“How to Prepare for the Psych Eval:
WHY the 31 VA Mental Health
Symptoms Matter and How to Be
UNCOMFORTABLY VULNERABLE!”
By: Brian Reese
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Game Day (Show Time) - USEFUL TIPS!
➔
Make sure your laptop/desktop/mobile device is working properly, to include webcam, microphone,
speakers - you’ll login to a HIPAA compliant Telehealth platform called Doxy (check your email invite).
➔
You’ll meet with a U.S. Board Certified Psychologist in your state (or proximity). They exist for you and
because of you. They’re used to talking to disabled veterans. They’re educated/trained/certified in this
work, and understand the unique needs of the Veteran Community (YOU!)
➔
This is your opportunity to TELL ALL! The good, the bad, and the ugly. Don’t hold anything back. The
more vulnerable you are with explaining your mental health issues/symptoms/behaviors, the more
accurate the disability picture you’ll paint for the doctor, which means a better, more accurate outcome.
➔
Be prepared to talk about your work/life/military history from childhood to active duty to today. When did
your mental health issues begin (month/year)? What caused/made your mental health condition worse?
How severe are your mental health symptoms today? Are you suffering from any daily chronic pain? How
is your mental health condition limiting/affecting your work, life, and social functioning.
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WHY You Must Be “Uncomfortably Vulnerable”
● Reason #1: The TRUTH will set you FREE! You’ll free yourself from the heavy burdens of your
past—you’ve probably kept your mental health issues close hold…(this might even be the first
time you’ve ever spoken to anyone about these things…
● Reason #2: You’ll learn a TON about yourself and why you do the things you do (behaviors), but
only if you tell the U.S. Board Certified Psychologist EVERYTHING (Good, Bad, and Ugly)...this
is the start of us celebrating LIFE CHANGE with YOU!
● Reason #3: ALL VA disability claims for Mental Health come down to your current level of
“OCCUPATIONAL & SOCIAL IMPAIRMENT” due to the Severity of Your Symptoms (31 mental
health condition symptoms). The more open, honest, and “Uncomfortably Vulnerable” you
are during your evaluation, the more accurate VA rating you’re likely to receive…
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WHAT “Uncomfortably Vulnerable” Means!
● Uncomfortably Vulnerable Means... Telling the U.S. Board Certified Psychologist intimate
details about your work/life and HOW your mental health conditions(s) are limiting or affecting
you in negative ways…if it’s uncomfortable/awkward for you to say, that means you’re on the right
track!
● Uncomfortably Vulnerable Means... Explaining your severe depression and anxiety, perhaps
you’re too depressed to get out of bed some mornings, you’ve called in sick to work, your anger
is so severe you throw things across the room, punch holes through walls, and yell/scream at
your spouse/children…and they’re afraid of you…
● Uncomfortably Vulnerable Means... Telling your uncomfortable truths, such as, your sexual
dysfunction due to the mental health medications you’re taking, explaining your panic attacks /
nightmares, and how you suffer from severe insomnia, and maybe even OCD-like behaviors such
as constantly checking windows/doors to ensure they’re locked…I’ve driven people off the road
ready to fight from “road rage…”
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3 Critical Elements for ALL VA Claims for Mental Health!
…
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Mental Health Conditions (31 ratable conditions
under the law)
● There are currently 31 ratable mental health conditions under the law, although the most common
include Post Traumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD),
Generalized Anxiety Disorder (GAD), Chronic Adjustment Disorder (CAD), and Somatic
Symptom Disorder (SSD, previously known as Chronic Pain Syndrome under DSM-IV)
● You’ll only get rated for ONE mental health condition due to the prohibition against “Pyramiding”
– if you’re already service-connected and rated for mental health, but you think you’re underrated,
you simply get an Independent Psych Eval, write a strong personal Statement in Support of a
Claim (may want a Buddy Letter as well), and file for an “INCREASE” inside your VA.gov account
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Mental Health Conditions – Some of the
Signs/Symptoms...
● Feeling sad or down (depression)
● Excessive fears or worries, or extreme feelings of guilt (anxiety)
● Confused thinking or reduced ability to concentrate (inability to understand/perform + memory issues)
● Extreme mood changes of highs and lows (anger issues)
● Withdrawal from friends and activities (detachment)
● Chronic sleep impairment - Significant tiredness, low energy or problems sleeping (insomnia)
● Detachment from reality (delusions), paranoia or hallucinations
● Inability to cope with daily problems or stress (hopelessness)
● Trouble understanding and relating to situations and to people (confusion)
● Problems with alcohol or drug use (abusing alcohol/drugs as a coping mechanism)
● Major changes in eating habits (losing weight or gaining weight)
● Lower / higher sex drive (ED or Female Sexual Arousal Disorder)
● Suicidal thoughts (active vs. passive)
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The 31 VA Mental Health
Symptoms…
REVEALED & EXPLAINED!
