I will find out my initial ratings on Tuesday and I'm a complete wreck right now. My anxiety is through the roof and so is my depression. I don't even know my rating yet and but I'm already 'catastrophizing' about the worst case scenario in my head. For the last two hours, I have been pacing around my apartment complex ---barefoot--- trying to calm down. I have even had thoughts of suicide because of the stress. My only DOD ratable condition is my Anxiety Disorder and I have nothing to fall back on if they low ball me. This is not a good feeling.
I'm a total wreck (PEBLO told me that my ratings are in)
- Thread starter Swiper
- Start date
Hang in there, this is a tough process. You can call the Veteran's Crisis line (1-800-273-8255), they can help and they are confidential. It might not be a bad idea to stay with someone you trust, if possible until Tues. Let me know if I can help in any way. Just know that you are not alone right now. I'm overseas, but I'll try every thing I can to be here for you.
The first thing you have to do in this situation is sit down, take a deep breath (or 20), and try to clear your mind. While it is good to prepare for the worst, you must also think of the good in this situation, which is the very thing that is making you stressed. Your ratings are back, the good thing about this is that you no longer have to wait and anticipate. While there is a possibility that they may "low ball" you, there is also a possibility that they may be fair. In the case that they do "low ball" you, you have to remember that the rating is not set-in-stone, you have the right to appeal their decision and submit evidence along with a statement explaining why you feel that the rating you received was not justified.
If you feel as though you cannot get rid of your thoughts of suicide I recommend calling the military crisis line at 1-800-273-8255 (press 1) , or you can also text them at 838255. You're not alone!!!
If you feel as though you cannot get rid of your thoughts of suicide I recommend calling the military crisis line at 1-800-273-8255 (press 1) , or you can also text them at 838255. You're not alone!!!
First take a deep breath and relax. There are some things you can do to war game your likely status update on Tuesday. Sign up for Ebenefits and sign up for a premium account on myhealthevet. Then login to myhealthevet and use the blue button to view "VA notes".
Have you been told you have been found unfit? If the answer to that question is yes, then look at your mental health CP exam on myhealthevet and use the following VA criteria below to see what percentage you can expect.
VA mental health Rating criteria key wording:
Total occupational and social impairment, due to such symptoms as: gross impairment in thought process 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 …………………..100%
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 ...................................... 70%
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 ………………..50%
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) ............................ 30%
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 .................. 10%
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 .............................. 0%
Your mental health CP exam WILL have some of the above wording in it, guaranteed! This is a very strong indicator of what your rating will be.
There is life after the military and life after anxiety. I still struggle daily and will likely go inpatient next week to try and get help that I should have gotten a long time ago. If what you are doing now is not working, go to the nearest ER and tell them you are suicdial. It is better to get help now than to kick the can down the road. I'm forcing myself to go inpatient because I know if I don't, I may spiral even further than I already have, and may reach a point from where I won't return.
Have you been told you have been found unfit? If the answer to that question is yes, then look at your mental health CP exam on myhealthevet and use the following VA criteria below to see what percentage you can expect.
VA mental health Rating criteria key wording:
Total occupational and social impairment, due to such symptoms as: gross impairment in thought process 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 …………………..100%
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 ...................................... 70%
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 ………………..50%
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) ............................ 30%
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 .................. 10%
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 .............................. 0%
Your mental health CP exam WILL have some of the above wording in it, guaranteed! This is a very strong indicator of what your rating will be.
There is life after the military and life after anxiety. I still struggle daily and will likely go inpatient next week to try and get help that I should have gotten a long time ago. If what you are doing now is not working, go to the nearest ER and tell them you are suicdial. It is better to get help now than to kick the can down the road. I'm forcing myself to go inpatient because I know if I don't, I may spiral even further than I already have, and may reach a point from where I won't return.
Also make note of the fact that even if low balled this time around, you still have appeal and VARR rights. I was able to increase my MH rating from 50 to 70% by appealing and one example I pointed out was that I had told 6 different MH professionals about suicidal ideations in the last 2 years. I backed this up with the documentation. There were a few other things I pointed out that were in the 70% range but I think that is the one that sealed the deal.
Commander's Letter
Soldier has profound difficulties in performing tasks that requires planning, organization, time management, and sustained attention. All of which are essential traits need to perform his job. This dysfunction in his executive functions appears to be static with no noticable improvement over time. Soldier has problem with impulse control which has caused him to undertake actions that are not appropriate for the situation and has caused unwanted results. Soldier is easily overwhelmed by stressful situations and is prone to debilitating anxiety and panic attacks. In the last six months, he has had to be transported by ambulance to a local hospital due to severe panic attacks. Soldier's hightened sensitivity to bright lights and loud noises causes severe difficulties for him to function in most --- if not all --- office environments. Exposure to bright lights, flashing lights, florescent lights and loud or sudden noise causes sensory overload, deminished execuctive functions and hightened levels of anxiety. Soldier has reoccurring episodes of major depression that significantly impacts his abilities to perform his duties satisfactory or even practice appropriate self-care. During these periods he require increased supervision to ensure his health and welfare. Due to past traumatic events in his life and service, he avoids getting involved in meaningful social interactions with co-workers, family and friends.
