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PTSD C&P Exam: The Questions That Determine Whether You Get 50% or 70% — Transcript

by Dr. Marshall Bahr | Xterra Health · 6,024 words · 939 segments · language en · Watch on YouTube

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0:00One checkbox on your PTSD exam
0:02determines whether you get 30% or 70%.
0:07One checkbox. The examiner at the CMP
0:10exam is going to sit across from you or
0:13on a screen if it's teleaalth and ask
0:15you questions about the worst things
0:17that ever happened to you. And while
0:19you're reliving your trauma, they're
0:21filling out a form, a standardized form
0:23with boxes to check. And those boxes,
0:26they directly correspond to your rating.
0:28Here's the problem. Most veterans walk
0:31into the CMP exam with no idea what's on
0:34that form. No idea what the examiner is
0:36actually looking for. No idea that the
0:38difference between difficulty adapting
0:40to stressful circumstances and inability
0:42to establish and maintain effective
0:44relationships can be the difference
0:45between 50% and 70%. That's over $500 a
0:49month based on which box gets checked.
0:52And a lot of veterans, they under they
0:54understate their symptoms. They
0:55minimize. They say, "I'm fine." when
0:57they're not fine because that's what we
0:59were trained to do. And they walk out
1:01underrated wondering why the VA doesn't
1:03believe them. The VA believed you all
1:05right. You just didn't tell them how bad
1:07it really was. I'm Dr. Marshall Bar, an
1:09actual physician, Army Ranger, combat
1:11medic, disabled veteran, someone who's
1:13done CMP exams. And today, I'm walking
1:15you through exactly what happens at your
1:17PTSD CMP exam. the form they're filling
1:19out, the questions they're asking, what
1:21each section means, and how to make sure
1:23you're actually representing your
1:25symptoms, not minimizing them like
1:27you've been trained to do for years.
1:28This is the most important exam of your
1:30VA claim. Let's make sure you're ready
1:32for it. So, quick context on what what
1:35we're dealing with here. The
1:36compensation and pension exam, CMP exam,
1:39is where the VA gathers medical evidence
1:41to rate your disability for PTSD claims.
1:44This means a mental health evaluation.
1:46You filed your claim. Now, the VA needs
1:49to determine what what to actually rate
1:51you. So, they they they need to
1:53determine, do you actually have PTSD? Is
1:55it connected to your service? How severe
1:57is it? The CAP exam answers all three of
2:01these questions. This isn't like a
2:03regular doctor's appointment. This isn't
2:05therapy appointments. The examiner isn't
2:08there to treat you or to help you feel
2:09better. They're there to evaluate you
2:12and fill out that form. That form goes
2:14to a VA raider who's never met you. And
2:17that raider assigns your percentage
2:19based on almost entirely what's
2:21documented on that form they filled out.
2:24The form is called the disability
2:26benefits questionnaire, DBQ for short,
2:29specifically for PTSD. It's the initial
2:32PTSD DBQ or review PTSD DBQ. This form
2:36is publicly available. You can download
2:38it from v.gov. Google it. You can look
2:40at every question they're going to ask.
2:42You can even have your own treating
2:43psychiatrist or psychologist fill out
2:46one to submit as evidence. PTSD ratings
2:48range from 0 to 100%. Rating, so monthly
2:51compensations all the way from zero all
2:53the way to 100%. The difference between
2:5630 and 70% is over $14,000 per year.
2:59Over 20 year, that's nearly $30 grand.
3:03Same trauma, same symptoms. The
3:04difference is how well they were
3:06communicated and documented. So, let me
3:09raise the stakes on what happens in this
3:11exam. Here's the pattern I see over and
3:14over again. Veteran goes to their CMP
3:16exam. The examiner asks, "How are you
3:18sleeping?" Veteran says, "Not great, but
3:20I manage." The examiner documents some
3:22sleep disturbance. What the veteran
3:24didn't say, "He hasn't slept more than 3
3:26hours straight in 5 years. He has
3:28nightmares multiple times a week. His
3:30wife sleeps in a different room because
3:31he thrashes around and yells at night.
3:33He's afraid to fall asleep. Not great,
3:36but I manage. doesn't capture that and
3:38the examiner can only document what you
3:40tell them. We were trained to minimize,
3:43to suck it up, embrace us up, to never
3:45show weakness, to answer, "I'm good no
3:47matter what." That training served you
3:50in combat. It's destroying you in the
3:52exam. The examiner asks, "Do you have
3:54thoughts of suicide?" You say no because
3:56admitting that feels weak, but the truth
3:58is you've thought about it maybe a lot.