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Symptom #1: Depressed Mood
Depression (Major Depressive Disorder) is a common and serious medical illness that
negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable.
Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can
lead to a variety of emotional and physical problems and can decrease a person’s ability to
function at work and at home.
Common signs and symptoms of Depression include:
○ Feeling sad or having a depressed mood
○ Loss of interest or pleasure in activities once enjoyed
○ Changes in appetite — weight loss or gain unrelated to dieting
○ Trouble sleeping or sleeping too much
○ Loss of energy or increased fatigue
○ Increase in purposeless physical activity (e.g., handwringing or pacing) or slowed
movements and speech (actions observable by others)
○ Feeling worthless or guilty
○ Difficulty thinking, concentrating or making decisions
○ Thoughts of death or suicide
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Symptom #2: Anxiety
Veterans with Anxiety Disorders frequently have intense, excessive and persistent worry and fear about
everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety
and fear or terror that reach a peak within minutes (panic attacks).
These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to
the actual danger and can last a long time. You may avoid places or situations to prevent these feelings.
Symptoms may start during childhood or the teen years and continue into adulthood.
Common signs and symptoms of Anxiety include:
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Feeling nervous, restless or tense
Having a sense of impending danger, panic or doom
Having an increased heart rate
Breathing rapidly (hyperventilation)
Sweating
Trembling
Feeling weak or tired
Trouble concentrating or thinking about anything other than the present worry
Having trouble sleeping
Experiencing gastrointestinal (GI) problems
Having difficulty controlling worry
Having the urge to avoid things that trigger anxiety
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Symptom #3: Suspiciousness
Veterans, do you have TRUST ISSUES with other people, and/or have you ever been suspicious
of others and their motives toward you?
Common signs and symptoms of Suspiciousness include:
● Believing that others have hidden motives or are out to harm them
● Doubting the loyalty of others
● Being hypersensitive to criticism
● Having trouble working with others
● Being quick to become angry and hostile
● Becoming detached or socially isolated
● Being argumentative and defensive
● Having trouble seeing their own problems
● Having trouble relaxing
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Symptoms #4, #5, #6: Panic
Attacks
Panic Attack is the abrupt onset of intense fear that
reaches a peak within minutes (10 minutes or less
typically) & includes at least four (4) of the following
symptoms:
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Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed, or faint
Chills or heat sensations
Paresthesia (numbness or tingling sensations)
Derealization (feelings of unreality) or depersonalization (being
detached from oneself)
● Fear of losing control or “going crazy”
● Fear of dying
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Symptoms #4, #5, #6: Panic Attack SEVERITY
● Symptom #4: Panic attacks that occur weekly or less often
○ Mild symptoms of panic attacks
● Symptom #5: Panic attacks more than once a week
○ Moderate symptoms of panic attacks
● Symptom #6: Near-continuous panic or depression affecting the ability to
function independently, appropriately and effectively
○ Severe symptoms of panic attacks
○ Do you live in a near constant state of fear, anxiety, panic, and depression?
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Symptom #7: Chronic
Sleep Impairment
● This refers to Insomnia!
● Do you have difficulty falling
asleep or staying sleep?
● Is your insomnia so severe that
it affects/limits your work, life,
and social functioning?
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Symptom #8: Mild memory loss, such as
forgetting names, directions or recent events
Veterans, have you ever occasionally forgotten things you should know? Such as:
● Names of people you’ve met?
● How to get to certain places?
● Things happening in your life or in the news?
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Symptom #9: Impairment of short- and long-term memory, for
example, retention of only highly learned material, while forgetting
to complete tasks
● Highly learned material includes repetitive tasks you’ve performed your entire life. You
remember how to brush your teeth, get dressed in the morning, go to the bathroom,
drive a car, count by fives, recite the alphabet, etc.
● You’re likely very forgetful of new things, however. For example, you read the paper
this morning and can’t remember any of the news stories. Your spouse tells you to clean
the house and you’ll forget unless you write it down. If you learn something new, you
quickly forget how to do it and it requires practice to pick-it-up again.
