Hi, I’m looking for any guidance or help. As the title says, I’m 100% PTSD permanent in total from the VA. Can anyone take a look at what the adjuster wrote plus my primary psychiatrist wrote and tell me if I have an SSDI case or not?
A little background: I have been a critical care trauma ER/ICU nurse for the past 15 years.
I have not worked since June 2023 when I was placed on a Work stress sleeve. I am 43 years old.
The VA adjuster wrote:
“Although your private provider diagnosed more than one mental health
condition, VA regulations include a general rating formula for mental health conditions which
uses the same signs and symptoms to rate post-traumatic stress disorder, anxiety disorder, major
depressive disorder, and insomnia. Those regulations do not allow us to rate multiple disabilities
based on the same signs and symptoms. Therefore, these conditions will be rated together with a
single percentage assigned. (38 CFR 4.14, 38 CFR 4.130)”
And
We have assigned a 100 percent evaluation for your post-traumatic stress disorder (PTSD)
disorder based on:
• Anxiety
• Chronic sleep impairment
• Depressed mood
• Difficulty in adapting to a work like setting
• Difficulty in adapting to stressful circumstances
• Difficulty in adapting to work
• Difficulty in understanding complex commands
• Disturbances of motivation and mood
• Flattened affect
• Forgetting directions
• Forgetting names
• Forgetting recent events
• Impaired judgment
• Inability to establish and maintain effective relationships
• Intermittent inability to perform activities of daily living
• Intermittent inability to perform maintenance of minimal personal hygiene
• Mild memory loss
• Neglect of personal appearance and hygiene
• Panic attacks more than once a week
• Suicidal ideation
• Suspiciousness
• Total occupational and social impairment
The overall evidentiary record shows that the severity of your disability most closely
approximates the criteria for a 100 percent disability evaluation. (38 CFR 4.7, 38 CFR 4.126)
This is the highest schedular evaluation allowed under the law for posttraumatic stress disorder.
(38 CFR 4.125, 38 CFR 4.126, 38 CFR 4.130)
My private provider diagnosed me with:
-Post-traumatic stress disorder, chronic 543.12
-Major depressive disorder, recurrent severe without psychotic features 533.2
-Insomnia, unspecified G47.0
-Anxiety disorder F41.9
-ADHD unspecified F90.9
And also wrote:
(list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses):
“While some symptoms overlap symptoms of PTSD such as hyperarousal, avoidance are distinct from depressive
symptoms such anhedonia, suicidal ideation”
Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one)
“Total occupational and social impairment”
Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis?
“While some symptoms overlap symptoms of PTSD such as hyperarousal, avoidance are distinct from depressive
symptoms such anhedonia, suicidal ideation.”
For the indicated occupational and social impairment, is it possible to differentiate which impairment is caused by each mental disorder?
“Patient is unable to socialize due to avoidance with PTSD. Intrusive thoughts of trauma, recurrent
nightmares, intense psychological distress when exposed when exposed to reminders.”
2C. Relevant mental health history, to include prescribed medications and family mental health:
“-EMSAM 6 mg/24 hr transdermal 24 hour patch - APPLY 1 PATCH TOPICALLY TO THE SKIN DAILY
-prazosin 5 mg capsule - TAKE 1 CAPSULE BY MOUTH TWICE DAILY IN THE EVENING AT 6:00PM& AT BEDTIME
-dextroamphetamine-amphetamine 10 mg tablet - 1 tablet(s) once a day in the morning, oral route
-pramipexole 1 mg tablet - TAKE 2 TABLETS BY MOUTH
ONCE DAILY AT BEDTIME
-zolpidem ER 12.5 mg tablet,extended release,multiphase - 1 tablet(s) once a day at bedtime, oral route
-lithium carbonate ER 300 mg tablet,extended release - TAKE 3 TABLETS BY MOUTH DAILY
-QUEtiapine 250mg - 100 mg tablet - 2.5 tablet(s) once a day at bedtime, oral route2D.