Soldier does not perform duties in MOS: Currently assigned a light-duty position to provide support to a XXXX office -- Soldier not in appropriate TO&A or TDA position for grade and MOS: Soldier unable to function effectively in a postition suitable for his grade.--I do not recommend retaining this Soldier: His conditions prevents him from being available for worldwide deployment.
Soldier often comes across as unmotivated, apathetic and unaware when it comes to social interactions with his co-workers. He does not attempt to seek out social interaction with his superiors, peers or subordinates. He also avoids seeking assistance with tasks that he has difficulties in completing within the prescribed deadline. His poor abilities to relate to and work with others significantly impairs or precludes workplace interaction on most days.
Soldier has moderate difficulties in performing new and/or unfamiliar tasks/duties to standard. It is difficult for him to perform those tasks without close supervision even after receiving hands-on training, setting clear rules and objectives.
Soldier get anxious and very hesitant when making complex or unfamiliar decisions and he avoids making such decisions unless pressured into doing so. Traits which are cenrtainly not consumate with or expected of a Soldier of his rank and TIS.
Soldier has occasionally come across as rude and dismissive toward others due to his social impairments. He frequently fails to initiate or complete tasks given through the use of verbal instructions due to his inattentiveness, poor working memory and executive dysfunction.
Soldier's chronic insomnia and hightened sensitivities to light and sound causes more than a moderate interference with his abilities to perform his duties in a satisfactory manner. He has a hard time getting ready in the morning and getting to work in a timely manner. His sensitivites toward light and sound makes it profoundly difficult for him to satisfactory function in an office environment and he requires frequent breaks from his work to rest and lower his sensory overload.
Soldier has profound difficulties in performing tasks that requires planning, organization, time management, and sustained attention. All of which are essential traits need to perform his job. This dysfunction in his executive functions appears to be static with no noticable improvement over time. Soldier has problem with impulse control which has caused him to undertake actions that are not appropriate for the situation and has caused unwanted results. Soldier is easily overwhelmed by stressful situations and is prone to debilitating anxiety and panic attacks. In the last six months, he has had to be transported by ambulance to a local hospital due to severe panic attacks. Soldier's hightened sensitivity to bright lights and loud noises causes severe difficulties for him to function in most --- if not all --- office environments. Exposure to bright lights, flashing lights, florescent lights and loud or sudden noise causes sensory overload, deminished execuctive functions and hightened levels of anxiety. Soldier has reoccurring episodes of major depression that significantly impacts his abilities to perform his duties satisfactory or even practice appropriate self-care. During these periods he require increased supervision to ensure his health and welfare. Due to past traumatic events in his life and service, he avoids getting involved in meaningful social interactions with co-workers, family and friends.
Soldier does not perform duties in MOS: Currently assigned a light-duty position to provide support to a XXXX office -- Soldier not in appropriate TO&A or TDA position for grade and MOS: Soldier unable to function effectively in a postition suitable for his grade.--I do not recommend retaining this Soldier: His conditions prevents him from being available for worldwide deployment.
Soldier often comes across as unmotivated, apathetic and unaware when it comes to social interactions with his co-workers. He does not attempt to seek out social interaction with his superiors, peers or subordinates. He also avoids seeking assistance with tasks that he has difficulties in completing within the prescribed deadline. His poor abilities to relate to and work with others significantly impairs or precludes workplace interaction on most days.
Soldier has moderate difficulties in performing new and/or unfamiliar tasks/duties to standard. It is difficult for him to perform those tasks without close supervision even after receiving hands-on training, setting clear rules and objectives.
Soldier get anxious and very hesitant when making complex or unfamiliar decisions and he avoids making such decisions unless pressured into doing so. Traits which are cenrtainly not consumate with or expected of a Soldier of his rank and TIS.
Soldier has occasionally come across as rude and dismissive toward others due to his social impairments. He frequently fails to initiate or complete tasks given through the use of verbal instructions due to his inattentiveness, poor working memory and executive dysfunction.
Soldier's chronic insomnia and hightened sensitivities to light and sound causes more than a moderate interference with his abilities to perform his duties in a satisfactory manner. He has a hard time getting ready in the morning and getting to work in a timely manner. His sensitivites toward light and sound makes it profoundly difficult for him to satisfactory function in an office environment and he requires frequent breaks from his work to rest and lower his sensory overload.
NARSUM
1. Baseline Documentation 13 January 2016
a. Component: SFC/E7/USA
b. PMOS: 27D4L (Paralegal Specialist)
c. BASD: 1999
d. Reason for referral into the IDES: Anxiety disorder, NOS
2. Sources and References:
a. AHLTA: Per Section 3 below
b. DA 3349/Physical Profile: 14 October 2015 (Anxiety, Autism Spectrum d/o – P1U1L1H2E1S3)
c. VA Referral: 23 October 2015
d. VA C&P examinations: 17, 20, 21 November 2015; 03 December 2015
3. Conditions Which Fail to Meet Retention Standards
Diagnosis 1: Unspecified Anxiety Disorder. Medically unacceptable IAW AR 40- 501, para 3-33 b and c; Year 2014; LOD yes; EPTS no
Diagnosis 2: Autism Spectrum Disorder (not ratable)
a. Basis of Diagnoses: The VA DBQ for Initial Post Traumatic Stress Disorder (PTSD) dated 17NOV2015 diagnosed the SM with Autism Spectrum Disorder and Unspecified Anxiety Disorder. These diagnoses are supported by the medical record. Unspecified Anxiety Disorder is manifested by worry thoughts, rumination, sleep disturbances and panic attacks. Autism Spectrum Disorder is manifested by persistent deficits in social communication and interaction as well as restricted, repetitive patterns of behavior and interests.