● Example: “I have to write down everything or I’ll forget … I keep a notepad with me at
all times.”
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Symptom #10: Memory loss for names of close
relatives, own occupation, or own name
● This is the most severe symptoms of memory loss and are usually indicate of the
most extreme mental health symptoms, often found in patients with advanced
Alzheimer’s.
● For example, have you ever forgotten things you should definitely know such as names
of loved ones, your job, or your own name?
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Symptom #11: Flattened Affect
“Flattened affect” refers to severe depression.
● A person with “flattened affect” aka, severe depression, may not show normal emotions,
facial expressions, or voice tones (monotone voice) to situations that would usually elicit
an emotional response.
● For example, have you ever been unresponsive to the world around you? Have you
ever had an inappropriate or no response to a positive or negative event?
● Maybe your children or grandchildren recently won an award. A normal person would
smile, celebrate, and say things like “congrats!”
● But when you found out, you had little to no expression, and perhaps didn’t even
respond.
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Symptom #12: Circumstantial, circumlocutory or
stereotyped speech
● Circumstantial speech (also referred to as
circumstantiality) is a communication disorder in which
the focus of a conversation drifts, but often comes
back to the point. In circumstantiality, unnecessary
details and irrelevant remarks cause a delay in getting
to the point. An example of circumstantial speech is
that when asked about the age of a person's mother at
death, the speaker responds by talking at length about
accidents and how too many people die in accidents,
then eventually says what the mother's age was at
death. Similarly, a patient afflicted with this condition,
for example, when asked about a certain recipe, could
give minute details about going to the grocery store,
the shopping experience, people there, and so on.
● Circumlocutory speech is a language disorder
where the patient refers to an object, event or person,
describing its characteristics instead of using its
name. “What do you cut hair with?” A normal person
would answer: “A scissors.” Maybe you think for a
while and answer with: “Well it has two circular hands
on it and some sharp blades, and you put your hand
in it, spread your fingers, and place it by the hair.”
● Stereotyped speech refers to persistent mechanical
repetition of speech or movement, sometimes
occurring as a symptom of schizophrenia, autism, or
other mental disorder. Examples include: Rambling,
babbling, one-word answers, no answer at all, or
excessive explanation of common questions and
answers.
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Symptom #13: Speech intermittently illogical,
obscure, or irrelevant
● Very severe mental health symptoms in which you have trouble holding a normal
conversation, you ramble on about something completely irrelevant to the discussion or
question, and often add things that don’t make sense to a normal person.
● “What is your favorite color?” A normal person would answer: “Blue” or “My favorite
color is blue.”
● But maybe you start with “I can’t believe how dang busy the roads were today. I’m so
sick and tired of having to drive in this traffic.” And this wasn’t just you changing the
subject…
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Symptom #14: Difficulty in understanding
complex commands
● Maybe you’re having trouble at work because your boss has asked you to create a new
report, and he/she even details-out “HOW” you should do it. But you don’t know how,
don’t know who to ask, and can’t figure it out. Maybe you don’t even understand what
he/she asked of you.
● Perhaps you’re unable to follow a complex command that involves 3 body parts and
discriminates between right and left (e.g., “Put your right thumb in your left ear, and stick
out your tongue”) and you forget or can’t do it.
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Symptom #15: Impaired Judgement
● Have you ever made very bad decisions and/or didn’t think through
consequences of your actions?
● Examples include but aren’t limited to:
○ Drunk driving
○ Buying a $5,000 watch you can’t afford
○ Gambling away your savings
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Symptom #16: Impaired Abstract Thinking
● Abstract thinking is a level of thinking about things that is removed from the facts of
the “here and now”, and from specific examples of the things or concepts being thought
about.
● Abstract thinkers can reflect on events and ideas, and on attributes and relationships
separate from the objects that have those attributes or share those relationships.
● For example, if you have difficulty explaining concepts, events, ideas, attributes, or
relationships among things, you probably have impairment of your abstract
thinking.
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Symptom #17: Gross impairment in thought
processes or communication
● Gross impairment in thought processes or communication refers to a person’s inability
to effectively communicate or think clearly.
● You have trouble forming a coherent thought or can’t communicate that thought clearly
and effectively.
● This is a very severe symptom of a mental health condition.
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Symptom #18: Disturbances of motivation & mood
● This is a form of Depression in which you don’t enjoy doing things you used to
do, or you just don’t see those activities as “fun” anymore.
● Perhaps you’re constantly in a down state of Depression or struggle to get out
of bed in the morning.
