2-ARE.pdf

I highly recommend you study the DBQ and information below, and try and write down how you feel in comparison to all of these things. Then go to a psychiatrist and ask them to assess you and fill out the DBQ.

What it all means for ratings:

0%
A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication

10%
Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or;
symptoms controlled by continuous medication

30%
Occupational and social impairment with occasional 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)

50%
Occupational and social impairment with reduced 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

70%
Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as:
suicidal ideation
obsessional rituals, which interfere with routine activities
speech intermittently illogical, obscure, or irrelevant
near-continuous panic or depression affecting the ability to function independently, appropriately and effectively
impaired impulse control (such as unprovoked irritability with periods of violence)
spatial disorientation
neglect of personal appearance and hygiene
difficulty in adapting to stressful circumstances (including work or a worklike setting)
inability to establish and maintain effective relationships


100%
Total occupational and social impairment, due to such symptoms as:
gross impairment in thought processes or communication
persistent delusions or hallucinations
grossly inappropriate behavior
persistent danger of hurting self or others
intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene)
disorientation to time or place
memory loss for names of close relatives, own occupation, or own name
 

chaplaincharlie

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@tidus955

Two things are being told you:

1. The process of how to fight this.
2. That you need a second opinion from a psychiatrist that attributes your problem to something other than personality disorder or intellectual capacity.

If you want this to turn out in your favor you must move out on both points. Failure to do so will leave you without compensation!
 

tidus955

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im trying to get a second opinion but im being told I cant see someone off base. Is this something I will just have to go and pay out of pocket for and how will I get the military to accept this. I feel like this whole system is against me and I dont know who to trust. The VA rep says everything will work out and to wait for the ratings, the peblo just turns me away saying they cant help, and mental health tells me I need to talk to my PCM who I know will agree with the results. My PCM wouldn't even write a statement to get my security clearance back. I don't trust anyone on my base currently and I cant seem to get into contact with any lawyers who only seem to want to charge me to even talk with them.
 

chaplaincharlie

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Ask for a second opinion from a psychiatrist. On or off base, you can't control.
 

JMcj7202

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Tidus955 if you need a second opinion find any doctor covered by Tricare in your area. Tricare will cover it because you are active duty. I have had many issues where the doctors tell me I could not go out in town for treatment or second opinions, I did anyways and I no issues. The most I have had to do is maybe pay a co pay but I believe that was only for ER visits.
 
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