SFC X underwent an extensive psychological evaluation on 08JAN2016 (AHLTA note dated 12JAN2015). SFC X reported being teased and bullied in schools (elementary through high school) because of his speech impediments. So he learned to avoid social interactions. He also shared that he is not a well-coordinated person his whole life, with poor balance and easily tripping over things including his own feet. The incoordination problem reportedly has been worsened in the past year due to additional knee problems. The SM further reported inability to multitask effectively because he is quick to become overloaded with the amount of information from these tasks. For instance, he recently wanted to attend a conference for his professional development in Utah but decided to not go at the last minute because he was too overwhelmed by the perceived complicated process (of booking an airplane ticket, calling the hotel to reserve a room, and making reservation for a car rental). He reportedly had a panic attack when he was almost done with booking an airplane ticket online. The thought of calling the hotel for room reservation and talking to someone at a car rental company was too overwhelming for him to complete these tasks. Hence, he decided to not go to this conference although he really wanted to attend it. The SM is also serious about passing up opportunities to be promoted to E-8. He explained that as an E-8, he would have to manage more personnel issues, and this is extremely difficult for him to perform. The SM further acknowledged that he easily becomes overwhelmed by external stimuli, particularly by other people’s strong emotions;“if people are happy, I’m happy. If people are not happy, I’m not happy…I can’t deal with strong emotions”. The SM admitted that he has difficulties dealing with people in general. He has been told by his supervisors for not understanding his subordinates’ needs, not exhibiting empathic gestures towards others, not understanding social cues, or having limited social-emotional reciprocity. The SM shared that he prefers keeping his life simple and wants to be around only a few people who are close to him (wife, daughter, 1-2 close friends, father, and brother). The SM stated that he has a wonderful social support online but actively avoids meeting people face to face for social activities. Part of his social avoidance is fears of the negative, harsh evaluations of him from others. He is very self-conscious about his speech impediments and issues related to his perceived low self-confidence and low self-esteem. He reported having difficulty in participating in general conversations including “small talks”. The SM acknowledged that it is extremely hard for him to join in conversations with others and to carry conversations for a lengthy period. Hence, he has actively avoided meeting other people for social purpose. Even at work, he keeps his interpersonal interactions to the minimum. The evaluation gave him the diagnoses of Autistic Spectrum Disorder without intellectual impairment, level 1 and Social Anxiety.
An AHLTA note dated 03SEP2014 stated that the SM described worsening depression over the last year, including a despondent mood, growing loneliness, and anhedonia. He described a decreased interest in activities (reading and cycling “take too much effort”); increased feelings of guilt (“I feel like a failure” and “I’m not meeting my full potential”); decreased energy (“I have a hard time motivating myself”); problems concentrating (“I’m easily distracted” and “I can’t multitask anymore”); and, initial insomnia (due to “thinking about concerns of my life”). He described frequent worrying over his career and personal life (“worst case scenarios”). He had felt unchallenged at work over the last 6 months and has had longstanding problems in his marriage (including a lack of intimacy over the last 10 years). Pt described increased irritability, primarily as an internal process (“I keep it to myself”). He experienced initial insomnia due to worry and brooding over life problems. His complaints at work involve dissatisfaction that he began doing “busy work” six months ago that he deems beneath his rank. Pt noted that the plan to send him to NCO school in Aug 2014 was postponed due to the fact he injured his wrists around Jul 2014. He appeared to take the lighter duties personally and he did not appear to consider how his pending transition to NCO school, the impact of his wrist injury, or his expected PCS contributed to the decision to transfer him to lighter duties.
b. Treatment: He denied any previous history of psychotherapy or mental health treatment and denied any history of being prescribed or taking psychiatric medication or psychiatric hospitalizations. An AHLTA note dated 03SEP2014 documented that he was self-referred to behavioral health. He was diagnosed with a Major Depression, single episode, moderate but was reluctant to consider medications, noting “I’m bad about taking medications.” However, he expressed interest in a course of psychotherapy, although noted he expects to PCS in about 6 months. He agreed to return to psychotherapy in 2 weeks due to TDY next week. A note by his psychiatrist dated 23OCT2014 noted that "I'm feeling better than before, but still have difficulty sleeping and have too much anxiety." The SM reported he had previously been evaluated and started psychotherapy, which has improved both anxiety and depressive symptoms. He added that insomnia is an unchanged residual symptom. Depressive symptoms are nearly resolved, and anxiety is better but that he would like further improvement. He was diagnosed with Autism Spectrum Disorder, Level I; and Unspecified Anxiety Disorder and started a 4-6 week trial of Paxil 20 mg by mouth at bedtime to target depressive and anxiety symptoms. He continued to be seen in individual therapy and an AHLTA note by his psychiatrist dated 26AUG2015 stated that the SM reported that he continued to experience fair control of anxiety using Paxil 80 mg po qhs because "I can't control the environment." He had also been prescribed Trazodone 50mg po qhs to address his insomnia. The last AHLTA note by his therapist dated 05JAN2016 noted the SM discussed his decision to self-discontinue all psychiatric medication in mid-December. He said he believed his medications were sapping his energy and contributing to weight gain. He described 'a rough couple of weeks' at first, although noted feeling much better over the last few days. He said overall he is feeling 'more energy, more motivation' and acknowledged a subsequent decrease in his 'threshold for frustration' and also noted 'more emotions now.' He discussed terminating treatment with DSM Clinic and his choice to begin treatment at Ft. Belvoir, which is closer to work and home. He said he is taking an introductory BH class at Ft. Belvoir on 22-Jan and will subsequently begin treatment. His final diagnoses were Asperger's syndrome and Other specified anxiety disorders.