4:00Maybe you have a plan. That's not
4:02weakness. That's a symptom, and it's a
4:04symptom that needs to be documented. If
4:06you minimize your symptoms, the examiner
4:09documents mild impairment. Raider sees
4:11mild impairment and you get 10 to 30%
4:13rating. You've undercomp you're
4:15undercompensated for a decade. You have
4:17to fight for an increase proving it's
4:19gotten worse when really it was always
4:22this bad all along. If you're accurately
4:25describing your symptoms, a lot of
4:26things go into your benefit, right? Into
4:28your favor. The CMP examiner will
4:30document what you actually experience.
4:32The raider sees the real picture. You
4:35get rated appropriately the first time
4:37and then you get compensation that
4:40reflects what you're actually dealing
4:42with and you can focus on the treatment
4:44that you deserve. I worked with a combat
4:46veteran with multiple deployments,
4:48significant trauma. He'd been rated 30%
4:50for PTSD for years. When I asked him
4:53about his symptoms, it was clear he was
4:55at least 70%, probably 100%. When I
4:58asked about the CMP exam, he said I
5:00didn't want to seem like I was
5:01complaining. I told them I was handling
5:03it. He wasn't he was not handling it. He
5:06was barely functioning. But the examiner
5:08documented managing symptoms with some
5:10difficulty. We got him re-evaluated.
5:12This time he was honest. Really honest
5:15about everything. The nightmares, the
5:16isolation, the anger, the thoughts he'd
5:18never told anyone. He went from 30% to
5:21100%. The same veteran, the same trauma,
5:24same symptoms he'd had for years. He
5:26just finally told the truth. So, let's
5:28start with the basics. What happens
5:30before you even walk into your CMP exam?
5:32Well, after you file your PTSD claim, if
5:35the VA determines they need more
5:36information, which they will usually
5:39need to do, they will schedule a CNP
5:41exam. You're going to get notification
5:43with the date and time of the exam, the
5:45location, is it a VA facility or a
5:47contract clinic like QTC, LHI or VES,
5:50the examiner's credentials, are they a
5:52doctor, nurse practitioner, PA, and the
5:54contact information to reschedule if
5:57needed. So for PTSD exams, the examiner
6:00will be typically one of these several
6:02kinds of credential providers. A
6:04doctoral level psychologist, which is
6:06either PhD or a SID, or a psychiatrist,
6:09which are either medical doctors, MDs or
6:12DO, doctors of osteopathic medicine. In
6:15some cases, you might be examined by it
6:18might be examined by someone not like an
6:20MD or a psychologist. You might get a
6:23psychiatric nurse practitioner or a
6:25physician assistant with mental health
6:27experience. But the key is is you're
6:29going to be evaluated by some mental
6:32health provider. These are qualified
6:36mental health professionals. They've
6:38done hundreds maybe thousands of these
6:40exams. Since co though, tellahalth CMP
6:43exams have become more and more common.
6:46So you might have the option to do your
6:48exam via a video call. This can be more
6:51comfortable for some veterans. You're in
6:52your own space, less clinical feeling,
6:55no white coat syndrome, but it's the
6:57same exam, same form, the same questions
7:00they will be asking you. But do not miss
7:03this exam. Missing without rescheduling
7:05a CMP exam can result in your claim
7:08being an automatically denial.
7:10Automatically denied, sorry. If you
7:12can't make it, life happens. They
7:14understand. call immediately and
7:16reschedule, but don't ghost your exam.
7:19Now, the DBQ, let's talk about what
7:22they're act what's actually happening
7:23during your CMP exam with it. The
7:25examiner is filling out the PTSD
7:28disability benefits questionnaire. This
7:30is a standalone form. Every PTSD exam
7:32uses the same one. You can download this
7:35form yourself from va.gov or Google PTSD
7:38DBQ and look at it. Know what's coming
7:41your way. Here's something most veterans
7:43don't know. You can have your own
7:45treating psychiatrist or psychologist
7:47fill out a DBQ and submit it as
7:49evidence. If you have an established
7:51mental health provider who knows you
7:53well, their completed DBQ can be
7:55powerful supporting evidence. It doesn't
7:57replace the CMP exam, but it gives the
8:00raider another perspective. The DBQ has
8:03several major sections. The most
8:05important, the diagnostic summary. Do
8:08you have PTSD and what other conditions
8:11do you have? What are your occupational
8:13and social impairments? How bad is it?
8:15This is where the rating gets
8:16determined. Then the evidence review,
8:18what records did the examiner look at?