● Examples: “I used to read a lot and now I don’t.” “I loved to workout, and now I
can’t get myself motivated anymore.”
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Symptom #19: Difficulty in establishing and
maintaining effective work and social relationships
● Do you struggle to meet new people?
● Do you not trust other people?
● Do you have friends at work or in your life?
● Do you find yourself not wanting to go to events, meet new people, try new
things, or socialize with others?
● Do you self-isolate, maybe even not wanting to leave your own home?
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Symptom #20: Difficulty adapting to stressful
circumstances, including work or a work like setting
● Do you get overwhelmed easily?
● Do you have to take breaks or naps when things get stressful?
● Do you struggle to get started on things because your anxiety spikes?
● Do you find your mind and body wandering when you know you should be trying
to accomplish something?
● Maybe you shut down completely and just want to stay home, watch TV, or go to
sleep?
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Symptom #21: Inability to establish and maintain
effective relationships
● Perhaps people don’t like to be around you because of your anger issues,
outbursts, difficulty communicating with others, etc.
● Maybe you’ve been divorced, you can’t keep a relationship intact, and you’re not
a good friend.
● You might not have friends…(NOTE: “Followers” does NOT equal “Friends!)
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Symptom #22: Suicidal Ideation
Suicidal ideation means wanting to take your own life or thinking about suicide. There are two (2) kinds of
suicidal ideation: Passive and Active.
● (#1) PASSIVE suicidal ideation occurs when you wish were dead or that you could die, but you don't actually have any
plans to commit suicide
● (#2) ACTIVE suicidal ideation, on the other hand, is not only thinking about it but having the intent to commit suicide,
including planning how to do it.
Warning signs that you or a loved one are thinking about
or contemplating suicide:
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Isolating yourself from your loved ones
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Feeling hopeless or trapped or stuck in severe depression
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Talking about death or suicide
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Giving away possessions
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An increase in substance use or misuse
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Increased mood swings, anger, rage, and/or irritability
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Engaging in risk-taking behavior (drugs or having unprotected sex)
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Accessing means to kill yourself, such as medications/drugs/firearm
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Acting as if you're saying goodbye to people
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Feeling extremely anxious
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Symptom #23: Obsessional rituals which interfere with
routine activities
● Perhaps you constantly check windows, doors, and locks (3-5-7x over).
● Maybe you struggle to leave your own home because you fear someone might
break-in, even though you have a security system.
Other examples include:
● Walking or talking a certain way
● Performing a repetitive activity, such as locking, unlocking, and relocking a door
● Repeating precise movements like sitting up and down, blinking, or walking through a
doorway a certain way
● Touching items, a specific way in a particular order or a certain number of times
● Ritualistic hand washing
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Symptom #24: Impaired impulse control, such as
unprovoked irritability with periods of violence
● Do you suffer from severe anger issues and maybe even resort to violence?
● Have you become very angry with a co-worker or spouse, and thrown things
across the room, punched a wall, or even become violent (hitting, kicking, verbal
abuse) with the individual?
● Can you go from 0-100 in a split second?
● Maybe you even have trouble remembering the things you said once you finally
cool-off
Symptom #25: Spatial Disorientation
● Spatial Disorientation means you’re unable to determine your location or
movements relative to the world around you.
● Perhaps you ALWAYS must drive with a GPS, Google Maps, or Waze, even
though you’re driving on roads you’ve driven hundreds of times.
● Have you ever gotten lost even with a GPS?
● Maybe you forget where you are, where you’re going, or why you left your house
in the first place…
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Symptom #26: Persistent Delusions or Hallucinations
● Persistent Delusions occur when you can’t tell what’s real from what’s imagined. Delusions are the
main symptom of delusional disorder. They’re unshakable beliefs in something that isn’t true or based
on reality. But that doesn’t mean they’re completely unrealistic. Delusional disorder involves delusions
that aren’t bizarre, having to do with situations that could happen in real life, like being followed,
poisoned, deceived, conspired against, or loved from a distance. These delusions usually involve
mistaken perceptions or experiences. But the situations are either not true at all or highly exaggerated.
● Hallucinations are generally seeing, hearing, touching, or smelling things that aren’t really there:
There are many different types of hallucinations, including but not limited to:
Auditory hallucinations: These are when someone hears something that is not there, such as a voice or radio.
Visual hallucinations: These cause someone to see something that is not real, such as a person or animal.
Olfactory hallucinations: These can occur when a person smells something that is not there.
Gustatory hallucinations: These cause someone to taste something they did not eat.
Tactile hallucinations: These occur when a person feels like something or someone touched them.
Somatic hallucinations: These hallucinations can affect the entire body, causing unreal sensations such as that
of bugs crawling on the skin.
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Symptom #27: Grossly Inappropriate Behavior
● Grossly Inappropriate Behavior is behavior that varies wildly from what a normal person would
consider “appropriate” under similar circumstances.
● Have you ever become extremely angry and actually threatened (or did) beat someone up?
Maybe you’ve been in bar fights.
● Have you ever smashed someone’s windows because of the way they looked at you?
● Perhaps your severe road rage led you to steer another driver off-the-road and you exited your
vehicle and got into a verbal or physical altercation.
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Symptom #28: Persistent Danger of Hurting Self/Others
● Persistent danger of hurting self or others OR persistent inability to maintain
minimum personal hygiene OR serious suicidal act with clear expectation of
death.
● This means you have re-occurrent periods of violence or threats of violence,
whereby normal people become afraid to be around you.
● These are very severe symptoms of a mental health condition.
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Symptom #29: Neglect of Personal Appearance and Hygiene
1. Physical Appearance:
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Poor personal hygiene
Not wearing suitable clothing for the weather
Messy hair, nails, or clothes
Unexplained weight loss
Unusual odors (not bathing)
Poor diet / nutrition
2. Living Conditions:
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Filthy home
Not doing household maintenance
Odd behavior and lifestyles
Hoarding animals and/or invaluable items
Dangerous living conditions; home infestations (e.g.,
mice, insects)
● Non-functioning utilities
● Rotten food; bad smells
● Threatened eviction
3. Health:
● Not refilling medications
● Missing provider’s appointment
● Refusal to seek medical treatment for serious
illness
4. Behaviors:
● Social isolation
● Refusing to let people provide services (e.g., utility
workers, home health care providers)
● Antisocial behavior / not getting along with others
● Dangerous forgetful behavior (e.g., leaving a
burning stove on and going to sleep)
● Not paying bills because you either forget or the
bills are lost in the clutter
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Symptom #30: Intermittent inability to perform activities of daily
living, including maintenance of minimal personal hygiene
● Same or similar symptoms to #29, however, you may even require the daily
assistance (aid & attendance) of someone else to help take care of you.
● These are very severe symptoms of a mental health condition.
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Symptom #31: Disorientation to time or place
● Disorientation refers to an altered mental state. A person who’s disoriented may not know their
location and identity, or the time and date.
● Disorientation is often accompanied with other severe symptoms such as:
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Confusion, or being unable to think with your normal level of clarity
Delirium, or being confused and having disrupted attention
Delusions, or believing things even if they’re false
Agitation, or feelings of aggressiveness and restlessness
Hallucinations, or seeing or hearing things that aren’t there
Wandering around
● These are very severe symptoms of a mental health condition.
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Mental Health Symptoms – IMPORTANT INFO!
● TELL YOUR TRUE STORY! You must be open, honest, and “Uncomfortably Vulnerable”
at all times.
● A big misconception among veterans is that you need to meet ALL the subjective symptoms
tied with a certain rating criterion for mental health in order to get that rating. This is simply
NOT true!
● The VA Rater, known as the “RVSR” will consider all the evidence of record and should
assign the appropriate VA mental health rating based upon “Preponderance of the
Symptoms.”
✔ For example, if a veteran has 3 of the symptoms from the 70% mental health rating criteria and 5 of the
symptoms from the 100% mental health rating criteria, the rating agency shall assign the HIGHER rating,
unless evidence of record contradicts this subjective assessment.
✔ The opposite is also true! For example, if a veteran has 5 of the symptoms from the 70% mental health
rating criteria and 3 of the symptoms from the 100% mental health rating criteria, the rating agency shall
assign the LOWER rating, unless evidence of record contradicts this subjective assessment.
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[ACTION MOMENT!]
● [IMPORTANT!] Download and Read: “The INSIDER’S Guide to 31 VA Mental Health
Symptoms Revealed and Explained!”
● Review any existing medical evidence from your Service Treatment Records (STRs), VA
medical records, and/or private medical records
● YOU GOT THIS! We are here for you every step of the way. It’s okay to reach out to your
Veteran Coach (VC), you might just need to talk to someone afterwards.
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WELCOME HOME!
You’re an “INSIDER” now!
Thank You for Your Service, and
God Bless You and Your Family!