(CHAMPAIGN, Ill) - According to one of my experts... there is much more to consider than what is listed here, especially when trying to get the earliest effective date possible for the PTSD grant, but what is here doesn't appear to be wrong.

There are two basic steps to receive a disability from the Veterans Administration for PTSD. The first step is filing a claim with the VA for PTSD. The second, and most Important, is submitting a stressor letter. Most combat veterans do not trust the government or the VA. This is understandable considering the treatment most veterans received during and after the Vietnam War. But the VA has improved in most places, and the benefits are there for the combat veterans. The VA does not go looking for the combat veteran with PTSD. You mush push aside any bad feelings and make the effort to receive the earned benefits.

As ridiculous at It may seem, ail combat veterans must not only prove that they were In combat, they must also prove that they were In the military. This process screens out the phony combat veterans. It is surprising how many combat veterans have surfaced who were on top secret missions, and of course, there is no record of their even being in the military because their missions were so secret.

You can file a claim on your own, but there are several veteran's organizations who will represent you on a disability claim. The best of these is probably the American Veterans (AMVETS), since their primary purpose Is helping the veterans file claims for disability. It you do not have an AMVETS office in your area where you can meet with a service officer, you can call the nearest AMVETS office and tell them you want to file a claim for disability. The AMVETS, will send you a power of attorney. You sign this paper and send it back through the mail. This gives the AMVETS your permission to represent you in your claim. The AMVETS opens your claim and forwards it to the VA regional office in your area. Opening the claim is actually a simple process.

This is the single most important factor In obtaining disability for the combat veteran. After your claim has been filed, usually within 30 to 60 days, you will receive a letter from the VA stating that they have received your claim for PTSD. Then you will be asked to submit a stressor letter. This is a written record of combat experiences which you felt were life threatening or have caused you to display symptoms of PTSD. They will also note that they understand how difficult this can be for some veterans (thinking about war experiences and writing them down). And for many this is difficult. Some can't write well. Some are to terrified to think in detail about their war experience.

Chances are the average veteran cannot write a stressor letter that will pass the rating board. Once a stressor letter has been rejected by the rating board, the process to receive disability can be long and discouraging. Many veterans give up and never receive the disability they deserve. The VA will tell-you how to write the letter or what details to include. If the letter is rejected, many combat veterans will give up before appealing the rating board decision. So a veteran must submit a solid stressor letter to pass the rating board. This is my area of expertise. I know what to put in the letter and how to present it so that the rating board will grant any where from 10% to 50% disability just from your stressor letter without rejection and VA appeal hearings. It will be impossible to receive a 100% rating from a stressor letter, but once the VA agrees you are disabled, you can appeal for a higher percentage.

PTSD IS A RECOGNIZED DISORDER WHICH DOES NOT GO AWAY. THE REACTIONS TO COMBAT STRESS OFTEN BECOMES A PERMANENT PART OF THE VETERAN'S PERSONALITY.

At some point after you file for disability, either before or after you have submitted your stressor letter, you will receive a letter asking you to come to the nearest VA Hospital in your area for a Compensation Examination. This just means that you are going to speak to a VA psychiatrist. The psychiatrist will ask you many questions about your background (including your childhood and current social life) and your war service. The meeting with the doctor will probably last anywhere from 20 to 45 minutes. The VA will also reimburse you with a small travel allowance for coming.

You must show up for this comp exam. If for some reason you can't make it, then call the VA and they will schedule you again. Most of all, relax. This psychiatrist is not your enemy, and ft is his or her job to send a report to the VA regional office as to whether you show symptoms of PTSD. The psychiatrist Is Impartial. If you show symptoms of PTSD, it will be reported without any favor toward the VA. So relax and answer questions to the best of your knowledge. Always stress the negative side of your life...never the positive. Just like at the close of the stressor letter. You can do this and still tell the truth just by avoiding the positive. Here are some things not to say at a Comp Exam.

1. My life is okay. Ifs not or you wouldn't be there.

2. I sometimes hear voices. Hearing voices can lead to a diagnosis of schizophrenia, and your PTSD claim may be rejected.

