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1DVBCWPT2 ;ALB/CMM PTSD WKS TEXT - 2 ; 6 MARCH 1997
2 ;;2.7;AMIE;**12**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;TOF
7 ;;E. Diagnosis:
8 ;;
9 ;; Provide:
10 ;; 1. The diangosis must conform to DSM-IV and be supported by the
11 ;; findings on the examination report.
12 ;; 2. If the diagnosis is changed, explain fully whether the new
13 ;; diagnosis represents a progression of the prior diagnosis or
14 ;; development of a new and separate condition.
15 ;; 3. If there are multiple mental disorders, delineate, to the
16 ;; extent possible, the symptoms associated with each and a
17 ;; discussion of relationship.
18 ;; 4. Evaluation is based on the effects of the signs and symptoms
19 ;; on occupational and social functioning.
20 ;;
21 ;; NOTE: VA is prohibited by statute from paying compensation for a
22 ;; disability that is a result of the veteran's own ALCOHOL OR DRUG
23 ;; ABUSE, whether based on direct service connection, secondary service
24 ;; connection, or aggravation by a service-connected condition.
25 ;; Therefore, when alcohol or drug abuse accompanies or is associated
26 ;; with another mental disorder, separate, to the extent possible, the
27 ;; effects of the alcohol or drug abuse from the effects of the other
28 ;; mental disorder(s). If it is not possible to separate the effects,
29 ;; explain why.
30 ;;
31 ;;F. Global Assessment or Functioning (GAF):
32 ;;
33 ;; NOTE: The complete multi-axial format as specified by DSM-IV may
34 ;; be required for REMAND or specifically requested by the rating
35 ;; specialist. If so, include the GAF, whether it refers to current
36 ;; functioning over the past year, etc.
37 ;;
38 ;; If multiple Axis I or Axis II diagnoses exist, attempt to the
39 ;; extent possible, to provide a GAF score on service connected
40 ;; conditions alone as well as a separate GAF score based on all
41 ;; mental disorders present and explain and discuss your rationale.
42 ;; (See the above note pertaining to alcohol or drug abuse, the
43 ;; effects of which cannot be used to assess the effects of a
44 ;; service-connected condition). If unable to separate
45 ;; symptomatology, explain why.
46 ;;
47 ;; DSM-IV is only for application from 11/7/96 on. Therefore, when
48 ;; applicable, note whether the diagnosis of PTSD was supportable under
49 ;; DSM-III-R prior to that date. The prior criteria under DSM-III-R
50 ;; are provided as an attachment.
51 ;;
52 ;;Signature: Date:
53 ;;
54 ;;TOF
55 ;;Attachment A
56 ;;
57 ;;Historical DSM-III-R Diagnostic criteria for PTSD
58 ;;
59 ;;A. The veteran has experienced an event that is outside the range of
60 ;; usual human experience and that would be markedly distressing to
61 ;; almost anyone (e.g., serious threat to one's life or physical
62 ;; integrity; serious threat to one's children, spouse, or other
63 ;; close relatives and friends; sudden destruction of one's home or
64 ;; community; seeing another person who has recently been seriously
65 ;; injured or killed as the result of an accident or physical violence).
66 ;;
67 ;;B. The traumatic event is persistently re-experienced in at least one
68 ;; of the following ways:
69 ;;
70 ;; 1. Recurrent and intrusive distressing recollections of the event.
71 ;; 2. Recurrent distressing dreams of the event.
72 ;; 3. Sudden acting or feeling as if the traumatic event were recurring
73 ;; (includes a sense of reliving the experience, illusions,
74 ;; hallucinations and dissociative [flashback] episodes, even
75 ;; those that occur upon waking or when intoxicated).
76 ;; 4. Intense psychological distress at exposure to events that
77 ;; symbolize or resemble an aspect of the traumatic event, including
78 ;; anniversaries of the trauma.
79 ;;
80 ;;C. Persistent avoidance of stimuli associated with the trauma or
81 ;; numbing of general responsiveness (not present before the trauma),
82 ;; as indicated by at least three of the following:
83 ;;
84 ;; 1. Efforts to avoid thoughts or feelings associated with the trauma.
85 ;; 2. Efforts to avoid activities or situations that arouse
86 ;; recollections of the trauma.
87 ;; 3. Inability to recall an important aspect of the trauma
88 ;; (psychogenic amnesia).
89 ;; 4. Markedly diminished interest in significant activities.
90 ;; 5. Feeling of detachment or estrangement from others.
91 ;; 6. Restricted range of affect, e.g., unable to have love feelings.
92 ;; 7. Sense of foreshortened future, e.g., does not expect to have a
93 ;; career, marriage, children, or a long life.
94 ;;
95 ;;TOF
96 ;;D. Persistent symptoms of increased arousal (not present before the
97 ;; trauma), as indicated by at least two of the following:
98 ;;
99 ;; 1. Difficulty falling or staying asleep.
100 ;; 2. Irritability or outbursts of anger.
101 ;; 3. Difficulty concentrating.
102 ;; 4. Hyper vigilance.
103 ;; 5. Exaggerated startle response.
104 ;; 6. Physiologic reactivity upon exposure to events that symbolize or
105 ;; resemble an aspect of the traumatic event (e.g., a woman who was
106 ;; raped in an elevator breaks out in a sweat when entering any
107 ;; elevator).
108 ;;END
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