c. Prognosis: His prognosis is good as shown by his improvement in his symptoms of anxiety and depression. It is likely he will continue to experience ongoing difficulties with anxiety and depression and will continue to benefit from ongoing therapy and should consider ongoing medication management and individual therapy.
d. Impact of condition on PMOS: The Profile dated 14OCT2015 has an S3 for Autism Spectrum Disorder. The Commander’s Performance and Functional Statement states “Soldier has profound difficulties in performing tasks that requires planning, organization, time management and sustained attention. This dysfunction in his executive functions appears to be static with no noticeable improvement over time. Soldier has problem with impulse control which has caused him to undertake action that are no appropriate for the situation and has caused unwanted results. Soldier is easily overwhelmed by stressful situations and is prone to debilitating anxiety and panic attacks.” Although he has responded to treatment, it is highly probable that he would have acute worsening of his symptoms of anxiety if placed in stressful environments such as deployment or combat. SM’s psychiatric symptoms necessitate significant limitations of duty and effective military performance and warrant an S3 Profile to include no carrying of weapons.
4. Medical Retention Determination Point (MRDP) Statement: The Soldier has had adequate evaluation for Diagnosis #1, Anxiety disorder, to reliably predict the course, and it is unlikely that further interventions will return the service member to full duty.
5. Conditions Meeting Medical Retention Standards
1. Moderate obstructive sleep apnea: SM underwent Polysomnogram on 02Dec15 that was consistent with moderate OSA. Respiratory disturbance index was 17.4/hour. CPAP12 cm H2O was recommended. Condition warrants P2, meets retention standards IAW AR 40-501 ch 3-41e.
2. Allergic rhinitis: Meets retention standards IAW AR 40-501 ch 3-41e.
3. Bilateral ankle sprains: Resolved no residual per VA DBQ examiner. Meets retention standards IAW AR 40-501 ch 3-41e.
4. Mild bilateral carpal tunnel syndrome: Several year history of intermittent numbness that involves both hands, all 4 fingers are involved in each hand. Symptoms are provoked by hand use such as typing or carrying boxes. No weakness. Managed with wrist splints. EDX BUE (Jul15) normal. Meets retention standards IAW AR 40-501 ch 3-30j.
5. Hearing loss, left ear associated with subjective tinnitus: Audiometry during VA DBQ exam c/w normal hearing right ear and sensorineural hearing loss left ear. SM endorsed bilateral constant tinnitus. Meets retention standards IAW AR 40-501 ch 3-10.
6. Bilateral shoulder DJD: RHD E7 with bilateral shoulder pain since 2010. Treated with PT in the past. Per VA DBQ exam, ongoing mild pain treated with rest and activity limitation. On exam, bilateral shoulder ROM met retentions standards. X-rays of right shoulder from 2011 showed mild degenerative changes, right AC joint. No evidence of impact on duty in available medical records. Meets retention standards IAW AR 40-501 ch 3-41e.
7. Urticaria: Meets retention standards IAW AR 40-501 ch 3-38.
8. Dermatitis: Meets retention standards IAW AR 40-501 ch 3-38.
9. Scar: Detailed in VA DBQ exam, non-disabling. Meets retention standards IAW AR 40-501 ch 3-38y.
10. Dry eye syndrome: Meets retention standards IAW AR 40-501 ch 3-41e.
11. Thoracic scoliosis: Low back pain secondary to scoliosis and kyphosis diagnosed more than 15 years ago. Scoliosis survey dated July 2015 with mild thoracic dextroscoliosis. SM underwent PT and CMT in the past. No evidence of impact on duty in available medical records. Meets retention standards IAW AR 40-501 ch 3-39g.
12. Bilateral wrist strain: Bilateral wrist pain started in 2011, gradual in onset. MRI right wrist from 2014 showed contusion of triquetrum, findings concerning for possible tear to the mid dorsal fibers of scaphocapitate ligament. Treated with OT. Uses wrist brace with benefit. Meets retention standards IAW AR 40-501 ch 3-41e.
13. Right wrist cyst: Meets retention standards IAW AR 40-501 ch 3-41e.
14. GERD: Meets retention standards IAW AR 40-501 ch 3-41e.
15. Minimal multilevel cervical spondylosis: Neck pain started approximately one year ago. C-spine MRI in July2015 showed pronounced cervical lordosis with mild degenerative spondylosis. He was prescribed muscle relaxers with benefit. CT scan from November 2015 showed minimal multilevel DJD. No evidence of impact on duty in available medical records. Meets retention standards IAW AR 40-501 ch 3-39h.
16. Bilateral knee DJD: Onset, March 2015 after slipping on ice. On exam, bilateral knee ROM met retentions standards. No evidence of impact on duty in available medical records. Meets retention standards IAW AR 40-501 ch 3-41e.