3. I am happily married. It has often been decided that having PTSD automatically means an unhappy marriage. It can but not always.

4. I love my job. I have been there twenty years. If you have managed to keep one job, it may be determined that you interact normally and do not have PTSD. You can have one job and still be miserable. It's a matter of survival.

5. I have lots of friends. Never admit you have lots of friends. Chances are you don't anyway. At least, not like the friends you made in combat situations who you can trust with your life.

6. Don't threaten the doctor. Some veterans scream, yell, and threaten to kill the doctor in an attempt to show symptoms of PTSD. 99% of the time this is an act and won't help your claim.

The main thing is to stress the negative side of your life, just as in the end of the stressor letter. If you have had a substance abuse problem since before your war service, it would be best not to mention it. Stress the fact that you are depressed and have nightmares and feel that the war has altered your life. Just remember to stress the negative instead of anything positive in your life.

1. Name, Rank. Service Number, Dates of Time in War Zone:

Make sure your current correct address and claim number are at the top of your stressor letter. Begin by re-stating your name, rank, and service number. Then begin with your war service. Do not mention time spent in the United Slates. Many veterans ramble on about stateside service, and this has nothing to do with combat stress, if your MOS or specialty was something other than combat related (supply, motor transport, ate.) but you did not serve in your MOS or specialty, mention it here because the VA will turn you down unless you prove you were in combat If you were in Special Forces or Recon, etc., don't go into any detail about stateside training.

2. Were you wounded?:

If you were wounded Include dates, If possible, and number of times wounded. This refers only to wounds which ware treated by medics, corpsmen, or doctors for which you received a purple heart and are a matter of record. If you have malaria or any type malaria fever and were treated for it, mention it also, if you believe it may be in your records.

3. If you killed the enemy:

Include the times you actually saw the enemy and killed them. Be specific if possible. Don't say something like (my outfit killed 53 NVA in the fire fight). This is too general. State what you were doing when the enemy was killed and how it affected you. (I kept firing and I could see them falling as they ran toward us).

4. If you saw Americans die:

Most combat vets lost close friends in combat. For some vets remembering names is difficult, but this will definitely help your claim if you can remember the approximate date and names of men in your outfit killed while you were there. If someone killed was your best friend, mention it and how it affected you. The names will be checked by the VA against KIA lists. If friends were wounded bad enough to be shipped home, you may mention this and include their names if possible. (This is all verification that you were in combat. Try to use real names instead of nicknames at all times).

5. If you saw civilian dead:

In villages, the jungle, or other places. This was traumatic to many combat troops, especially if they had to handle the bodies. Seeing dead children often has long range effects on combat vets, particularly if the children or civilians were killed during fire fights or mistaken for the enemy.

6. If you were on body detail:

Or if you otherwise handled the bodies of dead Americans, either in the field or in the rear where the bodies were stripped for shipment home. This often causes extreme trauma to those who handled the bodies.

7. Times you did not think you would survive:

Incidents when you thought you would not be alive the next day help with a PTSD claim. When you had given up hope and thought for sure you would be killed with no chance of survival. (Describe in detail).

8. All incidents of combat:

Small arms fire, fire fights, mortar and rocket attacks, booby traps, mines, artillery, etc. Each time you were in a life threatening situation whether you were able to return fire or not. (Walking through mine fields, walking point, etc.)

9. Names of operations or search and destroy:

Remembering names of specific field operations and sweeps can often be helpful because the military often left much Information out of service records. Some combat troops have very complete service records. Others have had their records lost or destroyed, or Information was never entered. Any Information you can remember about field operations Is verification of combat role.

10. How your life has changed because of the war:

State your problems today because of your war service. Divorce, substance abuse, nightmares, paranoia, trouble holding jobs, lack of feeling, etc. If you have been in therapy or other treatment, mention this. Stress the negative side of your life. Mention nothing good that has happened to you. Don't say you get along great with people and you are happy most of the lime. Stress that life is a constant struggle due to your combat service, (You used to love fireworks but now when you hear them you hit the ground. You used to love to go to sporting events but now you can't cope with being in crowds, etc.)