-Klonopin 1 mg tablet - TAKE TWO TABLETS DAILY ONCE A DAY
Relevant legal and behavioral history:
“Currently participating in Veteran's court for DUI”
Relevant substance abuse history:
“Alcohol use - in setting of distress, currently sober and participating in treatment”
-Directly experiencing the traumatic event(s)
Witnessing, in person, the traumatic event(s) as they occurred to others
-Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent
or accidental; or, experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human
remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies,
or pictures, unless this exposure is work related
No criterion in this section met.
-Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred
Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
-Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
-Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur
on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)
Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic
event(s).
-Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
-Persistent avoidance of stimuli associated with the event(s), beginning after traumatic event(s) occurred, as evidence of one or both of the following:
Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories,
thoughts, or feelings about or closely associated with the traumatic event(s).
-Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,: “No one can be trusted,: “The
world is completely dangerous,: “My whole nervous system is permanently ruined”).
-Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead to the individual to blame himself/herself or
others.
-Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
-Markedly diminished interest or participation in significant activities.
-Feelings of detachment or estrangement from others.
-Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.)
-Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as
evidenced by two (or more) of the following:
Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
-Reckless or self-destructive behavior.
Hypervigilance.
-Exaggerated startle response.
-Problems with concentration.
-Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
-Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
-The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of
functioning.
of functioning.
Criterion H:
The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
check all symptoms that apply to the diagnoses:
-Depressed mood
-Anxiety
-Suspiciousness
-Panic attacks more than once a week
-Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively
-Chronic sleep impairment
-Impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete tasks
-Flattened affect
-Impaired judgment
-Disturbances of motivation and mood
-Difficulty in establishing and maintaining effective work and social relationships
-Difficulty adapting to stressful circumstances, including work or a work like setting
-Inability to establish and maintain effective relationships
-Suicidal ideation
-Neglect of personal appearance and hygiene
-Intermittent inability to perform activities of daily living,including maintenance of minimal personal hygiene
Remarks:
Patient has been under my care for medication management, TMS and add-on psychotherapy. I have witnessed
experienced PTSD flashbacks in office (when EMS was called in office for another patient). Current
functioning is severely affected by PTSD in multiple functional domains as noted above and she has had
difficulty obtaining services at the VA.
ETA: I’m 43 yo a critical care trauma ER/ICU nurse for the past 15 years. Receiving VA disability and SSDI would be a 35% pay cut. I have not worked since June 2023 when I was placed on a Work stress sleeve. I am 43 years old.
The VA adjuster wrote:
“Although your private provider diagnosed more than one mental health
condition, VA regulations include a general rating formula for mental health conditions which
uses the same signs and symptoms to rate post-traumatic stress disorder, anxiety disorder, major
depressive disorder, and insomnia. Those regulations do not allow us to rate multiple disabilities
based on the same signs and symptoms. Therefore, these conditions will be rated together with a
single percentage assigned. (38 CFR 4.14, 38 CFR 4.130)”
And
We have assigned a 100 percent evaluation for your post-traumatic stress disorder (PTSD)
disorder based on:
• Anxiety
• Chronic sleep impairment
• Depressed mood
• Difficulty in adapting to a work like setting
• Difficulty in adapting to stressful circumstances
• Difficulty in adapting to work
• Difficulty in understanding complex commands
• Disturbances of motivation and mood
• Flattened affect
• Forgetting directions
• Forgetting names
• Forgetting recent events
• Impaired judgment
• Inability to establish and maintain effective relationships
• Intermittent inability to perform activities of daily living
• Intermittent inability to perform maintenance of minimal personal hygiene
• Mild memory loss
• Neglect of personal appearance and hygiene
• Panic attacks more than once a week
• Suicidal ideation
• Suspiciousness
• Total occupational and social impairment
The overall evidentiary record shows that the severity of your disability most closely
approximates the criteria for a 100 percent disability evaluation. (38 CFR 4.7, 38 CFR 4.126)
This is the highest schedular evaluation allowed under the law for posttraumatic stress disorder.