17. Right fibula fracture: Onset, March 2015 after slipping on ice. Wore a cast for 2 months. X-rays from May 2015 showed interval healing of nondisplaced transverse fracture of proximal fibula. Meets retention standards IAW AR 40-501 ch 3-41e.
18. Acute bronchitis: Resolved. Meets retention standards IAW AR 40-501 ch 3-41e.
19. Hypertension: Average BP at goal during VA DBQ exam. Not currently managed with medication. Meets retention standards IAW AR 40-501 ch 3-41e.
20. Traumatic Brain Injury (TBI): The VA DBQ for NERUO TBI initial Exam diagnosed the SM with a Traumatic Brain Injury. The VA TBI exam reported that in November of 2013 he fell off his bicycle and struck his helmeted head. He was briefly dazed and sent to WRNMCC where the ER evaluation was negative. A Neurology evaluation (AHLTA note dated 03MAY2015) reported that SFC X “fell down while bicycling two years ago, helmet cracked, dazed for minutes, head imaging was reportedly normal; collided head against head 5 years ago while doing PT, dizzy for minutes; another similar head-to-head collision 8 years ago; fire extinguisher exploded next to him in 2005, dazed for minutes.” The neurological evaluation was unremarkable for cognitive issues stating “well dressed with good hygiene, pleasant, cooperative, alert, attentive, normal psychomotor activity, no gross abnormal movements, fluent and spontaneous speech with poor articulation, intact comprehension, methodical but sequential three-step hand movements B, mood is euthymic, affect is reactive with intact prosody, thoughts sequential and related, memory and insight are adequate based on conversation.” The VA examiner stated that none of the SMs conditions attributable to a traumatic brain injury impacts his ability to work. There is no evidence that further evaluation of his TBI is warranted to include neuropsychological testing. There is no evidence that any residual symptoms from his TBI by themselves or in combination with his psychological and physical problems prevent him from performing the requirements of his rank and Service. This condition is medically acceptable IAW AR 40-501 ch 3-30j.
6. DA 3349/Physical Profile: S3 for anxiety disorder: No access to weapons/munitions. SM needs access to BH for ongoing therapy.P2 for OSA, due to need for electricity.
7. Competency: Per VA C&P Mental Disorders examination the Soldier is mentally competent for pay purposes and capable of understanding the nature of, and cooperating, in PEB proceedings.
8. Reconciliation of Apparent Inconsistencies
a. The VA examiner did not establish diagnoses related to the following claims, and there is no evidence of impact on duty in available medical records: constipation. SM claimed anxiety disorder, NOS; Asperger Syndrome; Major Depression; Executive Function Disorder, memory Loss, Impulsive Control Disorder; PTSD, TBI and Sleep Disturbance, chronic insomnia. These complaints are subsumed under the diagnoses of Autism Spectrum Disorder and Unspecified Anxiety Disorder.
b. Information in this document is current as of 13 January 2016
1. Baseline Documentation 13 January 2016
a. Component: SFC/E7/USA
b. PMOS: 27D4L (Paralegal Specialist)
c. BASD: 1999
d. Reason for referral into the IDES: Anxiety disorder, NOS
2. Sources and References:
a. AHLTA: Per Section 3 below
b. DA 3349/Physical Profile: 14 October 2015 (Anxiety, Autism Spectrum d/o – P1U1L1H2E1S3)
c. VA Referral: 23 October 2015
d. VA C&P examinations: 17, 20, 21 November 2015; 03 December 2015
3. Conditions Which Fail to Meet Retention Standards
Diagnosis 1: Unspecified Anxiety Disorder. Medically unacceptable IAW AR 40- 501, para 3-33 b and c; Year 2014; LOD yes; EPTS no
Diagnosis 2: Autism Spectrum Disorder (not ratable)
a. Basis of Diagnoses: The VA DBQ for Initial Post Traumatic Stress Disorder (PTSD) dated 17NOV2015 diagnosed the SM with Autism Spectrum Disorder and Unspecified Anxiety Disorder. These diagnoses are supported by the medical record. Unspecified Anxiety Disorder is manifested by worry thoughts, rumination, sleep disturbances and panic attacks. Autism Spectrum Disorder is manifested by persistent deficits in social communication and interaction as well as restricted, repetitive patterns of behavior and interests.