NOTE: These ten points will help you write a stressor letter which will have a good chance of passing the VA rating board. When writing about combat, write how it affected you personally. Don't write stuff like.(We sat around and ate dinner and then the sergeant told us a story about his wife and then Joe tried to steal my bean and wieners). Too many vets go in to detail which Is not important. Begin each segment of combat with the combat and how it affected you. (You were scared. You thought you were going to die, etc.). Many veterans are afraid to mention certain situations when they killed people for fear of charges being brought against them. This will not happen. Killings during combat are for survival. The government would have to prove you killed on purpose without just cause, and in the case of enemy troops and civilians, this is not possible.

Many of these ten points overlap with each other. You must try to put them in some kind of order. Think about what you want to say for a few weeks before writing it down. Then try to arrange your thoughts in some kind of order. The best solution is to be brief and to the point. This is difficult for many veterans, which is why so many veterans with PTSD never follow through with a claim. The best average length for a stressor letter is not more than four pages single-spaced.

0%

Neurotic symptoms which may somewhat adversely affect relationships with others but which do not cause impairment of working ability.

10%

The psychoneurotic disorder produces mild social and Industrial Impairment.

30%

The symptoms result in such reduction in Initiative, flexibility, efficiency, and reliability levels as to produce definite Industrial Impairment There will be definite impairment in the ability to establish or maintain effective and wholesome relationships with people.

50%

The veteran's ability to establish or maintain effective or favorable relationships with people is considerably impaired. By reason of psychoneurotic symptoms the reliability, flexibility, and efficiency levels are so reduced as to result in considerable industrial Impairment.

70%

The disability severely impairs the veteran's ability to establish and maintain effective or favorable relationships with people. The psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain and retain employment.

100%

The attitudes of all contacts except the most Intimate are so adversely affected as to result in virtual isolation in the community. Total Incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic, and explosions of aggressive energy resulting in profound retreat from mature behavior will be present. He or she will be demonstrably unable to obtain or retain employment

100-91

Superior functioning in a wide range of activities. Life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms.

90-81

Absent or minimum symptoms (e.g. mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns ("e.g.. an occasional argument with family members).

80-71

If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g. temporarily failing behind in schoolwork).

70-61

Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.

60-51

Moderate symptoms (e.g.. flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

50-41

Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).

40-31

Some impairment in reality testing or communication (e.g... speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g. depressed man avoids friends, neglects family, and is unable to work: child frequently beats up younger children. Is defiant at home, and is failing at school).

30-21

Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas. (e.g. stays in bed all day; no job, home, or friends).

20-11

Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death, frequency violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g. smears feces) OR gross impairment in communication (e.g., largely incoherent or mute.)

10-01

Persistent danger of severely hurting self or others. (e.g. recurrent violence) OR recurrent inability to maintain minimal personal hygiene OR Serious suicidal act with clear expectation of death.

Inadequate information

Are you ready to File a PTSD Claim?

Now that you have read about Stressors and Gaff scores and finding a service officer lets think about one other area you need to be prepared for. Your chances of getting a higher rating are diminished greatly if you have not been under the care of a shrink, have not had meds given to you for PTSD symptoms and also if you have not been going to the either the shrink, social worker or a PTSD group or all of these for at least 6 months on a regular basis. You must show that you have tried to have your illness treated. This carries allot of weight with your claim. I feel you need to do the following to strengthen you claim.

First get a complete copy of your VA records, you will have to sign for them and usually wait a few weeks, once you have these copies carry them with you Always when you go to the VA, especially your records con-cerning your PTSD claim. Remember the VA has the bad habit of losing your records. Have them updated at least quarterly.

Go to your Shrink, the Dr. that ordered your meds, any group leader you have had for PTSD group, any social worker and any civilian Dr. you have worked with and ask them all to write you a Personal Letter rating you with the severity of your PTSD and also have them include your Gaff score in the letter. They will not offer these letters and don't ask for a letter in front of others do it privately. You should never be refused. The letter may not say what you want but the chances of you getting a solid letter from them is highly likely. Once you have these letters have them included in your file by your Service Officer. Do not trust that the VA will include them.

Always have them with you at all times also.