8:19The history, your background across
8:21multiple areas, and then the PTSD
8:23diagnostic criteria that they use the
8:25DSM5 criteria, trauma exposures, the
8:27symptoms you have, and then clinical
8:29findings, observed behaviors, and
8:31reported symptoms. And then what is your
8:32competency? Can you manage your own
8:34financial affairs? And last is the
8:36remarks. Anything the examiner will have
8:38additionally will go into that section.
8:40Now, the most important section is the
8:42occupational and social impairment
8:43section. It has specific check boxes
8:46that directly correspond to the rating
8:48percentages. The examiner checks one box
8:50summarizing your overall level of
8:52impairment. That box largely determines
8:55your rating. We're going to go through
8:57each section so you know exactly what to
9:01expect. Okay, first DBQ section is the
9:04diagnostic summary. the first thing the
9:07examiner determines. Do you have PTSD?
9:11If you've already been diagnosed with
9:12PTSD by another provider, that'll
9:14they'll they'll note that. But here's
9:16what's important. The CMP examiner can
9:18diagnose you during the exam. You don't
9:20need a prior PTSD diagnosis to file a
9:23claim. The examiner is qualified to
9:25evaluate you and make a diagnosis based
9:27on the exam itself. Now, the DBQ also
9:30asks about other mental health
9:32disorders. Do you have depression,
9:33anxiety, substance use disorder,
9:35traumatic brain injury? This is
9:37important for two reasons really. One,
9:40you might have multiple conditions that
9:42are all service connected. Each could
9:44potentially be rated separately or
9:46together. And two, the examiner needs to
9:49determine which symptoms come from which
9:51condition. This is where it gets
9:53complicated. If you have PTSD and a
9:55traumatic brain injury, some symptoms
9:57overlap. Memory problems, concentration,
10:00irritability. These could be from either
10:02condition. The examiner will try to
10:04differentiate which symptoms are
10:05attributable to PTSD versus TBI or other
10:08conditions. This is not time to hide
10:11other mental health issues. If you have
10:12depression secondary to PTSD, say so. If
10:15you have anxiety, say so. Don't try to
10:18simplify your mental health picture.
10:19Tell them everything. Let the examiner
10:22sort out what's what. Now, the next
10:25section is the occupational and social
10:27impairment section. Right? This is the
10:28most important section of the entire
10:30DBQ. The examiner checks one box that
10:33summarizes your overall level of
10:35impairment. These boxes directly
10:37correspond to rating percentages. Box
10:39one means there is no mental disorder
10:42diagnosed. 0% means you don't have PTSD.
10:45Box two is mental disorder diagnosed but
10:47symptoms are not severe enough to
10:49interfere with occupational and social
10:51functioning or to require continuous
10:53medication. 0% means you have PTSD but
10:56it's not affecting your life. Box three
10:58is occupational social impairment due to
11:00mild or transient symptoms which
11:02decrease work efficiency and ability to
11:04perform occupational tasks only during
11:06periods of significant stress. It's 10%.
11:08It means you have mild symptoms that are
11:10mostly controlled. Box four is
11:12occupational and social impairment with
11:14occasional decrease in work efficiency
11:15and intermittent periods of inability to
11:17perform occupational tasks. So this is
11:2030% occasional problems generally
11:22functioning. Okay. Then box five is
11:24occupational and social impairment with
11:26reduced reliability and productivity.
11:28It's 50% means you have noticeable
11:30impact on work and relationships. Box
11:33six is occupational social impairment
11:35with deficiencies in most areas such as
11:37work, school, family, judgment, thinking
11:39or mood. 70% for this. It's because you
11:41have significant impairment across
11:43multiple life areas. And then 100% is
11:45for box seven total occupational and
11:48social impairment. It means you're
11:49unable to function in work or social
11:51settings. So look at the language
11:53occasional decrease versus reduced
11:55reliability versus deficiencies in most
11:57areas or generally functioning
11:59satisfactoryy versus reduced
12:01productivity versus and then
12:03intermittent periods versus most areas
12:05affected. The difference between these
12:06descriptions is the difference between
12:0830% and 70% over 14 grand per year. When
12:12you're describing your symptoms, think
12:14about work. Can you hold a job? Have you
12:16lost jobs? Do you have conflicts with
12:18co-workers or supervisors? Do you call
12:20in sick because you can't handle or face
12:23people? Your family. How do you handle
12:25relationships with your spouse, your
12:26kids, your parents? Do you isolate? Do
12:28you have anger outbursts that affect
12:30your family? Your judgment. Do you make
12:32impulsive decisions? Have you done
12:34things you regret because of your mental
12:36state? And then your thinking. Can you
12:38concentrate, focus, remember things,
12:40complete tasks on time? And then your
12:41mood. How often are you depressed,
12:43anxious, angry, or numb to everything?