SFC X underwent an extensive psychological evaluation on 08JAN2016 (AHLTA note dated 12JAN2015). SFC X reported being teased and bullied in schools (elementary through high school) because of his speech impediments. So he learned to avoid social interactions. He also shared that he is not a well-coordinated person his whole life, with poor balance and easily tripping over things including his own feet. The incoordination problem reportedly has been worsened in the past year due to additional knee problems. The SM further reported inability to multitask effectively because he is quick to become overloaded with the amount of information from these tasks. For instance, he recently wanted to attend a conference for his professional development in Utah but decided to not go at the last minute because he was too overwhelmed by the perceived complicated process (of booking an airplane ticket, calling the hotel to reserve a room, and making reservation for a car rental). He reportedly had a panic attack when he was almost done with booking an airplane ticket online. The thought of calling the hotel for room reservation and talking to someone at a car rental company was too overwhelming for him to complete these tasks. Hence, he decided to not go to this conference although he really wanted to attend it. The SM is also serious about passing up opportunities to be promoted to E-8. He explained that as an E-8, he would have to manage more personnel issues, and this is extremely difficult for him to perform. The SM further acknowledged that he easily becomes overwhelmed by external stimuli, particularly by other people’s strong emotions;“if people are happy, I’m happy. If people are not happy, I’m not happy…I can’t deal with strong emotions”. The SM admitted that he has difficulties dealing with people in general. He has been told by his supervisors for not understanding his subordinates’ needs, not exhibiting empathic gestures towards others, not understanding social cues, or having limited social-emotional reciprocity. The SM shared that he prefers keeping his life simple and wants to be around only a few people who are close to him (wife, daughter, 1-2 close friends, father, and brother). The SM stated that he has a wonderful social support online but actively avoids meeting people face to face for social activities. Part of his social avoidance is fears of the negative, harsh evaluations of him from others. He is very self-conscious about his speech impediments and issues related to his perceived low self-confidence and low self-esteem. He reported having difficulty in participating in general conversations including “small talks”. The SM acknowledged that it is extremely hard for him to join in conversations with others and to carry conversations for a lengthy period. Hence, he has actively avoided meeting other people for social purpose. Even at work, he keeps his interpersonal interactions to the minimum. The evaluation gave him the diagnoses of Autistic Spectrum Disorder without intellectual impairment, level 1 and Social Anxiety.
An AHLTA note dated 03SEP2014 stated that the SM described worsening depression over the last year, including a despondent mood, growing loneliness, and anhedonia. He described a decreased interest in activities (reading and cycling “take too much effort”); increased feelings of guilt (“I feel like a failure” and “I’m not meeting my full potential”); decreased energy (“I have a hard time motivating myself”); problems concentrating (“I’m easily distracted” and “I can’t multitask anymore”); and, initial insomnia (due to “thinking about concerns of my life”). He described frequent worrying over his career and personal life (“worst case scenarios”). He had felt unchallenged at work over the last 6 months and has had longstanding problems in his marriage (including a lack of intimacy over the last 10 years). Pt described increased irritability, primarily as an internal process (“I keep it to myself”). He experienced initial insomnia due to worry and brooding over life problems. His complaints at work involve dissatisfaction that he began doing “busy work” six months ago that he deems beneath his rank. Pt noted that the plan to send him to NCO school in Aug 2014 was postponed due to the fact he injured his wrists around Jul 2014. He appeared to take the lighter duties personally and he did not appear to consider how his pending transition to NCO school, the impact of his wrist injury, or his expected PCS contributed to the decision to transfer him to lighter duties.
b. Treatment: He denied any previous history of psychotherapy or mental health treatment and denied any history of being prescribed or taking psychiatric medication or psychiatric hospitalizations. An AHLTA note dated 03SEP2014 documented that he was self-referred to behavioral health. He was diagnosed with a Major Depression, single episode, moderate but was reluctant to consider medications, noting “I’m bad about taking medications.” However, he expressed interest in a course of psychotherapy, although noted he expects to PCS in about 6 months. He agreed to return to psychotherapy in 2 weeks due to TDY next week. A note by his psychiatrist dated 23OCT2014 noted that "I'm feeling better than before, but still have difficulty sleeping and have too much anxiety." The SM reported he had previously been evaluated and started psychotherapy, which has improved both anxiety and depressive symptoms. He added that insomnia is an unchanged residual symptom. Depressive symptoms are nearly resolved, and anxiety is better but that he would like further improvement. He was diagnosed with Autism Spectrum Disorder, Level I; and Unspecified Anxiety Disorder and started a 4-6 week trial of Paxil 20 mg by mouth at bedtime to target depressive and anxiety symptoms. He continued to be seen in individual therapy and an AHLTA note by his psychiatrist dated 26AUG2015 stated that the SM reported that he continued to experience fair control of anxiety using Paxil 80 mg po qhs because "I can't control the environment." He had also been prescribed Trazodone 50mg po qhs to address his insomnia. The last AHLTA note by his therapist dated 05JAN2016 noted the SM discussed his decision to self-discontinue all psychiatric medication in mid-December. He said he believed his medications were sapping his energy and contributing to weight gain. He described 'a rough couple of weeks' at first, although noted feeling much better over the last few days. He said overall he is feeling 'more energy, more motivation' and acknowledged a subsequent decrease in his 'threshold for frustration' and also noted 'more emotions now.' He discussed terminating treatment with DSM Clinic and his choice to begin treatment at Ft. Belvoir, which is closer to work and home. He said he is taking an introductory BH class at Ft. Belvoir on 22-Jan and will subsequently begin treatment. His final diagnoses were Asperger's syndrome and Other specified anxiety disorders.
c. Prognosis: His prognosis is good as shown by his improvement in his symptoms of anxiety and depression. It is likely he will continue to experience ongoing difficulties with anxiety and depression and will continue to benefit from ongoing therapy and should consider ongoing medication management and individual therapy.
d. Impact of condition on PMOS: The Profile dated 14OCT2015 has an S3 for Autism Spectrum Disorder. The Commander’s Performance and Functional Statement states “Soldier has profound difficulties in performing tasks that requires planning, organization, time management and sustained attention. This dysfunction in his executive functions appears to be static with no noticeable improvement over time. Soldier has problem with impulse control which has caused him to undertake action that are no appropriate for the situation and has caused unwanted results. Soldier is easily overwhelmed by stressful situations and is prone to debilitating anxiety and panic attacks.” Although he has responded to treatment, it is highly probable that he would have acute worsening of his symptoms of anxiety if placed in stressful environments such as deployment or combat. SM’s psychiatric symptoms necessitate significant limitations of duty and effective military performance and warrant an S3 Profile to include no carrying of weapons.