I would recommend that when possible that you do not subject yourself to a extended lock down for PTSD, Try using group or one on one counseling in lieu of this or PTSD group.

Remember if you don't show emotion and tears in your interviews or groups that you are probably going to go no where with your claim. 1 know it's hard and you have in many cases had your feelings hidden for years now, but you have to release them. This is not the time for you to be sucking up your pain as you have been doing for years. Don't try and be a hard ass and don't ever curse or threaten your Dr. or go there under the in-fluence of any drugs or alcohol other than what has been prescribed by the VA to you. You will find that not only will this benefit your claim but it will also benefit your personal well being by helping you expunge many of the horrors you experienced in combat.

When you go for your C & P. Take your records and these letters with you and offer them Before the C & P begins. Chances are they won't have this information. This same applies if you apply for Social Security.

Remember if you end up with a total disability rating of 70% or more for PTSD or a combination of Service Connected disabilities you are considered unemployable (that's assuming you are not working ) and you can get 100% from the VA and if you have worked enough quarters from Social Security also.

I encourage you to call me if I can assist you, If you like call me prior to a C & P maybe I can help you get a idea on what's going to occur in this very important meeting. Don't forget we did things by the numbers in the Military if you do them by the numbers for your claim your chances of being turned down the first time have been greatly decreased. The least that will happen is that out of the gate whatever rating you get will be higher than it would have been without this supportive information. You can always appeal a lower rating which is al-lot easier to appeal than a flat denial.

Welcome Home and Good Luck
The Exam
POST TRAUMATIC STRESS DISORDER (PTSD)
Name: SSN:
Date of Exam: C-number:
Place of Exam:

Narrative: Service connection for post-traumatic stress disorder (PTSD) requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. It is the responsibility of the examiner to indicate the extreme traumatic stressor leading to PTSD, if he or she makes the diagnosis of PTSD. It is the responsibility of the rating specialist to confirm that the cited stressor occurred during active duty.

A diagnosis of PTSD cannot be adequately documented or ruled out without obtaining a detailed military history and reviewing the claims folder. This means that initial review of the folder prior to examination, the history and examination itself, and the dictation for an examination initially establishing PTSD will often require more time than for examinations of other disorders. Ninety minutes to two hours on an initial exam is normal.

A: Review of Medical Records:

B. Medical History (Subjective Complaints):

Comment on:

1. Past Medical History:

a. Previous hospitalizations and outpatient care.

b. Medical and occupational history (from the time between last rating examination and the present need be accounted for, UNLESS the purpose of this examination is to ESTABLISH service connection, then complete medical history including description of stressors and history since discharge from military service is required.

c. Review of Claims Folder is also required on initial exams to establish or rule out the diagnosis.

2. Present Medical, Occupational and Social History - over the past one year.

a. Frequency, severity, and duration of psychiatric symptoms.

b. Length of remissions, to include capacity for adjustment during periods of remissions.

c. Extent of social impairment and time lost from work over the past 12 month period. If employed, identify current occupation and length of time at this job. If unemployed, note in complaints whether veteran contends it is due to the effects of a mental disorder. Further discuss in DIAGNOSIS what factors, and objective findings support or rebut that contention.

3. Subjective Complaints:

a. Describe fully.

C. Examination (Objective Findings):

Address each of the following and fully describe:

1. Stressor information: Clearly describe the stressor. Particularly if the stressor is a type of personal assault, including sexual assault, provide information, with examples, if possible, on behavioral, cognitive, social, or affective changes that the veteran links to the stressor. Include information on related somatic symptoms. If there is a history of multiple stressors, assess the impact of each, to the extent possible.

2 Mental status exam to confirm or establish diagnosis in accordance with DSM-IV:

a. Are all diagnostic criteria to establish a diagnosis for 309.81 Post-traumatic Stress Disorder, as specified in DSM-IV, fully met?

b. For initial examination to establish service connection, fully discuss the criteria in steps A through F supporting or ruling out the diagnosis.

c. Describe any associated symptoms.

d. Specify onset and duration of symptoms as acute, chronic, or with delayed onset.