12:45Don't just say, "I have some problems."
12:48be specific and be honest about how bad
12:51it is actually. Okay, so now I want to
12:53get into three pieces of advice for your
12:55PTSD, CCMP exam. Advice number one, be
12:58completely honest even when it's hard,
13:01especially when it's hard. This is the
13:04most important advice I can give you.
13:05The examiner is going to ask you about
13:07the worst things that ever happened to
13:08you. They're going to ask about symptoms
13:10you probably never told anyone. Tell
13:12them the truth. If you have nightmares
13:14every night, say so. Don't say, "I have
13:17them sometimes." If you thought about
13:19suicide, say so. Don't pretend you
13:21haven't. If you drink to cope, say so.
13:24Don't hide it. If your marriage is
13:26falling apart because of your PTSD, say
13:29so. If you can't hold a job, say so. If
13:31you isolate yourself and haven't seen
13:34friends in months, say so. I know what
13:37you're afraid of, cuz I've been there.
13:38You're afraid that if you're really
13:40honest, something bad will happen.
13:42They'll think you're crazy. They'll take
13:44something away. They'll judge you.
13:46Here's the truth. The examiner has heard
13:48everything. They've sat across from
13:50thousands of veterans. Your symptoms are
13:52not unique to them. They're not going to
13:54judge you. They're going to document
13:56what you tell them. But if you minimize,
13:58you will get underrated and you'll spend
14:00years fighting for an increase trying to
14:03prove something got worse when really
14:05you just finally admitted how bad it's
14:07always been. So save yourself years of
14:09appeals and be honest now. So write down
14:12your symptoms before you even go to the
14:14exam. Not to re rehearse, but to make
14:16sure you don't forget anything when
14:18you're in the room and the emotions are
14:20high. Nightmares, how often? What are
14:23they about? Your sleep, how many hours
14:26you get? What's the quality?
14:27Hypervigilance, give some examples.
14:29Avoidance, what do you avoid and why?
14:31Your relationships, how are they
14:32affected? Your work, is it impacted?
14:35Your anger is, what's the frequency of
14:36it? The intensity, the suicidal
14:39thoughts, do you have them ever? Are
14:40they current? Write it down. Bring it
14:42with you. Reference it if you need to.
14:45Now, if you need help preparing for your
14:47PTSD exam, if you need a next letter
14:50establishing service connection or
14:51documentation of how your PTSD affects
14:53your daily life, that's what I do and we
14:55do every day at Extera Health. It's a
14:57free consultation with the medical
14:58writer, free records review. We write
15:00the documentation before you ever pay
15:02anything and you get to edit with it.
15:04$500 per letter, not per condition.
15:06There are no contracts, no risk. The
15:08link's in the description below. So
15:10don't go into the exam unprepared.
15:13Advice number two is the is going
15:16getting into the evidence and history
15:18section. Right? So section three is
15:20evidence review. The examiner will
15:22document what records they reviewed for
15:24the exam. These are going to be things
15:26like your your VA medical records or
15:28blue button report, your service
15:30treatment records, your DD214, your
15:32private medical records that you
15:34submitted, any DBQs from your your own
15:36providers, and then your C file, which
15:38is your claims file. Now, why does this
15:41matter? Well, if the CMP examiner didn't
15:43review important records, that could be
15:45a problem. If you have treatment records
15:47that show the severity of your PTSD and
15:50the examiner didn't see them, you should
15:51mention them. I've been in treatment
15:53with Dr. XYZ for 2 years. Did you see
15:57those records? Make sure that you ask
16:00because if they didn't, then it didn't
16:02get documented. Now, section four is the
16:04history. And I'm going to do a little
16:05bit of a deep dive here. This is where
16:07the exam gets very personal. The
16:09examiner is going to ask about your
16:11history across multiple different areas
16:14in your life. The first thing they ask
16:16is about your social history. Where did
16:19you grow up? What was your childhood
16:21like? Did you have any traumatic events
16:23or trauma before the military? Where are
16:26you currently living? What's your
16:27current living situation? And then what
16:29are your friends like? Do you have
16:30friends? What social activities do you
16:33do? Do you do any social activities? The
16:35next one they ask about is your marital
16:37and family history. This is where they
16:39deep dive into your personal
16:41relationships with the ones you love.
16:43Are you married? Are you divorced? How
16:45many times have you been divorced? How
16:47is your current relationship with the
16:49person you're in the relationship with?
16:51Do you have children? What's your
16:53relationship with them? What's your
16:54relationship with your parents? How has
16:56your family been affected by your PTSD
16:59symptoms? The next section they get they
17:01get a deep dive is your occupational
17:03history. essentially your job history.
17:05What jobs have you had since the
17:07military? How long have you been at each
17:09job? Why did you leave said job? What is
17:13your current employment status?
17:14Part-time, full-time, unemployed, and
17:17have you had problems documented at
17:19work? Any disciplinary action, any
17:21supervisory action against you? Next
17:23section is your educational history.
17:26They want to know everything about your
17:28education level, vocational schools
17:29you've been to, college, high school,
17:31how far did you get in school? Did you
17:33have any issues with concentration or
17:36completion when you're going to school?
17:38What has been your education since
17:39you've left the military? Did you go to
17:41college? Did you go to vocational
17:43school? Next section is your mental
17:45health treatment history where they will
17:47do a deep dive on all the mental health
17:49stuff before, during, and after service.
17:52So, have you ever been in therapy? When?
17:54How long? Have you ever been
17:56hospitalized in a psychiatric hospital?
17:58Are you on current treatment for mental
18:00health disorders? What medications
18:02specifically? What are you taking, how
18:05often, and when? The next section is
18:08your family mental health history.
18:10They're looking to see if you have any
18:12family history of mental health
18:14disorders. So, do you have any mental
18:15health issues in your entire family
18:17tree? This helps establish whether PTSD
18:20symptoms are new since service or
18:22because [snorts] of service or maybe you
18:24had mental health dis issues prior to
18:27service. Next section they look at and
18:29ask about is your legal history. They're
18:32looking for issues before, during, and
18:34even after service. Any arrests, any
18:37convictions, any legal issues related to
18:40your PTSD symptoms. This is a very
18:43important section. Don't hide it even
18:45though it might feel like you should.
18:47The next section they ask is behavioral
18:50observations. Things in your behavior
18:53that happened before, during, and after
18:56service. How did you act during the
18:58exam? Even what was your eye contact
19:00like during the exam? Were you agitated?
19:03Were you tearful? The CMP examiner is
19:05observing you the whole time you are
19:08talking to them during your CMP exam.
19:11Next section is the substance abuse
19:13history section. Did you have any issues
19:16with substances before, during, or after
19:18service? What's your alcohol use? How
19:20much? How often? Any drug use? How
19:23often? How frequent? What drug of
19:25choice? This is not the time to lie, to
19:28minimize, or say none of if if it truly
19:31is something that you've been dealing or
19:32struggling with. [snorts] I want to
19:34address this directly. Many veterans
19:37self-medicate with alcohol or drugs.
19:39It's increasingly common. I did with my
19:41PTSD. Do not hide this from the
19:44examiner. Substance use secondary to
19:46PTSD is a documented phenomenon. If you
19:49drink to cope with nightmares, that's
19:51relevant. If you use marijuana to manage
19:53anxiety, that's relevant. Hiding it
19:55doesn't help you. Being honest allows
19:57the examiner to see the full picture of
19:59how PTSD affects your life. If you've
20:01had legal problems, arrests, fights,
20:03DUIs, domestic issues, and they're
20:06related to your PTSD symptoms, like
20:08anger, impulsivity, substance use, tell
20:10the examiner. These are evidence of
20:12functional impairment. They show how
20:14PTSD affects your life. Hiding them
20:17hides evidence that supports your claim.
20:19The next section is the PTSD diagnostic
20:22criteria based on the DSM5 criteria. So
20:24this section goes through the official
20:26diagnostic criteria for PTSD from the
20:29DSM5. The manual psychiatrist and
20:31psychologists use to diagnose mental
20:33disorders. There are specific criteria
20:35that must be met for a PTSD diagnosis.
20:38The examiner is checking whether you
20:40meet each one. So criteria A is an
20:43exposure to a traumatic event. The
20:44examiner must establish that you were
20:46exposed to a traumatic event. This can
20:48include a multitude of things, right?
20:50Like direct exposure. Did you experience
20:52the trauma yourself? Were you a witness?
20:55Did you see a traumatic event happen to
20:57other people? Did you learn about it? A
21:00close family member or friend
21:01experienced it or were there repeated
21:03exposures? Were you a first responder, a
21:05military medic? Military roles with
21:07repeated exposure to traumatic details.
21:10For service connection, the traumata the
21:12trauma needs to be related to your
21:14military service. Combat is the most
21:16obvious, but there are many, many others
21:19like military sexual trauma or MST,
21:22accidents or injuries that occurred,
21:23witnessing deaths or casualties,
21:25handling remains of fallen or deceased
21:28soldiers, training accidents, and even
21:30non-combat violence. So when I get into
21:34the combat presumption, right? If you
21:36have had a if you have a combat infantry
21:38badge, combat action badge, combat
21:40action ribbon, combat medical badge or
21:42similar, you get a combat presumption,
21:45meaning the VA accepts that you were in
21:47combat situations without requiring you
21:49to provide specific events. This makes
21:52service connection easier to establish.