4. Medical Retention Determination Point (MRDP) Statement: The Soldier has had adequate evaluation for Diagnosis #1, Anxiety disorder, to reliably predict the course, and it is unlikely that further interventions will return the service member to full duty.
5. Conditions Meeting Medical Retention Standards
1. Moderate obstructive sleep apnea: SM underwent Polysomnogram on 02Dec15 that was consistent with moderate OSA. Respiratory disturbance index was 17.4/hour. CPAP12 cm H2O was recommended. Condition warrants P2, meets retention standards IAW AR 40-501 ch 3-41e.
2. Allergic rhinitis: Meets retention standards IAW AR 40-501 ch 3-41e.
3. Bilateral ankle sprains: Resolved no residual per VA DBQ examiner. Meets retention standards IAW AR 40-501 ch 3-41e.
4. Mild bilateral carpal tunnel syndrome: Several year history of intermittent numbness that involves both hands, all 4 fingers are involved in each hand. Symptoms are provoked by hand use such as typing or carrying boxes. No weakness. Managed with wrist splints. EDX BUE (Jul15) normal. Meets retention standards IAW AR 40-501 ch 3-30j.
5. Hearing loss, left ear associated with subjective tinnitus: Audiometry during VA DBQ exam c/w normal hearing right ear and sensorineural hearing loss left ear. SM endorsed bilateral constant tinnitus. Meets retention standards IAW AR 40-501 ch 3-10.
6. Bilateral shoulder DJD: RHD E7 with bilateral shoulder pain since 2010. Treated with PT in the past. Per VA DBQ exam, ongoing mild pain treated with rest and activity limitation. On exam, bilateral shoulder ROM met retentions standards. X-rays of right shoulder from 2011 showed mild degenerative changes, right AC joint. No evidence of impact on duty in available medical records. Meets retention standards IAW AR 40-501 ch 3-41e.
7. Urticaria: Meets retention standards IAW AR 40-501 ch 3-38.
8. Dermatitis: Meets retention standards IAW AR 40-501 ch 3-38.
9. Scar: Detailed in VA DBQ exam, non-disabling. Meets retention standards IAW AR 40-501 ch 3-38y.
10. Dry eye syndrome: Meets retention standards IAW AR 40-501 ch 3-41e.
11. Thoracic scoliosis: Low back pain secondary to scoliosis and kyphosis diagnosed more than 15 years ago. Scoliosis survey dated July 2015 with mild thoracic dextroscoliosis. SM underwent PT and CMT in the past. No evidence of impact on duty in available medical records. Meets retention standards IAW AR 40-501 ch 3-39g.
12. Bilateral wrist strain: Bilateral wrist pain started in 2011, gradual in onset. MRI right wrist from 2014 showed contusion of triquetrum, findings concerning for possible tear to the mid dorsal fibers of scaphocapitate ligament. Treated with OT. Uses wrist brace with benefit. Meets retention standards IAW AR 40-501 ch 3-41e.
13. Right wrist cyst: Meets retention standards IAW AR 40-501 ch 3-41e.
14. GERD: Meets retention standards IAW AR 40-501 ch 3-41e.
15. Minimal multilevel cervical spondylosis: Neck pain started approximately one year ago. C-spine MRI in July2015 showed pronounced cervical lordosis with mild degenerative spondylosis. He was prescribed muscle relaxers with benefit. CT scan from November 2015 showed minimal multilevel DJD. No evidence of impact on duty in available medical records. Meets retention standards IAW AR 40-501 ch 3-39h.
16. Bilateral knee DJD: Onset, March 2015 after slipping on ice. On exam, bilateral knee ROM met retentions standards. No evidence of impact on duty in available medical records. Meets retention standards IAW AR 40-501 ch 3-41e.
17. Right fibula fracture: Onset, March 2015 after slipping on ice. Wore a cast for 2 months. X-rays from May 2015 showed interval healing of nondisplaced transverse fracture of proximal fibula. Meets retention standards IAW AR 40-501 ch 3-41e.
18. Acute bronchitis: Resolved. Meets retention standards IAW AR 40-501 ch 3-41e.
19. Hypertension: Average BP at goal during VA DBQ exam. Not currently managed with medication. Meets retention standards IAW AR 40-501 ch 3-41e.