3. Describe in detail the linkage between the stressor and the current symptoms and clinical findings.

4. Describe and fully explain the existence, frequency, and extent of the following signs and symptoms, or any others present, and relate how they interfere with employment and social functioning:

a. Impairment of thought process or communication.

b. Delusions, hallucinations and their persistence.

c. Inappropriate behavior cited with examples.

d. Suicidal or homicidal thoughts, ideations or plans or intent.

e. Ability to maintain minimal personal hygiene and other basic activities of daily living.

f. Orientation to person, place, and time.

g. Memory loss, or impairment (both short and long-term).

h. Obsessive or ritualistic behavior which interferes with routine activities and describe any found.

i. Rate and flow of speech and note any irrelevant, illogical, or obscure speech patterns and whether constant or intermittent.

j. Panic attacks noting the severity, duration, frequency, and effect on independent functioning and whether clinically observed or good evidence of prior clinical or equivalent observation is shown.

k. Depression, depressed mood or anxiety.

l. Impaired impulse control and its effect on motivation or mood.

m. Sleep impairment and describe extent it interferes with daytime activities.

n. Other symptoms and the extent they interfere with activities.

D. Diagnostic Tests:

1. Provide psychological testing if deemed necessary.

2. If testing is requested, the results must be reported and considered in arriving at the diagnosis.

3. Provide specific evaluation information required by the rating board or on a BVA Remand.

a. Competency: State whether the veteran is capable of managing his or her benefit payments in the individual's own best interests (a physical disability which prevents the veteran from attending to financial matters in person is not a proper basis for a finding of incompetency unless the veteran is, by reason of that disability, incapable of directing someone else in handling the individual's financial affairs).

b. Other Opinion: Furnish any other specific opinion requested by the rating board or BVA remand furnishing the complete rationale and citation of medical texts or treatise supporting opinion, if medical literature review was undertaken. If the requested opinion is medically not ascertainable on exam or testing please state why. If the requested opinion can not be expressed without resorting to speculation or making improbable assumptions say so, and explain why. If the opinion asks " ... is it at least as likely as not ... ", fully explain the clinical findings and rationale for the opinion.

4. Include results of all diagnostic and clinical tests conducted in the examination report.

E. Diagnosis:

Provide:

1. The Diagnosis must conform to DSM-IV and be supported by the findings on the examination report.

2. If the diagnosis is changed, explain fully whether the new diagnosis represents a progression of the prior diagnosis or development of a new and separate condition.

3. If there are multiple mental disorders, delineate to the extent possible the symptoms associated with each and a discussion of relationship.

4. Evaluation is based on the effects of the signs and symptoms on occupational and social functioning.

NOTE: VA is prohibited by statute from paying compensation for a disability that is a result of the veteran's own ALCOHOL OR DRUG ABUSE, whether based on direct service connection, secondary service connection, or aggravation by a service-connected condition. Therefore, when alcohol or drug abuse accompanies or is associated with another mental disorder, separate, to the extent possible, the effects of the alcohol or drug abuse from the effects of the other mental disorder(s). If it is not possible to separate the effects, explain why.

F. Global Assessment of Functioning (GAF):

NOTE: The complete multi-axial format as specified by DSM-IV may be required by BVA REMAND or specifically requested by the rating specialist. If so, include the GAF score and note whether it refers to current functioning, functioning over the past year, etc.

If multiple Axis I or Axis II diagnoses exist, attempt to the extent possible, to provide a GAF score for the service connected conditions alone as well as a separate overall GAF score based on all mental disorders present, and explain and discuss your rationale. (See the above note pertaining to alcohol or drug abuse, the effects of which cannot be used to assess the effects of a service-connected condition.) If it is not possible to separate the symptomatology, explain why.

DSM-IV is only for application from 11/7/96 on. Therefore, when applicable note whether the diagnosis of PTSD was supportable under DSM-III-R prior to that date. The prior criteria under DSM-III-R are provided as an attachment.