21:55The next criteria is criteria B or
21:57intrus intrusion symptoms. So, do you
22:00experience intrusive symptoms related to
22:03the trauma? At least one of these is
22:06required. Intrusive memories, like
22:08unwanted, distressing memories that pop
22:10into your head randomly. Do you have
22:12nightmares or distressing dreams related
22:14to the trauma? Do you have flashbacks or
22:16feelings like the trauma is actually
22:17happening again in real time? Do you
22:19have psychological distress or getting
22:21upset when reminded of the traumatic
22:23event? Do you have physical reactions?
22:25Meaning your heart starts to race. You
22:27start to sweat. You breathe really fast
22:28when reminded of the traumatic event.
22:31Don't just say, "Yeah, I have
22:32nightmares." Say, "I have nightmares."
22:34Three to four times a week. Thereabout
22:36whatever it was. I wake up sweating. My
22:39heart is pounding. My wife sleeps in
22:41another room because I thrash and yell
22:42at night. I'm afraid to go to sleep.
22:45This will specifically help the examiner
22:47to document the severity. Now, criteria
22:50C is avoidance. Do you avoid things
22:53related to the trauma? At least one of
22:55these is required. Do avoid memories or
22:58or thoughts, trying not to think about
23:00it. Do avoid reminders, avoiding people,
23:02places, activities, any situation that
23:05re that could or would remind you of the
23:08traumatic event. So some specific
23:10examples, right? Like you won't watch
23:13war movies anymore. You avoid Fourth of
23:15July or any any event with fireworks.
23:17You don't talk about your service with
23:19anyone, even fellow service members you
23:21served with. You avoid crowded places.
23:23You've changed your route to avoid
23:25certain areas. Or maybe you even stopped
23:27doing activities you used to enjoy. Next
23:30is criteria D symptoms. Negative changes
23:33in thoughts and mood. So, have you had
23:35negative changes in how you think and
23:37feel since the traumatic event? And you
23:38need at least two of these. Okay? So,
23:40you can't remember important parts of
23:41the traumatic event. You have negative
23:43beliefs about yourself or others of the
23:45world. Like, I'm worthless. No one can
23:47be trusted. The world is a dangerous
23:49place. You have distorted blame, meaning
23:51you blame yourself or others
23:52inappropriately for the traumatic event.
23:54Or you have persistent negative emotions
23:56like fear, horror, anger, guilt, shame.
23:58Maybe you have diminished interest in
24:00activities you used to enjoy or feeling
24:02detached from others. Or you can't feel
24:04positive emotions, meaning you're unable
24:06to feel happiness, love, or
24:08satisfaction. The next criteria is
24:10criteria E, which is arousal and
24:12reactivity. So changes in arousal and
24:15reactivity since the traumatic event.
24:16And you need to have at least two of
24:18these. Okay. So, inability or anger
24:20outburst or sorry, irritability or anger
24:22outburst, recklessness or
24:24self-destructive behavior,
24:26hypervigilance, meaning you're always on
24:28guard, scanning for threats, an
24:30exaggerated startle response like
24:32jumping at noises or you have
24:34concentration and focus problems and
24:36even sleep disturbance. Now, duration
24:39and impairment, right? So, so there are
24:41some additional criteria. So, they look
24:43at duration of symptoms, right? So, have
24:45your symptoms lasted more than one
24:47month? They look at functional
24:48impairment symptoms cause sign do the
24:51symptoms cause significant distress or
24:52impairment in social, occupational or
24:55other important areas not attributable
24:57to substances or medical conditions. Now
25:01I want to get to the next piece of
25:02advice. I want you to describe your
25:04worst days, not your best days. When the
25:06CMP examiner asks about your symptoms,
25:09don't describe a good day. Describe what
25:11it's really like when things are bad.
25:14But the tendency here is veterans will
25:16tend to normalize their symptoms. You've
25:18been living with this for years. You've
25:20adapted. You've learned to cope in your
25:22own way. Whether it is maladaptive, when
25:24someone asks how you're doing, you
25:26compare to your worst moments and say,
25:29"I'm okay." But okay to you might be
25:32severely impaired by normal standards.
25:35So, here's how to actually answer this.
25:37Right? When the examiner asks about
25:39sleep, say don't say, "I'm I'm not
25:43great, but I get by." Instead, say, "On
25:46bad nights," which is most nights, I get
25:48maybe 3 hours. I have nightmares that
25:50wake me up. I can't fall back asleep.
25:53I'm exhausted all the time during the
25:55day. When they ask about relationships,
25:58do not say, "My marriage has some
26:01problems." Say, "My wife and I barely
26:03talk anymore. I isolate in the garage.
26:06we've almost divorced twice. My kids are
26:09now afraid of me when I get angry or
26:11upset. And then when they ask about your
26:14work, what you should not say is
26:16something like, "Yeah, it's difficult,
26:19but I, you know, I get by. I've had some
26:21issues at my jobs." Instead, I want you
26:24to say, "I've been fired three times in
26:275 years. I can't handle supervisors
26:29anymore. I've gotten into conflicts with
26:32co-workers. I can't I I actually will
26:34call in sick when I can't face going in
26:37because of my PTSD symptoms. The point
26:39here is the VA needs to understand your
26:42functional impairment at its worst, not
26:44its best. Your rating should reflect the
26:47reality of living with PTSD, not the
26:50sanitized version you present to the
26:52world by when you wear your mask. Okay.
26:55Section six and seven is the clinical
26:57findings and competency section. All
26:59right. So, section six, symptoms and
27:01clinical findings. This section will
27:03cover two two things, okay? Uh both
27:05observed and reported symptoms. So what
27:09you report the symptoms that you
27:11describe and then what the CMP examiner
27:14will actually observe during the exam,
27:16how you presented during the entirety of
27:19the exam. What did you look like? How
27:20did you act? What was your eye contact
27:22like? So common symptoms that will get
27:25documented in this section are going to
27:27be things like your depressed mood. Are
27:29you feeling anxious? Do you feel like
27:32you're wanting to to hurt people? Uh are
27:35you suspicious of other people? Do you
27:37have panic attacks? And then how
27:39frequent are these panic attacks
27:40happening? Do you have any level of
27:42sleep impairment? Do you have mild,
27:44moderate, maybe severe memory loss, even
27:46short-term memory, like where you put
27:48things, forgetting to do tasks you've
27:50been told to do? Do you have flattened a
27:52effect, meaning limited emotional
27:53expression? Do you have circumstantial
27:55or tangential speech, meaning you go off
27:57on on tangents when you're talking to
27:59someone? Do you have difficulty
28:00understanding complex commands? Do you
28:02have impaired judgment? Do you have
28:04impaired abstract thinking? Do you have
28:06disturbances of motivation and mood
28:08during the day? Do you have difficulty
28:09establishing and maintaining
28:11relationships? Do you have difficulty
28:12adapting to stressful circumstances? Do
28:14you have an inability to establish and
28:16maintain effective relationships? Do you
28:18have any amount of suicidal thoughts?
28:20Any homicidal thoughts of hurting other
28:22people, any obsessional rituals, any
28:24impaired impulse control, any neglect of
28:26your personal hygiene, even any
28:28disorientation at all, any persistent
28:30delusions or hallucinations, and any
28:33grossly inappropriate behavior? And
28:35lastly, they want to look for things
28:37like any persistent danger of hurting
28:39yourself or other people. Now throughout
28:43the exam, the CMP examiner is watching
28:46your eye contact, your emotional state,
28:48how you describe events. Is it flat when
28:51you deliver it, emotional, avoidant,
28:53your concentration, focus during the
28:55entire exam, any signs of anxiety,
28:58hypervigilance, agitations, your hygiene
29:01even, and your self-care, how you
29:02present yourself in the during the exam.
29:05This is all documented under behavioral
29:08observations. The next section is
29:11section seven which section seven which
29:12is competency. So financial management.
29:15The DBQ asks whether you're capable of
29:17managing your own financial affairs.
29:20This is about whether you need a
29:21fiduciary, someone to manage your VA
29:24benefits for you. For most veterans, the
29:26answer is yes, you can manage your
29:28finances. But if your PTSD is so severe
29:32that you can't handle money responsibly,
29:34that needs to be documented and you need
29:36to explain why. And the last section is
29:39the remark section. It's just the a
29:42catch-all section for the examiner
29:43notes. The examiner has space to add
29:46remarks, additional observations,
29:48clarifications, or notes about your
29:50specific case. This is where they might
29:53explain their reasoning or note anything
29:55unusual or add context to their previous
29:58findings they documented. The last piece
30:01of advice is don't try to diagnose
30:05yourself or guide the examiner. Just
30:08describe your life. Be direct. Your job
30:10in this exam is not to convince the
30:12examiner you have PTSD. It's not to tell
30:15them what rating you deserve. It's not
30:17to use clinical terminology or recite
30:19DSM criteria. Your job is to honestly
30:22describe how your life has been
30:24affected. Don't say, "I have
30:25hypervigilance in an exaggerated startle
30:28response consistent with criteria E." I
30:30would rather you say, "I can't sit with
30:32my back to the door. I'm always scanning
30:34for threats. I know it's not rational,
30:35but I can't sleep either. I can't stop
30:38doing it. When a car backfires, I hit
30:40the ground. My wife can't touch me from
30:42behind without me spinning around ready
30:43to fight. Don't say, "I believe I have
30:46occupational impairment consistent with
30:47a 70% rating." Instead, say, "I've lost
30:50three jobs in 5 years. I can't handle
30:51authority figures. I got into a fight
30:53with a co-orker last year. I spend most
30:55days in my garage because I can't deal
30:57with people, even my family." The
30:59examiner is trained to take your
31:01description and translate them into
31:03clinical findings and ratings. That's
31:05their expertise. Your expertise is
31:07knowing what your life actually is like.
31:10Focus on communicating that
31:11specifically, completely, and honestly.
31:14So, when you go to the exam, I want you
31:17to consider bringing a couple things.
31:18Notes from your family members about
31:19your PTSD and how it affects them.
31:21Documentation of your lost jobs, records
31:23of any legal issues, any list of
31:25medications you take, and any treatment
31:27records. And then physical evidence.
31:29Remember, physical evidence supports
31:32your verbal description. Okay, so
31:34summary here. So, a quick reference for
31:36your PTSD CMP exam. Before the exam, I
31:39need you to know your exam date, the
31:41time, and location. Download and review
31:43the PTSD DBQ from va.gov or simply just
31:46Google PTSD DBQ. Write down your
31:49symptoms and how they affect your life.
31:51Gather supporting documents like
31:53treatment records, buddy statements,
31:54witness statements, spouse statements,
31:56personal statements. Note your traumatic
31:59history, and be prepared to discuss it.
32:01And then DBQ sections. You know, this is
32:04where you got to I would recommend just
32:07googling the form PTSD DBQ, reading
32:10through everything and be prepared for
32:12those questions that are on the DBQ.
32:14I've already described them in great
32:16detail. But it is very important that
32:18you are prepared for those questions cuz
32:20they are going to ask all of those
32:23questions. Let me bring this all home.
32:25Okay, the PTSD CMP exam is going to be
32:28hard. What I mean, you're going to sit
32:30across from a stranger and talk about
32:32the worst things that have ever happened
32:33to you. You're going to discuss symptoms
32:36you probably hidden away and
32:38compartmentalized from everyone, maybe
32:40even yourself. It is not going to be
32:42easy. And I know it's not going to be
32:44easy, but it is necessary. The
32:46alternative is walking out of the exam
32:48underrated because you said, "I'm fine."
32:50When you're not fine, and then spending
32:52years, maybe decades, fighting for an
32:54increase that you should have gotten the
32:56first time. Before your exam, I need you
32:58and I want you to one download the PTSD
33:01DBQ and look at it. Know what's coming.
33:04Know what boxes they're checking.
33:06Understand that occupational and social
33:08impairment section determines your
33:09rating. Two, write down your symptoms
33:12honestly. How often do you have
33:13nightmares? What do you avoid? How are
33:15your relationships really doing? What's
33:17work been like? Have you had thoughts of
33:19suicide? Write it all down. Bring it
33:22with you. And three, tell the truth. Not
33:24the version you tell everyone else. Not
33:26the I'm handling it version, the real
33:29truth about what living with PTSD is
33:31actually like. The examiner is not there
33:33to deny your claim. They're there to
33:35document your condition. Help them to
33:37help [clears throat] them do that by
33:38giving them accurate information. The
33:40enemy is the training that taught you to
33:43minimize, to hide weakness, to say, "I'm
33:45good when you're drowning." The training
33:47is over. This is not a formation. This
33:49is no longer the military. This is a
33:51medical exam that determines your
33:53compensation. So, be honest. If you need
33:55help with your PTSD claim, a nexus
33:57letter, DBQ, documentation, preparation,
34:00that's what I do and we do every day at
34:01Extera Health. You get a free medical
34:03consultation with the provider, free
34:04records review. We write the whole
34:06entire letter for you before you pay
34:07anything. Only $500 per letter, no
34:10contracts. Links in the description
34:12below. Again, I am Dr. Marshall Bar, an
34:15actual physician, Army Ranger, combat
34:18medic, disabled veteran, someone who's
34:20done CMP exams. The exam is hard, but
34:23you've done harder things. Walk in
34:25prepared, tell your truth, and get rated
34:28for what you've actually gone through
34:30and what you're going through. I will
34:31see you in the next video and until next
34:33time, stay mission

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