20. Traumatic Brain Injury (TBI): The VA DBQ for NERUO TBI initial Exam diagnosed the SM with a Traumatic Brain Injury. The VA TBI exam reported that in November of 2013 he fell off his bicycle and struck his helmeted head. He was briefly dazed and sent to WRNMCC where the ER evaluation was negative. A Neurology evaluation (AHLTA note dated 03MAY2015) reported that SFC X “fell down while bicycling two years ago, helmet cracked, dazed for minutes, head imaging was reportedly normal; collided head against head 5 years ago while doing PT, dizzy for minutes; another similar head-to-head collision 8 years ago; fire extinguisher exploded next to him in 2005, dazed for minutes.” The neurological evaluation was unremarkable for cognitive issues stating “well dressed with good hygiene, pleasant, cooperative, alert, attentive, normal psychomotor activity, no gross abnormal movements, fluent and spontaneous speech with poor articulation, intact comprehension, methodical but sequential three-step hand movements B, mood is euthymic, affect is reactive with intact prosody, thoughts sequential and related, memory and insight are adequate based on conversation.” The VA examiner stated that none of the SMs conditions attributable to a traumatic brain injury impacts his ability to work. There is no evidence that further evaluation of his TBI is warranted to include neuropsychological testing. There is no evidence that any residual symptoms from his TBI by themselves or in combination with his psychological and physical problems prevent him from performing the requirements of his rank and Service. This condition is medically acceptable IAW AR 40-501 ch 3-30j.
6. DA 3349/Physical Profile: S3 for anxiety disorder: No access to weapons/munitions. SM needs access to BH for ongoing therapy.P2 for OSA, due to need for electricity.
7. Competency: Per VA C&P Mental Disorders examination the Soldier is mentally competent for pay purposes and capable of understanding the nature of, and cooperating, in PEB proceedings.
8. Reconciliation of Apparent Inconsistencies
a. The VA examiner did not establish diagnoses related to the following claims, and there is no evidence of impact on duty in available medical records: constipation. SM claimed anxiety disorder, NOS; Asperger Syndrome; Major Depression; Executive Function Disorder, memory Loss, Impulsive Control Disorder; PTSD, TBI and Sleep Disturbance, chronic insomnia. These complaints are subsumed under the diagnoses of Autism Spectrum Disorder and Unspecified Anxiety Disorder.
b. Information in this document is current as of 13 January 2016
I have talked with four mental health providers about having suicidal ideations. That's why I am not allowed to have access to firearms. I don't see it being mentioned in the NARSUM or the Commander's Letter. There's some hints, but nothing that directly mentions it.
For the VA comp and pension mental health exam go to the myhealthevet website and sign up for a premium account. Then login and click the blue button in the upper right corner of the homepage. There will be some more clicking after that but it's pretty intuitive. At this point you can just "select all" instead of "VA notes" but it should show your comp and pension exams, you should have 4 of them, general medical, psych, hearing, and optometry. I think those 4 are pretty standard.
What part are you getting stuck on? Let us know and someone can help.
What part are you getting stuck on? Let us know and someone can help.
Symptoms
---------------
For VA rating purposes. check all symptoms that actively apply to the veterans's diagnoses:
- Anxiety
- Panic attacks that occur weekly or less often
- Chronic sleep impairment
- Mild memory loss, such as forgetting names, directions or recent events
- Flattened effect
- Impaired judgment
- Disturbances of motivation and mood
- Difficulty in establishing and maintaining effective work and social relationships
- Obsessional rituals which interfere with routine activities
---------------
For VA rating purposes. check all symptoms that actively apply to the veterans's diagnoses:
- Anxiety
- Panic attacks that occur weekly or less often
- Chronic sleep impairment
- Mild memory loss, such as forgetting names, directions or recent events
- Flattened effect
- Impaired judgment
- Disturbances of motivation and mood
- Difficulty in establishing and maintaining effective work and social relationships
- Obsessional rituals which interfere with routine activities
"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"
You'll be rated at 30% and thus medical retirement. However, you have a very strong case for a VARR. Under symptoms there are some 50% symptoms and one 70% (obsessional rituals that interfere with routine activity). I would aim high and use the obsessional rituals and the documented suicidal ideations and ask for a VARR increase to 70%. If possible, get your current mental health provider to fill out a MH DBQ for you and submit it with the VARR as well. Don't just take the 30% TDRL and think your just do a NOD later. That way can work but the VARR is far quicker and easier. But you have to submit good documentation with it.
Your symptoms:
- Anxiety (30%)
- Panic attacks that occur weekly or less often (30%)
- Chronic sleep impairment (30%)
- Mild memory loss, such as forgetting names, directions or recent events (30%)
- Flattened effect (50%)
- Impaired judgment (50%)
- Disturbances of motivation and mood (50%)
- Difficulty in establishing and maintaining effective work and social relationships (50%)
- Obsessional rituals which interfere with routine activities (70%)
So here you have four 30's, three 50's, and one 70. They obviously left out a second 70, suicidal ideations. Make your VARR argue that the constellation of symptoms warrants a higher overall rating, especially the two 70% ones. If you can get your mental health provider to fill out a DBQ for you, the VA has to give it more weight because this is the provider you see regularly, vs the VA psych who you only saw once for 30 minutes....
- Anxiety (30%)
- Panic attacks that occur weekly or less often (30%)
- Chronic sleep impairment (30%)
- Mild memory loss, such as forgetting names, directions or recent events (30%)
- Flattened effect (50%)
- Impaired judgment (50%)
- Disturbances of motivation and mood (50%)
- Difficulty in establishing and maintaining effective work and social relationships (50%)
- Obsessional rituals which interfere with routine activities (70%)
So here you have four 30's, three 50's, and one 70. They obviously left out a second 70, suicidal ideations. Make your VARR argue that the constellation of symptoms warrants a higher overall rating, especially the two 70% ones. If you can get your mental health provider to fill out a DBQ for you, the VA has to give it more weight because this is the provider you see regularly, vs the VA psych who you only saw once for 30 minutes....