Signature: Date:
Attachment A -- Historical DSM-III-R Diagnostic Criteria for PTSD

------------ --------- --------- --------- --------- --------- - -----------

ATTACHMENT A TO POST TRAUMATIC STRESS DISORDER (PTSD) A. The veteran has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone, e.g., serious threat to one's life or physical integrity; serious threat to one's children, spouse, or other close relatives and friends; sudden destruction of one's home or community; seeing another person who has recently been seriously injured or killed as the result of an accident or physical violence.

B. The traumatic event is persistently re-experienced in at least one of the following ways:

1. Recurrent and intrusive distressing recollections of the event.

2. Recurrent distressing dreams of the event.

3. Sudden acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative [flashback] episodes, even those that occur upon waking or when intoxicated) .

4. Intense psychological distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries of the trauma.

C. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

1. Efforts to avoid thoughts or feelings associated with the trauma.

2. Efforts to avoid activities or situations that arouse recollections of the trauma.

3. Inability to recall an important aspect of the trauma (psychogenic amnesia).

4. Markedly diminished interest in significant activities.

5. Feeling of detachment or estrangement from others.

6. Restricted range of affect, e.g., unable to have love feelings.

7. Sense of a foreshortened future, e.g., does not expect to have a career, marriage, children, or a long life.

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following:

1. Difficulty falling or staying asleep.

2. Irritability or outbursts of anger.

3. Difficulty concentrating.

4. Hyper vigilance.

5. Exaggerated startle response.

6. Physiologic reactivity upon exposure to events that symbolize or resemble an aspect of the traumatic event (e.g., a woman who was raped in an elevator breaks out in a sweat when entering any elevator).

------------ --------- --------- --------- --------- --------- - -----------

EATING DISORDERS (MENTAL DISORDERS)
Name: SSN:
Date of Exam: C-number:
Place of Exam

A. Review of Medical Records:

B. Medical History (Subjective Complaints):

Comment on:

1. Past Medical History:

a. Previous hospitalizations and outpatient care for parenteral nutrition or tube feeding.

b. Medical and occupational history from the time between the last such rating examination and the present needs to be accounted for, UNLESS the purpose of this examination is to ESTABLISH service connection, then a complete medical history since discharge from military service is required.

c. Periods of incapacitation (during which bedrest and treatment by a physician are required due to the eating disorder). Describe the frequency and duration.

d. Current treatment, response, side effects.

2. Present Medical, Occupational and Social History - over the past one year.

a. History of onset of eating disorder.

b. Its course, treatment, and current status to include symptoms.

c. Extent of time lost from work over the past 12 month period and social impairment. If employed, identify current occupation and length of time at this job.

3. Subjective Complaints:

a. Describe fully.

C. Examination (Objective Findings):

Address each of the following and fully describe:

1. Mental status exam to confirm or establish diagnosis in accordance with DSM-IV.

2. Additionally, please provide this specific information:

a. Current weight.

b. Expected minimum weight based on age, height, and body build.

c. Obtain weight history.

3. Additionally, to allow evaluation by the rating specialist, describe and fully explain the existence, frequency, and extent of the following signs and symptoms and relate how they interfere with employment:

a. Binge eating.

b. Self-induced vomiting or other measure to prevent weight gain when weight is already below expected minimum normal weight.

D. Diagnostic Tests (including psychological testing if deemed necessary):

1. Provide specific evaluation information required by the rating board or on a BVA Remand. Diagnostic Tests (See the examination request remarks for specifics.):

a. Competency: State whether the veteran is capable of managing his or her benefit payments in the individual's own best interests (a physical disability which prevents the veteran from attending to financial matters in person is not a proper basis for a finding of incompetency unless the veteran is, by reason of that disability, incapable of directing someone else in handling the individual's financial affairs).

b. Other Opinion: Furnish any other specific opinion requested by the rating board or BVA Remand furnishing the complete rationale and citation of medical texts or treatise supporting opinion, if medical literature review was undertaken. If the requested opinion is medically not ascertainable on exam or testing please state WHY. If the requested opinion can not be expressed without resorting to speculation or making improbable assumptions say so, and explain why. If the opinion asks "...is it at least as likely as not...", fully explain the clinical findings and rationale for the opinion.

2. Include results of all diagnostic and clinical tests conducted in the examination report.

E. Diagnosis: