[Music]
Leah Bucholz:
hey guys it's Leah B from Prestige veteran medical Consulting I a US Army veteran physician assistant and former compensation and pension examiner today I want to come on and do a video about depression and what happens in a compensation and pension exam for depression so we've done several videos on what happens in a CMP exam in the past they seem to be super popular and helpful um maybe they're easing some of you guys' fears when you're preparing for those exams so hopefully this one will do the same for those of you going in for a depression uh CMP exam

so let's start off by talking about how people get service connected for depression so if a veteran was diagnosed with depression while on active duty they experienced um something and were treated for it and it's continued in service it may be relatively simple a simple process especially if it did not exist prior to service for the person to show or establish that they were um that this was directly related to their service okay um that's not in every case but that's in some cases if a person had um pre-existing depression but it was aggravated or worsened Beyond its natural progression by their service that would also be some um sort of a direct service connection on a secondary basis a person could develop uh a back condition or any other medical condition that they become service connected for let's say you were on active duty and you injured your back really bad while you were deployed or you had a traumatic amputation of your arm or something like that uh you can and you develop depression after that it could be right after that or many years later it can be secondary to a physical condition or even another medical condition can cause it um not just you know an orthopedic condition it can be another medical condition like idus or sleep apnea or just about anything if that particular condition is causing you to be depressed now that doesn't mean that everybody has condition a condition B is is related to that it's just all person or patient or veteran specific right based on your history you could be depressed because of your back pain but then it resolves and you get depressed because you're getting divorced or you know sometimes they can be intertwined

okay so we'll get off of that and we'll go on to what happens in the CMP exam so for the most part you should get a packet in the mail um that has the DBQ or disability benefit questionnaire in it and it also should have who your exam is with how long they've been an examiner where where it's going to be at what time it's going to be at you know all the five W's right um so once you get that you can either hopefully that BBQ will be in there that disability benefit questionnaire that's the document and we're going to go over that that here shortly that is the document that the CMP examiner is going to go over with you at the CMP exam and it and it sort of outlines all the questions that are relative um relevant and pertinent to the condition that helps the adjudicators decide what percentage you should get if if you're going to be service connected Etc so again it should be in that packet but if it's not you can head on over to va.gov and they should have a copy of it over there for you as well so I'm going to just share my screen with you guys really quick so that y'all can um see what I'm seeing

okay okay so let me just make this just slightly larger if I can

okay so this is from va.gov this is the mental disorders other than PTSD and eating disorder disability benefit questionnaire um if you guys want to I have another one about what happens in a PTSD CMP exam if you guys want to check that one out that's a great video as well but this one is going to be for mental health disorders and specifically we're going to go over depression today so as you can see here again this is what they're going to go over with you at the CMP exam so they're going to put your information up here at the top um this is all just sort of like some demographic information that they're going to fill out uh that that's not really questions for you so are you completing this DBQ at the request of the veteran claimant or other so you can take this to your regular um psychologist and ask them to fill it out if you'd like or your psychiatrist um and so that's where they would fill out some of that information you know are they regularly seeing your clinic yes or no was the veteran examine in person yes or no or was it done like for example via tah Health exam so diagnosis does the veteran now have or have they ever been diagnosed with a mental health disorder yes or no they're going to ask they're going to put the ICD code that's not something you need to really have in the back of your mind they're going to the medical provider is going to know that

then it asks if the veteran currently has one or more mental disorders that conform to the dsm5 criteria provide all diagnoses so you know maybe you've got more than one maybe you've got depression and anxiety maybe you've got generalized anxiety disorder adjustment disorder but for the purposes of today we're just going to talk about depression and if there's any so it's listing for three if there's more diagnoses they can put them here medical diagnoses relevant to the to the understanding or management of the mental health disorder to include TBI so different differenti differentiation of symptoms does the veteran have more than one mental health disorder diagnosed yes or no is it possible to differentiate which symptoms are attributable to each diagnosis so this I don't want to get two in the weeds but this can become important if one of the conditions is sort of related to service and maybe one of them isn't or perhaps if there's an overlap they want to be able to determine um especially with TB I which we're going to go down here a little bit later is there an overlap of symptoms or are they really distinguishable okay does the veteran have a diagnosed TBI yes or no and then it says if yes you're going to fill out 2D so is it so if the answer was yes then is it possible to differentiate which symptoms are attributable to the TBI and um any non-tbi mental health diagnosis so a lot of people are combined for those not always but a lot of people people are combined for a mental health condition and TBI if they suffer from both

so now it's going to go on to occupational and social impairments which of the following best summarizes the veterans level of Occupational and social impairment with regard to all mental health diagnoses and they only want the person to check one so obviously if you don't have a mental uh disorder diagnosis they're going to check that and it goes all the way from the condition has been formally diagnosed but symptoms are not severe enough to either interfere with occupational and social functioning or to require continuous medication the next block is 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 medication the next one is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks although generally functioning satisfactorily with normal routine Behavior self-care and conversation the next one is occupational and social impairment with reduced reliability and productivity so the next one is occupational and social impairment with deficiencies in most areas such as work school family relations judgment thinking Andor mood and then there's total occupational and social impairment so you know this question is going to be asked so if you have some examples like hey I'm late to work all the time I'm reprimanded at work constantly I don't get along with people at work I maybe you're in school right you have been failing several courses uh in in Social environments are you just totally incapable of communicating with people try to try to write down some examples that way when you get there you're not like overwhelmed by the process and you can provide some feedback that might be helpful so for have you been fired from tons of jobs that's another thing have you quit tons of jobs uh anything like that for the indicator occupational and social impairment is it possible to differentiate which impairment is caused by each mental health disorder yes or no if a diagnosis of TBI exists is it possible to differentiate which occupational and social impairment indicated above is caused by the TBI yes or no

so now it's asking for which what evidence was reviewed what did they look at did they look at your claims file did they look at just your private treatment records did they look at uh your VA medical records your service medical records did they look at nothing what was reviewed here and the date ranges

so this History Section so question 2a is relevant social marital Family History pre-military Military and postmilitary so basically they they want to see it says if this is if this is a review exam only indicate any relevant history since prior exam so we're talking you know that's that's really talking about whether this is like a update exam whether it's for a reevaluation or whatever or or a initial exam but anyways relevant social marital family history

so were you are you married are you divorced are you widowed what is your family history do your is your mom did your mom have a mental health disorder or any of your siblings relevant occupational and educational history so it's asking about what is your occupation any relevant you know what were you in the military what was your job what is your current job what what level of education do you have right relevant mental health history to include prescribed medications and family mental health so again this is going to be that those prescribed medications that you might be on now maybe you've been on a slew of different medications that have changed over the years what are you currently on maybe you were on nothing relevant legal and behavioral health history relevant legal and behavioral history did you you get a bunch of article 15s did you have UCM other UCMJ action were you Court Marshal have you been arrested were you arrested pre-service were you arrested in the service were you arrested post service right relevant substance abuse history pre- poost and in the military did you get arrested or have problems with substances prior to service did you have problems with substances in the service and do you have problems now or have you since you've separated from service and then other

so symptoms so for VA rating purposes check all symptoms that apply to this veterans diagnosis so so there's a slew of symptoms so depressed mood anxiety suspiciousness panic attacks that occur weekly or less so this is going to be a catchall where they check everything that's relevant to you okay so you can review this list and so if there are some examples that come to your mind again write them down so that you can tell them hey I'm suspicious I'm always worried about X Y or Z I'm you know I think people are following me I am anxious wherever I go I have to have a drink before I go out somewhere because I'm always nervous um and you guys can read the rest of these here near continuous Panic or depression affecting the ability to function independently appropriately or effectively chronic sleep impairment mild memory loss so talk about your sleep are do you have insomnia are you staying up all night are you waking up throughout the night and having some of that middle phase and sonnia okay so I I challenge you guys to look over this list flattened affet stereotype speech speech intermittently illogical obscure or irrelevant difficulty in understanding complex commands impaired judgment impaired abstract thinking so they might not ask you these one by one they may just pull these out of the interview as well they might just look at you and be able to you know some of these are objective findings meaning they look at they can evaluate and and decide hey this person has let's see a flattened affect right or it could be something that you tell them and that they gather from your history suicidal ideation Obsession obsessional rituals which inter interfere with routine activities spacial disorientation grossly inappropriate behavior um neglect of personal appearance and hygiene disorientation to time and place there there's a slew of blocks here behavioral observations

okay other symptoms do you have any other symptoms attributable to mental health disorders that are not listed above so a catch all competency so for VA purposes a mentally comp incompetent person is one who because of injury or disease lacks the mental capacity to contract or to manage his her own Affairs including dispersement of funds without limitation so are you capable of that okay if you're not capable of that and that's checked no there may be some implications for that right for you not being able to manage your financial affairs and then remarks okay so they might even say in here in some of these remarks like hey the person came in here and they look like they haven't showered for a week they're wearing mismatched shoes right I things that they observe

okay then the person is going to certify this they're going to sign it put their credentials their MPI number their license number and they're going to sign it right so let me jump off of this share screen

so I hope that was helpful like I said I challenge you guys to take a look at this to write down some thoughts because I know I mean I've been in a CMP exam before on both sides right so I've been the veteran on the CMP exam and I've been a I've been an examiner and I know that it can be overwhelming and and it can be just a lot so if you're prepared in advance and you have some of these things written down it can be helpful to your examiner to have some

feedback about that right so I hope this was helpful and please drop some com comments let me know if you guys have any other requests for upcoming videos and I as always I appreciate you watching and please like And subscribe all right talk to you guys soon

[Music] bye