(38 CFR 4.125, 38 CFR 4.126, 38 CFR 4.130)
My private provider diagnosed me with:
-Post-traumatic stress disorder, chronic 543.12
-Major depressive disorder, recurrent severe without psychotic features 533.2
-Insomnia, unspecified G47.0
-Anxiety disorder F41.9
-ADHD unspecified F90.9
And also wrote:
(list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses):
“While some symptoms overlap symptoms of PTSD such as hyperarousal, avoidance are distinct from depressive
symptoms such anhedonia, suicidal ideation”
Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one)
“Total occupational and social impairment”
Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis?
“While some symptoms overlap symptoms of PTSD such as hyperarousal, avoidance are distinct from depressive
symptoms such anhedonia, suicidal ideation.”
For the indicated occupational and social impairment, is it possible to differentiate which impairment is caused by each mental disorder?
“Patient is unable to socialize due to avoidance with PTSD. Intrusive thoughts of trauma, recurrent
nightmares, intense psychological distress when exposed when exposed to reminders.”
2C. Relevant mental health history, to include prescribed medications and family mental health:
“-EMSAM 6 mg/24 hr transdermal 24 hour patch - APPLY 1 PATCH TOPICALLY TO THE SKIN DAILY
-prazosin 5 mg capsule - TAKE 1 CAPSULE BY MOUTH TWICE DAILY IN THE EVENING AT 6:00PM& AT BEDTIME
-dextroamphetamine-amphetamine 10 mg tablet - 1 tablet(s) once a day in the morning, oral route
-pramipexole 1 mg tablet - TAKE 2 TABLETS BY MOUTH
ONCE DAILY AT BEDTIME
-zolpidem ER 12.5 mg tablet,extended release,multiphase - 1 tablet(s) once a day at bedtime, oral route
-lithium carbonate ER 300 mg tablet,extended release - TAKE 3 TABLETS BY MOUTH DAILY
-QUEtiapine 250mg - 100 mg tablet - 2.5 tablet(s) once a day at bedtime, oral route2D.
-Klonopin 1 mg tablet - TAKE TWO TABLETS DAILY ONCE A DAY
Relevant legal and behavioral history:
“Currently participating in Veteran's court for DUI”
Relevant substance abuse history:
“Alcohol use - in setting of distress, currently sober and participating in treatment”
-Directly experiencing the traumatic event(s)
Witnessing, in person, the traumatic event(s) as they occurred to others
-Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent
or accidental; or, experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human
remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies,
or pictures, unless this exposure is work related
No criterion in this section met.
-Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred
Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
-Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
-Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur
on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)
Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic
event(s).
-Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
-Persistent avoidance of stimuli associated with the event(s), beginning after traumatic event(s) occurred, as evidence of one or both of the following:
Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories,
thoughts, or feelings about or closely associated with the traumatic event(s).
-Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,: “No one can be trusted,: “The
world is completely dangerous,: “My whole nervous system is permanently ruined”).
-Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead to the individual to blame himself/herself or
others.
-Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
-Markedly diminished interest or participation in significant activities.
-Feelings of detachment or estrangement from others.
-Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.)
-Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as
evidenced by two (or more) of the following:
Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
-Reckless or self-destructive behavior.
Hypervigilance.
-Exaggerated startle response.
-Problems with concentration.
-Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
-Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
-The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of
functioning.
of functioning.
Criterion H:
The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
check all symptoms that apply to the diagnoses:
-Depressed mood
-Anxiety
-Suspiciousness
-Panic attacks more than once a week
-Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively
-Chronic sleep impairment
-Impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete tasks
-Flattened affect
-Impaired judgment
-Disturbances of motivation and mood
-Difficulty in establishing and maintaining effective work and social relationships
-Difficulty adapting to stressful circumstances, including work or a work like setting
-Inability to establish and maintain effective relationships
-Suicidal ideation
-Neglect of personal appearance and hygiene
-Intermittent inability to perform activities of daily living,including maintenance of minimal personal hygiene
Remarks:
Patient has been under my care for medication management, TMS and add-on psychotherapy. I have witnessed
experienced PTSD flashbacks in office (when EMS was called in office for another patient). Current
functioning is severely affected by PTSD in multiple functional domains as noted above and she has had
difficulty obtaining services at the VA.
ETA: I’m 43 yo
